The question of how to treat an incapacitated patient is vexed, both normatively and practically—normatively, because it is not obvious what the relevant objectives are; practically, because even once the relevant objectives are set, it is often difficult to determine which treatment option is best given those objectives. But despite these complications, here is one consideration that is clearly relevant: what a patient prefers. And so any device that could reliably identify a patient’s preferences would be a promising tool for (...) guiding the treatment of incapacitated patients. The patient preference predictor is just such a tool—an algorithm that takes as inputs a patient’s sociodemographic characteristics, and outputs a reliable prediction about that patient’s treatment preferences.1 But some have worried that the use of such a tool would violate or fail to appropriately respect patients’ autonomy. There are, I think, two ways to understand this kind of criticism. First, globally—as a worry that any systematic implementation of the PPP would be problematic on the grounds that it would result in significant or pervasive autonomy violations. Second, locally—as a worry that in some important range of cases, certain uses of the PPP would be problematic on autonomy grounds. Jardas et al, as I read them, address global autonomy-based criticisms, arguing—convincingly, in my view—that there’s no reason to suspect the autonomy concerns raised by the PPP would be so significant and pervasive as to render any implementation of it generally problematic.1 But even with the global criticisms rebuffed, there remains work to be done. Any ethically acceptable implementation of the PPP must be sensitive to the more local autonomy-based criticisms, with restrictions and safeguards in place to ensure respect for autonomy in the kinds of cases in which the use of the PPP might otherwise threaten …. (shrink)

Many digital technologies, designed and controlled by intensive data-driven corporate platforms, have become ubiquitous for many of our daily activities. This has raised political and ethical concerns over how they might be threatening our personal autonomy. However, not much philosophical attention has been paid to the specific role that their hyper-designed (sensorimotor) interfaces play in this regard. In this paper, we aim to offer a novel framework that can ground personal autonomy on sensorimotor interaction and, from there, directly address how (...) technological design affects personal autonomy. To do this, we will draw from enactive sensorimotor approaches to cognition, focusing on the central notion of habits, understood as sensorimotor schemes that, in networked relations, give rise to sensorimotor agency. Starting from sensorimotor agency as a basis for more complex forms of personal autonomy, our approach gives us grounds to analyse our relationship with technology (in general) and to distinguish between autonomy-enhancing and autonomy-diminishing technologies. We argue that, by favouring/obstructing the enactment of certain (networks of) habits over others, technologies can directly act upon our personal autonomy, locally and globally. With this in mind, we then discuss how current digital technologies are often being designed to be autonomy-diminishing (as is the case of “dark patterns” in design), and sketch some ideas on how to build more autonomy-enhancing digital technologies. (shrink)

Soda taxes are controversial. While proponents point to their potential health benefits and the public projects that could be funded with their revenue, critics argue that they are paternalistic and regressive. In this paper, we explore the prospects for designing a just soda tax, one that appropriately balances the often-competing ethical considerations of promoting social welfare, respecting people’s autonomy, and ensuring distributive fairness. We argue that policymakers have several paths forward for designing a just soda tax, but that the considerations (...) relevant to ethical policy design are more complicated than is sometimes acknowledged. (shrink)

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct verdicts about (...) who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

Navin, Brummett, and Wasserman (2022) argue—successfully, we think—that the standard “comparative” account of decision-making capacity (DMC) fails to capture an important range of cases in which a...

Political philosophy should focus not on uplifting ideals, but rather, so I argue, on minimizing serious suffering. This is so not because other things do not ultimately matter (they do), but rather because in the political context, the stakes in terms of suffering are usually extremely high, so that any other considerations are almost always outweighed. Put in moderately deontological terms: the high stakes carry most political decisions across the thresholds of the relevant deontological constraints. While the argument is substantive (...) rather than exegetical, I engage in detail Judith Shklar's “Liberalism of Fear”. I share with Shklar her pessimistic starting point, but I also show how a focus on suffering (rather than cruelty and fear) is what plausibly follows from such a starting point. I then pursue the implications of this difference—they are theoretically profound, but perhaps less significant practically. (shrink)

Many believe that paternalism is less wrong in intimate relationships. In this paper, we argue that this view cannot be justified by appeal to (i) beneficence, (ii) shared projects, (iii) vulnerability, (iv) epistemic access, (v) expressivism, or (vi) autonomy as nonalienation. We finally provide an error theory for why many may have believed that paternalism is less wrong in intimate relations.