Philip Reed argues that laws that grant people access to euthanasia on the basis of terminal illness are discriminatory. In support of this claim, he offers an argument by analogy: it would be discriminatory to offer a person access to euthanasia because they are women or because they are disabled, as such restricted access would send the message ‘that life as a woman or as a disabled person is (very often) not worth living’.1 And so it must also be discriminatory (...) to offer people access to euthanasia because they are terminally ill. Arguments by analogies are only as good as the analogies on which they are built. Having a terminal illness, I’m going to suggest, is not relevantly similar enough to either being disabled or being a member of an oppressed social group to make Reed’s claim compelling. Let’s explore each branch of the analogy in turn. Why think that terminal illness is relevantly unlike disability, in a way that makes offering access to euthanasia in the latter case discriminatory, but not the former? For one thing, terminal illness is necessarily time-limited. When my father was dying, he found himself in constant …. (shrink)

We often feel survivor guilt when the very circumstances that harm others leave us unscathed. Although survivor guilt is both commonplace and intelligible, it raises a puzzle for the standard philosophical account of guilt, according to which people feel guilt only when they take themselves to be morally blameworthy. The standard account implies that survivor guilt is uniformly unfitting, as people are not blameworthy simply for having fared better than others. In this paper, we offer a rival account of guilt, (...) the relational account of guilt, which makes sense of survivor guilt and other forms of guilt without self-blame while preserving the intelligibility of guilt about culpable wrongdoing. According to this account, guilt involves the feeling of being unable to justify ourselves to others, and we lack self-justification when we (however blamelessly) stand on the positive side of an undesirable asymmetry with them. When someone survives something that those around her do not, the disparity in outcome constitutes an asymmetry that is often undesirable, because it arises from luck or violates a requirement of solidarity. Thus, survivor guilt is often fitting. (shrink)

Descartes with his sharp separation of the mental and the physical set the stage for the philosophy of mind for the next 350 years. Philosopher Patrick T. Mackenzie finds in the later writings of Wittgenstein the suggestion that Descartes got off on the wrong foot. Following Wittgenstein's lead, Mackenzie argues that instead of analyzing our human nature as a composite of mind and body, we should view ourselves as whole persons. One of the dividends of this approach to (...) the mind-body problem is that it provides us with a resolution to the problem of human freedom—i.e., how can a human being be free if his or her body (including the brain) belongs to a deterministic world? Mackenzie here argues that the person is largely free even though the movements of the body are determined by neurophysiological events. He takes the same approach to the philosophy of mind as that taken by M.R.Bennett and P.M.S.Hacker in their recent and controversial book, The Philosophical Foundations of Neuroscience. Mackenzie's approach is, however, much more accessible. Students of philosophy and philosophers interested in the problem of human freedom will welcome Mackenzie's fresh approach, especially those disenchanted by the present list of mind-body "isms.". (shrink)

In The Bodhisattva’s Brain: Buddhism Naturalized, Owen Flanagan undertakes a project of what he calls ‘cosmopolitan philosophy’, with an aim to develop and interrogate a naturalized Buddhism. A project of naturalization requires a conception of naturalism that can serve as a hermeneutic and philosophical standard against which certain things may be judged naturalistically acceptable or unacceptable. On Flanagan’s account, Buddhism ‘naturalized’ is primarily a Buddhism, “without the mind-numbing and wishful hocus-pocus.” Instead, he sets out to sketch a version of Buddhism (...) (or a new view inspired by it) that is consistent with neo-Darwinian evolutionary theory and scientific materialism, including ‘neurophysicalism’ or the view that “mental events are brain events.” However, classical Buddhist philosophers rejected materialism on philosophical, not merely dogmatic, grounds. In contemporary terms, Buddhist philosophers saw that phenomenal consciousness, intentionality, and mental causation present serious problems for materialism. So, rather than dismissing Buddhist anti-materialist accounts of mind as simply ‘hocus-pocus’, in this chapter takes up the question of whether and how these views might inform a naturalistic Buddhist philosophy. The question, then, is whether a naturalistic Buddhism requires some form of neurophysicalism. It is argued that it does not, by way of examining two distinct versions of naturalistic, but non-physicalist accounts of consciousness reconstructed from the Indian Buddhist tradition. The first, drawing on the work of Dharmakīrti, is a form of trope dualism. The second, drawing on the work of Śāntarakṣita, is a form of pragmatic pluralism that gives a central place to consciousness. And while these two accounts are distinct, and in some important respects incompatible, what they have in common is the idea that consciousness is both non-physical and fully natural. (shrink)

When our nearest and dearest experience medical crises, we may need to step into caregiving roles. But in doing so, we may find that our new caregiving relationship is actually in tension with the loving relationship that motivated us towards care. What we owe and are entitled to as friends, spouses, and family members, can be different from what we owe and are entitled to as caregivers. For this reason, caregiving carries with it the risk of a type of moral (...) distress that I call “role conflict distress.” Rather than view role conflict distress as a sign that we are falling short, I suggest that it actually speaks to the commitment that we have to the loving relationship that grounds our duty of care. (shrink)

Bioethicists who seek to defend commercial transactions that intuitively seem exploitative, such as organ sales and commercial surrogacy, typically pair a liberal analysis of exploitation with a libertarian analysis of autonomy. In this paper, I argue that the liberal analysis of exploitation, which focuses primarily on two party transactions between individuals, occludes the structural dimensions of exploitation. This occlusion then paves the way for the transaction to be understood in terms of libertarian autonomy. I propose that a vulnerability analysis paired (...) with a multidimensional and relational theory of autonomy highlights the structural dimensions of exploitation and exposes the myth-making that underlies claims that these forms of exploitation are autonomy-enhancing. (shrink)

Philosophers are inclined to raise philosophical dust by asking such questions as, what relations must exist between two body occurrences for them to be body occurrences of the same body? or what relation among person-stages makes them stages of the same person? and then complain that they cannot see the answers. I want to argue that the reason they cannot see the answers is that these questions and others like them are misconceived.

When experienced in-person, engagement with art has been associated—in a growing body of evidence—with positive outcomes in wellbeing and mental health. This represents an exciting new field for psychology, curation, and health interventions, suggesting a widely-accessible, cost-effective, and non-pharmaceutical means of regulating factors such as mood or anxiety. However, can similar impacts be found with online presentations? If so, this would open up positive outcomes to an even-wider population—a trend accelerating due to the current COVID-19 pandemic. Despite its promise, this (...) question, and the underlying mechanisms of art interventions and impacts, has largely not been explored. Participants were asked to engage with one of two online exhibitions from Google Arts and Culture. With just 1–2 min exposure, both improved negative mood, state-anxiety, loneliness, and wellbeing. Stepdown analysis suggested the changes can be explained primarily via negative mood, while improvements in mood correlated with aesthetic appraisals and cognitive-emotional experience of the exhibition. However, no difference was found between exhibitions. We discuss the findings in terms of applications and targets for future research. (shrink)

The significance of big data for driving health research and improvements in patient care is well recognised. Along with these potential benefits, however, come significant challenges, including those concerning the sharing and linkage of health and social care records. Recently, there has been a shift in attention towards a paradigm of data sharing centred on the ‘trusted research environment’ (TRE). TREs are being widely adopted by the UK’s health data initiatives including Health Data Research UK (HDR UK),1 Our Future Health2 (...) and Genomics England.3 A recent review commissioned by the UK’s Department of Health and Social Care (hereafter referred to as the ‘Goldacre Review’) places TREs at the heart of its recommendations around the future of National Health Service (NHS) health data sharing for research, describing them as the ‘clear path forward’ to a health data system in which trust is ‘earned’ through ‘provable, credible steps to protect patient privacy, and by being transparent with everyone about everything that is done with their deepest medical secrets’.4 We argue that rather than building public trust, the TRE model actually reduces the need for trust in the use and sharing of patient health data. This is because trust is importantly connected to vulnerability and uncertainty; an essential part of trusting someone is accepting that one’s trust could be disappointed or betrayed. In attempting to provide assurances or guarantees of data privacy and security, TREs strive to remove this vulnerability, and so remove the need for trust. We do not see this as a problem and are broadly supportive of this kind of data sharing model because of the increased security and oversight it provides. However, having argued that TREs are not actually concerned with trust, we consider the importance of being precise about the words that we use …. (shrink)

Powered by ‘big health data’ and enormous gains in computing power, artificial intelligence and related technologies are already changing the healthcare landscape. Harnessing the potential of these technologies will necessitate partnerships between health institutions and commercial companies, particularly as it relates to sharing health data. The need for commercial companies to be trustworthy users of data has been argued to be critical to the success of this endeavour. I argue that this approach is mistaken. Our interactions with commercial companies need (...) not, and should not, be based on trust. Rather, they should be based on confidence. I begin by elucidating the differences between trust, reliability, and confidence, and argue that trust is not the appropriate attitude to adopt when it comes to sharing data with commercial companies. I argue that what we really should want is confidence in a system of data sharing. I then provide an outline of what a confidence-worthy system of data sharing with commercial companies might look like, and conclude with some remarks about the role of trust within this system. (shrink)

In his recent book Reflective Democracy, Robert Goodin argues that 'external-collaborative' models of democratic deliberation procedures need to be supplemented by 'internal-reflective' deliberation. The exercise of the moral imagination plays a central role in Goodin's account of 'democratic deliberation within'. By imaginatively putting ourselves in the place of a range of others, he argues, including those who maybe not be able to represent their own interests, we can make their points of view 'communicatively present' in deliberation. Goodin's argument emphasizes the (...) role of art and other forms of cultural representation in helping to bring about this expansion of moral imagination. Drawing on debates in philosophy of mind concerning the scope and limits of our capacities to simulate other minds, I argue that Goodin's analysis of 'democratic deliberation within' conflates different kinds of imaginative project. In doing so, it underestimates both the difficulties of imaginatively putting ourselves in the place of others and the political risks in doing so. I argue, alternatively, that moral engagement with others involves the capacity for sympathy and that art and other forms of cultural representation can enlarge the scope of our sympathies, by assisting us to overcome imaginative resistance to alien points of view. In developing this argument, I provide a qualified defense of Iris Young's claim that respect for others involves 'asymmetrical reciprocity'. (shrink)

Patients in the vegetative state are wholly unaware of themselves, or their surroundings. However, a minority of patients diagnosed as vegetative are actually aware. What is the well-being of these patients? How are their lives going, for them? It has been argued that on a reasonable conception of well-being, these patients are faring so poorly that it may be in their best interests not to continue existing. I argue against this claim. Standard conceptions of well-being do not clearly support the (...) conclusion that these patients would be better off having life-sustaining treatment withdrawn, and in fact, it may be possible for these patients to retain a passable level of well-being. I suggest that further research into the subjective experiences of these patients will allow us to better promote their well-being. (shrink)

Unresponsive wakefulness syndrome is a disorder of consciousness wherein a patient is awake, but completely non-responsive at the bedside. However, research has shown that a minority of these patients remain aware, and can demonstrate their awareness via functional neuroimaging; these patients are referred to as having ‘cognitive motor dissociation’. Unfortunately, we have little insight into the subjective experiences of these patients, making it difficult to determine how best to promote their well-being. In this paper, I argue that the capacity to (...) experience pain or pleasure is a key component of well-being for these patients. While patients with unresponsive wakefulness syndrome are believed to be incapable of experiencing pain or pleasure, I argue that there is evidence to support the notion that CMD patients likely can experience pain and pleasure. I analyze current neuroscientific research into the mechanisms of pain experience in patients with disorders of consciousness, and provide an explanation for why CMD patients likely can experience physical pain. I then do the same for physical pleasure. I conclude that providing these patients with pleasurable experiences, and avoiding subjecting them to pain, are viable means of promoting their well-being. (shrink)

Based upon the Decision Field Theory (Busemeyer and Townsend 1993), we tested a model of dynamic reasoning to predict the effect of time pressure on analytical and experiential processing during decision-making. Forty-six participants were required to make investment decisions under four levels of time pressure. In each decision, participants were presented with experiential cues which were either congruent or incongruent with the analytical information. The congruent/incongruent conditions allowed us to examine how many decisions were based upon the experiential versus the (...) analytical information, and to see if this was affected by the varying degrees of time pressure. As expected, the overall accuracy was reduced with greater time pressure and accuracy was higher when the experiential and analytical cues were congruent than when they were incongruent. Of great interest was the data showing that under high time pressure participants used more experiential cues than at other time pressures. We suggest that the dynamic reasoning paradigm has some future potential for predicting the effects of experiential biases in general, and specifically under time pressure. (shrink)

An important goal of ethical investment is to influence companies to improve their ethical and environmental performance. The principal means that many ethical funds employ is passive market signalling, which may not, on its own, have a significant effect. A much more promising approach may be active engagement. This paper reports on a questionnaire study of a sample of 1146 ethical investors in order to assess whether U.K. ethical investors would support more activist ethical investment and whether they would be (...) prepared to invest in companies which are failing ethically in order to do so. The results show general support for the current practice of passive signalling accompanied by "soft" engagement in the form of lobbying and the development of dialogue in order to improve corporate practice. The "harder" options of investing in companies that err in order to change them is, however, favoured by consistent minorities. (shrink)

The aim of this article is to give an account of a methodological link between drama and political theory. This account is drawn primarily from the early philosophical work of Deleuze. Following Deleuze, we will refer to it as ‘the method of dramatization’. We will argue that dramatization is a method aimed at determining the quality of political concepts by ‘bringing them to life’, in the way that dramatic performances bring to life the characters and themes of a play-script. We (...) demonstrate that this can be specified in relation to the development of this method in Deleuze's early philosophical work as a practical, critical and artistic method and, in relation to the ontological assumptions he articulated and defended in Difference and Repetition, as a process of intensification of the Idea of the political. By way of example, we discuss how the dramatization of the concept of ideology functions in Deleuze and Guattari's Anti-Oedipus and A Thousand Plateaus. We conclude with some lines of inquiry that could be pursued by political theorists looking to investigate further the dramatic nature of method in political theory. (shrink)

Giant bones unearthed throughout the Mesoamerican countryside provoked early modern thinkers to grapple with the earth’s ages, partially syncretizing Nahua histories of human conquest with Spanish colonial medicinal and natural historical knowledge. European naturalists’ willingness to accept the giant remains required them to embrace localized Mesoamerican cosmologies. The fossilized landscape provided evidence that conquest and eradication had happened before at the hands of the peoples whom the Spaniards had conquered in turn. Lost from early modern collections and failing to translate (...) far beyond New Spain during the sixteenth century, the giant remains highlight the possibilities and challenges of integrating Mesoamerican knowledge into the global history of science, with an emphasis on emplaced thinking, medicine and the body, and deeper temporal frameworks. Moving beyond itinerary histories to globalizing cosmologies in the history of science can better explain the compromises Europeans and Mesoamericans were required to make to enter into a syncretic intellectual contract, as well as the non-European concept of time that came with local reckonings with the human and more-than-human natural world. (shrink)

Patients with disorders of consciousness after severe brain injury need surrogate decision makers to guide treatment decisions on their behalf. Formal guidelines for surrogate decisionmaking generally instruct decision makers to first appeal to a patient’s written advance directive, followed by making a substituted judgment of what the patient would have chosen, and lastly, to make decisions according to what seems to be in the patient’s best medical interests. Substituted judgment is preferable because it is taken to preserve patient autonomy, by (...) using a patient’s past wishes and values to reconstruct what they would have chosen for themselves. In this paper, the author argues that for a certain population of patients, the standard interpretation of substituted judgment cannot ensure the preservation of patient autonomy. Patients with “covert awareness” may continue to have values and an authentic sense of self, which may differ from their past values and wishes. Accordingly, surrogate decision makers should make decisions based on how the patient is likely to experience their condition in the present, rather than their past wishes and values. (shrink)

The essays collected in this volume address a range of issues that arise when the focus of philosophical reflection on identity is shifted from metaphysical to practical and evaluative concerns. They also explore the usefulness of the notion of narrative for articulating and responding to these issues. The chapters, written by an outstanding roster of international scholars, address a range of complex philosophical issues concerning the relationship between practical and metaphysical identity, the embodied dimensions of the first-personal perspective, the kind (...) of reflexive agency involved in the self-constitution of one’s practical identity, the relationship between practical identity and normativity, and the temporal dimensions of identity and selfhood. In addressing these issues, contributors engage with debates in the literatures on personal identity, phenomenology, moral psychology, action theory, normative ethical theory, and feminist philosophy. (shrink)

What happens when neuroscientific knowledges move from laboratories and clinics into therapeutic settings concerned with the care of children? ‘Brain-based parenting’ is a set of discourses and practices emerging at the confluence of attachment theory, neuroscience, psychotherapy and social work. The neuroscientific knowledges involved understand affective states such as fear, anger and intimacy as dynamic patterns of coordination between brain localities, as well as flows of biochemical signals via hormones such as cortisol. Drawing on our own attempts to adopt brain-based (...) parenting, and engaging with various strands and critiques of new materialism and affect theory, we explore the ways in which the social sciences and humanities might fruitfully engage with neuroscientific concepts and affects. How does science-affected indeterminacy, with all its promises of ontological and experiential agency, help us to observe, wait, bind or hold together volatile mixtures of habit, speech and action? (shrink)

For a period in the middle of the present century moral philosophy was dominated by the debate between prescriptivists and descriptivists. Prescriptivists proclaimed a gap between ‘is’ and ‘ought’, between facts and values, and cheerfully accepted the sceptical consequence that morals, and values generally, could not be objects of knowledge.

Concern for human vulnerability seems to be at the heart of bioethical inquiry, but the concept of vulnerability is under-theorized in the bioethical literature. The aim of this article is to show why bioethics needs an adequately theorized and nuanced conception of vulnerability. We first review approaches to vulnerability in research ethics and public health ethics, and show that the bioethical literature associates vulnerability with risk of harm and exploitation, and limited capacity for autonomy. We identify some of the challenges (...) emerging from this literature: in particular, how to reconcile universal human vulnerability with a context-sensitive analysis of specific kinds and sources of vulnerability; and how to reconcile obligations to protect vulnerable persons with obligations to respect autonomy. We then briefly survey some of the theoretical resources available within the philosophical literature to address these challenges, and to assist in understanding the conceptual connections between vulnerability and related concepts such as harm, exploitation, needs, and autonomy. We also sketch out a taxonomy of sources and kinds of vulnerability. Finally, we consider the implications for policy evaluation of making vulnerability an explicit and central focus of bioethics. Our investigation is in the form of a broad survey motivating a research agenda rather than a detailed analysis. (shrink)

The concept of dignity plays a foundational role in the more recent versions of Martha Nussbaum’s capabilities theory. However, despite its centrality to her theory, Nussbaum’s conception of dignity remains under-theorised. In this paper we critically examine the role that dignity plays in Nussbaum’s theory by, first, developing an account of the concept of dignity and introducing a distinction between two types of dignity, status dignity and achievement dignity. Next, drawing on this account, we analyse Nussbaum’s conception of dignity and (...) contrast it with Kant’s conception of dignity. On the basis of this comparison between Nussbaum and Kant, we highlight tensions between Nussbaum’s Aristotelianism, which is central to her conception of dignity, and her commitment to political liberalism. This leads us to conclude that Nussbaum’s claim that her conception of dignity is only a partial political conception is implausible and that her conception of dignity seems to commit her to a satisficing form of perfectionist liberalism. (shrink)