Autonomy is a concept that holds much appeal to social and legal philosophers. Within a medical context, it is often argued that it should be afforded supremacy over other concepts and interests. When respect for autonomy merely requires non-intervention, an adult’s right to refuse treatment is held at law to be absolute. This apparently simple statement of principle does not hold true in practice. This is in part because an individual must be found to be competent to make a valid (...) refusal of consent to medical treatment, and capacity to decide is not an absolute concept. But further to this, I argue that there are three relevant understandings of autonomy within our society, and each can demand in differing cases that different courses of action be followed. Judges, perhaps inadvertently, have been able to take advantage of the equivocal nature of the concept to come tacitly to decisions that reflect their own moral judgments of patients or decisions made in particular cases. The result is the inconsistent application of principle. I ask whether this is an unforeseen outcome or if it reflects a wilful disregard for equal treatment in favour of silent moral judgments in legal cases. Whatever the cause, I suggest that once this practice is seen to occur, acceptable justification of it in some cases is difficult to find. (shrink)

Experiences of moral distress encountered in psychiatric practice were explored in a hermeneutic phenomenological study. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychiatrists describe struggling ‘to do the right thing’ for individual patients within a societal system that places unrealistic demands on psychiatric expertise. Certainty on the part of the psychiatrist is an expectation when judgments of dangerousness and/or the need for coercive treatments are made. This assumption, however, ignores the uncertainty and (...) complexity of reality. Society entrusts psychiatrists to care for and treat those among its most vulnerable members: persons deemed to have a severely diminished capacity for autonomy due to a mental disorder. Simultaneously, psychiatrists are held accountable by society for the protection of the public. Moral distress arose for psychiatrists in their efforts to fulfill both roles. They described an ‘outsider/insider’ status and the ways in which they attempted to cope with moral distress. (shrink)

Psychopathy, as articulated in Hare’s PCL-R, appears to reliably pick out a forensic category of troubled people. This chapter considers the use and utility of PCL-R by focussing upon two interrelated questions. Does philosophical investigation direct attention toward the issues that should interest us about psychopathy? Is being diagnosed as psychopathic or having ASPD clinically useful, as well as for judicial and sentencing purposes? While the research programmes that developed following the attention paid to psychopathy are warranted, more attention could (...) be directed to the varied nature of psychopathy and the presentations of it that Cleckley described in the Mask of Sanity. It is important to understand psychopathy as it affects lives, as well as a forensic problem. (shrink)

A pressing and difficult practical problem concerns the general issue of the right social response to offenders classified as having antisocial personality disorder. This paper approaches this general problem by focusing, from a philosophical perspective, on the still relevant but more approachable question whether psychopathic offenders are morally responsible. In particular, I investigate whether psychopaths possess moral understanding. A plausible way to approach the last question requires a satisfactory philosophical interpretation of the empirical evidence that appears to show that psychopaths (...) fail to draw the distinction between conventional and moral norms. Specifically, I will consider a recent philosophical debate polarized between supporters of rationalist and sentimentalist accounts of moral understanding. These opponents have discussed whether the case of psychopathy offers empirical support for their account and undermine the rival view. I will argue that the available empirical data leave the outcome of this discussion indeterminate. However, this implies that both these principal theories of moral understanding, if independently motivated, would imply that psychopaths have certain deficits that might affect their moral understanding and, consequently, their moral responsibility. (shrink)

Gorući i težak praktički problem vezan je uz opće pitanje ispravnog društvenog odgovora na prijestupnike klasificirane kao osobe s antisocijalnim poremećajem ličnosti. Članak prilazi ovom općem problemu fokusirajući se, iz filozofske perspektive, na još uvijek važno ali lakše dohvatljivo pitanje jesu li psihopatski prijestupnici moralno odgovorni. Posebno se istražuje imaju li psihopati mogućnost moralnog razumijevanja. Vjerodostojni pristup posljednjem pitanju zahtijeva zadovoljavajuću filozofsku interpretaciju empirijskog dokaza koji pokazuje da psihopati ne uspijevaju naći razliku između konvencionalnih i moralnih normi. Preciznije, uzet ću (...) u obzir nedavnu filozofsku raspravu polariziranu između pobornika racionalističkog i sentimentalističkog objašnjenja moralnog razumijevanja. Ovi su suparnici otvorili raspravu nudi li slučaj psihopatije empirijsku potporu za njihovo objašnjenje i potkopava suparnički pogled. U radu tvrdim da dostupni empirijski podaci ostavljaju ishod ove rasprave neodlučenim. To implicira da bi obje teorije moralnog razumijevanja, ako su neovisno motivirane, uzele u obzir psihopate kao osobe koje imaju određene nedostatke koje bi mogle utjecati na njihovo moralno razumijevanje a stoga i na njihovu moralnu odgovornost. (shrink)