Ethical evaluation of deep brain stimulation as a treatment for Parkinson’s disease is complicated by results that can be described as involving changes in the patient’s identity. The risk of becoming another person following surgery is alarming for patients, caregivers and clinicians alike. It is one of the most urgent conceptual and ethical problems facing deep brain stimulation in Parkinson’s disease at this time. In our paper we take issue with this problem on two accounts. First, we elucidate what is (...) meant by “becoming another person” from a conceptual point of view. After critically discussing two broad approaches we concentrate on the notion of “individual identity” which centers on the idea of “core attitudes”. Subsequently we discuss several approaches to determine what distinguishes core attitudes from those that are more peripheral. We argue for a “foundational-function model” highlighting the importance of specific dependency relations between these attitudes. Our second aim is to comment on the possibility to empirically measure changes in individual identity and argue that many of the instruments now commonly used in selecting and monitoring DBS-patients are inappropriate for this purpose. Future research in this area is advised combining a conceptual and an empirical approach as a basis of sound ethical appraisal. (shrink)

Ein Leitmotiv der medizinethischen Auseinandersetzung mit der tiefen Hirnstimulation (THS) ist die Beschäftigung mit Fragen personaler Identität. Da es sich bei personaler Identität auch um ein Problem der theoretischen Philosophie handelt, wird in diesem Aufsatz nicht nur die praktische Frage nach der ethischen Legitimation der THS durch informierte Einwilligung gestellt und ein modifiziertes Legitimationskriterium für wesensändernde THS erarbeitet. Vielmehr wird zunächst versucht, das Problem, um das es in der Debatte um THS und personaler Identität geht, besser zu verstehen.

Ein Leitmotiv der medizinethischen Auseinandersetzung mit der tiefen Hirnstimulation (THS) ist die Beschäftigung mit Fragen personaler Identität. Da es sich bei personaler Identität auch um ein Problem der theoretischen Philosophie handelt, wird in diesem Aufsatz nicht nur die praktische Frage nach der ethischen Legitimation der THS durch informierte Einwilligung gestellt und ein modifiziertes Legitimationskriterium für wesensändernde THS erarbeitet. Vielmehr wird zunächst versucht, das Problem, um das es in der Debatte um THS und personaler Identität geht, besser zu verstehen.

Ein Leitmotiv der medizinethischen Auseinandersetzung mit der tiefen Hirnstimulation (THS) ist die Beschäftigung mit Fragen personaler Identität. Da es sich bei personaler Identität auch um ein Problem der theoretischen Philosophie handelt, wird in diesem Aufsatz nicht nur die praktische Frage nach der ethischen Legitimation der THS durch informierte Einwilligung gestellt und ein modifiziertes Legitimationskriterium für wesensändernde THS erarbeitet. Vielmehr wird zunächst versucht, das Problem, um das es in der Debatte um THS und personaler Identität geht, besser zu verstehen.

I argue that four-dimensionalism and the desire satisfaction account of well-being are incompatible. For every person whose desires are satisfied, there will be many shorter-lived individuals (‘person-stages’ or ‘subpersons’) who share the person’s desires but who do not exist long enough to see those desires satisfied; not only this, but in many cases their desires are frustrated so that the desires of the beings in whom they are embedded as proper temporal parts may be fulfilled. I call this the frustrating (...) problem for four-dimensionalism. In the first half of the paper I lay the groundwork for understanding the frustrating problem, and then in the second half, I will examine six possible responses to the frustrating problem on behalf of the four-dimensionalist, (i) the Parfit (1984) inspired claim that identity is not what matters, (ii) the personal pronoun revisionism of Noonan (2010), (iii) the indirect concern account of Hudson (2001), (iv) the sensible stages account of Lewis (1986), (v) a multiple-concepts account of desire satisfaction, and (vi) a No Desire View according to which subpersons have no mental states and thus no desires to frustrate. I argue that none of these solutions will help the four-dimensionalist; she does better to reject the desire satisfaction theory, while the defender of the desire satisfaction theory does better to reject four-dimensionalism. (shrink)

The paper begins with a well-known objection to the idea that reasons for action are provided by desires. The objection holds that since desires are based on reasons (first premise), which they transmit but to which they cannot add (second premise), they cannot themselves provide reasons for action. In the paper I investigate an attack that has recently been launched against the first premise of the argument by David Sobel. Sobel invokes a counterexample: hedonic desires, i.e. the likings and dislikings (...) of our present conscious states. The aim of the paper is to defend the premise by bringing the alleged counterexample under its scope. I first point out that reference to hedonic desires as a counterexample presupposes a particular understanding of pleasure, which we might call desire-based. In response, following Sobel, I draw up two alternative accounts, the phenomenological and the tracking views of pleasure. Although Sobel raises several objections to both accounts, I argue in detail that the phenomenological view is not as implausible as he claims it to be, whereas the tracking view, on its best version advocated by Thomas Scanlon, is an instance of the phenomenological view and is therefore also defensible. (shrink)

In an overlooked section of his influential book What We Owe to Each Other Thomas Scanlon advances an argument against the desire-model of practical reasoning. In Scanlon’s view the model gives a distorted picture of the structure of our practical thinking. His idea is that there is an alternative to the “weighing behavior” of reasons, a particular way in which reasons can relate to each other. This phenomenon, which the paper calls “silencing”, is not something that the desire-model can accommodate, (...) or so Scanlon argues. The paper first presents and interprets Scanlon’s challenge. After this, the paper argues, through the examination of three responses, that Scanlon is right in claiming that the model cannot accommodate the phenomenon as he describes it. However, the paper further argues that there is no need to accept Scanlon’s depiction of silencing: advocates of the model can give an alternative account of what happens in cases of silencing that is just as plausible as Scanlon’s own. Scanlon’s challenge is thus, the paper concludes, illegitimate. (shrink)

According to the Desire-Based Reasons Model reasons for action are provided by desires. Many, however, are critical about the Model holding an alternative view of practical reason, which is often called valued-based. In this paper I consider one particular attempt to refute the Model, which advocates of the valued-based view often appeal to: the idea of reason-based desires. The argument is built up from two premises. The first claims that desires are states that we have reason to have. The second (...) argues that desires do not add to the stock of reasons the agent has for having them. Together the two theses entail that desires are based on reasons, which they transmit but to which they cannot add. In the paper I deal with a counterexample to the second premise: tie-breaking desires. I first distinguish two interesting cases and argue that only the second challenges the premise. Then I move onto analyze this challenge by focusing on Ruth Chang’s recent employment of it. I show that contrary to its counterintuitive appearance, the challenge can be sustained. However, I also argue that Chang overlooks the full potential of one particular response to the challenge: the introduction of higher-order reasons determining the normative significance of these desires. At the same time, I show that this response has a problem that Chang does not consider. As a result, the response can only partially disarm the challenge of tie-breaking desires; or not at all, depending on what significance we attribute to the counterexamples. (shrink)

Despite the fact that most of us value integrity, and despite the fact that we readily understand one another when we talk and argue about it, integrity remains elusive to understand. Considerable scholarly attention has left troubling disagreement on fundamental issues: Is integrity in fact a virtue? If it is, what is it a virtue of? Why exactly should we value integrity? What is the appropriate way to have concern for one’s own integrity? Is having integrity compatible with having significant (...) moral flaws? After an overview of common ‘data points’ or platitudes concerning integrity, this article outlines six distinct views of integrity that have been defended and draws attention to problems each has accommodating these data points. (shrink)

According to many popular views in normative ethics, meta-ethics and axiology, facts about what we ought to do or what is good for us depend on facts about the attitudes that some agent would have in some relevant idealized circumstances. This paper presents an unrecognized structural problem for such views which threatens to be devastating.

Eudaimonistic theorists of welfare have recently attacked conative accounts of welfare. Such accounts, it is claimed, are unable to classify states normally associated with physical and emotional health as non-instrumentally good and states associated with physical and psychological damage as non-instrumentally bad. However, leading eudaimonistic theories such as the self-fulfillment theory and developmentalism have problems of their own. Furthermore, conative theorists can respond to this challenge by dispositionalizing their theories, i.e., by saying that it is not merely the realization of (...) one’s values that is non-instrumentally good for one, but that the disposition to realize one’s values is also non-instrumentally good for one. This approach, properly elaborated, can accommodate the idea that, in many cases, states normally associated with physical and psychological health (or unhealth) are non-instrumentally good (or bad). It also preserves the many well-known advantages of conative theories. (shrink)

Subjectivism about wellbeing rests on the idea that what is good for a person must ‘fit’ her, ‘resonate’ with her, not be ‘alien’ to her, etc. This idea has been called the ‘beating heart’ of subjectivism. In this article, I present the No-Beating-Heart Challenge for subjectivism, which holds that there is no satisfactory statement of this idea. I proceed by first identifying three criteria that any statement of the idea must meet if it is to provide support for subjectivism: Distinctness, (...) Exclusiveness, and Explicitness. I then argue that no statement of this idea meets these criteria. (shrink)

The desire-satisfaction theory of well-being says, in its simplest form, that a person’s level of welfare is determined by the extent to which their desires are satisfied. A question faced by anyone attracted to such a view is, *Which desires*? This paper proposes a new answer to this question by characterizing a distinction among desires that isn’t much discussed in the well-being literature. This is the distinction between what a person wants in a merely behavioral sense, in that the person (...) is, for some reason or other, disposed to act so as to try to get it, and what a person wants in a more robust sense, the sense of being *genuinely attracted* to the thing. I try to make this distinction more clear, and I argue for its axiological relevance by putting it to work in solving four problem cases for desire satisfactionism. The theory defended holds that only desires in the latter, genuine-attraction sense are relevant to welfare. (shrink)

According to the argument from self-sacrifice, standard, unrestricted desire-based theories of welfare fail because they have the absurd implication that self-sacrifice is conceptually impossible. I attempt to show that, in fact, the simplest imaginable, completely unrestricted desire-based theory of well-being is perfectly compatible with the phenomenon of self-sacrifice – so long as the theory takes the right form. I go on to consider a new argument from self-sacrifice against this simple theory, which, I argue, also fails. I conclude that, contrary (...) to popular opinion, considerations of self-sacrifice do not pose a problem for preferentist theories of welfare. (shrink)

Even though respect for integrity is hailed in several authoritative legal and ethical documents, and is typically presented as a complement to respect for autonomy, it is largely neglected in many leading works in ethics. Is such neglect warranted, or does it express a prejudice? This article argues that the latter is the case, and that this is due to misplaced conceptual concerns. It offers some proposals as regards the conceptualization of integrity in social ethics in general and in biomedical (...) ethics in particular. Five main directions of interpretation of “integrity” are discerned and shown to be relevant for different areas of biomedical ethics. The defense of respect for integrity is served by a softening of principlism and by greater attention to context among the initial critics of this principle. (shrink)

Recently several authors have proposed proxies of welfare that equate some (as opposed to all) choices with welfare. In this paper, I first distinguish between two prominent proxies: one based oncontext-independent choicesand the other based onreason-based choices. I then propose an original proxy based on choices that individuals state they would want themselves to repeat at the time of the welfare/policy evaluation (confirmed choices). I articulate three complementary arguments that, I claim, support confirmed choices as a more reliable proxy of (...) welfare than context-independent and reason-based choices. Finally, I discuss the implications of these arguments fornudgesandboosts. (shrink)

Integrity looks dangerous. Passionate willpower, focused devotion and driving self-belief nestle all-too-closely to extremism, narcissism and intolerant hubris. How can integrity skirt such perils? This question opens the perennial issue of whether devout, driven devotees can guard themselves from antisocial extremes. Current proposals to inoculate integrity from moral danger hone in on integrity’s reflective side. I argue that this epistemic approach disarms integrity’s dangers only by stripping it of everything that initially made it worthwhile. Instead, I argue that integrity contains (...) substantive moral principles serving to surgically target the dangers the trait would otherwise pose. The person of integrity avoids extremism not by questioning whether her values are right, but by recognizing that in a social world whether her values are right is not the only factor that bears on how she should act. Normatively, the proposed account allows integrity to retain its intuitive allures of willpower, direction and unified character. Descriptively, it explains the surprising capacity for principled compromise displayed by canonical figures of integrity. Ultimately, integrity empowers us to be fit for society, even as we are true to ourselves. (shrink)

One of the most important disputes in the foundations of ethics concerns the source of practical reasons. On the desire-based view, only one’s desires provide one with reasons to act. On the value-based view, reasons are instead provided by the objective evaluative facts, and never by our desires. Similarly, there are desire-based and non-desired-based theories about two other phenomena: pleasure and welfare. It has been argued, and is natural to think, that holding a desire-based theory about either pleasure or welfare (...) commits one to recognizing that desires do provide reasons for action – i.e., commits one to abandoning the value-based theory of reasons. The purpose of this paper is to show that this is not so. All of the following can be true: pleasure and welfare provide reasons; pleasure and welfare are to be understood in terms of desire; desires never provide reasons, in the relevant way. (shrink)

Desire theories of well-being claim that how well someone’s life goes for them is entirely determined by the fulfilment and frustration of their desires. This thesis considers the viability of theories of this sort. It examines a series of objections that threaten to undermine these views. These objections claim that desire theories of well-being are incorrect because they have implausible implications. I consider four main objections over the course of this thesis. The first claims that these theories are incorrect because (...) they implausibly entail that self-sacrifice does not exist. The second claims that these theories are incorrect because they implausibly entail that severe depression does not diminish the well-being of those afflicted by this condition. The third claims that these theories are incorrect because they have implausible implications about the relative importance of fleeting desires, long-standing desires, and fluctuations in desire strength to well-being. The fourth claims that these theories are incorrect because they fail to capture the intuition that desire fulfilments which leave us disappointed and bereft of feelings of satisfaction do not improve well-being. In each of these cases, I find that desire theories of well-being have sufficient resources to refute these objections. The primary finding of this thesis is that many of the arguments against desire theories of well-being are unsuccessful. A secondary set of findings concern observations about the structure of human psychology. (shrink)

In this dissertation, I argue that all extant theories of prudential value are either a) enumeratively deficient, in that they are unable to accommodate everything that, intuitively, is a basic constituent of prudential value, b) explanatorily deficient, in that they are at least sometimes unable to offer a plausible story about what makes a given thing prudentially valuable, or c) both. In response to the unsatisfactory state of the literature, I present my own account, the Disjunctive Hybrid Theory or DHT. (...) DHT answers to and remedies each of the above inadequacies in a way that no other approach can. This account has the following general structure:Disjunctive Hybrid Theory (DHT): Thing x is basically good for person P if and only if x is either a) cared about (sufficiently and in the right way) by P, b) a bearer of (the right kind of) attitude-independent value, or c) both.Although it follows other recent accounts in combining elements from objective and subjective theories, DHT is a hybrid theory of a quite new kind. This is because it denies both subjective necessity (the constraint that, if thing x is to be basically good for person P, P must have some pro-attitude toward x) and objective necessity (the constraint that, if thing x is to be basically good for person P, x must have some attitude-independent value). I argue that the rejection of both necessity claims is called for if we are to move beyond the enumerative and explanatory limitations of existing accounts.I begin by outlining the general structure of DHT. I then argue, against various recent authors, that desire-satisfactionism remains the most appealing subjectivist approach to prudential value, in that it is best able to capture the central subjectivist insight. This insight is that a person can confer prudential value upon things by caring about them (sufficiently and in the right way). The subjectivist strand of DHT will thus be a version of desire-satisfactionism, which must be interpreted in line with what I call the object, as opposed to the combo, view. I move on to further motivate and develop the second, objectivist strand of DHT. This part of the theory involves a commitment to robustly attitude-independent prudential goods. I close by addressing some puzzles for the theory, and considering some of its more specific applications. (shrink)

Integrity is one of the leading normative concepts employed in our society. We frequently talk about the degree of integrity of community leaders and famous historical figures, and we highly value integrity in our elected public officials. But philosophers have had a difficult time arriving at consensus about what integrity consists in. Some claim that it is a purely formal relation of consistency, others that it has to do primarily with one‟s identity, and still others that it involves subjective or (...) objective moral requirements. The primarily goal here is to outline the leading facets of integrity in the contemporary philosophical literature. (shrink)

Theories of welfare answer the ancient question, What makes a person's life go well? Prominent among these are desire-satisfaction or preferentist theories, according to which welfare has to do ultimately with desire. This dissertation aims to criticize some recent popular arguments against standard desire-satisfaction theories of welfare, to develop and defend a novel version of the desire-satisfaction theory capable of answering the better objections, to defend the thesis that pleasure is reducible to desire, and to demonstrate an interesting link between (...) preferentism and hedonism. The second chapter defends a simple "actualist" desire-satisfaction theory against the contention that such a theory cannot accommodate the fact that we can desire things that are bad for us. All the allegedly defective desires, I attempt to show, are either not genuinely defective or else can be accounted for by the theory. The third chapter criticizes the popular line that standard desire-based theories of welfare are incompatible with the conceptual possibility of self-sacrifice. I show that even the simplest imaginable, completely unrestricted desire theory is compatible with self-sacrifice, so long as it is formulated properly. The fourth chapter presents and defends a theory according to which welfare consists in the perceived satisfaction, or "subjective satisfaction," of desire. I argue that this theory is best suited to deflect the many lines of argument threatening the preferentist program. The fifth chapter defends the view that desire is what unifies the heterogeneous lot of experiences that all count as sensory pleasures. I develop and defend a desire theory of sensory pleasure. The sixth chapter argues that the most plausible form of preferentism is equivalent to the most plausible form of its main rival, hedonism. This is because what the best preferentism says---that welfare consists in subjective desire satisfaction---is the same as what the best hedonism says---that welfare consists in propositional pleasure---given a reduction of pleasure to desire along the lines of that defended above. (shrink)