Public health and service delivery programmes, interventions and policies are typically developed and implemented for the primary purpose of effecting change rather than generating knowledge. Nonetheless, evaluations of these programmes may produce valuable learning that helps determine effectiveness and costs as well as informing design and implementation of future programmes. Such studies might be termed ‘opportunistic evaluations’, since they are responsive to emergent opportunities rather than being studies of interventions that are initiated or designed by researchers. However, current ethical guidance (...) and registration procedures make little allowance for scenarios where researchers have played no role in the development or implementation of a programme, but nevertheless plan to conduct a prospective evaluation. We explore the limitations of the guidance and procedures with respect to opportunistic evaluations, providing a number of examples. We propose that one key missing distinction in current guidance is moral responsibility: researchers can only be held accountable for those aspects of a study over which they have control. We argue that requiring researchers to justify an intervention, programme or policy that would occur regardless of their involvement prevents or hinders research in the public interest without providing any further protections to research participants. We recommend that trial consent and ethics procedures allow for a clear separation of responsibilities for the intervention and the evaluation. (shrink)

In a recent issue of Journal of Medical Ethics, we discussed the ethical review of evaluations of interventions that would occur whether or not the evaluation was taking place. We concluded that standard research ethics frameworks including the Ottawa Statement, which requires justification for all aspects of an intervention and its roll-out, were a poor guide in this area. We proposed that a consideration of researcher responsibility, based on the consequences of the research taking place, would be a more appropriate (...) way delineate the scope of research ethics review. Weijer and Taljaard present a counterargument to our proposal, which we address in this reply. They claim that a focus on researcher responsibility will weaken the protection of research participants and link it to ‘unethical research’ and a ‘government experimenting on its own people’. However, the moral responsibility of researchers is defined in terms of the consequences of the research on human welfare and harm, not in opposition to it. Weijer and Taljaard argue that researchers must justify what they are studying whether or not they have any control over it and that governments must justify their programmes, including by demonstrating equipoise, to a research ethics committee if they implement them in a randomised way. We strongly disagree that this is a defensible way to define the scope of research ethics review and argue that this provides no further protections to research participants beyond what we propose, but places a potential barrier to learning from government programmes. (shrink)

Mintz examines seventeenth-century reactions to the political philosophy of Thomas Hobbes.

IntroductionDespite the need for trained physician ethicists, fellowships in clinical ethics are limited and primarily offered to thosewho have completed a graduate degree. The standardization of credentialing for clinical ethics consultants (CECs) and the restructuring of undergraduate medical education allow innovative models to train CECs that can provide an expanded opportunity for formal ethics training at an earlier stage.MethodsAt the University of Michigan Medical School we developed, implemented, and evaluated a pre-doctoral clinical ethics fellowship program from 2017 to 2019 for (...) senior medical students, designed to meet established competencies for CECs. Consultation notes from the beginning and end of the fellowship program were randomly selected for each fellow and independently rated by two faculty ethicists who used the validated Ethics Consultation Quality Assessment Tool (ECQAT).1 Inter rater reliability and trends in scores over time were calculated.ResultsThree students successfully completed the fellowship at the University of Michigan Medical School, conducted at least 50 formal ethics consultations, and spent approximately 40 hours a week on service for a minimum of six months. All students finished the fellowship with teaching and policy development experience, first-authored peer-reviewed manuscripts, and national presentations. The fellows demonstrated improvement in their ECQAT overall holistic rating score; all ended their fellowship with a holistic score of adequate or above. There was 92 percent agreement between raters withrespect to the acceptability of the fellows’ ethics consult notes. Two fellows have taken and passed the Healthcare Ethics Consultant-Certification (HEC-C) exam offered by the American Society for Bioethics and Humanities (ASBH).ConclusionsIntegration of a pre-doctoral fellowship model that meets professional certification standards for clinical ethics consultation creates an opportunity for medical students to become trained CECs early in their career. (shrink)

Volume 11, Issue 1, March 2020, Page 114-130.

Scholars discuss the nature of semantics, the problems and characteristics of contemporary communication, and man's linguistic behavior. Bibliogs.

Ethical training in graduate programs is an important part of the professional development process. Such training has taken a position of prominence in both counseling and clinical psychology but seems to be lagging behind in the field of sport psychology. A debate exists about whether such training is necessary and, if so, how it should be provided. An important step in better understanding these issues is to identify how such training is currently taking place. This study surveyed the program directors (...) of sport psychology programs listed in the Directory of Graduate Programs in Applied Sport Psychology (Burke, Sachs, & Schrader, 2002) about the ethical training that takes place in their programs and their perceptions of the preparedness of the students in their programs. Of those contacted, 54% (n = 47) responded to the e-mail based survey. The results from these respondents indicated that 64.4% of programs require training in ethics and that the training was most commonly integrated into other nonethics courses. Overall, respondents did not feel as if students were completely prepared for either the ethical or legal issues that they will face in their professional careers. The importance of ethical training and suggestions for improving ethical training are discussed. (shrink)

This paper focuses on how African national leaders can make global democracy relevant to sustainable development in Africa. Seeing the problem of sustainable development in Africa from the structural and functional angles, this paper begins with an introduction and a clarification of terms such as ‘democracy’, ‘globalization’ and ‘development’. It then analyzes the underlying foundations of global democracy and its implications to cultures of the African peoples. This paper tries to place the impact of global democracy on Africa in perspectives (...) by weighing the pros and cons of global democracy. Tracing the genesis of functional and developmental problems in the post-colonial Africa to structural problems occasioned by Africa’s colonial experience, this paper however strongly contends that the main problem militating against sustainable development in the post-colonial Africa is bad politics and mismanagement of national resources. African peoples need to be taught that some of the African national leaders are responsible for the bad condition of underdevelopment in the global period because of bad political governance ranging from the inability of African leaders to calculate all the relevant factors in the making of their policies as well as failing to provide effective technologies and competent staff to deal with rigging of elections and other electoral problems in addition to corruption and mismanagement of public funds. There is no way for the African nations to survive without production of goods and services in terms of farming, agriculture and diversification of their revenue base. National leaders of the various African nations cannot avoid policies that enable the industrialization of African nations through the provision of the basic infrastructures and viable amenities for social, economic, and political development. They should however be wary of debt traps of International Monetary Fund and World Bank because borrowing nations are often given difficult conditions that often make it difficult for them to obtain the desired benefits in terms of sustainable development. The study recommends that for sustainable development to take place in Africa there is need for national leaders to embrace good political governance that places the people at the centre of development to be manifested in guileless electoral process and effective management of the resources. This paper contends that the realization of sustainable development in African nations requires moral, political, and economic integration. It concludes with perspectives for further research on the issue. (shrink)

This dissertation focuses on the massive modularity hypothesis defended by evolutionary psychologists---the hypothesis that the human mind is composed largely or perhaps even entirely of special purpose information processing organs or "modulees" that have been shaped by natural selection to handle the sorts of recurrent information processing problems that confronted our hunter-gatherer forebears. ;In discussing MMH, I have three central goals. First, I aim to clarify the hypothesis and develop theoretically useful notions of "module" and "domain-specificity" that can play the (...) roles required of them by evolutionary psychology. Second, I aim to evaluate the plausibility MMH in the light of the broad range of arguments that have been developed and defended in the literature. I argue that all the main, general arguments both for and against MMH are unsatisfactory. Moreover, I suggest that if the case for MMH is to be made, it will only result from the successive accumulation of specific, empirical evidence for the existence of particular modules. ;Finally, I address a range of issues that arise from evolutionary psychological approaches to reasoning and rationality. Much of what evolutionary psychologists have said about human reasoning is in response to a widely discussed "pessimistic" interpretation that has been developed and defended by Kahneman, Tversky and their followers. According to this view, human beings are prone to systematic deviations from appropriate norms of rationality because they lack the underlying competence to handle a wide array of reasoning tasks. Evolutionary psychologists appear to reject this pessimistic interpretation in favor of the view that we possess a wide range of reasoning modules that employ rational rules of inference. I argue, however, that there is no genuine disagreement between evolutionary psychologists and their opponents over the extent to which human beings are rational. I also discuss the distinction between competence efforts and performance efforts. Although this distinction has played a central role in recent discussions of human rationality, I argue that if MMH is true, then we face insurmountable problems in trying to draw the performance error/competence error distinction. (shrink)

Volume 20, Issue 7, July 2020, Page 77-80.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 193-194 [Access article in PDF] A Comment on Christopher Ciocchetti:"The Responsibility of the Psychopathic Offender" Daniel W. Shuman Questions of responsibility for serious harm are complex and potentially divisive. The way in which we frame these questions and the criteria by which we assess answers to them are colored, in part, by the lens though which we view them. I am a (...) law professor whose writings includes issues relating to criminal responsibility of person with mentally disabilities and I come to this commentary from that perspective. For me questions of moral responsibility raise psychological and philosophical, as well as legal, questions.Ciocchetti's (2003) paper addressees the criminal responsibility of the psychopathic offender. Not sure quite what the author meant by this label, I began to try to understand the concept of psychopathic offender by picking up my DSM-IV-TR and found no reference to such a diagnostic category. Absent a handy reference in the DSM, I looked in the paper for some other definition or recognition of the category of psychopathic offender and found no satisfactory grounding in any body of sound research. Left with the author's unsupported assertions that such a category of persons exists and that they behave in ways the author asks me to accept without support, my lawyer instincts cautioned me to proceed carefully. The psychopathic offender the author describes might well exist, but I am not persuaded of that, nor would be my legal colleagues, absent proof.Next, to the author's thesis that "[t]he offender must have the capacities necessary to understand relationships to justify holding that offender responsible" (p. 176) and that because psychopaths lack this capacity they should not be held criminally responsible. Is the author proposing a new test for criminal responsibility? Certainly no test for criminal nonresponsibility based on mental disability (i.e., insanity defense) in Anglo-American jurisprudence, or any other with which I am familiar, makes status (i.e., a diagnostic category) exculpatory for criminal responsibility. Rather, every test addresses the impact of a mental illness or disorder on the cognitive or volitional capacity of the offender at the time of the offense. The author offers no reason to reject the approach taken for the last several hundred years [End Page 193] by Anglo-American jurisprudence. Moreover, to the extent that status or diagnostic category is relevant in the insanity defense in Anglo-American jurisprudence, character or personality disorders (the genus to which I take it that psychopathy belongs) are often specifically excluded from consideration. For example, the Texas Penal Code (Tex. Penal Code Ann. § 8.01 (Vernon 1994)) states that:It is an affirmative defense to prosecution that, at the time of the conduct charged, the actor, as a result of a severe mental disease or defect, did not know that his conduct was wrong. The term "mental disease or defect" does not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct.The federal Insanity Defense Reform Act raises the same issue: The government relies on the legislative history of 18 U.S.C. § 17, which states: "The concept of severity was added to emphasize that non-psychotic behavior disorders or neuroses such as an 'inadequate personality,' 'immature personality,' or a pattern of 'antisocial tendencies' do not constitute the defense.".... The government argues that because Dr. Lorenz would have testified that Salava was not psychotic but suffered from antisocial personality disorder, his testimony was not relevant to either prong of the insanity defense under the statute.... As a general matter, the government's point is well-taken. It seems clear that Congress intended by its inclusion of the modifier "severe" to place certain "disorders" outside the purview of the insanity defense altogether. United States v. Salava, 978 F.2d 320, 323 (7th Cir. 1992) Nowhere in the paper does Chiochetti acknowledge or address these societal judgments of moral responsibility that have already rejected a far more modest version of his proposal in categorically ruling out character or personality disorders from inclusion as... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Multiple Personality and Moral Responsibility”Daniel W. Shuman (bio)Stephen Braude’s essay, “Multiple Personality and Moral Responsibility,” discusses a number of important issues about the moral and legal responsibility of persons diagnosed with multiple personality disorder (MPD), known in DSM-IV as Dissociative Identity Disorder (DID). One issue that is fundamental to this debate, which Braude does not address, however, is the empirical reality underlying the debate. Does MPD/DID (...) exist? A prerequisite to a debate about the legal consequences of MPD/DID is legally sufficient proof of its existence and its behavioral consequences.Proof that MPD/DID exists, its impact on legal standards of responsibility, and that the defendant suffers from it, must come from expert testimony; it is not part of the common knowledge or experience of the typical judge or juror. Courts are, however, increasingly, unwilling to assume that because an expert has impressive qualifications, he or she will necessarily present scientifically valid evidence. Particularly in cases of psychiatric and psychological evidence, courts that once looked solely at the expert’s qualifications to determine the admissibility for expert scientific evidence, now understand that the expert’s qualifications are a necessary but not a sufficient condition for the presentation of accurate expert testimony. Courts increasingly want to know how experts know what they claim to know and whether their methods of knowing meet the hallmarks of good science.Thus, from a legal standpoint, a prerequisite to admissibility of the evidence that serves as a basis for a discussion of the legal implications of MPD/DID is rigorous scientific proof of its existence. Proof of the existence of MPD/DID has not, however, been the subject of rigorous scientific research, but instead has consisted of non-falsifiable clinical experience where the risk of iatrogenesis (i.e., hypnosis and suggestion) is ever present. While these clinical observations and opinions may ultimately be proven valid by subsequent research, there is simply no way to know whether that is so in the absence of rigorous scientific research. If proof of the existence of MPD/DID is clinically but not scientifically grounded, legal rules based upon it are suspect. Moreover, claims of MPD/DID often arise in a legal context where there are significant benefits to be gained from receiving the diagnosis which heightens the importance of rigorous scientific scrutiny.Diagnostic validity and reliability matters in different ways in the forensic context than it does in the therapeutic context. These contextual differences [End Page 59] are reflected in disparate standards for scrutinizing each. There is no threshold requirement, for example, that a psychotherapist prove that a diagnostic category is valid or that a psychotherapeutic treatment used for a person suffering from it is generally recognized as safe and effective before using it; however, there is a threshold requirement of rigorous scientific scrutiny before admission of this information in evidence. If a therapist’s diagnostic hypothesis that there are two personality states influencing a patient’s behavior is not borne out, it can be revised in later sessions. Even if MPD/DID does not exist, treatment that assumes it does may nonetheless be effective because therapeutic outcome is more closely tied to the nature of the therapist-patient relationship than the content of therapy, or because multiple personality states is an effective therapeutic metaphor. Moreover, if the patient is not satisfied that the diagnosis or treatment rendered is helpful, the patient can leave therapy or seek another therapist.In contrast, judicial determinations are a one-shot determination which cannot be revisited in light of subsequently acquired knowledge. The defendant/patient is not free to change courts, or withdraw from the legal proceedings. Thus, it would be entirely appropriate for psychiatrists and psychologists to treat patients presenting symptoms of what they label MPD/DID and for courts to reject exculpatory evidence from psychiatrists and psychologists of that disorder.Related ArticlesFeature Article: Multiple Personality and Moral ResponsibilityCommentary: Commentary by ClarkCommentary: Commentary by ShumanDaniel W. Shuman Daniel W. Shuman, Professor of Law, Southern Methodist University, Dallas, TX 75235, USA.Copyright © 1996 The Johns Hopkins University Press... (shrink)

I am writing on moral knowledge in Locke's Essay Concerning Human Understanding. There are two basic parts. In the first part, I articulate and attack a predominant interpretation of the Essay . This interpretation attributes to Locke the view that he did not write in the Essay anything that would be inconsistent with his early views in the Questions Concerning the Laws of Nature that there exists a single, ultimate, moral standard, i.e., the Law of Nature. For example, John Colman, (...) in his book John Locke's Moral Philosophy , argues that even though Locke explains in the Essay that we arbitrarily create our moral notions, they are still objective since they are bound together with the Law of Nature. Colman explains that the features of human nature relevant to the derivation of the Law of Nature are universally shared needs and concerns . I argue that this presupposes a view of Locke which assumes that there are essences of species independent of our beliefs about them. However, I attempt to show from the text of the Essay that this view cannot be supported. ;In the second part, I argue that the text of the Essay supports two alternative theses. The first is that given the kind of metaphysical world-view presupposed by the corpuscular method of science employed within the Essay, coupled with Locke's commitment to the possibility of moral knowledge, he was left with only one option with reference to ethics, viz., to make moral goodness or evil a mind-dependent relation between a rule and an action, instead of a property of an action or person which exists independently of our moral beliefs. This view is logically inconsistent with the existence of the Law of Nature. The second is that Locke has a semantical view of moral claims which is consistent with his relational view of moral goodness, viz., the primary function of moral judgments is to recommend behavior for ourselves and others. I described. However, Locke explains in the Essay that the opposite takes place with respect to our moral notions: events and persons must conform to the moral notion. ;On the account that I offer, Locke's views on moral epistemology are much closer to David Hume's than many have supposed, and correspondingly, anticipate the more skeptical views of moral epistemology in the twentieth century. (shrink)

Much attention has been paid to moral understanding as an individual achievement, when a single agent gains insight into distinctly moral matters. Crucially overlooked, I argue, is the phenomenon of shared moral understanding, when you and I understand moral matters together, in a way that can’t be reduced to each of us having moral understanding on our own. My argument pays close attention to two central moral practices: justifying our actions to others, and apologizing for wrongdoing. I argue that, whenever (...) I owe you a justification or an apology, I thereby owe it to you to aim at our coming to a shared moral understanding. My argument has two upshots. The first is a novel explanation of the importance of moral understanding in our lives, one that emphasizes the importance of understanding moral reasons together. The second is a better understanding of the very obligations involved in two of our most central interpersonal moral practices. (shrink)

I argue here that the ways we experience, think about, and treat pain are bound up with sociocultural and technological phenomena that shape our desires and expectations. I propose a way of imagining caring for and offering healing to those who suffer pain informed by the Christian theological tradition. This way does not aspire to replace the care and healing made possible by modern medicine, but rather to place it within the common life of a community of mutual love, hospitality, (...) and reciprocal care. (shrink)

In The Body of Compassion, Joel Shuman presents an important, new theological treatment of contemporary bioethics, weaving together personal experience, a critical treatise on contemporary bioethics, and an exploration of a Christian theological alternative.The author first draws the reader into a consideration of the current state of bioethics by relating the story of his grandfather, a hard-working family man who died a solitary death, unaccompanied by loved ones, in the unfamiliar and sterile world of a hospital. Troubled by the (...) way his grandfather died, Shuman takes the reader along as he explores how modern medicine has distanced itself from dealing with people as living beings beyond their immediate physicality. He examines how various approaches to bioethics over the past twenty years have tried to remedy this problem by prescribing certain standards for treatment and how each of these ultimately has fallen short due to the lack of “a teleological concern for the body”—i.e., to trying to understand what the body is actually for in a larger context. From this point, Shuman deftly moves to a discussion of the centrality of the body to Christianity, focusing on how baptism, participation in the liturgy, and the partaking of the Eucharist all serve to unite Christians as one in the body of Christ. For Christians, the author argues, the body does not just belong to the individual but rather is one with the community of the Church. With this in mind, Shuman proposes a new kind of bioethics for Christians, where care for the body of Christ becomes the model of how we should care for and receive care from each other.This fresh and thought-provoking book is sure to be of interest to ethicists, medical professionals, and everyone who is troubled by places where science and religion intersect and seem to conflict. (shrink)

I argue here that Weberian disenchantment is manifest in the triumph of instrumental reason and the expansion of analytic enquiry, which now dominates not simply those sciences upon which medicine depends, but medical practice itself. I suggest ways that analytic enquiry, also referred to here as anatomical reasoning, are part of a particular ideology—a way of seeing, speaking about, and inhabiting the world—that often fails to serve the health of patients because it is incapable of “seeing” them in the moral (...) sense described by Iris Murdoch and others. I use the work of James Elkins and Wendell Berry to call for the recovery of a way of seeing the human body as both other and more than an object of scientific enquiry and social control. (shrink)

[Samuel Scheffler] Some egalitarian liberals have proposed a division of moral labour between social institutions and individual agents, but the division-of-labour metaphor has been understood in different ways. This paper aims to disentangle some of these different understandings, with an eye to clarifying the appeal of the egalitarian-liberal project and the challenges that it faces. The idea of a division of moral labour is best understood as the expression of a strategy for accommodating diverse values. It is not an (...) apology for economic self-interest or a device for justifying personal acquisitiveness. /// [Véronique Munoz-Dardé] Are there distinctively political values? Certain egalitarians seem to think that equality is one such value. Scheffler's contribution to the symposium seeks to articulate a division of moral labour between norms of personal morality and the principles of justice that regulate social institutions, and using this suggests that the egalitarian critique of Rawls can be deflected. In this paper, instead, I question the status of equality as an intrinsic value. I argue that an egalitarianism which focuses on the status of equality as valuable in itself embraces a theory of value with the worst elements of utilitarianism while leaving behind any of the intuitive appeal that utilitarianism has. In its place I press that we need a political conception of egalitarianism which stresses the role we engage beyond those found in the norms of personal morality. (shrink)

I provide a theory of the metaphysical foundations of identity: an account what grounds facts of the form a=b. In particular, I defend the claim that indiscernibility grounds identity. This is typically rejected because it is viciously circular; plausible assumptions about the logic of ground entail that the fact that a=b partially grounds itself. The theory I defend is immune to this circularity.

We sometimes fail unwittingly to do things that we ought to do. And we are, from time to time, culpable for these unwitting omissions. We provide an outline of a theory of responsibility for unwitting omissions. We emphasize two distinctive ideas: (i) many unwitting omissions can be understood as failures of appropriate vigilance, and; (ii) the sort of self-control implicated in these failures of appropriate vigilance is valuable. We argue that the norms that govern vigilance and the value of self-control (...) explain culpability for unwitting omissions. (shrink)

I argue that Spinoza endorses "conceptual dependence monism," the thesis that all forms of metaphysical dependence (such as causation, inherence, and existential dependence) are conceptual in kind. In the course of explaining the view, I further argue that it is actually presupposed in the proof for his more famed substance monism. Conceptual dependence monism also illuminates several of Spinoza’s most striking metaphysical views, including the intensionality of causal contexts, parallelism, metaphysical perfection, and explanatory rationalism. I also argue that this priority (...) of the conceptual does not commit Spinoza to forms of idealism or mentalism. The question of how to understand different kinds of metaphysical dependence is quite controversial in Spinoza studies; I address major alternative readings in the notes. But there I also try to draw connections to the growing debate in contemporary discussions about metaphysical dependence, as this topic is a happy point of shared interest between Spinoza and contemporary metaphysicians alike. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Operating Through HatredAndrew G. Shuman“You’re not cutting my ***ing neck. The cancer is in my ***ing mouth.”While many patient encounters are memorable, Mr. K’s introduction to the head and [End Page 20] neck surgical oncology clinic is indelibly imprinted into the minds of all of the clinicians present on that certain autumn morning. This was, quite simply, a man who resonated hate. He was rude and disruptive. He (...) insisted on an expedited workup “without any waiting.” He questioned the ethnicity and nationality of his care providers. He told me, in no uncertain terms, that he did not appreciate my Jewish heritage—the swastika tattooed on his bicep underscored the point. He bragged about his recent incarceration for armed robbery. While my colleagues and I were tempted to simply refuse to assume his care, Mr. K had a bad problem—his recurrent tongue cancer required a major operation in order to offer him any hope for cure.Mr. K initially received an abbreviated course of radiation at an outside institution, which was limited by his non–compliance. While one might debate the wisdom of this decision in retrospect—in general, surgery is preferred for his type of tumor—the die was already cast. A heroic attempt at surgical salvage was now his only curative option. He previously sought care elsewhere... only to be fired by this original surgeon when Mr. K physically threatened him in the outpatient office during preoperative consultation. [It was the doctor’s fault for insulting him in the first place, Mr. K maintained... and no charges were filed.] We were, indeed, his last resort. Other than his recurrent cancer, Mr. K was robust; he was in his sixth decade, physically fit, and on the whole, fairly healthy. In the classic surgical lexicon, he was a reasonable surgical candidate. But was it reasonable to operate on such a person?I remember thinking, at the time, about our obligation to care for such an individual. Of course, being a medical professional carries with it many obligations, including a judicious assumption of personal risk. And, working in a tertiary care center begets the responsibility to assist referring clinicians in the management of difficult cases. Although professional obligations certainly have their limits, defining their bounds is decidedly more difficult. Paramount is creating an atmosphere of mutual trust and acceptance. Naturally, this was easier said than done in regard to Mr. K.Perhaps against our better judgment, we agreed to operate under the condition that he abide by strict behavioral ground rules, on our terms. We agreed upon the extent of the necessary operation (which indeed involved cutting his ***ing neck, much to his chagrin and reluctant acceptance). Mr. K promised to follow instructions for postoperative care. He assured us that he would not swear or yell (again). And, in the presence of hospital security, who reinforced our institutional policies regarding patient behavior, he guaranteed that he would not be verbally or physically violent or inappropriate, and would not make disparaging comments to other patients or staff. It seemed, at least, that we had an understanding.Needless to say, these rules were broken shortly after he awoke from surgery. I vividly remember being summoned from the OR when he threatened to murder his impressionable and terrified nurse a few days later, who would not acquiesce to his unreasonable demands. From that point onward, hospital security was deployed to his room regularly, and anything resembling a potential weapon was safeguarded. Any semblance of a mutual doctor–patient bond was shattered. At this point, everyone’s goal was simply to get Mr. K home.My visceral reactions to his behavior, while intense, were not unexpected, and fell in line with those of the entire team of clinicians caring for him. His antics brought his healthcare team together in collective unity (and condemnation). However, my surgical colleagues and I also felt somewhat guilty and responsible. While surgeons can choose to assume some degree of inherent personal danger in caring for a violent and angry patient, we also put the safety and soundness of the entire perioperative team in jeopardy, without necessarily seeking their input. But once we had decided to... (shrink)

My primary target in this paper is a puzzle that emerges from the conjunction of several seemingly innocent assumptions in action theory and the metaphysics of moral responsibility. The puzzle I have in mind is this. On one widely held account of moral responsibility, an agent is morally responsible only for those actions or outcomes over which that agent exercises control. Recently, however, some have cited cases where agents appear to be morally responsible without exercising any control. This leads some (...) to abandon the control-based account of responsibility and replace it with an alternative account. It leads others to deny the intuition that agents are responsible in these troublesome cases. After outlining the account of moral responsibility I have in mind, I look at some of the arguments made against the viability of this theory. I show that there are conceptual resources for salvaging the control account, focusing in particular on the nature of vigilance. I also argue that there is empirical data that supports the control account so conceived. (shrink)

This article challenges the association between realist methodology and ideals of legitimacy. Many who seek a more “realistic” or “political” approach to political theory replace the familiar orientation towards a state of justice with a structurally similar orientation towards a state of legitimacy. As a result, they fail to provide more reliable practical guidance, and wrongly displace radical demands. Rather than orienting action towards any state of affairs, I suggest that a more practically useful approach to political theory would directly (...) address judgments, by comparing the concrete possibilities for action faced by real political actors. (shrink)

I provide an analysis of sentences of the form ‘To be F is to be G’ in terms of exact truth-maker semantics—an approach that identifies the meanings of sentences with the states of the world directly responsible for their truth-values. Roughly, I argue that these sentences hold just in case that which makes something F is that which makes it G. This approach is hyperintensional, and possesses desirable logical and modal features. These sentences are reflexive, transitive and symmetric, and, if (...) they are true, then they are necessarily true, and it is necessary that all and only Fs are Gs. I close by defining an asymmetric and irreflexive notion of analysis in terms of the reflexive and symmetric one. (shrink)

I provide an analysis of sentences of the form ‘To be F is to be G’ in terms of exact truth-maker semantics—an approach that identifies the meanings of sentences with the states of the world directly responsible for their truth-values. Roughly, I argue that these sentences hold just in case that which makes something F also makes it G. This approach is hyperintensional and possesses desirable logical and modal features. In particular, these sentences are reflexive, transitive, and symmetric, and if (...) they are true, then they are necessarily true, and it is necessary that all and only Fs are Gs. I motivate my account over Correia and Skiles’ [11] prominent alternative and close by defining an irreflexive and asymmetric notion of analysis in terms of the symmetric and reflexive notion. (shrink)

Josh is a typical 27-year-old in a career that he enjoys and a successful marriage. Josh begins to exhibit the symptoms of a manic episode. He is soon diagnosed with bipolar disorder. While non-manic, Josh’s preferences are typical. While manic, his preferences change dramatically. He quits his job, cheats on his partner, and squanders his savings. These are behaviors that Josh, when non-manic (euthymic), would never agree to. When Josh returns to a euthymic state, he regrets these decisions. Should those (...) close to Josh have prevented him from making these decisions, or does his competence to decide persist despite his acute mania? In this paper, I examine the connections be-tween bipolar disorder and consent. I defend the view that many (although far from all) individuals with bipolar disorder are competent to consent to a wide variety of things when they are in a manic state. This means that mania should not be presumed to undermine competence in clinical settings. -/- I have several goals in this paper. I want to bring philosophy to bear on the connection between consent and bipolar disorder. Additionally, I intend this paper to contribute to the general debate about the conditions of informed consent. Bipolar disorder presents novel challenges to existing conceptions of competence to consent which require stable core of values for an agent to be competent. For example, Buchanan and Brock endorse such a view. In showing that shifting values do not undermine the competence of a person experiencing acute mania, I show that the aforementioned views of competence are false. Overall, this paper makes substantive contributions to the debate about competence to consent and presents the first sustained philosophical treatment of consent among people with bipolar disorder. (shrink)

In this article, I explicate Kant’s position on the wide right to abortion. That is, I explore the extent to which, according to Kant’s practical philosophy, abortion is punishable, even if it involves an unjust infringement of the right to life. By focusing on the state’s right to punish, rather than the right to life or the onset of personhood, I use Kant to expose a novel range of issues and questions about the legal status of abortion (and criminal punishment (...) more generally). The article is divided into four sections. In the first, I lay the groundwork for Kant’s theory of rights and briefly canvass some of the literature on Kantian approaches to abortion. In the second, I look at Kant’s discussion of equivocal rights. In the third, I turn to Kant’s discussions of capital punishment and suicide. In the fourth, I examine Kant on honor killings, and I use his position on infanticide in order to extrapolate and explain his ideas about the right to punish in the context of abortion. (shrink)

Leibniz’s views on modality are among the most discussed by his interpreters. Although most of the discussion has focused on Leibniz’s analyses of modality, this essay explores Leibniz’s grounding of modality. Leibniz holds that possibilities and possibilia are grounded in the intellect of God. Although other early moderns agreed that modal truths are in some way dependent on God, there were sharp disagreements surrounding two distinct questions: (1) On what in God do modal truths and modal truth-makers depend? (2) What (...) is the manner(s) of dependence by which modal truths and modal truth-makers depend on God? Very roughly, Leibniz’s own answers are: (1) God’s intellect and (2) a form of ontological dependence. The essay first distinguishes Leibniz’s account from two nearby (and often misunderstood) alternatives found in Descartes and Spinoza. It then examines Leibniz’s theory in detail, showing how, on his account, God’s ideas provide both truth-makers for possibilities and necessities and an ontological foothold for those truth-makers, thereby explaining modal truths. Along the way, it suggests several refinements and possible amendments to Leibniz’s grounding thesis. It then defends Leibniz against a pair of recent objections by Robert Merrihew Adams and Andrew Chignell that invoke the early work of Kant. I conclude that whereas Leibniz’s alternative avoids collapsing into yet another form of Spinozism, the alternatives proposed by Adams, Chignell, and the early Kant do not. (shrink)

*Please email me for a copy of the paper if you are interested! -/- Liberal theories of animal consciousness maintain that we should attribute consciousness widely across various species. Conservative theories of animal consciousness maintain that we should not attribute consciousness widely. This paper makes a case for a conservative theory of animal consciousness. The case depends on two defensive moves and one offensive move. The defensive moves indicate that the indistinguishable causal profiles of conscious and non-conscious mental states are (...) not a problem for conservative theories and that intuitions about animal consciousness should not play a role in theory selection. Offensively, I argue that liberal theories of animal consciousness are less parsimonious than conservative theories. The upshot is that liberal theories of animal consciousness are not obviously rationally preferable to conservative theories. (shrink)

Discussions of Aristotle’s Metaphysics Z tend to treat it either as an independent treatise on substance and essence or as preliminary to the main conclusions of the Metaphysics. I argue instead that Z is central to Aristotle’s project of first philosophy in the Metaphysics: the first philosopher seeks the first causes of being qua being, especially substances, and in Z, Aristotle establishes that essences or forms are the first causes of being of perceptible substances. I also argue that the centrality (...) of Z to first philosophy is compatible with its status as theology. (shrink)

One of the lessons of the COVID-19 pandemic is that the lay public relies immensely on the knowledge of public health officials. At every phase of the pandemic, the testimony of public health officials has been crucial for guiding public policy and individual behavior. The reason is simple: public health officials know a lot more than you and I do about public health. As lay people, we rely on experts. This seems straightforward. But the COVID-19 pandemic has shown that public (...) health officials seem undecided as to what, precisely, their role is; are they providing the public information as it presents itself, or are they informing the public in a way that produces a desired or optimal outcome? In this article, I answer the following question: what are public health officials morally obligated to tell the public? As I see it, these are the main options: (1) public health officials should tell the full truth, regardless of outcome; or (2) they should tell partial truths or lies that are aimed to promote a socially optimal outcome. My answer to this question is that public health officials are only allowed to lie under very narrow and rare conditions. -/- . (shrink)