Many spectacular claims about psychopaths are circulated. This contribution aims at providing the reader with the more complex reality of the phenomenon (or phenomena), and to point to issues of particular interest to philosophers working in moral psychology and moral theory. I first discuss the current evidence regarding psychopaths’ deficient empathy and decision-making skills. I then explore what difference it makes to our thinking whether we regard their deficit dimensionally (as involving abilities that are on or off) and whether we (...) focus on primary or secondary psychopathy. My conclusion is that most grand claims about psychopathy settling long-standing debates in moral philosophy and psychology are overblown, but there is much to be learnt from this disorder when it comes to formulating modern theories of moral psychology. (shrink)

Psychopaths are renowned for their immoral behavior. They are ideal candidates for testing the empirical plausibility of moral theories. Many think the source of their immorality is their emotional deficits. Psychopaths experience no guilt or remorse, feel no empathy, and appear to be perfectly rational. If this is true, sentimentalism is supported over rationalism. Here, I examine the nature of psychopathic practical reason and argue that it is impaired. The relevance to morality is discussed. I conclude that rationalists can explain (...) the moral deficits of psychopaths as well as sentimentalists. In the process, I identify psychological structures that underpin practical rationality. (shrink)

It is common for philosophers to argue that psychopaths are not morally responsible because they lack some of the essential capacities for morality. In legal terms, they are criminally insane. Typically, however, the insanity defense is not available to psychopaths. The primary reason is that they appear to have the knowledge and understanding required under the M’Naghten Rules. However, it has been argued that what is required for moral and legal responsibility is ‘deep’ moral understanding, something that psychopaths do not (...) have either due to their lacking empathy or practical reason. In the first part of the paper, I argue that psychopaths do not lack the abilities required for deep moral understanding, although they have deficits in those areas. According the M’Naghten Rules, therefore, psychopaths are not insane. Under a less strict formulation of the insanity plea, like the Model Penal Code, however, there is a good case to be made for their lacking substantial capacity. I argue that because psychopathy is an essentially moral disorder, and because of the nature of psychopathic violence, psychopaths should not be excused under the insanity plea. It would be tantamount to excusing someone for committing a crime because they are bad. Arguably, this contravenes the entire system of law. (shrink)

Shame is a painful emotion concerned with failure to live up to certain standards, norms, or ideals. The subject feels that she falls in the regard of others; she feels watched and exposed. As a result, she feels bad about the person that she is. The most popular view of shame is that someone only feels ashamed if she fails to live up to standards, norms, or ideals that she, herself, accepts. In this paper, I provide support for a different (...) view, according to which shame is about failure to live up to public expectations. Such a view of shame has difficulties explaining why an audience is central to shame, why shame concerns the self as a whole, and why the social rank of someone affects their ability to shame others. These features, I argue, are best explained by reference to the descent of shame in the emotion connected with submission in nonhuman animals. The function of submission—to appease relevant social others—also throws light on the sort of emotion that shame is. From the point of view of other people, a subject who experiences shame at her own failing is someone who is committed to living together with others in a socially sanctioned way. The argument is not that we must understand the nature of shame in terms of what it evolved for, but that its heritage is important to understanding the emotion that shame has become. (shrink)

It used to be thought that folk psychology is the only game in town. Focusing merely on what people do will not allow you to predict what they are likely to do next. For that, you must consider their beliefs, desires, intentions, etc. Recent evidence from developmental psychology and fMRI studies indicates that this conclusion was premature. We parse motion in an environment as behavior of a particular type, and behavior thus construed can feature in systematizations that we know. Building (...) on the view that folk psychological knowledge is knowledge of theoretical models, I argue that social knowledge is best understood as lying on a continuum between behavioral and full-blown psychological models. Between the two extremes, we have what I call social models. Social models represent social structures in terms of their overall purpose and circumscribe individuals' roles within them. These models help us predict what others will do or plan what we should do without providing information about what agents think or want. Thinking about social knowledge this way gives us a more nuanced picture of what capacities are engaged in social planning and interaction, and gives us a better tool with which to think about the social knowledge of animals and young children. (shrink)

Shame is a painful emotion concerned with failure to live up to certain standards, norms, or ideals. The subject feels that she falls in the regard of others; she feels watched and exposed. As a result, she feels bad about the person that she is. The most popular view of shame is that someone only feels ashamed if she fails to live up to standards, norms, or ideals that she, herself, accepts. In this paper, I provide support for a different (...) view, according to which shame is about failure to live up to public expectations. Such a view of shame has difficulties explaining why an audience is central to shame, why shame concerns the self as a whole, and why the social rank of someone affects their ability to shame others. These features, I argue, are best explained by reference to the descent of shame in the emotion connected with submission in nonhuman animals. The function of submission—to appease relevant social others—also throws light on the sort of emotion that shame is. From the point of view of other people, a subject who experiences shame at her own failing is someone who is committed to living together with others in a socially sanctioned way. The argument is not that we must understand the nature of shame in terms of what it evolved for, but that its heritage is important to understanding the emotion that shame has become. (shrink)

An increasingly popular suggestion is that empathy and/or sympathy plays a foundational role in understanding harm norms and being motivated by them. In this paper, I argue these emotions play a rather more moderate role in harms norms than we are often led to believe. Evidence from people with frontal lobe damage suggests that neither empathy, nor sympathy is necessary for the understanding of such norms. Furthermore, people's understanding of why it is wrong to harm varies and is by no (...) means limited to considerations of welfare arising from the abilities to sympathize and/or empathize. And the sorts of considerations of welfare that are central to sympathy and, to some extent empathy, are often already moralized. As such, these considerations cannot form the non-moral foundation of harm norms. Finally, empathy and sympathy are not the only emotions that motivate harm norms. Indeed, much of the evidence that has been adduced in favor of the motivational force of empathy and sympathy are studies on helping, which is quite a different behavior than aggression inhibition. Understanding and being motivated by harm norms are complex abilities. To understand them better, we need to move beyond the current fixation on empathy and sympathy. (shrink)

Some people are now quite optimistic about the possibility of treating psychopathy with drugs that directly modulate brain function. I argue that this optimism is misplaced. Psychopathy is a global disorder in an individual’s worldview, including his social and moral outlook. Because of the unity of this Weltanschauung, it is unlikely to be treatable in a piecemeal fashion. Recent neuroscientific methods do not give us much hope that we can replace, in a wholesale manner, problematic views of the world with (...) more socially desirable ones. There are, therefore, principled reasons that psychopathy is so singularly treatment resistant. (shrink)

In this article, I investigate the ethical potential of Victorian literature that markedly discourages readerly sympathy with the protagonists. Generating sympathy for fictional characters was, and often still is, considered to be the primary way in which the novel promotes ethical thoughts, feelings, and behavior in readers. For this reason, the ethical prospects of novels that fail or refuse to make their main characters appealing and instead inspire aversion in readers have received very little critical attention. Taking an unpopular novel (...) by Anthony Trollope as my primary example, I analyze how the formal narrative strategy of “disnarration” (theorized by Gerald Prince) creates profound dislike for the book’s protagonists. Further, I propose that these same passages of disnarration, by emphasizing the text’s fictionality, can encourage readers to seek the sympathetic fulfillment that the text refuses them by engaging with the real world. In this way, I argue, even Victorian realist novels that defy the conventions of sympathy might still share an investment in realizing the ethical potential of fiction. (shrink)

In this article, I investigate the ethical potential of Victorian literature that markedly discourages readerly sympathy with the protagonists. Generating sympathy for fictional characters was, and often still is, considered to be the primary way in which the novel promotes ethical thoughts, feelings, and behavior in readers. For this reason, the ethical prospects of novels that fail or refuse to make their main characters appealing and instead inspire aversion in readers have received very little critical attention. Taking an unpopular novel (...) by Anthony Trollope as my primary example, I analyze how the formal narrative strategy of “disnarration” (theorized by Gerald Prince) creates profound dislike for the book’s protagonists. Further, I propose that these same passages of disnarration, by emphasizing the text’s fictionality, can encourage readers to seek the sympathetic fulfillment that the text refuses them by engaging with the real world. In this way, I argue, even Victorian realist novels that defy the conventions of sympathy might still share an investment in realizing the ethical potential of fiction. (shrink)

This volume, written by a new generation of scholars engaged with contemporary global movements for social justice and peace, reflects their efforts in trying ...

In this paper, I evaluate one of the most prominent accounts of how emotion regulation features in empathy. According to this account, by Nancy Eisenberg and colleagues, empathy develops into either personal distress or sympathy depending on the ability to regulate one’s empathic distress. I argue that recent evidence suggests that empathic distress and sympathy co-occur throughout the empathic episode, that a certain degree of empathic distress may be necessary for prosocial motivation, as high emotion regulation leads to loss of (...) this motivation, and that emotion regulation is not an unmitigated good since much of it is achieved by dehumanizing the sufferer or minimizing her pain. A fertile ground for further research, I suggest, is the role of up-regulation of sympathy. (shrink)

Compassionate Moral Realism, by MarshallColin. New York: Oxford University Press, 2018. Pp. 265 + xi.

It is often argued that the ability to imagine what others think and feel is central to moral func- tioning. In this paper, I consider to what extent this is true. I argue that neither the ability to think of others as having representational mental states, nor the ability to imagine being in their position, is necessary for moral understanding or moral motivation. I go on to argue that the area in which thinking about others’ thoughts and feelings appears to (...) play the largest role is that of supererogatory actions. Being able to get on well with others seems to be importantly predicated on our ability to think about their thoughts and feelings and being able to take up their perspective. However, when it comes to grosser moral norms and restrictions, such as harm norms, there is little reason to think that thinking about others’ thoughts and feelings plays a central role in understanding such norms or being motivated by them. (shrink)

It is often argued that the ability to imagine what others think and feel is central to moral functioning. In this paper, I consider to what extent this is true. I argue that neither the ability to think of others as having representational mental states, nor the ability to imagine being in their position, is necessary for moral understanding or moral motivation. I go on to argue that the area in which thinking about others’ thoughts and feelings appears to play (...) the largest role is that of supererogatory actions. Being able to get on well with others seems to be importantly predicated on our ability to think about their thoughts and feelings and being able to take up their perspective. However, when it comes to grosser moral norms and restrictions, such as harm norms, there is little reason to think that thinking about others’ thoughts and feelings plays a central role in understanding such norms or being motivated by them. (shrink)

In this article, I investigate the ethical potential of Victorian literature that markedly discourages readerly sympathy with the protagonists. Generating sympathy for fictional characters was, and often still is, considered to be the primary way in which the novel promotes ethical thoughts, feelings, and behavior in readers. For this reason, the ethical prospects of novels that fail or refuse to make their main characters appealing and instead inspire aversion in readers have received very little critical attention. Taking an unpopular novel (...) by Anthony Trollope as my primary example, I analyze how the formal narrative strategy of “disnarration” (theorized by Gerald Prince) creates profound dislike for the book’s protagonists. Further, I propose that these same passages of disnarration, by emphasizing the text’s fictionality, can encourage readers to seek the sympathetic fulfillment that the text refuses them by engaging with the real world. In this way, I argue, even Victorian realist novels that defy the conventions of sympathy might still share an investment in realizing the ethical potential of fiction. (shrink)

Vygotsky (1997) coined the term speech-drawing to describe what he saw as the most significant moment in intellectual development, the moment when two psychological tools intersect each other. This paper resurrects the utilization of speech-drawing as a methodological tool to investigate children’s thinking. Specifically, this paper will examine children’s drawings of make-believe houses and the private speech, or spontaneous self-directed speech, children produccd while drawing. These instances of speech-drawing will be utilized to illuminate critical and creative thinking from a Vygotskian (...) perspective. The future use of speech-drawing, as a promising methodological tool to study children’s thought processes, will also be presented and discussed. (shrink)

We raise two objections to Slote’s article. First, empathy cannot provide information about the world in the direct way Slote proposes. Emotional contagion might be able to do so, but this type of process is different from the empathic one. Second, even if we accept his view of empathy, his claim that we make moral judgments via empathizing with the ‘warmth’ or ‘coldness’ of the actor seems misguided because, we usually empathize with the patient, and we empathize with emotions, not (...) “temperatures”. (shrink)

Multi-stakeholder initiatives for biodiversity conservation on working landscapes often necessitate strategies to facilitate learning in order to foster successful collaboration. To investigate the learning processes that both undergird and result from collaborative efforts, this case study employs the concept of boundary work as a lens to examine learning between rice growers and conservation professionals in California’s Central Valley, who were engaged in a collaborative research project focused on migratory bird conservation. Through analysis of workshop observations, project documents, and interviews with (...) rice growers and conservation professionals, we identified five distinct factors of the collaborative research process that influenced learning amongst these two groups: having mutually beneficial goals, sharing ownership of the collaborative research process, building trust, integrating knowledge, and institutional alignment. We also examined and identified learning outcomes for both rice growers and conservation professionals, which included new knowledge of the social-ecological system, new practices around farming and collaboration, and shifting identities. Our findings suggest that applying these factors and outcomes for learning when structuring collaborative research, and other multi-stakeholder initiatives, can foster learning amongst diverse stakeholder groups to support new approaches for balancing resource use and adaptive management. (shrink)

Although medical and public health practitioners aim for high rates of vaccination, parent vaccination concerns confound doctors and complicate doctor-patient interactions. Medical and public health researchers have studied and attempted to counter antivaccination sentiments, but recommended approaches to dispel vaccination concerns have failed to produce long-lasting effects. We use observations made during a small study in a rural area in a southeastern state to demonstrate how a shift away from analyzing vaccination skepticism as a national issue with a global remedy (...) reveals the nuances in vaccination sentiments based on locality. Instead of seeing antivaccinationists as a distinct public based on statistical commonalities, we argue that examining vaccination beliefs and practices at the local level offers a fuller picture of the contextualized nature of vaccination decisions within the psychosocial spaces of families. A view of vaccination that emphasizes the local public, rather than a globally conceived antivaccination public, enables medical humanists and rhetoricians to offer important considerations for improving communications about vaccinations in clinical settings. (shrink)

This collection of papers by prominent feminist thinkers advances the positive feminist project of remapping the moral by developing theory that acknowledges the diversity of women.

This article considers how race and gender shape latina and Latino paths to school success in college. A purposive sample of successful high school and college students was selected. Through interviews, fieldwork, and school records, the researchers find that Latinas navigate successfully through negative stereotypes by maintaining positive definitions of themselves and by emphasizing their group membership as Latina. Young Latino men also see themselves as part of a larger cultural group but tend to have less positive racial and ethnic (...) identities than women do. Typically, they are supported by mentors, such as white athletic coaches, and tend to draw from the meritocratic ethos of sports, regarding their success in individualistic terms. While successful Latinas do not assimilate in the ways predicted by the literature, the young men in this study accept the individualistic and meritocratic ethos of the dominant culture, but with a psychological price. (shrink)

Mistakes and errors happen in most spheres of human life and activity, including in medicine. A mistake can be as simple and benign as the collection of an extra and unnecessary urine sample. Or a mistake can cause serious but reversible harm, such as an overdose of insulin in a patient with diabetes, resulting in hypoglycemia, seizures, and coma. Or a mistake can result in serious and permanent damage for the patient, such as the failure to consider epiglottitis in an (...) initial differential diagnosis, resulting in a chronic vegetative state for a seven-year-old boy. Or a mistake can be an error in judgment that leads to a patient's death. (shrink)

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between (...) studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. (shrink)

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between (...) studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. (shrink)

Much of Barnes’s critique depends on a misunderstanding of my position and, where we do substantively disagree, Barnes’s arguments fail to take into account important distinctions. As a result, his arguments are not persuasive. In my reply, I begin by clarifying my position and then proceed to address specific points of disagreement, identifying those distinctions that Barnes needs to take into account in critiquing my view.

Résumé Si l’absence de moralité des psychopathes a été largement étudiée, il existe peu de recherches sur leurs capacités esthétiques. Pourtant, beaucoup d’études cliniques de cas montrent qu’ils présentent un grave déficit dans ce domaine. Cet article se propose d’en chercher les causes. Il analyse les forces et les limites de l’hypothèse d’un manque d’empathie pour expliquer ces carences esthétiques, et montre pourquoi l’hypothèse d’un manque de distance psychique se révèle plus féconde. Celle-ci permet en outre de comprendre le lien (...) de l’esthétique et de l’éthique par leur filiation commune : elles ont pour socle commun la capacité à prendre de la distance par rapport à des intérêts étroitement égoïstes. (shrink)

In a recent article in this journal, Heidi Giannini (2017) has argued that the Christian doctrines of love and of hope require Christians to endorse universal, unconditional forgiveness, understood in terms of the renunciation of “negative reactive attitudes.” She also addresses criticisms of this interpretation. It is argued that Giannini has failed to provide a Christian justification for universal, unconditional forgiveness. Part of the problem is that she espouses a definition of forgiveness and an understanding of the nature of (...) forgiveness that, as a result of neglecting the teaching of the New Testament, exhibits a number of incoherencies and theological weaknesses. Her account is also vulnerable to philosophical and moral criticisms of a serious nature. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors’ NoteJames M. DuBois, Ana S. Iltis, and Heidi A. WalshFrom childhood, David Slakter had undergone tests and invasive procedures to monitor his nephritis. It was not a surprise when in 2015, doctors told him he needed a kidney transplant. The wife of a childhood friend was a close match and gave him one of her kidneys. Before his transplant, aerobic exercise was difficult; a few months after (...) transplant, Slakter could ride his bike, hike, and work out with a personal trainer. He no longer had to weigh food or gauge his potassium consumption, a concern for people with kidney failure. For Slakter, “life post-transplant has been a significant improvement.”Individuals or family members of those who have received an organ transplant from a living or deceased donor share their stories in this issue of Narrative Inquiry in Bioethics. The symposium is titled “Receiving the Gift of Life: Stories from Organ Transplant Recipients.” Organ transplantation can extend an individual’s life by decades. It can also greatly improve an individual’s quality of life, as was Slakter’s experience. At the same time, organ transplantation is expensive and stressful. Recipients can experience complications, including organ rejection, and there are few appealing alternatives.After her heart transplant, author Leilani R. Graham required four open-heart surgeries, ECMO, and an intra-aortic balloon pump. She experienced delirium, necrotizing pneumonia, and severe muscular atrophy that required her to re-learn how to walk. She struggled with weight gain, explosive mood swings, hair loss, and was terrified that her body would reject the new heart. For Graham, “[Transplant] was not the miracle [she] was hoping for.” Graham says she felt unprepared for and inadequately informed about what to expect after her transplant, which left her “battered, beaten, and bruised” with a 12-inch line from neck to navel and “bullet holes” up and down her torso from the chest tubes. When reflecting on her experience post-transplant, Graham says, “It wasn’t the physical trauma that hurt the most. It was that no one seemed surprised [by the aftereffects of transplant].” Seemingly no one, that is except Graham, who calls on transplant providers to “prioritize empathy.”The symposium editors are Jason T. Eberl and Tristan McIntosh. Three commentary articles, written by Macey Leigh Levan, Heather Lannon, and Vidya A. Fleetwood, Roslyn B. Mannon & Krista L. Lentine, offer important insights into the authors’ stories. The editors thank Mid-America Transplant, the UCSF Lung Transplant Program, Donor Connect, William L. Freeman, MD, MPH, MJIL, CIP, Janet Monk, and the individuals who gave anonymous donations to support the publication of this issue, an open-access VOICES edition of the symposium, and accompanying teaching guides.The research article in this issue, “‘A Shell of My Former Self’: Using Figurative Language to Promote Communication about Patient Suffering,” was written by Tyler Tate, Elizabeth Stein, and Robert A. Pearlman. The relief of suffering is a primary goal of medicine. However, the authors note that clinicians often miss or ignore suffering because they focus on the causes rather than the experience of suffering, or the subjective nature of suffering makes it difficult to discuss. The authors believe that “the key to communicating about suffering lies in finding [End Page vii] the right kind of words to describe the experience” and say that figurative language offers a promising approach. In their research, the authors performed qualitative analysis on 52 works of literature and identified 254 excerpts of figurative language with themes of non-physical or psychological suffering. The authors found 13 salient themes: brokenness, diminishment, disorientation, drowning, emptiness, imprisonment, battle, darkness, isolation, invisibility, lifelessness, punishment, and torture. The authors reiterate that developing a shared language of suffering could foster a therapeutic patient-clinician relationship and improve clinicians’ ability to recognize and address a patient’s experience of suffering.María Susana Ciruzzi wrote the first of two case studies included in this issue. “The Sword of King Solomon” addresses a tragic and difficult subject—how to navigate the situation posed by conjoined twins when “any decision will produce damage and suffering.” The case involves two infant male patients born at 37 weeks gestation as omphalo-ischiopagus conjoined twins... (shrink)

Few emotions have divided opinion as deeply as shame. Some scholars have argued that shame is essentially a maladaptive emotion used to oppress minorities and reinforce stigmas and traumas, an emotion that leaves the self at the mercy of powerful others. Other scholars, however, have argued that the absence of a sense of shame in a subject--their shamelessness--is tantamount to a vicious moral insensitivity. As the twelve original chapters in this collection attest, however, shame scholars are entering a new phase, (...) one in which scholarship no longer attempts to defend one side of shame against the other, but rather accepts both faces as faithful to the phenomenon to be explained. At the core of our understanding of shame there are profound disagreements about the importance of the Other in shaping our moral identity. As this collection shows by its study of shame, the difficulty of the connection between Self, Other, and morality spans over millennia and cultures and currently animates important debates at the core of feminism and disability studies. Contributors: Mark Alfano, Alessandra Fussi, Lorenzo Greco, JeeLoo Liu, Katrine Krause-Jensen, Heidi L. Maibom, Tjeert Olthof, Imke von Maur, Alba Montes Sánchez, Raffaele Rodogno, Alessandro Salice, Krista K. Thomason, Íngrid Vendrell Ferran. (shrink)

Proposed educational outcomes for the health humanities in medical education range from empathy to visual thinking skills to social accountability. This lack of widely agreed-upon high-level curricular goals limits humanities educators’ ability to design purposeful curricula toward clear, common ends and threatens justifications for scarce curricular time. We propose a novel approach to the hoped-for outcomes of health humanities training in medical schools, which has the potential to encompass traditional health humanities knowledge, skills, and behaviors while also being concrete and (...) measurable: humanistic practice. Humanistic practice, adapted from the concept of ethical sensitivity, is an intentional process of applying humanities knowledge and skills to a clinical scenario by 1) noticing that the scenario requires humanities knowledge or skills, 2) informing one’s clinical and interpersonal strategy and behavior with humanities knowledge or skills, 3) reflecting on the effectiveness of the strategy and behavior, and 4) reorienting to develop new approaches for future practice. The construct of humanistic practice may help address some of the foundational problems in health humanities outcomes research since it transcends the traditional diverse content domains in the health humanities, can link patient and provider experiences, and may bridge the divide among the additive, curative, and intrinsic epistemic positions of humanities to medical education. (shrink)

Doug Husak suggests that sometimes an actor should be deemed reckless, and not merely negligent, with respect to the risks that she knowingly created but has forgotten at the moment of action. The validity of this conclusion, he points out, depends crucially on what it means to be aware of a risk. Husak’s neutral prompt and counterfactual actual belief criteria are problematic, however. More persuasive is his suggestion that we understand belief, in this moral and criminal law context, as a (...) concept whose meaning is determined by its function as a culpability standard. Husak concludes that inadvertent actors are often less culpable than knowing-but-later-forgetful actors; this is plausible, but there are also numerous counterexamples. Holly Smith focuses on negligence cases in which an agent’s failure to notice a risk stems, not from a prior culpable choice, but from an objectionable attitude or set of attitudes. She is right to emphasize that genuine moral culpability does not depend on conscious choice. However, Smith also asserts that decisions that flow from an actor’s objectionable attitudes are only rarely culpable, because they often do not arise from a reasonably full configuration of the actor’s motives. This last requirement is, I fear, an unrealistic and unnecessarily demanding criterion of culpability. Even when many of the actor’s evaluative attitudes are inactive in Smith’s sense, the actor might deserve blame for not bringing them to bear on his decision. Michael Moore and Heidi Hurd thoroughly explore, and find deficient, H.L.A. Hart’s unexercised capacity theory of negligence. They are correct that that theory requires a further judgment: an actor’s inadvertence is culpable only if he had the capacity to have adverted if X where X is the source of the actor’s moral desert. They overstate, however, in suggesting that the capacity issue falls out of the picture once we identify that underlying desert basis. The authors also worry that if desert is grounded on an underlying vice, we lack a reliable way of ranking the different vices that might explain the actor’s inadvertence; this is not a fatal objection, however, because negligence determinations are quite feasible even in the absence of clear rankings. Moore and Hurd conclude by identifying eight distinct categories in which criminal liability for negligence is justifiable. Negligence is indeed a surprisingly complex and pluralist concept. The three articles in this symposium brightly illuminate some of the most fundamental conceptual and normative issues in the debate over whether it is just to blame and punish the negligently inadvertent. (shrink)