This paper defends a distinctly liberal approach to public health ethics and replies to possible objections. In particular, I look at a set of recent proposals aiming to revise and expand liberalism in light of public health's rationale and epidemiological findings. I argue that they fail to provide a sociologically informed version of liberalism. Instead, they rest on an implicit normative premise about the value of health, which I show to be invalid. I then make explicit the unobvious, republican background (...) of these proposals. Finally, I expand on the liberal understanding of freedom as non-interference and show its advantages over the republican alternative of freedom as non-domination within the context of public health. The views of freedom I discuss in the paper do not overlap with the classical distinction between negative and positive freedom. In addition, my account differentiates the concepts of freedom and autonomy and does not rule out substantive accounts of the latter. Nor does it confine political liberalism to an essentially procedural form. (shrink)

In this chapter, I articulate the structure of a general concept of autonomy and then reply to possible objections with reference to Ulysses arrangements in psychiatry. The line of argument is as follows. Firstly, I examine three alternative conceptions of autonomy: value-neutral, value-laden, and relational. Secondly, I identify two paradigm cases of autonomy and offer a sketch of its concept as opposed to the closely related freedom of action and intentional agency. Finally, I explain away the autonomy paradox, to which (...) the previously identified pair of paradigm cases seems to give rise in the context of mental disorder. By addressing this paradox, we learn two valuable lessons. The first is about the relationships between the three conceptions of autonomy above. The second is about the relationship between autonomy and mental disorder. (shrink)

In this chapter, I explore moral competence as a central condition on moral responsibility. I distinguish two main conceptions. On the first, a morally competent agent is someone who knows right from wrong. On the second, a morally competent agent is someone who responds aptly to reasons. These two conceptions merit separate treatment as they offer different insights on how and why moral competence might be compromised. This distinction is of particular relevance since the chapter critically examines a standard assumption (...) stating that whenever a mental disorder impacts moral competence, it decreases its scope (on the first conception) or precision (on the second). In close conversation with the memoir literatures on bipolar disorder, autism and schizophrenia, I argue that moral competence may also be affected by what looks like increases in scope or precision; moreover, neither impact – decrease or increase – necessarily undermines moral competence in and of itself; oftentimes, either could enhance it in a reliable way. Finally, by critically revisiting the ecological or scaffolding approach to moral responsibility, I show that moral competence is best understood as a practical way of knowing right from wrong embedded in daily routines and habits, and irreducible to propositional understanding or intellectual skills. (shrink)

In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the context of decisional (...) capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)

This paper identifies a distinctive kind of moral luck, deep circumstantial luck and then explores its effects on moral responsibility. A key feature of the phenomenon is that it is recurrent rather than one-off. It also affects agents across a wide range of situations making it difficult to detect. Deeply unlucky agents are subject to unfavourable moral assessments through no fault of their own both in specific cases and when they try to respond to such initial assessments. In this respect, (...) deep circumstantial luck takes the form of a normative burden that grows over time. A process-oriented conception of moral responsibility as answerability is proposed to explain this phenomenon and highlight its implications for rethinking vicarious responsibility. (shrink)

This chapter explores four kinds of skepticism about autonomy in general and its applicability to psychiatric ethics in particular. It is argued that although there are valuable lessons to be learnt from each of these skeptical challenges, their overall contribution is best understood in terms of friendly correctives to an autonomy-centered normative and conceptual framework instead of viable alternatives to it. The first four sections each provide a logical reconstruction of a distinct skeptical line of reasoning about autonomy and expand (...) on its implications for psychiatric ethics: skepticism about personal autonomy; skepticism about autonomy as an agency concept; vulnerability-grounded skepticism about autonomy; and paternalism-friendly skepticism about autonomy. The fifth section identifies and explores the underlying presuppositions that motivate the previously discussed forms of skepticism about autonomy, and the sixth reflects on the significance of psychiatric ethics for rebutting skepticism about autonomy and developing a new, more promising positive theory. (shrink)

Philosophy has much to offer psychiatry, not least regarding ethical issues, but also issues regarding the mind, identity, values, and volition. This has become only more important as we have witnessed the growth and power of the pharmaceutical industry, accompanied by developments in the neurosciences.

In this article, I develop an Aristotelian account of akrasia as a primary failure of intentional agency in contrast to a phenomenon I refer to as ‘ordinary weakness of will’: I argue that ordinary weakness of will is best understood as a secondary failure of intentional agency, that to tackle akrasia.

This Editorial outlines recent developments in the Journal’s scope, mission and review policy. It also illustrates the range of topics addressed on the pages of Ethical Theory and Moral Practice, which is now entering its 24th year.

This chapter outlines a new disentangling strategy for moral epistemology. It builds on the fundamental distinction between value-neutrality and value-independence as two separate aspects of methodological austerity introduced by Matthew Kramer. This type of conceptual analysis is then applied to two major challenges in moral epistemology: globalised scepticism and debate fragmentation. Both challenges arise from collapsing the fact/value dichotomy. They can be addressed by comprehensive disentangling that runs along both dimensions – value neutrality vs. value non-neutrality and value independence vs. (...) value dependence. The success of this strategy rests on two factors. The first is broadening the scope of disentangling to include theoretical-explanatory values on a par with distinctly ethical values. The second is differentiating between wider and narrower conceptualisations of what value neutrality requires with respect to contested matters. The objective is to pre-empt unjust theorising, a distinctive form of epistemic injustice that derives from the exclusive methodological focus on ethical evaluations at the expense of epistemic ones. When these methodological conditions are fulfilled, opponents should gain the confidence to treat each other as fellow inquirers engaged in the same project, that of reducing the scope of unhelpful disagreements. (shrink)

This chapter aims to distinguish between pathologies of agency in the strict sense and mere sources of impediments or distortion. Expanding on a recent notion of necessarily less-than-successful agency, it complements a mainstream approach to mental disorders and anomalous psychological conditions in the philosophy of mind and action. According this approach, the interest of such clinical case studies is heuristic, to differentiate between facets of agency that are functionally and conceptually separate even though they typically come together. Yet, in the (...) absence of independent criterion for a pathology of as opposed to inner obstacle to agency, this heuristic is at risk of becoming circular or uninformative, falling back on a clinical diagnosis it is meant to take as a starting point only. The chapter develops such a criterion and shows how it could work tracking agential achievement across two core dimensions of agency: planning and responsiveness to reasons. The discussion concludes with some implications on assessing decisional capacity and safeguarding agent autonomy in psychiatric settings. (shrink)

This article offers a critical analysis of David Miller’s proposal that liberal immigration policies should be conceptualized in terms of a quasi-contract between receiving nations and immigrant groups, designed to ensure both that cultural diversity does not undermine trust among citizens and that immigrants are treated fairly. This proposal fails to address sufficiently two related concerns. Firstly, an open-ended, quasi-contractual requirement for cultural integration leaves immigrant groups exposed to arbitrary critique as insufficiently integrated and unworthy of trust as citizens. Secondly, (...) the focus on national culture instead of citizenship obfuscates the close link between political membership and political trustworthiness. An examination of two models of interpersonal trust, affective and cognitive,shows that there is no room for the mid-way position associated with a quasi-contract. The effect of grounding political trust in a shared national culture instead of democratic institutions is to normalize the domination of immigrants and citizens alike. (shrink)

In a recent Editorial, Kious et al. (2023) put forward the claim that psychiatrists should resist calls to integrate concerns about epistemic injustice into their practice as this concept not only fails to add significantly to the current professional standards but would also lead to deleterious clinical outcomes. We believe their claim is mistaken, as it arises from several misconceptions about both the nature of epistemic injustice, and its clinical relevance. First, epistemic justice is conflated with what the authors term (...) ‘a quest for social justice’ that could ‘sideline principles of good clinical reasoning’ (Kious at al 2023: 4). Second, the claim about the impracticality and/or counterproductivity of epistemic injustice as a critical tool within psychiatric practice reflects a series of misconceptions about the normative framework from which this concept derives, so the standards they evaluate it against are ill-chosen. Pace Kious at al., fostering epistemic justice in any area of knowledge and inquiry could not – unwittingly or otherwise – inhibit the consideration of relevant evidence, restrict sound argument or facilitate the casual treatment of testimonies at face value. Third and final, this claim obfuscates some immediate ways in which a focus on epistemic justice as an integral goal will strengthen psychiatric practice according to its own internal standards. (shrink)

This chapter offers a fine-grained analysis of the relationship between autonomy and responsibility in order to address a challenge according to which considering autonomy and responsibility as closely related is misleading since these concepts serve different normative objectives. In response to this challenge, I first explore two criteria of ascription – rationality and control – that autonomy and responsibility seem to share. I then contrast and compare three pairs of autonomy and responsibility conceptions. Examining these pairs rescues the idea that (...) there are normatively significant connections between autonomy and responsibility, albeit that what that connection is and why it matters is highly sensitive to the different understandings of autonomy and responsibility one might adopt. The first pair, self-governance and accountability, posits a notion of core agency as irreducibly valuable. The second, authenticity and attributability, rests on a shared ideal of actively becoming a distinctive self. The third and final, relational autonomy and answerability, derives from the thought that unequal standing impacts heavily on whether and how the criteria of rationality and control are applied in specific cases. This analysis demonstrates that rationality and control are not independent criteria but always work in tandem. Failing to appreciate these conceptual interactions could obfuscate promising pathways for both supporting personal autonomy and challenging unwarranted responsibility ascriptions. (shrink)

Contemporary analytic philosophers tend to see akrasia, or acting against one’s better judgement, as a problem of motivation. On this standard view, akratic actions are paradoxical since akratic agents know that they have a better alternative but nevertheless take up the worse, akratic option. In other words, akratic agents know what they are doing. They do not make any epistemic mistakes but – inexplicably – engage in behaviours that they correctly identify as wrong. The thought that akratic agents are not (...) flawed as inquirers and knowers but only as agents plays a key role in turning akrasia into a textbook example of motivational only, or practical irrationality. This paper will aim to revise the standard view by emphasizing the epistemic dimensions of phenomenon, that is, the ways in which akrasia affects both how agents understand their own involvement and how they handle evidence about their prospects of success. The ambition is to show that akratic agents typically rationalise their akrasia. They do not recognise it as paradoxical or irrational. Instead, they reinterpret it as separate goal-directed actions undertaken under conditions that are not ideal for them. This rationalisation of akrasia is closely related to another epistemically deficient habit: akratic agents pay too much heed to evidence that they are unlikely to succeed. In so doing, they display too little of what philosophers have described as ‘epistemic resilience’, or more simply, ‘grit’. (shrink)

Weakness of will, or akrasia, is an exciting issue at the heart of moral psychology and the philosophy of mind and action. This articleoffers a problem-centered guide to the relevant literature in contemporary analytic philosophy with reference to the main classical texts. The topics covered include: contemporary versus classical conceptions of akrasia, the possibility of weakness of will and its significance within instrumental and substantive theories of practical rationality, the nature of akratic actions and akratic attitudes, and the plausibility of (...) a theoretical counterpart of weakness of will, such as epistemic akrasia. (shrink)