When a patient lacks decision-making capacity, then according to standard clinical ethics practice in the United States, the health care team should seek guidance from a surrogate decision-maker, either previously selected by the patient or appointed by the courts. If there are no surrogates willing or able to exercise substituted judgment, then the team is to choose interventions that promote a patient’s best interests. We argue that, even when there is input from a surrogate, patient preferences should be an additional (...) source of guidance for decisions about patients who lack decision-making capacity. (shrink)

The debate over persistence is often cast as a disagreement between two rival theories—the perdurantist theory that objects persist through time by having different temporal parts at different times, and the endurantist theory that objects persist through time by being wholly present at different times. This way of framing the debate over persistence involves both an important insight and an important error. Unfortunately, the error is often embraced and the insight is often ignored. This paper aims to correct both of (...) these mistakes, and thus clarify the debate over persistence. (shrink)

Philosophy and Phenomenological Research, EarlyView.

The idea that some of God's past beliefs depend on our future actions has a long history, going back to Origen in the third century CE. However, it is not always clear what this idea amounts to, since it is not always clear what kind of dependence is at issue. This paper surveys five different interpretations of dependence and, in each case, considers the implications for the debate over theological fatalism. Along the way, we discuss a number of related issues, (...) including the nature of explanation, the scope of metaphysical grounding, and the possibility of backward causation. (shrink)

The problem of temporary intrinsics is the problem of how persisting objects can have different intrinsic properties at different times. The relativizer responds to this problem by replacing ordinary intrinsic properties with relations to times. In this note, I identify and respond to three different objections to the relativizer's proposal, each of which can be traced to the work of David Lewis.

Philosophy and Phenomenological Research, Volume 104, Issue 1, Page 66-77, January 2022.

This is a paper about the nature of metaphysical laws and their relation to the phenomenon of vagueness. Metaphysical laws are introduced as analogous to natural laws, and metaphysical indeterminism is modeled on causal indeterminacy. This kind of indeterminacy is then put to work in developing a novel theory of vagueness and a solution to the sorites paradox.

Our world is a world of change. Children are born and grow into adults. Material possessions rust and decay with age and ultimately perish. Yet scepticism about change is as old as philosophy itself. Heraclitus, for example, argued that nothing could survive the replacement of parts, so that it is impossible to step into the same river twice. Zeno argued that motion is paradoxical, so that nothing can alter its location. Parmenides and his followers went even further, arguing that the (...) very concept of qualitative change is inconsistent. Change in any respect is impossible, they argued, since change requires difference and nothing differs from itself.1 Few today would accept the Eleatic conclusion that change is impossible. But the topic of change continues to be a source of much debate, as it brings together various issues that are central to metaphysics, language and logic – including identity, persistence, time, tense, and temporal logic. As we consider various approaches to our topic, it will become clear that one’s perspective on change is often determined by one’s position in the broader philosophical landscape. (shrink)

Jon Elster reports that in 1940, and again in 1970, the U.S. draft lottery was challenged for falling short of the legally mandated ‘random selection’. On both occasions, the physical mixing of the lots appeared to be incomplete, since the birth dates were clustered in a way that would have been extremely unlikely if the lots were fully mixed. There appears to have been no suspicion on either occasion that the deficiency in the mixing was intended, known, or believed to (...) favor or disfavor any identifiable group. If the selection was non-random in the way charged, Elster asks, was it unfair? (shrink)

David Lewis has long defended an analysis of counterfactuals in terms of comparative similarity of possible worlds. The purpose of this paper is to reevaluate Lewis’s response to one of the oldest and most familiar objections to this proposal, the future similarity objection.

David Lewis famously defends a counterfactual theory of causation and a non-causal, similarity-based theory of counterfactuals. Lewis also famously defends the possibility of backward causation. I argue that this combination of views is untenable—given the possibility of backward causation, one ought to reject Lewis's theories of causation and counterfactuals.

In their comprehensive article, Bayefsky and Berkman outline a framework for limiting access to certain types of fetal genetic information through professional self-regulation. Given the rap...

Much of the recent work in action theory can be organized around a set of objections facing the Simple View and other intention-based accounts of intentional action. In this paper, I review three of the most popular objections to the Simple View and argue that all three objections commit a common fallacy. I then draw some more general conclusions about the relationship between intentional action and moral responsibility.

This paper examines the moral import of a distinction between natural and social inequalities. Following Thomas Nagel, it argues for a “denatured” distinction that relies less on the biological vs. social causation of inequalities than on the idea that society is morally responsible for some inequalities but not others. It maintains that securing fair equality of opportunity by eliminating such social inequalities has particularly high priority in distributive justice. Departing from Nagel, it argues that society can be responsible for inequalities (...) not only when they are the unintended result of justifiable projects, but even when their alleviation would be very costly. Sharing Nagel’s general concept of ‘social inequality’, then, this paper proposes a far more expansive conception. We argue that many disadvantages due to disability fall under this conception. Eliminating or alleviating those disadvantages should be regarded as securing fair equality of opportunity, not improving the condition of the worst-off. (shrink)

In his thoughtful defence of very modest moral enhancement, David DeGrazia1 makes the following assumption: ‘Behavioural improvement is highly desirable in the interest of making the world a better place and securing better lives for human beings and other sentient beings’. Later in the paper, he gives a list of some psychological characteristics that ‘all reasonable people can agree … represent moral defects’. I think I am a reasonable person, and I agree that most if not all items on the (...) lists do represent moral defects—I certainly would regard them as such in a close family member or friend. But if I were in the business of ‘making the world a better place and securing better lives for human beings and other sentient beings’, I would hesitate to prescribe moral enhancement for everyone with these acknowledged defects. A lot of good work, from removing tumours to negotiating treaties, may be best done by people with serious moral defects.For a simple consequentialist, a moral defect is just a trait that tends to make the world a worse place. Not being a consequentialist, I think that moral defects should be identified independently of their tendency to produce worse outcomes. For this reason, I think it's necessary to qualify DeGrazia's starting assumption—I think behavioural improvement may sometimes be undesirable if our goal is to make the world a better place. My reasons will be familiar to readers of Bernard Williams.As …. (shrink)

This article reports results of a survey about employment and compensation models for clinical ethics consultants working in the United States and discusses the relevance of these results for the professionalization of clinical ethics. This project uses self-reported data from healthcare ethics consultants to estimate compensation across different employment models. The average full-time annualized salary of respondents with a clinical doctorate is $188,310.08 (SD=$88,556.67), $146,134.85 (SD=$55,485.63) for those with a non-clinical doctorate, and $113,625.00 (SD=$35,872.96) for those with a masters as (...) their highest degree. Pay differences across degree level and type were statistically significant (F = 3.43; p. (shrink)

Ingmar Persson and Julian Savulescu1 warn of our destruction by the cognitively enhanced beings we create. Now, in a fascinating paper, Nicholas Agar2 warns of an even more disturbing prospect: cognitively enhanced beings may be entitled to sacrifice us for their own ends. These post-humans would likely conclude that they had higher moral status than we mere human beings, and we would have good reason to defer to their vastly superior moral knowledge. We would lack even the consolation of moral (...) complaint.I will question both these claims: that we would have good reason to accept the conclusion of cognitively enhanced beings that they had superior moral status, and that they would be likely to reach such a conclusion . I will also question whether, if they were to have higher moral status, it would be wrong to create them, because it would be wrong to create beings with such costly needs.Agar argues that moral truths, including those about moral status, are like mathematical truths in eventually yielding to expert reasoning. This belief in moral enlightenment is extreme even for a moral realist. Michael Smith,3 whom Agar cites, merely adduces the gradual consensus that has emerged about issues that were once the subject of seemingly intractable disagreement: slavery, workers’ and women's rights and democracy. One may agree with Smith about slow, halting, moral progress, …. (shrink)

Humeans hold that the nomological features of our world, including causal facts, are determined by the global distribution of fundamental properties. Since persistence presupposes causation, it follows that facts about personal identity are also globally determined. I argue that this is unacceptable for a number of reasons, and that the doctrine of Humean supervenience should therefore be rejected.

The authors respond to four JME commentaries on their Feature Article, ‘Autonomy-based criticisms of the patient preference predictor’.

In this article I want to ask what we should do, either collectively or individually, if we could identify by genetic and family profding the 12% of the male population likely to commit almost half the violent crime in our society. What if we could identify some individuals in that 12% not only at birth, but in utero, or before implantation? I will explain the source of these figures later; for now, I will use them only to provide a concrete (...) example of the kind of predictive claims we can expect to be made with some frequency, and some scientific credibility, over the next generation. I will adopt an outlook that one commentator has called “pragmatic optimism,” but which could also be called technological optimism - the belief that a science or technology will achieve many or most of its advertised goals. My optimism will be directed towards human behavioral genetics, the source of predictions like the one I just offered; I will assume that this controversial discipline will achieve a substantial pan of its scientific ambition to identlfy genetic differences among individuals that help predict and possibly explain future behavior, psychological health, and cognitive skill. This optimism is very limited -it concerns the scientific success of behavioral genetics, not the social value of that success. (shrink)

abstract In this paper, we examine issues raised by the possibility of regulating emotions through pharmacological means. We argue that emotions induced through these means can be authentic phenomenologically, and that the manner of inducing them need not make them any less our own than emotions arising 'naturally'. We recognize that in taking drugs to induce emotions, one may lose opportunities for self-knowledge; act narcissistically; or treat oneself as a mere means. But we propose that there are circumstances in which (...) none of these concerns arise. Finally, we consider how the possibility of drug-regulation might affect duties to feel emotions. (shrink)

In this article I want to ask what we should do, either collectively or individually, if we could identify by genetic and family profding the 12% of the male population likely to commit almost half the violent crime in our society. What if we could identify some individuals in that 12% not only at birth, but in utero, or before implantation? I will explain the source of these figures later; for now, I will use them only to provide a concrete (...) example of the kind of predictive claims we can expect to be made with some frequency, and some scientific credibility, over the next generation. I will adopt an outlook that one commentator has called “pragmatic optimism,” but which could also be called technological optimism - the belief that a science or technology will achieve many or most of its advertised goals. My optimism will be directed towards human behavioral genetics, the source of predictions like the one I just offered; I will assume that this controversial discipline will achieve a substantial pan of its scientific ambition to identlfy genetic differences among individuals that help predict and possibly explain future behavior, psychological health, and cognitive skill. This optimism is very limited -it concerns the scientific success of behavioral genetics, not the social value of that success. (shrink)

This imaginative guide to decision-making about prenatal genomics is situated in a not-too-distant future in which parents can easily choose among embryos from gametes that have been produced in a laboratory using their own skin cells. Readers are invited into a future vision of conscientious parenting that involves testing to protect, rather than to select, a future child.

Priority setting in healthcare is a highly contentious area of public decision making, in which different values often support incompatible policy options and compromise can be elusive. One promising approach to resolving priority-setting conflicts divides the decision-making process into two steps. In the first, a set of eligible options is identified; in the second, one of those options is chosen by a deliberative process. This paper considers the first step, examining proposals for identifying a set of options eligible for deliberation. (...) It focuses on the approach proposed by Anders Herlitz, which limits deliberation to options that are on a par; neither better or worse than, nor strictly equal to the alternatives. Once these “maximal” options are identified, the choice among them is made though a deliberative process that acknowledges the difficult tradeoffs which must be made. While parity and kindred notions are clearly useful in resolving some priority-setting conflicts, this paper argues that the conflicts that arise in setting priorities make it as difficult to decide which options are on a par as it is to decide among those options. The paper draws on priority-setting debates that occurred during the recent pandemic to illustrate the challenges in identifying eligible options: There may be sharp disagreement about how to understand and individuate relevant values; about whether certain values are relevant in a priority-setting context; about how to establish parity between “consequential” and “deontic” options, and about whether one option remains on a par with others after it is modified in various ways. (shrink)

As imaging technologies help us understand the structure and function of the brain, providing insight into human capabilities as basic as vision and as complex as memory, and human conditions as impairing as depression and as fraught as psychopathy, some have asked whether they can also help us understand human agency. Specifically, could neuroimaging lead us to reassess the socially significant practice of assigning and taking responsibility?While responsibility itself is not a psychological process open to investigation through neuroimaging, decision‐making is. (...) Over the past decade, different researchers and scholars have sought to use neuroimaging (or the results of neuroimaging studies) to investigate what is going on in the brain when we make decisions. The results of this research raise the question whether neuroscience—especially now that it includes neuroimaging—can and should alter our understandings of responsibility and our related practice of holding people responsible. It is this question that we investigate here. (shrink)

We agree with Emily Walsh (2020) that the current preferences of patients with dementia should sometimes supersede those patients’ advance directives. We also agree that consensus clinical ethics guidance does a poor job of explaining the moral value of such patients’ preferences. Furthermore, Walsh correctly notes that clinicians are often averse to treating patients with dementia over their objections, and that this aversion reflects clinical wisdom that can inform revisions to clinical ethics guidance. But Walsh’s account of the moral value (...) of the preferences of patients with dementia suffers from three major problems: (1) it does not engage the actual practices of clinical ethics; (2) it provides an inadequate account of why these patients’ preferences matter; and (3) it offers a poor explanation of clinicians’ intuitions in these cases. Her arguments engage a philosophical debate that is largely irrelevant to clinical practice and she therefore leaves pressing real-world clinical ethics questions unaddressed. After underscoring some of Walsh’s main points, we will discuss each of these shortcomings. (shrink)

The moral limits on how, and how much, parents may attempt to shape their children depend on what the moral project of parenthood is all about. A great deal has been written in the past forty years on the moral functions of parents and families and the acquisition and character of parental duties and rights. There has also been a great deal of philosophical writing on the use of technologies to create, select, and modify children, with such seminal works as (...) Warnock et al., and Robertson. The two literatures have overlapped... (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 30-31, August 2012.

Some physicians refuse to perform life-sustaining interventions, such as tracheostomy, on patients who are very likely to remain permanently unconscious. To explain their refusal, these clinicians often invoke the language of “futility”, but this can be inaccurate and can mask problematic forms of clinical power. This paper explores whether such refusals should instead be framed as conscientious objections. We contend that the refusal to provide interventions for patients very likely to remain permanently unconscious meets widely recognized ethical standards for the (...) exercise of conscience. We conclude that conscientious objection to tracheostomy and other life-sustaining interventions on such patients can be ethical because it does not necessarily constitute a form of invidious discrimination. Furthermore, when a physician frames their refusal as conscientious objection, it makes transparent the value-laden nature of their objection and can better facilitate patient access to the requested treatment. (shrink)

This article explores the relation between the government and the media in post-apartheid South Africa. An overview is given of key developments and tensions between the government and the media in the first 10 years of democracy and the ethical frameworks underlying the respective positions. An overview of the debate between the so-called "national interest" and the "public interest" is given, and linked to normative ethical frameworks of libertarianism vis-a-vis communitarianism. A mean between the 2 is suggested in the form (...) of mutualism, whereas the necessity for conceptual clarification in debating the relation between the government and the media is emphasized. (shrink)

This comment argues for increased tolerance of privacy risks in the Internet activity of adults with intellectual disabilities. Excessive caution about such risks denies those individuals not only the great benefits of Internet use but also the difficult but valuable experiences of loss, disappointment, and hurt associated with those risks. A level of risk-aversion appropriate for small children will be disrespectful for adults with intellectual disabilities. To the extent that additional safeguards are justified, they are better achieved through individualized security (...) and privacy settings than through caregiver oversight. (shrink)

Calls for incorporating social science into patient care typically have accounted for neither the logistic constraints of medical training nor the methodological fallacies of utilizing aggregate “social facts” in clinical practice. By elucidating the different epistemic approaches of artistic and scientific practices, this paper illustrates an integrative artistic pedagogy that allows clinical practitioners to generate social scientific insights from actual patient encounters. Although there is no shortage of calls to bring social science into medicine, the more fundamental processes of thinking (...) by which art and science proceed have not been addressed to this end. As such, the art of medical practice is conceptualized as an innate gift, and thus little is done to cultivate it. Yet doing so is more important than ever because uncertainty in diagnosing and treating chronic illnesses, the most significant contemporary mortality risks, suggests a re-expanding role for clinical judgment. (shrink)