This article is about the information relevant to decision-making capacity in refusal of life-prolonging medical treatment cases. We examine the degree to which the phenomenology of the options available to the agent—what the relevant states of affairs will feel like for them—forms part of the capacity-relevant information in the law of England and Wales, and how this informational basis varies across adolescent and adult medical treatment cases. We identify an important doctrinal phenomenon. In the leading authorities, the courts appear to (...) count the first-personal phenomenology of the available options among the information that adolescents seeking to refuse life-prolonging treatment must understand and appreciate in order to possess capacity; adults are not held to this (higher) standard. We evaluate this differential treatment in light of philosophical work on transformative choice—decisions involving options whose sensory character, and effect on our values and preferences, are grasped only through experience itself. (shrink)

The main aim of this book is to introduce the topic of limited awareness, and changes in awareness, to those interested in the philosophy of decision-making and uncertain reasoning.

According to L. A. Paul, the subjective value of an outcome is normally assessed by running a cognitive model of what it would be like if that outcome were to occur. However, cognitive models, along with the expectations in which they result, are unreliable for application to transformative experiences because we cannot know what it would be like for an outcome to occur if we have never experienced it before. This paper argues that despite their unreliability, expectations are still important (...) in the case of chosen and unchosen transformative experiences because expectations about an outcome can systematically influence the very experience of that outcome. More precisely, empirical research shows that affective experiences tend to assimilate to affective expectations. In turn, more positive affective experiences lead, ceteris paribus, to higher subjective value. Therefore, rational agents confronting transformative outcomes should form or cultivate positive/optimistic affective expectations since, all else being equal, that maximizes subjective value. (shrink)

According to L. A. Paul (2014), transformative experiences pose a challenge for decision theory, as their subjective value is not epistemically accessible. However, several authors propose that the subjective values of options are often irrelevant to their ranking; in many cases, all we need for rational transformative decision-making are the known non-subjective values. This stance is in conflict with Paul’s argument that the subjective value can always swamp the non-subjective value. The approach presented in this paper takes Paul’s argument into (...) account and shows how potential swamping can be controlled given that one desires the transformative outcome: If one knows from previous decisions that desired transformative outcomes are associated with positive subjective value and if, in addition, testimony confirms this association for the current decision situation, one can infer that a desired outcome’s expected subjective value has a positive valence. Accordingly, one can rationally choose the desired transformative option if its non-subjective value is no lower than the overall value of any other option. (shrink)

Laurie Paul argues that, when it comes to many of your most significant life-changing decisions, the principles of rational choice are silent. That is because, in these cases, you anticipate that one of your choice options would yield a transformative experience. We argue that such decisions are best seen as ones in which you anticipate awareness growth. You do not merely lack knowledge about which possible outcome will arise from a transformative option; you lack knowledge about what are the possible (...) outcomes. We show how principles of rational choice can be extended to cases of anticipated awareness growth. (shrink)

In the last seven years, philosophers have discussed the topic of transformative experiences. In this paper, we contribute to a crucial issue that is currently under-researched: transformative experiences' influence on cognitive modelling. We argue that cognitive modelling can be operationalized as affective forecasting, and we compare transformative and non-transformative experiences with respect to the ability of affective forecasting. Our finding is that decision-makers’ performance in cognitively modelling transformative experiences does not systematically differ from decision-makers’ performance in cognitively modelling non-transformative experiences. (...) This claim stands in strict opposition to L.A. Paul’s main argument. (shrink)

L. A. Paul’s Transformative Experience makes the claim that many important life decisions are epistemically and personally transformative in a way that does not allow us to assign subjective values to their outcomes. As a result, we cannot use normative decision theory to make such decisions rationally, or when we modify it to do so, decision theory leads us to choose in a way that is in tension with our authenticity. This paper examines Paul’s version of decision theory, and whether (...) this version in fact admits of the challenge she wants to raise. I focus on her psychological realist view of utilities and beliefs and her notion of rational, authentic preferences as informed by imaginative acquaintance. I argue that Paul fails to engage critically with traditional accounts of decision theory and, on closer inspection, it is not clear that her version of decision theory entails a tension between rational and authentic choice. More importantly, I argue that if her contribution is instead to bring to light the importance of authenticity alongside rational decision-making, the definition she provides of authenticity in fact undermines her argument. (shrink)

In her ground-breaking and highly influential book Transformative Experience, L.A. Paul makes two claims: (1) one cannot evaluate and compare certain experiential outcomes (e.g. being a parent and being a non-parent) unless one can grasp what these outcomes are like; and (2) one can evaluate and compare certain intuitively horrible outcomes (e.g. being eaten alive by sharks) as bad and worse than certain other outcomes even if one cannot grasp what these intuitively horrible outcomes are like. We argue that the (...) conjunction of these two claims leads to an implausible discontinuity in the evaluability of outcomes. One implication of positing such a discontinuity is that evaluative comparisons of outcomes will not be proportionally sensitive to variation in the underlying features of these outcomes. This puts pressure on Paul to abandon either (1) or (2). But (1) is central to her view and (2) is very hard to deny. We call this the Shark Problem. (shrink)