On 11 September 2019, the verdict was read in the first prosecution of a doctor for euthanasia since the Termination of Life on Request and Assisted Suicide Act of 2002 was installed in the Netherlands. The case concerned euthanasia on the basis of an advance euthanasia directive for a patient with severe dementia. In this paper we describe the review process for euthanasia cases in the Netherlands. Then we describe the case in detail, the judgement of the Regional Review Committees (...) for Termination of Life on Request and Euthanasia and the judgement of the medical disciplinary court. Both the review committees and the disciplinary court came to the conclusion there were concerns with this case, which mainly hinged on the wording of the AED. They also addressed the lack of communication with the patient, the absence of oral confirmation of the wish to die and the fact that the euthanasia was performed without the patient being aware of this. However, the doctor was acquitted by the criminal court as the court found she had in fact met all due care criteria laid down in the act. We then describe what this judgement means for euthanasia in the Netherlands. It clarifies the power and reach of AEDs, it allows taking conversations with physicians and the testimony of the family into account when interpreting the AED. However, as a practical consequence the prosecution of this physician has led to fear among doctors about prosecution after euthanasia. (shrink)
There has been a move in medicine towards patient-centred care, leading to more demands from patients for particular therapies and treatments, and for wish-fulfilling medicine: the use of medical services according to the patient's wishes to enhance their subjective functioning, appearance or health. In contrast to conventional medicine, this use of medical services is not needed from a medical point of view. Boundaries in wish-fulfilling medicine are partly set by a physician's decision to fulfil or decline a patient's wish in (...) practice. In order to develop a better understanding of how wish-fulfilling medicine occurs in practice in The Netherlands, a qualitative study (15 semistructured interviews and 1 focus group) was undertaken. The aim was to investigate the range and kind of arguments used by general practitioners and plastic surgeons in wish-fulfilling medicine. These groups represent the public funded realm of medicine as well as privately paid for services. Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’. (shrink)
Health checks identify disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as ‘personal health checks’. Health check providers’ perspective of ‘good’ health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks. In 2015, we interviewed twenty Dutch health check providers on criteria for ‘good’ health checks, and the role these criteria play in their practices. Providers unanimously formulate a (...) number of minimal criteria: Checks must focus on treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources. Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice. According to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health checks potential conflicts between criteria and underlying values should be explicated, guidance in weighing of criteria should be provided and the larger context should be taken into account: other actors than providers need to take up responsibility, and ideally benefits and harms of health checks should be weighed against other measures targeting disease. (shrink)
Developments in biotechnology present difficult social and ethical challenges that need to be resolved by regulators among others. One crucial problem for regulators of new technologies is to ensure that regulation is both clear and sufficiently flexible to respond to new developments. This is particularly difficult to achieve in contentious fields such as medical biotechnology. In the European Union there is a divergence in the solutions to this problem which has lead to different regulatory frameworks for medical biotechnology. This paper (...) compares and contrasts the British and Dutch regulatory frameworks for the selection of embryos by preimplantation genetic diagnosis as an example of the regulation of medical biotechnology. Some of the outcomes of the regulatory choices and possible reasons behind the divergent frameworks are discussed, such as the ethical outlooks and political systems in these countries. (shrink)
Health checks or health screenings identify disease in people without a specific medical indication. So far, the perspective of health check users has remained underexposed in discussions about the ethics and regulation of health checks. In 2017, we conducted a qualitative study with lay people from the Netherlands. We asked what participants consider characteristics of good and bad health checks, and whether they saw a role for the Dutch government. Participants consider a good predictive value the most important characteristic of (...) a good health check. Information before, during and after the test, knowledgeable and reliable providers, tests for treatable disease, respect for privacy, no unnecessary health risks and accessibility are also mentioned as criteria for good health checks. Participants make many assumptions about health check offers. They assume health checks provide certainty about the presence or absence of disease, that health checks offer opportunities for health benefits and that the privacy of health check data is guaranteed. In their choice for provider and test they tend to rely more on heuristics than information. Participants trust physicians to put the interest of potential health check users first and expect the Dutch government to intervene if providers other than physicians failed to do so by offering tests with a low predictive value, or tests that may harm people, or by infringing the privacy of users. Assumptions of participants are not always justified, but they may influence the choice to participate. This is problematic because choices for checks with a low predictive value that do not provide health benefits may create uncertainty and may cause harm to health; an outcome diametrically opposite to the one intended. Also, this may impair the relationship of trust with physicians and the Dutch government. To further and protect autonomous choice and to maintain trust, we recommend the following measures to timely adjust false expectations: advertisements that give an accurate impression of health check offers, and the installation of a quality mark. (shrink)
Cardiovascular health checks test risk factors for cardiovascular disease. They are offered to improve health: in case of an increased risk, participants receive lifestyle advice and medication. With this review, we investigate what is known about the reasons why people do or do not test for CVD risk factors. To what extent do these reasons relate to health monitoring and/or improvement? And do reasons differ in different contexts in which health checks are offered? We conducted a literature search and included (...) 22 papers in which we identified a broad range of motives. We conclude that people have reasons to test related to health improvement and reasons other than health improvement, practical reasons related to the way health checks are offered play an important role and motives should be understood in the context of the situation in which health checks are offered. Our results are relevant for public health officials and providers of health checks: first, if people undergo testing for reasons unrelated to health, this could explain why participation in health checks does not necessarily lead to health improvement. Second, efforts to improve uptake not necessarily serve justice and may hamper informed consent. (shrink)
Health checks identify disease in individuals without a medical indication. More and more checks are offered by more providers on more risk factors and diseases, so we may speak of an omnipresence of health checks. Current ethical evaluation of health checks considers checks on an individual basis only. However, omnipresent checks have effects over and above the effects of individual health checks. They might give the impression that health is entirely manageable by individual actions and strengthen the norm of individual (...) responsibility for health to the point where people hold themselves and others responsible for health outcomes they cannot reasonably be held accountable for. This process of so-called ‘over-responsibilization’ may result in increased feelings of guilt over health, decreased health solidarity and unfairly distributed health outcomes. Moreover, effects on privacy and peace of mind may be observed. Taking into account all possible harms and benefits of health checks in their ethical evaluation requires evaluation of health checks on an individual basis as well as on the level of all checks. Therefore, we urge the amendment of existing ethical evaluation to include the effects of an omnipresence of health checks. We make a first attempt at the formulation of amended criteria. (shrink)
IntroductionIDIS is a multidisciplinary journal with a focus on identity in the information society. The information society is usually associated with information and communication technologies, such as computers, mobile phones and the Internet, and with information in the form of computer- or human-readable data. In this special issue on genetics, information and identity, however, we focus on a different type of information, namely genetic information. The DNA of the human genome is often called a ‘blueprint’ of human life, containing information (...) that regulates—in various and very complex ways—most of the processes in human life. In this sense, genetics may well be considered an information technology in its own right.Genetic information is becoming ever more important in society, although current knowledge of the human genome and how the genome relates to human life is still limited. Nevertheless, what knowledge we have about the genetic make-up of people—whether in terms of congen .. (shrink)
How do we theorize the experiences of caregivers abused by their children with autism without intensifying stigma toward disability? Eva Kittay emphasizes examples of extreme vulnerability to overturn myths of independence, but she ignores the possibility that dependents with disabilities may be vulnerable and aggressive. Instead, her work over-emphasizes caregivers' capabilities and the constancy of disabled dependents' vulnerability. I turn to Judith Butler's ethics and her conception of the self as opaque to rethink care amid conflict. Person-centered planning approaches, pioneered (...) by disability rights activists, merge Butler's analysis of opacity with Kittay's work on embodied care, while also inviting a broader network of people to both interpret needs and change communities. By expanding our conceptions of dependency, feminist disability studies can continue the aim of both Kittay and Butler: to humanize unintelligible lives. (shrink)
Le texte reproduit ici et traduit en français par Eva Beate Fuhrmann est celui d'une conférence donnée le 12 mai 1981 à Constance lors de la session d'introduction de la Fondation Alexander v. Humboldt et publiée sous le titre ‘Europa — Zur Geschichte einer kulturellen und politischen Idee’ dans Universitätsverlag Konstanz GmbH.
Ideas about heredity and evolution are undergoing a revolutionary change. New findings in molecular biology challenge the gene-centered version of Darwinian theory according to which adaptation occurs only through natural selection of chance DNA variations. In Evolution in Four Dimensions, Eva Jablonka and Marion Lamb argue that there is more to heredity than genes. They trace four "dimensions" in evolution -- four inheritance systems that play a role in evolution: genetic, epigenetic, behavioral, and symbolic. These systems, they argue, can all (...) provide variations on which natural selection can act. Evolution in Four Dimensions offers a richer, more complex view of evolution than the gene-based, one-dimensional view held by many today. The new synthesis advanced by Jablonka and Lamb makes clear that induced and acquired changes also play a role in evolution.After discussing each of the four inheritance systems in detail, Jablonka and Lamb "put Humpty Dumpty together again" by showing how all of these systems interact. They consider how each may have originated and guided evolutionary history and they discuss the social and philosophical implications of the four-dimensional view of evolution. Each chapter ends with a dialogue in which the authors engage the contrarieties of the fictional "I.M.," or Ifcha Mistabra -- Aramaic for "the opposite conjecture" -- refining their arguments against I.M.'s vigorous counterarguments. The lucid and accessible text is accompanied by artist-physician Anna Zeligowski's lively drawings, which humorously and effectively illustrate the authors' points. (shrink)
Representationalism, the view that phenomenal character supervenes on intentional content, has attracted a wide following in recent years. Most representationalists have also endorsed what I call 'standard Russellianism'. According to standard Russellianism, phenomenal content is Russellian in nature, and the properties represented by perceptual experiences are mind-independent physical properties. I argue that standard Russellianism conflicts with the everyday experience of colour constancy. Due to colour constancy, standard Russellianism is unable to simultaneously give a proper account of the phenomenal content of (...) colour experience and do justice to its phenomenology. (shrink)
Colour constancy is a foundational and yet puzzling phenomenon. Standard appearance invariantism is threatened by the psychophysical matching argument, which is taken to favour variantism. This argument, however, is inconclusive. The data at best support a pluralist view: colour constancy is sometimes variantist, sometimes invariantist. I add another potential explanation of these data, complex invariantism, which adopts an atypical six-dimensional model of colour appearance. Finally I prospect for a unifying conception of constancy among two neglected notions: discriminatory colour constancy and (...) relational colour constancy. The former arguably marks a common core capacity that is present across widely differing viewing contexts. (shrink)
This article proposes an account of color constancy based on an examination of the relevant scientific literature. Differences in experimental settings and task instructions that lead to variation in subject performance are given particular attention. Based on the evidence discussed, the core of the proposal made is that there are two different forms of color constancy, one phenomenal and the other projective. This follows the hypothesis of Reeves et al. (Perception & Psychophysics 70:219–228, 2008). Unlike Reeves et al. (Perception & (...) Psychophysics 70:219–228, 2008), it is argued that projective color constancy is crucially dependent upon phenomenal color constancy and certain aspects of scene perception. Additionally, it is hypothesized that capacities that support projective color constancy have an important role to play in facilitating our ability to quickly recognize scenes with diagnostic chromatic properties independently of assignments of colors to object surfaces. (shrink)
In Willing, Wanting, Waiting, Richard Holton lays out a detailed account of resolutions, arguing that they enable agents to resist temptation. Holton claims that temptation often leads to inappropriate shifts in judgment, and that resolutions are a special kind of first- and second-order intention pair that blocks such judgment shift. In this paper, I elaborate upon an intuitive but underdeveloped objection to Holton’s view – namely, that his view does not enable agents to successfully block the transmission of temptation in (...) the way that he claims, because the second-order intention is as equally susceptible to temptation as the first-order intention alone would be. I appeal to independently compelling principles – principles that Holton should accept, because they help fill an important explanatory gap in his account – to demonstrate why this objection succeeds. This argument both shows us where Holton’s view goes wrong and points us to the kind of solu-tion we need. In conclusion, I sketch an alternative account of resolutions as a first-order intention paired with a second-order desire. I argue that my account is not susceptible to the same objection because a temptation that cannot be blocked by an intention can be blocked by a desire. (shrink)
In this journal, Schulte develops a novel solution to the problem of distal content: by virtue of what is a mental representation about a distal object rather than a more proximal cause of that representation? Schulte maintains that in order for a representation to have a distal content, it must be produced by a constancy mechanism, along with two other conditions. I raise three objections to his solution. First, a core component of Schulte's solution is just a restrictive version of (...) Dretske's solution, but Schulte gives no argument for his restriction. Second, his proposed solution to a disjunction problem is ad hoc. Finally, his ‘far-out’ version of the distality problem is not a version of the distality problem at all. I conclude that Dretske's solution is preferable to Schulte's. (shrink)
We can start with a definition. “[C]olour constancy is the constancy of the perceived colours of surfaces under changes in the intensity and spectral composition of the illumination.” (Foster et al. 1997) Given the definition we can now ask a question: Does human color vision exhibit color constancy?1 The answer to the question depends in part on how we interpret it. If the question is understood as asking whether human color vision displays constancy for every possible scene across every possible (...) illumination then the answer is no.2 If the question is understood as asking whether human color vision displays some degree of constancy for some scenes across some range of illuminants then the answer is yes. The more interesting questions involve characterizing the degree of constancy human vision displays, the types of scenes and ranges of illuminants for which approximate constancy can be achieved and the.. (shrink)
There is nothing in this World constant but Inconstancy. [Swift 1711: 258] In this paper I argue that two standard characterizations of colour constancy are inadequate to the phenomenon. This inadequacy matters, since, I contend, philosophical appeals to colour constancy as a way of motivating illumination-independent conceptions of colour turn crucially on the shortcomings of these characterizations. After critically reviewing the standard characterizations, I provide a novel counterfactualist understanding of colour constancy, argue that it avoids difficulties of its traditional rivals, (...) and defend it from objections. Finally, I show why, on this improved understanding, colour constancy does not have the philosophical consequences that have been claimed for it in the literature. (shrink)
In this essay, we draw on John Haugeland’s work in order to argue that Burge is wrong to think that exercises of perceptual constancy mechanisms suffice for perceptual representation. Although Haugeland did not live to read or respond to Burge’s Origins of Objectivity, we think that his work contains resources that can be developed into a critique of the very foundation of Burge’s approach. Specifically, we identify two related problems for Burge. First, if (what Burge calls) mere sensory responses are (...) not representational, then neither are exercises of constancy mechanisms, since the differences between them do not suffice to imply that one is representational and the other is not. Second, taken by themselves, exercises of constancy mechanisms are only derivatively representational, so merely understanding how they work is not sufficient for understanding what is required for something, in itself, to be representational (and thereby provide a full solution to the problem of perceptual representation). (shrink)
Students of perception have long known that perceptual constancy is an important aspect of our perceptual interaction with the world. Here is a simple example of the phenomenon concerning color perception: there is some ordinary sense in which an unpainted ceramic coffee cup made from a uniform material looks a uniform color when it is viewed under uneven illumination, even though the light reflected by the shaded regions to our eyes is quite different from the light reflected by the unshaded (...) regions to our eyes (see figure 1). Or consider this example concerning size perception: there is some ordinary sense in which two telephone poles look the same size when the first is viewed from 100 meters and when the second is viewed from 1 meter, even though the visual angle subtended by the two poles on our retinae is very different (see figure 2). Or consider this example concerning shape perception: there is some ordinary sense in which a penny looks round both when viewed head on and when viewed from an acute angle, even though the area projected by the penny onto our retinae under these two conditions is very different (see figure 3). Or, finally, consider this example concerning auditory volume perception (which I cannot depict graphically): there is some ordinary sense in which a speaker’s voice sounds the same volume when heard from across the room and when heard from a distance of 1 meter, even though the energy striking our ears under these two conditions is very different. (shrink)
I argue for the following claims: (1) A core Husserlian account of perceptual constancy needs to be given in terms of indicative future-oriented conditionals but can be complemented by a counterfactual account; (2) thus conceived, constancy is a necessary aspect of content. I speak about a “core Husserlian” account so as to capture certain ideas that Michael Madary has presented as the core of Edmund Husserl's approach to perceptual constancy, viz., that “perception is partly constituted by the continuous interplay of (...) intention and fulfilment” and that this “gives us a way to understand the relationship between different appearances of the same object” (See Madary, M. (2012) “Husserl on Perceptual Constancy.” European Journal of Philosophy 20(1): 145–165.). I take myself to be developing, and perhaps correcting, Madary's view as I discuss the role of the core Husserlian ideas, and counterfactuals, in accounting for shape and color constancy, respectively. I bridge constancy and fulfilment-conditional content by appealing to the Husserlian notion of constitution, which captures the process in which objectivity and, correlatively, intentional experience, are built up in the experiential flow. (shrink)
The essays of this volume consider how acknowledgement of the fact of dependency changes our conceptions of law, political theory, and morality, as well as our very conceptions of self.
Perceptual constancies have been studied by psychologists for decades, but in recent years, they have also become a major topic in the philosophy of mind. One reason for this surge of interest is Tyler Burge’s (2010) influential claim that constancy mechanisms mark the difference between perception and mere sensitivity, and thereby also the difference between organisms with genuine representational capacities and ‘mindless’ beings. Burge’s claim has been the subject of intense debate. It is becoming increasingly clear, however, that we cannot (...) hope to settle this debate (as well as related debates in the philosophy of mind) without a clear and substantive theoretical account of what perceptual constancies are. In the first part of this paper, I argue that the standard definitions in the literature fall short of providing such an account. Still, as I aim to show in the second part of the paper, by taking a closer look at some of the paradigm examples, it is possible to construct a plausible general account of perceptual constancies that is both clear and substantive, and that can serve as a firm foundation for settling debates like the dispute about Burge’s ‘constancy mechanism criterion’ for perception. (shrink)
Sensory perceptions represent things in the outside world. This mundane fact raises a major problem for naturalistic theories of content: the ‘distality problem’. In a previous paper for this journal, I presented a solution to this problem which makes central appeal to constancy mechanisms. Justin Garson, also in this journal, recently criticized my solution and suggested a Dretskean alternative to it. Here, I defend my proposal by arguing, first, that Garson's criticisms ultimately miss the mark, and secondly, that his Dretskean (...) alternative is not viable, because it faces two fundamental problems: the empirical problem and the problem of changing response functions. (shrink)
I answer two questions: what are people doing when they exchange conventional wedding vows? and under what circumstances are these things morally and rationally permissible to do? I propose that wedding pledges are public proclamations that are simultaneously both private vows and interpersonal promises, and that they are often subject to uncertainty. I argue that the permissibility of uncertain wedding promises depends on whether the uncertainty stems from doubts about one’s own internal weakness of will and susceptibility to temptation or (...) from the expectation that external circumstances might change. I then explain why uncertainty is a prima facie challenge for unconditional wedding vows, and I offer a solution: rational wedding vows are unconditional in their content but implicitly conditional in their structure; the spouse pledges to act in certain ways unconditionally, so long as they remain in the spousal role. I respond to objections to my view, and conclude with some suggestions about what marrying couples should do to ensure permissible pledges. (shrink)
This article shows that in 1.4.2.15-24 of the Treatise of Human Nature, Hume presents his own position on objects, which is to be distinguished from both the vulgar and philosophical conception of objects. Here, Hume argues that objects that are effectively imagined to have a “perfect identity” are imagined due to the constancy and coherence of our perceptions (what we may call ‘level 1 constancy and coherence’). In particular, we imagine that objects cause such perceptions, via what I call ‘indirect (...) causation.’ In virtue of imagining ideas of objects that have a perfect identity, our perceptions seem to be even more constant and coherent (what we may call ‘level 2 constancy and coherence’). Thus, in addition to seeing that Hume is presenting his own position on objects in this section of the Treatise, we see that he is working with a previously unrecognized kind of causation, i.e., indirect causation, and that he has two kinds of constancy and coherence in mind: level 1 and level 2. (shrink)
In this outstanding introduction, Constance Meinwald covers all of Plato's philosophy and shows how he shaped the landscape of Western philosophy. Beginning with a helpful overview of what is known about Plato's life and times, she clearly explains and assesses Plato's fundamental arguments and ideas. These include the importance of Plato's view of what philosophy is and the distinctive way in which his most important arguments are presented in dialogues; his theories of ethics addressed through the fundamental and enduring (...) questions happiness and virtue; his influential treatments of the soul and immortality; the lasting contributions he made to the study of metaphysics and the nature of knowledge through his theory of the Forms; and his enduring and controversial insights into political and social thought in the context of his theories of human nature. Throughout, Constance Meinwwald draws expertly on Plato's most important dialogues to present a thorough and lively picture of his philosophy. Essential reading for students of ancient philosophy and Classics, Plato is an ideal introduction to arguably the greatest of all Western philosophers. (shrink)
This paper discusses an exercise that Alida Liberman facilitated among participants at a Teaching and Learning workshop sponsored by the American Association of Philosophy Teachers aimed at helping instructors become more learner-centered in their pedagogy. The exercise was designed to place participants in the role of inadequately supported learners by asking them to fold an origami crane with varying levels of instruction and feedback. The failure of many participants to successfully fold cranes functioned as a striking analogy for student (...) failures to learn without explicit how-to instruction, goal-directed practice, and frequent, targeted feedback. In reflecting on the activity, participants developed strategies to become more learner-centered and to better support student success. This paper explains the origami exercise and the lessons it illustrates, and discusses how the lessons learned from the exercise can translate into specific tangible strategies for the classroom. (shrink)
Does life have meaning? What is flourishing? How do we attain the good life? Philosophers, and many others of us, have explored these questions for centuries. As Eva Feder Kittay points out, however, there is a flaw in the essential premise of these questions: they seem oblivious to the very nature of the ways in which humans live, omitting a world of co-dependency, and of the fact that we live in and through our bodies, whether they are fully abled or (...) disabled. Our dependent, vulnerable, messy, changeable, and embodied experience colors everything about our lives both on the surface and when it comes to deeper concepts, but we tend to leave aside the body for the mind when it comes to philosophical matters. Disability offers a powerful challenge to long-held philosophical views about the nature of the good life, what provides meaning in our lives, and the centrality of reason, as well as questions of justice, dignity, and personhood. These concepts need not be distant and idealized; the answers are right before us, in the way humans interact with one another, care for one another, and need one another--whether they possess full mental capacities or have cognitive limitations. We need to revise our concepts of things like dignity and personhood in light of this important correction, Kittay argues. This is the first of two books in which Kittay will grapple with just how we need to revisit core philosophical ideas in light of disabled people's experience and way of being in the world. Kittay, an award-winning philosopher who is also the mother to a multiply-disabled daughter, interweaves the personal voice with the philosophical as a critical method of philosophical investigation. Here, she addresses why cognitive disability can reorient us to what truly matters, and questions the centrality of normalcy as part of a good life. With profound sensitivity and insight, Kittay examines other difficult topics: How can we look at the ethical questions regarding prenatal testing in light of a new appreciation of the personhood of disabled people? What do new possibilities in genetic testing imply for understanding disability, the family, and bioethics? How can we reconsider the importance of care, and how does it work best? In the process of pursuing these questions, Kittay articulates an ethic of care, which is the ethical theory most useful for claiming full rights for disabled people and providing the opportunities for everyone to live joyful and fulfilling lives. She applies the lessons of care to the controversial alteration of severely cognitively disabled children known as the Ashley Treatment, whereby a child's growth is halted with extensive estrogen treatment and related bodily interventions are justified. This book both imparts lessons that advocate on behalf of those with significant disabilities, and constructs a moral theory grounded on our ability to give, receive, and share care and love. Above all, it aims to adjust social attitudes and misconceptions about life with disability. (shrink)
I explore the debate about whether consequentialist theories can adequately accommodate the moral force of promissory obligation. I outline a straightforward act consequentialist account grounded in the value of satisfying expectations, and raise and assess three objections to this account: that it counterintuitively predicts that certain promises should be broken when commonsense morality insists that they should be kept, that the account is circular, and Michael Cholbi’s argument that this account problematically implies that promise-making is frequently obligatory. I then discuss (...) alternative act consequentialist accounts, including Philip Pettit’s suggestion that promise-keeping is an intrinsic good and Michael Smith’s agent-relative account. I outline Brad Hooker’s rule consequentialist account of promissory obligation and raise a challenge for it. I conclude that appeals to intuitions about cases will not settle the dispute, and that consequentialists and their critics must instead engage in substantive debate about the nature and stringency of promissory obligation. (shrink)
I offer a philosophical account of vowing and the rationality of vow-making. I argue that vows are most productively understood as exceptionless resolutions that do not have any excusing conditions. I then articulate an apparent problem for exceptionless vow-making: how can it be rational to bind yourself unconditionally, when circumstances might change unexpectedly and make it the case that vow-keeping no longer makes sense for you? As a solution, I propose that vows can be rational to make only if they (...) are implicitly conditional on a personal identification or social role that is itself escapable. (shrink)
The right not to know is underappreciated in policy-making. Despite its articulation in medical law and ethics, policy-makers too easily let other concerns override the right not to know. This observation is triggered by a recent decision of the Dutch government on embryo selection for Huntington’s disease. This is a monogenetic debilitating disease without cure, leading to death in early middle age, and thus is a likely candidate for preimplantation genetic diagnosis. People possibly affected with the Huntington gene do not (...) always want to know their genetic status themselves, which is very burdensome knowledge. For prospective parents, this creates a difficulty in having unaffected children through embryo selection without knowing their own genetic status. A solution is provided by the exclusion test: it allows embryo selection while honouring the parents’ right not to know. The Dutch government however disallowed the exclusion test and chose to allow PGD on Huntington only for parents who test themselves first. To avoid “unnecessary” in-vitro fertilisation procedures for unaffected parents, prospective parents are “forced to know” before they can conceive through embryo selection. This article analyses the scope of the right not to know in the context of embryo selection against Huntington’s disease. It concludes that the right not to know implies that PGD against Huntington should be allowed by means of the exclusion test. (shrink)