Although philosophers have explored several connections between neuroscience and moral responsibility, the issue of how real-world neurological modifications, such as Deep Brain Stimulation, impact moral responsibility has received little attention. In this article, we draw on debates about the relevance of history and manipulation to moral responsibility to argue that certain kinds of neurological modification can diminish the responsibility of the agents so modified. We argue for a historicist position - a version of the history-sensitive reflection view - and defend (...) that account against a rival, relational view of responsibility. We conclude that DBS can, under certain conditions, diminish responsibility, and explore the circumstances under which this might be so. We conclude by suggesting that philosophical debates about moral responsibility, manipulation, and history have greater practical relevance than is sometimes thought, and that attention to practical cases can help inform and deepen this body of scholarship. (shrink)

While there is much literature on autonomy and the conditions for its attainment, there is less on how those conditions reflect on agents’ ordinary careers. Most people’s careers involve a great deal of subservient activity that would prevent the kind of control over agents’ actions that autonomy would seem to require. Yet, it would seem strange to deny autonomy to every agent who regularly follows orders at work—to do so would make autonomy a futile ideal. Most contemporary autonomy accounts provide (...) purely theoretical analysis without reference to any practical goal that autonomy could serve. These accounts are likely to resolve this issue in one direction: either almost entirely including or excluding subservient workers from autonomy. Either solution would fail to distinguish agents who sufficiently control their lives, in spite of limited subservience, according to their own standards, from agents for whom subservience precludes a fulfilling life. I suggest the solution lies in a return to goal-oriented autonomy accounts, which can use the goal to distinguish when subservience overwhelms autonomy from when subservience and autonomy can coexist. I present an account that anchors autonomy in the happiness that it provides for agents who sufficiently control their lives as determined by their more important prudential standards. On this account, agents in subservient careers can be autonomous if they determine how to make their careers consistent with their happiness. (shrink)

Where ethical or regulatory questions arise about an individual’s interests in accessing bioinformation about herself, the value of this information has traditionally been construed in terms of its clinical utility. It is increasingly argued, however, that the “personal utility” of findings should also be taken into account. This article characterizes one particular aspect of personal utility: that derived from the role of personal bioinformation in identity construction. The suggestion that some kinds of information are relevant to identity is not in (...) itself new. However, the account outlined here seeks to advance the debate by proposing a conception of the relationship between bioinformation and identity that does not depend on essentialist assumptions and applies beyond the narrow genetic contexts in which identity is customarily invoked. The proposal is that the identity-value of personal bioinformation may be understood in terms of its instrumental role in the construction of our narrative identities, specifically that its value lies in helping us to develop self-narratives that support us in navigating our embodied existences. I argue that this narrative conception provides useful insights that are pertinent to the ethical governance of personal bioinformation. It illuminates a wider range of ethical considerations in relation to information access; it accounts for variations in the utility of different kinds of information; and it highlights that the context in which information is conveyed can be as important as whether it is disclosed at all. These arguments are illustrated using an example drawn from psychiatric neuroimaging research. (shrink)

The ideal of personal autonomy faces a challenge from advocates of orthonomy, who think good government should displace self-government. These critics claim that autonomy is an arbitrary kind of psychological harmony and that we should instead concentrate on ensuring our motivations and deliberations are responsive to reasons. This paper recasts these objections as part of an intramural debate between approaches to autonomy that accept or reject the requirement for robust rational capacities. It argues that autonomy depends upon such responsiveness to (...) reasons, countering objections that ‘externalist’ rationalist criteria strip the self from self-government. (shrink)

This article discusses left-libertarian justifications of basic income. The basic income policy is designed to decouple income from employment in the monetized economy by allowing the individual to access, on a regular stipulated basis, a grant that is independent of her ability and willingness to work for remuneration. This article attempts to amend an important failure with respect to the way in which the concept of real freedom has been treated in Van Parijs’ pioneering defense of the universal grant. Van (...) Parijs’ defense of basic income does not pay substantial attention to the freedom that work-lovers would gain from the opportunity to opt out of work, which the grant would facilitate if sufficiently generous. Van Parijs’ justification of basic income is incomplete in terms of the value it places on the opportunity to enjoy freedom from employment from the purview of every member of society, not only those that will, or might, decide to lead a life outside of work. The article develops the argument that such failure results from the fact that Van Parijs’ conception of freedom is centered on the importance of actual or potential preference satisfaction as opposed to non-agent-centered reasons. (shrink)

In this paper we defend the notion of narrative identity against Galen Strawson's recent critique. With reference to Elyn Saks's memoir of her schizophrenia, we question the coherence ofStrawsons conception of the Episodic self and show why the capacity for narrative integration is important for a flourishing life. We aho argue that Scú put pressure on narrative theories that specify unduly restncúve constraints on self-constituting narratives, and chrify the need to distinguish identity from autonomy.

Muchos autores que se han ocupado de la autonomía personal parecen identificar la capacidad de autonomía esencialmente con la capacidad de todo agente racional para identificar preferencias y tomar decisiones conforme a las mismas. Estos autores -entre los que podríamos ubicar a C. Nino- prescinden a menudo de ulteriores elementos o condiciones para su ejercicio. Sin embargo, resulta fundamental ahondar en esos aspectos a veces pasados por alto; ahondar principalmente en las opciones y el proceso de formación de preferencias de (...) los agentes, para delinear mejor los aspectos normativos de la autonomía. En este trabajo propongo recuperar un elemento central del concepto que ha sido extensamente desarrollado en la literatura feminista, me refiero al contexto de relaciones que ha dado lugar a la llamada "autonomía relacional". Propongo incorporar esta noción al núcleo conceptual de la autonomía sin renunciar, sin embargo, a otros elementos del concepto entre los que destacaré las "opciones relevantes", es decir, la presencia de cursos de acción, de oportunidades, que la persona es capaz de reconocer como propuestas no solo viables sino legítimas para sí. Para desarrollar esta idea comenzaré por definir la autonomía a través de los que considero los elementos o condiciones centrales del concepto, deteniéndome especialmente en la condición de opciones relevantes. A continuación se abordará la cuestión relativa al modo en que las opciones se perfilan, se construyen y son percibidas por los sujetos. En este punto el estudio se fijará específicamente en el entorno contextual y de relaciones que sirve de trasfondo para la construcción de las opciones, para proponer la noción de opciones relacionales. Many authors have written about autonomy focusing mainly on the capacity of the autonomous agent for identifying preferences and making decisions. These authors -C. Nino among them- do not take into consideration further elements or conditions for being autonomous. However, it is necessary to take other aspects into consideration; mainly it is important to take account of both options and the building of the agent’s preferences. This way, autonomy normative aspects will be better understood. I propose here to analyse the concept of "relational autonomy", which has been largely elaborated within feminist theory. My aim is to incorporate relations and options to the core of the concept of personal autonomy. In this article, I will define personal autonomy first, highlighting the importance of relevant options. Second, I will describe the way options are built and their perception by the agent. Finally, I will focus on the context and relations on the background, and I will propose the notion of relational options. (shrink)

The last few years have seen a marked increase of interest in the ethics of psychotherapy. As the field of mental health has recently taken on a new level of prominence, renewed commitment to the ethical analysis of psychiatric and psychological treatment is clearly required. In this review essay, we survey recent work on psychotherapy ethics, taking a critical yet generally sympathetic view of the new literature. There are important considerations that remain neglected or overlooked entirely, in our view, and (...) several substantive and methodological trends are in need of diagnosis and critical response. We structure the discussion around several themes, including the inherently moral nature of psychotherapy, the heterogeneity of such practices, the significance of social, cultural, and historical context, and, finally, questions concerning prevailing methodological assumptions. (shrink)

This paper argues that a certain kind of alienation from labour can be analyzed and explained in the theoretical framework that is dominant in current economics. Given a neoclassical model of a labour market, the intrinsic value that different kinds of labour may have for people can be represented as a source of utility (in the technical sense). It can then be shown that in capitalist economies, basing one’s supply decisions on this intrinsic value is predictably costly. So in the (...) long run, rational agents can be – and will be – expected to make their labour supply decisions based only on considerations of income and leisure time. In the resulting picture, rational agents are indifferent with regard to different qualitatively specific kinds of labour. I draw on the theory of efficiency wages to show that this picture lies at the root of contemporary problems like involuntary unemployment and injustice. (shrink)

Desire satisfaction theorists and attitudinal-happiness theorists of well-being are committed to correcting the psychological attitudes upon which their theories are built. However, it is not often recognized that some of the attitudes in need of correction are evaluative attitudes. Moreover, it is hard to know how to correct for poor evaluative attitudes in ways that respect the traditional commitment to the authority of the individual subject's evaluative perspective. L. W. Sumner has proposed an autonomy-as-authenticity requirement to perform this task, but (...) this article argues that it cannot do the job. Sumner's proposal focuses on the social origins of our values and overlooks the deep psychological roots of other evaluative attitudes that are just as problematic for welfare. If subjective theories of welfare are to be at all plausible they may need to abandon or modify their traditional commitment to the authority of the individual subject. (shrink)

One of the most pervasive criticisms of nudges has been the claim that they violate, undermine or decrease people’s autonomy. This claim, however, is seldom backed up by an explicit and detailed conception of autonomy. In this paper, we aim to do three things. First, we want to clear up some conceptual confusion by distinguishing the different conceptions used by Cass Sunstein and his critics in order to get clear on how they conceive of autonomy. Second, we want to add (...) to the existing discussion by distinguishing between ‘autonomy’ as the ability to set your own ends and ‘autocracy’ as the ability to actually realize those ends. This will allow for a more careful ethical evaluation of specific nudge interventions. Third, we will introduce the idea of ‘perimeters of autonomy’ in an attempt to provide a realistic account of personal autonomy and we will argue that it can alleviate most of the worries about nudging being autonomy-undermining. (shrink)

In the theoretical literature on moral responsibility, one sometimes comes across cases of manipulated agents. In cases of this type, the agent is a victim of wholesale manipulation, involving the implantation of various pro-attitudes (desires, values, etc.) along with the deletion of competing pro-attitudes. As a result of this manipulation, the agent ends up performing some action unlike any that she would have performed were it not for the manipulation. These sorts of cases are sometimes thought to motivate historical views (...) of responsibility, on which the agent’s past is relevant to whether she is responsible for a specific action. In a recent paper, Daniel Sharp and David Wasserman bring these theoretical discussions on moral responsibility to bear on practical issues regarding neurological modifications of individuals. After proposing and arguing for a historical view, Sharp and Wasserman offer some insight into how such a view may help us in determining the responsibility of subjects who have undergone Deep Brain Stimulation. This paper aims to join this discussion, by arguing that the correct historical view to be applied will also appeal to the agent’s control over her mental life and the fact that this was bypassed. I conclude with some brief comments on the practical implications of such a historical view. (shrink)

Recent philosophy has developed an overblown concept of autonomy. In fact we do not have moral autonomy, and personal autonomy we only have in the sense of being able to decide some things that affect the course of our lives, not in the sense of shaping these lives and being master over them; nor ought we to have autonomy in the latter sense, or come closer to having it. As for our political institutions, they do not presuppose, as prevailing doctrines (...) claim they do, citizens’ autonomy in a more demanding sense. Freedom and democracy as understood for instance in the German constitution only assume subordinates capable of deciding some matters on their own. Current talk of autonomy is just gilding people’s real dependence. (shrink)

The risk that direct-to-consumer advertising of prescription pharmaceuticals (DTCA) may increase inappropriate medicine use is well recognized. The U.S. Food and Drug Administration addresses this concern by subjecting DTCA content to strict scrutiny. Its strictures are, however, heavily focused on the explicit claims made in commercials, what we term their “propositional content.” Yet research in social psychology suggests advertising employs techniques to influence viewers via nonpropositional content, for example, images and music. We argue that one such technique, evaluative conditioning, is (...) operative in DTCA. We further argue that evaluative conditioning fosters unjustified beliefs about drug safety and efficacy, antagonising the autonomy of viewers’ choices about advertised medicines. We conclude that current guidelines are deficient in failing to account for evaluative conditioning, and that more research and debate are needed to determine the permissibility of this and other forms of nonpropositional persuasion. (shrink)

It has been argued - most prominently in Harry Frankfurt's recent work - that the normative authority of personal commitments derives not from their intrinsic worth but from the way in which one's will is invested in what one cares about. In this essay, I argue that even if this approach is construed broadly and supplemented in various ways, its intrasubjective character leaves it ill-prepared to explain the normative grip of commitments in cases of purported self-betrayal. As an alternative, I (...) sketch a view that focuses on intersubjective constraints of intelligibility built into social practices and on the pragmatics of how those norms are contested in an ongoing fashion. (shrink)

Communitarian writers argue that social identity is deeply important to individual autonomy and thus liberal societies have an obligation to recognize identity. Any liberal view that attempts to account for this charge must specify a procedure to recognize identity that also ensures that the liberal sense of autonomy is not weakened. In this article, I develop such an account. I argue that liberals must distinguish an identity that belongs to particular persons (particularized identity) from the collective form of that identity. (...) For instance, Naisha will have her own particularized way of being Indian in addition to the collective form of the culture that she shares with others. To determine which acts would be about recognizing the particularized form, I provide a counterfactual test. One major implication of the test is that special collective rights would not be endorsed. At the same time, the test is not equivalent to the liberal positions of insisting either that rights belong to individuals or that individuals are not harmed. Because identity is almost always viewed in terms of groups, valuing identity seems to be at odds with the principles of liberalism and democratic theory in which individual persons are the ultimate source of value. I show that there is a significant way to recognize identity that is harmonious with these principles. (shrink)

Part I of the dissertation examines the cognitive aspects of autonomy. The central question concerns what kind of cognitive capacity autonomy is. It will be argued that the concept of autonomy is best understood in terms of a metacognitive capacity of the individual. It is argued that metacognition has two components: procedural reflexivity and metarepresentation. Metarepresentation in turn can be divided into inferential reflexivity and other-attributiveness. These two components are essential for autonomy. Particular emphasis is put on procedural reflexivity. Further, (...) since the essential function of metacognition is control, it is argued that the concept of autonomy, understood as a metacognitive capacity, can be interpreted in terms of control. Issues arising from empirical data from neuroscience on functional, as well as impaired, metacognition, and on undermined autonomy, are dealt with. It is argued that autonomy cannot be determined with respect to subjective conditions. Neurological impairments, like Anton’s Syndrome, dementia, and thought insertion in schizophrenia, are put forward in support of this claim. To determine autonomy we require external conditions. In order to determine whether an individual is autonomous, both the metacognitive status of the individual and the external setting must be considered, since they are in interplay and consequently influence each other. In Part II, the analysis put forward in Part I is applied to Swedish healthcare. It is argued that the distinction between autonomy as a right and as a capacity must be explicit in order to understand what autonomy means and to deal with it effectively in healthcare practice. A discussion about whether or not the patient’s right to autonomy sometimes tends to be over-emphasized in healthcare is put forward. Special emphasis is placed on psychitaric issues such as deinstitutionalization and participation. Following the closure of the mental hospitals, deinstitutionalization and community-based care have become central topics in psychiatry. At the same time, the implementation of such care can be demanding for patients suffering from a persistent mental disorder. In part II it is also suggested that the metacognitive account of the concept of autonomy might help clarify the criteria governing coercive care. Finally, some suggestions concerning developments and improvements in Swedish healthcare, especially in psychiatry, where the concept of autonomy is important but problematic, are put forward. (shrink)