Informed consent is a central topic in contemporary biomedical ethics. Yet attempts to set defensible and feasible standards for consenting have led to persistent difficulties. In Rethinking Informed Consent in Bioethics Neil Manson and Onora O'Neill set debates about informed consent in medicine and research in a fresh light. They show why informed consent cannot be fully specific or fully explicit, and why more specific consent is not always ethically better. They argue that consent needs distinctive communicative transactions, by which (...) other obligations, prohibitions, and rights can be waived or set aside in controlled and specific ways. Their book offers a coherent, wide-ranging and practical account of the role of consent in biomedicine which will be valuable to readers working in a range of areas in bioethics, medicine and law. (shrink)

Over the past couple of decades, there has been an ongoing, often fierce, debate about the ethics of biobank participation. One central element of that debate has concerned the nature of informed consent, must specific reconsent be gained for each new use, or user, or is broad consent ethically adequate? Recently, Thomas Ploug and Søren Holm have developed an alternative to both specific and broad consent: what they call a meta-consent framework. On a meta-consent framework, participants can choose the type (...) of consent framework they require, for different kinds of use, different types of user and so on. Meta-consent involves a distinctive kind of design of the consent process. Here it is argued, first, that although a meta-consent framework does not wrong participants, Ploug and Holm understate the likely costs and burdens of such a framework, so there are good practical reasons not to offer it. Second, although Ploug and Holm allude to some ethical considerations that might seem to ground an ethical argument for providing meta-consent, they do not offer any sound argument, and it does not wrong participants in any way to fail to offer them the opportunity to design their own consent process. (shrink)

In recent years there has been wide-ranging discussion of epistemic virtues. Given the value and importance of acquiring knowledge this discussion has tended to focus upon those traits that are relevant to the acquisition of knowledge. This acquisitionist focus ignores or downplays the importance of epistemic restraint: refraining from seeking knowledge. In contrast, in many periods of history, curiosity was viewed as a vice. By drawing upon critiques of curiositas in Middle Platonism and Early Christian philosophy, we gain useful insights (...) into the value and importance of epistemic restraint. The historical discussion paves the way for a clarification of epistemic restraint, one that distinguishes the morally relevant features of epistemic process, content, purpose, and context. Epistemic restraint is identified as an important virtue where our epistemic pursuits pose risks and burdens, where such pursuits have opportunity costs, where they are pursued for vicious purposes. But it is in the social realm where epistemic restraint has most purchase, epistemic restraint is important both because privacy is important and because being trusted are important. Finally, some suggestions are offered as to why epistemic restraint has not received the contemporary attention that it deserves. (shrink)

In a recent article, I argued that Ploug and Holm’s ‘meta-consent’ proposal should be rejected for biobank governance. This was because, although meta-consent is permissible, it is both burdensome and ethically omissible. There is no ethical reason why funders should undertake the additional costs. Ploug and Holm have sought to respond to these arguments. Here, it is noted that not only do they fail to adequately refuse the case against meta-consent, they fail to even engage with the arguments, either misunderstanding (...) them or ignoring them. In their response, Ploug and Holm unwittingly provide the basis of an even stronger case against meta-consent. They argue that broad consent has a built in tendency to expire, while also holding that broad consent should be one of the options available in meta-consent. Meta-consent thus ends up being more like dynamic consent, but, arguably, even more burdensome and costly. (shrink)

In many jurisdictions, adolescents acquire the right to consent to treatment; but in some cases their refusals – e.g. of life-saving treatment – may not be respected. This asymmetry of adolescent consent and refusal seems puzzling, even incoherent. The aim here is to offer an original explanation, and a justification, of this asymmetry. Rather than trying to explain the asymmetry in terms of a variable standard of competence – where the adolescent is competent to consent to, but not refuse, certain (...) interventions – the account offered here focuses more closely on the normative power to render actions permissible. Where normative powers are shared they can readily give rise to an asymmetry between consent and refusal. We then turn to why it is justifiable that normative powers be shared in adolescence. Transitional paternalism holds that the acquisition of normative powers by competent adolescents should not be an instant one, achieved in a single step, but that there should be a transitional period where paternalistic protection is rolled back, but not entirely withdrawn until a later date. Transitional paternalism could be implemented without generating the asymmetry between consent and refusal but, it is argued, the asymmetric version of transitional paternalism is to be preferred insofar as it offers a greater respect for the adolescent's decisions than the symmetrical alternative. (shrink)

It is widely held that there is an important distinction between the notion of consciousness as it is applied to creatures and, on the other hand, the notion of consciousness as it applies to mental states. McBride has recently argued in this journal that whilst there may be a grammatical distinction between state consciousness and creature consciousness, there is no parallel ontological distinction. It is argued here that whilst state consciousness and creature consciousness are indeed related, they are distinct properties. (...) Conscious creatures can have, at one time, both conscious and unconscious mental states. This raises the question of what distinguishes the conscious from unconscious mental states of a subject: a question about what state consciousness consists in. Whilst the state/creature distinction may not be of use in explaining every aspect of a subject's consciousness, it does provide a key part of the explanandum for theories of consciousness and mind. The state/creature consciousness distinction is a real one and should not be dropped from our psychological taxonomy. (shrink)

If we are to understand why psychoanalysis extends ordinary psychology in the precise ways that it does, we must take account of the existence of, and the interplay between, two distinct kinds of explanatory concern: functional and idiographic. The form and content of psychoanalytic explanation and its unusual methodology can, at least in part, be viewed as emerging out of Freud's attempt to reconcile these two types of explanatory concern. We must also acknowledge the role of the background theoretical context (...) that shapes Freud's functional thinking about the mind. A neglect of the role of the background theory in shaping the extension of ordinary psychology leaves us with puzzles about the nature and direction of the psychoanalytic extension and gives rise to an unbelievable history of psychoanalysis. (shrink)

Some self-ascriptions of belief, desire and other attitudes exhibit first-person authority. The aim here is to offer a novel account of this kind of first-person authority. The account is a development of Robert Gordon's ascent routine theory but is framed in terms of our ability to bring it about that others know of our attitudes via speech acts which do not deploy attitudinal vocabulary but which nonetheless ‘show’ our attitudes to others. Unlike Gordon's ascent routine theory, the theory readily applies (...) to attitudes other than belief, avoids a need to appeal to processes of making up one's mind, and does not rest upon a distinction between ‘outward looking’ and ‘inward looking’ processes. (shrink)

If we are to understand why psychoanalysis extends ordinary psychology in the precise ways that it does, we must take account of the existence of, and the interplay between, two distinct kinds of explanatory concern: functional and idiographic. The form and content of psychoanalytic explanation and its unusual methodology can, at least in part, be viewed as emerging out of Freud's attempt to reconcile these two types of explanatory concern. We must also acknowledge the role of the background theoretical context (...) that shapes Freud's functional thinking about the mind. A neglect of the role of the background theory in shaping the extension of ordinary psychology leaves us with puzzles about the nature and direction of the psychoanalytic extension and gives rise to an unbelievable history of psychoanalysis. (shrink)

Abstract: “Consciousness” seems to be a polysemic, ambiguous, term. Because of this, theorists have sought to distinguish the different kinds of phenomena that “consciousness” denotes, leading to a proliferation of terms for different kinds of consciousness. However, some philosophers—univocalists about consciousness—argue that “consciousness” is not polysemic or ambiguous. By drawing upon the history of philosophy and psychology, and some resources from semantic theory, univocalism about consciousness is shown to be implausible. This finding is important, for if we accept the univocalist (...) account then we are less likely to subject our thought and talk about the mind to the kind of critical analysis that it needs. The exploration of the semantics of “consciousness” offered here, by way of contrast, clarifies and fine-tunes our thought and talk about consciousness and conscious mentality and explains why “consciousness” means what it does, and why it means a number of different, but related, things. (shrink)

Informed consent requirements for medical research have expanded over the past half-century. The Declaration of Helsinki now includes an explicit positive obligation to inform subjects about funding sources. This is problematic in a number of ways and seems to oblige researchers to disclose information irrelevant to most consent decisions. It is argued here that such a problematic obligation involves an “informational fallacy.” The aim in the second part of the paper is to provide a better approach to making sense of (...) how a failure to inform about funding sources wrongs subjects: by making appeals to obligations to refrain from misleading by omission. This alternative approach—grounded in a general obligation to refrain from misleading, an obligation that is independent of informed consent—provides a basis for a norm that protects subjects’ interests, without the informational fallacy. The approach developed here avoids the problems identified with the currently specified general obligation to inform about funding sources. (shrink)

If we are to understand why psychoanalysis extends ordinary psychology in the precise ways that it does, we must take account of the existence of, and the interplay between, two distinct kinds of explanatory concern: functional and idiographic. The form and content of psychoanalytic explanation and its unusual methodology can, at least in part, be viewed as emerging out of Freud's attempt to reconcile these two types of explanatory concern. We must also acknowledge the role of the background theoretical context (...) that shapes Freud's functional thinking about the mind. A neglect of the role of the background theory in shaping the extension of ordinary psychology leaves us with puzzles about the nature and direction of the psychoanalytic extension and gives rise to an unbelievable history of psychoanalysis. (shrink)

Is genetic information of special ethical significance? Does it require special regulation? There is considerable contemporary debate about this question (the genetic exceptionalism debate). Genetic information is an ambiguous term and, as an aid to avoiding conflation in the genetic exceptionalism debate, a detailed account is given of just how and why genetic information is ambiguous. Whilst ambiguity is a ubiquitous problem of communication, it is suggested that genetic information is ambiguous in a particular way, one that gives rise to (...) the problem of significance creep (i.e., where claims about the significance of certain kinds of genetic information in one context influence our thinking about the significance of other kinds of genetic information in other contexts). A contextual and contrastive methodology is proposed: evaluating the significance of genetic information requires us to be sensitive to the polysemy of genetic information across contexts and then examine the contrast in significance (if any) of genetic, as opposed to nongenetic, information within contexts. This, in turn, suggests that a proper solution to the regulatory question requires us to pay more attention to how and why information, and its acquisition, possession and use, come to be of ethical significance. (shrink)

With aims to both increase organ supply and better reflect individual donation preferences, many nations worldwide have shifted from ‘opt-in’ to ‘opt-out’ systems for post-mortem organ donation (PMOD). In such countries, while a prospective donor's willingness to donate their organs/tissues for PMOD was previously ascertained—at least partially—by their having recorded positive donation preferences on an official register prior to death, this willingness is now presumed or inferred—at least partially—from their not having recorded an objection to PMOD—on an official organ donation (...) register. Using evidence regarding the presence and prevalence of selective donation preferences, and via exploration of how appeals to donation preferences are used to both motivate and legitimate shifts to opt-out frameworks, this paper draws attention to a set of previously unexplored problems for opt-out organ donation arising in contexts where: (a) individuals demonstrate selective post-mortem organ/tissue donation preferences, (b) legislation provides prospective donors with the opportunity to selectively permit/refuse the donation of certain organs/tissues in line with these preferences. While selective preferences pose few problems for opt-in systems where a selective occasion is built into the process of signing the donor register, this is not the case for opt-out systems. The loss of this selective occasion can cause significant problems where appeals to preferences motivate/legitimate shifts to opt-out but evidence regarding variable preferences does not feed into determinations regarding organ/tissue exclusions. The nature of these problems depends on how the authorization aspect of ‘opt-out’ systems is framed (e.g. as presumed consent, deemed consent or, given the role of familial consent in many jurisdictions as consent in name only). (shrink)

“Spin” is a pejorative term for a ubiquitous form of communication. Spin is viewed by many as deceptive, and by others as bending or twisting the truth. But spin need not be deceptive and the metaphors are less than clear. The aim here is to clarify what spin is: spin is identified as a form of selective claim-making, where the process of selection is governed by an intention to bring about promotional perlocutionary effects. The process of selection may pertain to (...) aspects of some situation or phenomenon,; or to the lexis used in making the claims. Not all selective promotional communication is spin. Spin involves a distinctive kind of dissociation between the speaker’s first-order interpretation and the constructed interpretation or claim offered to others. With these clarifications in place the discussion turns to the complex connections between spin, truthfulness and deception. Aspect-selective spin can be truthful, and it need not be deceptive in its intentions or effects, but may risk deceiving audiences. Lexical spin is less readily truthful, and both forms of spin prudentially require a distinctive kind of concealment of the speaker’s intentions. The account developed here does not address normative questions about whether, or how, spin might be wrong, but aims to provide a clear and adequate account of spin as a basis for addressing normative questions about spin. (shrink)

How do reason explanations explain? One view is that they require the deployment of a tacit psychological theory; another is that even if no tacit theory is involved, we must still conceive of reasons as mental states. By focusing on the subjective nature of agency, and by casting explanations as responses to 'why' questions that assuage agents' puzzlement, reason explanations can be profitably understood as part of our traffic in first-order content amongst perspectival subjects. An outline is offered of such (...) an account of reason explanation, one that fully acknowledges the distinctive first-order first-person normative perspective of agency. (shrink)

Is genetic information of special ethical significance? Does it require special regulation? There is considerable contemporary debate about this question. Genetic information is an ambiguous term and, as an aid to avoiding conflation in the genetic exceptionalism debate, a detailed account is given of just how and why genetic information is ambiguous. Whilst ambiguity is a ubiquitous problem of communication, it is suggested that genetic information is ambiguous in a particular way, one that gives rise to the problem of significance (...) creep. A contextual and contrastive methodology is proposed: evaluating the significance of genetic information requires us to be sensitive to the polysemy of genetic information across contexts and then examine the contrast in significance of genetic, as opposed to nongenetic, information within contexts. This, in turn, suggests that a proper solution to the regulatory question requires us to pay more attention to how and why information, and its acquisition, possession and use, come to be of ethical significance. (shrink)

The modern vat-brain debate is an epistemological one, and it focuses on the point of view of a putatively deceived subject. Semantic externalists argue that we cannot coherently wonder whether we are brains in vats. This paper examines a new experimental paradigm for cognitive neuroscience—the neurally-controlled animat (NCA) paradigm—that seems to have a great deal in common with the vat-brain scenario. Neural cells are provided with a simulated body within an artificial world in order to study the brain both in (...) vitro and in vivo. Given the similarity between the NCA scenario and the vat-brain scenario, semantic externalism seems to undermine the utility of the NCA methodology. Three initial responses to the externalist challenge are offered. A fourth response clarifies the distinctive theoretical background to the NCA in ‘artificial life’ and, in doing so, we uncover an anti-representationalist conception of the NCA. This distances the NCA paradigm from externalist objections and casts cognitive neuroscience, and the vat-brain debate, in a new light. # 2004 Published by Elsevier Ltd. (shrink)

Contrary to certain rumours, the mind-body problem is alive and well. So argues Joseph Levine in Purple Haze: The Puzzle of Consciousness . The main argument is simple enough. Considerations of causal efficacy require us to accept that subjective experiential, or 'phenomenal', properties are realized in basic non-mental, probably physical properties. But no amount of knowledge of those physical properties will allow us conclusively to deduce facts about the existence and nature of phenomenal properties. This failure of deducibility constitutes an (...) explanatory problem - an explanatory gap - but does not imply the existence of immaterial mental properties. Levine introduced this notion of the explanatory gap almost two decades ago. Purple Haze allows Levine to situate the explanatory gap in a broader philosophical context. He engages with those who hold that the explanatory gap is best understood as implying anti-materialist metaphysical conclusions. But he also seeks to distance himself from contemporary naturalistic philosophical theorizing about consciousness by arguing that reductive and eliminative theories of consciousness all fail. Levine's work is best seen as an attempt to firmly establish a definite status for the mind-body problem, i.e. that the mind-body problem is a real, substantive epistemological problem but emphatically not a metaphysical one. Because Levine's work is tightly focused upon contemporary Anglophone analytic philosophy of mind, there is little discussion of the broader conceptual background to the mind-body problem. My aim here is to place Levine's work in a broader conceptual context. In particular, I focus on the relationship between consciousness and intentionality in the belief that doing so will allow us better to understand and evaluate Levine's arguments and their place in contemporary theorizing about mentality and consciousness. (shrink)

abstract Allen Buchanan argues that conventional applied ethics is impoverished and would be enriched by the addition of social moral epistemology. The aim here is to clarify this argument and to raise questions about whether such an addition is necessary about how such enrichment would work in practice. Two broad problems are identified. First, there are various kinds and sources of epistemic inertia, which act as an obstacle to epistemic change. Religion is one striking example and seems to pose a (...) deep problem for Buchanan's liberal social moral epistemology. Philosophy also exhibits a distinctive kind of epistemic inertia, but also suffers from epistemic isolationism:. It is concluded that not only will a liberal social moral epistemology have to overcome a pernicious epistemic inertia with regard to religious belief, but also a different kind of epistemic inertia closer to home. (shrink)

abstract Allen Buchanan argues that conventional applied ethics is impoverished and would be enriched by the addition of social moral epistemology. The aim here is to clarify this argument and to raise questions about whether such an addition is necessary about how such enrichment would work in practice. Two broad problems are identified. First, there are various kinds and sources of epistemic inertia, which act as an obstacle to epistemic change. Religion is one striking example and seems to pose a (...) deep problem for Buchanan's liberal social moral epistemology. Philosophy also exhibits a distinctive kind of epistemic inertia (metaphilosophical beliefs about the impropriety of applying philosophy are hard to shift), but also suffers from epistemic isolationism: (its arguments and conclusions are isolated from practical influence). It is concluded that not only will a liberal social moral epistemology have to overcome a pernicious epistemic inertia with regard to religious belief, but also a different kind of epistemic inertia closer to home. (shrink)

In some jurisdictions there is a puzzling asymmetry between consent and refusal, where, for some kinds of treatment, the adolescent patient has the power to permit her own treatment but her refusal does not have the same kind of normative significance as refusal of treatment by a competent adult. In this journal I recently offered a clarification and defence of this asymmetry in terms of a paternalistic justification of the sharing of normative powers between adolescents and other parties. Lawlor offers (...) a number of objections to this account. Three of his objections can be dealt with quickly. But one of them is much more challenging: the asymmetry of consent and refusal entails a practice of making sham offers. They do not really offer a choice at all. Genuine offers seem to require a commitment to be symmetrically responsive to whatever decision outcome is reached by the recipient of the offer. When we reflect upon the way that offers can be made in complex social contexts, where different parties have a ‘say’ in what ought to be done, the symmetry of responsiveness need not apply. Offers can be genuine, without being symmetrically responsive. Contrary to the seemingly plausible objection, the asymmetry of consent and refusal does not entail sham offers, or the offer of ‘sham choices’. (shrink)

How do reason explanations explain? One view is that they require the deployment of a tacit psychological theory; another is that even if no tacit theory is involved, we must still conceive of reasons as mental states. By focusing on the subjective nature of agency, and by casting explanations as responses to why questions that assuage agents puzzlement, reason explanations can be profitably understood as part of our traffic in first-order content amongst perspectival subjects. An outline is offered of such (...) an account of reason explanation, one that fully acknowledges the distinctive first-order first-person normative perspective of agency. (shrink)

The modern vat-brain debate is an epistemological one, and it focuses on the point of view of a putatively deceived subject. Semantic externalists argue that we cannot coherently wonder whether we are brains in vats. This paper examines a new experimental paradigm for cognitive neuroscience—the neurally-controlled animat paradigm—that seems to have a great deal in common with the vat-brain scenario. Neural cells are provided with a simulated body within an artificial world in order to study the brain both in vitro (...) and in vivo. Given the similarity between the NCA scenario and the vat-brain scenario, semantic externalism seems to undermine the utility of the NCA methodology. Three initial responses to the externalist challenge are offered. A fourth response clarifies the distinctive theoretical background to the NCA in ‘artificial life’ and, in doing so, we uncover an anti-representationalist conception of the NCA. This distances the NCA paradigm from externalist objections and casts cognitive neuroscience, and the vat-brain debate, in a new light. (shrink)