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)

In part one, I identify the core logical structure of the precautionary principle and distinguish it from the various key concepts that appear in the many different formulations of the principle. I survey these concepts and suggest a program of further conceptual analysis. In part two, I examine a particular version of the precautionary principle dubbed “the catastrophe principle” and criticize it in light of its similarities to the principle at work in Pascal’s Wager. I conclude with some suggestions for (...) advocates of the precautionary principle who wish their formulation to avoid the pitfalls confronting the catastrophe principle. (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)

There is an ongoing debate about the “ontology” of consent. Some argue that it is a mental act, some that it is a “hybrid” of a mental act plus behaviour that signifies that act; others argue that consent is a performative, akin to promising or commanding. Here it is argued that all these views are mistaken—though some more so than others. We begin with the question whether a normatively efficacious act of consent can be completed in the mind alone. Standard (...) objections to this “mentalist” account of consent can be rebutted. Here we identify a much deeper problem for mentalism. Normatively transformative acts of consent change others’ reasons for acting in a distinctive—“robust”—way. Robust reason-changing involves acts aimed at fulfilling a distinctive kind of reflexive and recognition-directed intention. Such acts cannot be coherently performed in the mind alone. Consent is not a mental act, but nor is it the signification of such an act. Acts of consent cannot be “completed” in the mind, and it is a mistake to view consent behaviour as making known a completed act of consent. The robust reason-changing account of consent developed here shares something with the performative theory, but is not saddled with a label whose home is philosophy of language. Certain kinds of performative utterance may change reasons robustly, but not all robust reason-changing involves or requires acts of speech, and consent can be effected by a wide range of behavioural acts. (shrink)

The Fine-Tuning Argument (FTA) is a variant of the Design Argument for the existence of God. In this paper the evidence of fine-tuning is explained and the Fine-Tuning Design Argument for God is presented. Then two objections are covered. The first objection is that fine-tuning can be explained in terms of the existence of multiple universes (the 'multiverse') plus the operation of the anthropic principle. The second objection is the 'normalizability problem'– the objection that the Fine-Tuning Argument fails because fine-tuning (...) is not actually improbable. (shrink)

Recent discoveries in physics, cosmology and biochemistry have captured the public imagination and made the Design Argument - the theory that God created the world according to a specific plan - the object of renewed scientific and philosophical interest. This accessible but serious introduction to the design problem brings together new perspectives from prominent scientists and philosophers including Paul Davies, Richard Swinburne, Sir Martin Rees, Michael Behe, Elliot Sober and Peter van Inwagen.

The discovery that the universe is fine-tuned for life ? a discovery to which the phrase ?the anthropic principle? is often applied ? has prompted much extra-cosmic speculation by philosophers, theologians, and theoretical physicists. Such speculation is referred to as extra-cosmic because an inference is made to the existence either of one unobservable entity that is distinct from the cosmos and any of its parts (God) or of many such entities (multiple universes). In this article a case is mounted for (...) the sceptical position that cosmic fine-tuning does not support an inference to anything extra-cosmic. To that end three definitions of ?fine-tuned for life? are proposed: the ?slight difference? definition, the (unconditional) probability definition, and John Leslie?s conditional probability definition. These three definitions are the only ones suggested by the relevant literature on fine-tuning and the anthropic principle. Since on none of them do claims of fine-tuning warrant an inference to something extracosmic, it is concluded that there is no definition of ?fine-tuned for life? serving this function. (shrink)

The multiverse hypothesis is one of the leading proposed explanations of cosmic fine-tuning for life. One common objection to the multiverse hypothesis is that, even if it were true, it would not explain why this universe, our universe, is fine-tuned for life. To think it would so explain is allegedly to commit “the inverse gambler's fallacy.” This paper presents what the inverse gambler's fallacy is supposed to be, then surveys the discussion of it in the philosophical literature of the last (...) 35 years. (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)

There is empirical evidence that many patients want information about treatment options even though they do not want to take a full part in decision-making about treatment. Such evidence may have considerable ethical implications but is methodologically problematic. It is argued here that, in fact, it is not at all surprising that patients' informational interests should be separable from their interests in decision-making. A number of different reasons for wanting information are offered, some to do with the content of information; (...) some with the process, others with the fact or occasion of informing. This philosophical clarification leads to some suggestions for further empirical study. (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)

The idea of individual responsibility for action is central to our conception of what it is to be a person. Behavioural genetic research may seem to call into question the idea of individual responsibility with possible implications for the criminal justice system. These implications will depend on the understandings of the various agencies and professional groups involved in responding to violent and anti-social behaviour, and, the result of negotiations between them over resulting practice. The paper considers two kinds of approaches (...) to the question of responsibility and ‘criminal genes’ arising from a sociological and philosophical perspective respectively. One is to consider the social context and possible practical implications of research into ‘criminal genes’ which will later be examined through interviews and discussions with a range of experts including lawyers and social workers. A second and different kind of approach is to ask whether the findings of behavioural genetics ought to have implications for attributions of responsibility. Issues of genetic influence are central to both approaches. (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)

If you have taken a college biology class, or just watched Animal Planet, you may have been struck by the startling complexity of living organisms. From the grandest mammal to the lowliest cell, life displays intricacy and structure that would put a high-paid team of engineers to shame. How could such fantastically organized, complex structures arise blindly out of unintelligent matter? Speaking of matter, why is it the way it is? Though unimaginably vast, our universe has precise features, as does (...) the matter in it. A glance at the inside back cover of a college physics textbook shows that there are extremely precise numbers describing the fundamental properties of matter. These include numbers for the speed of light in a vacuum, for the masses of fundamental particles like the electron, proton, and neutron, and for the strengths of forces like gravity and electromagnetism that act on those particles. These numbers seem utterly arbitrary. For all we know, they could have been completely different. Yet they turn out to be exactly what a universe needs in order for complex life to emerge in it. Likewise, the cosmology section of an astronomy course will teach you that there are very precise values for the temperature of the universe, for how much matter there is per cubic centimeter in the universe, for the rate at which the universe is expanding, and so on. How did those numbers get to be what they are? Were they just magically pulled out of a cosmic hat at the Big Bang? (shrink)

The design argument for the existence of God is often criticized for resting on anthropocentrism. Some critics maintain that anthropocentrism explains the origin of the design argument. Such critics commit the genetic fallacy. Others say anthropocentrism explains the appeal of the belief that human beings are ends especially worthy of creation. They fail to appreciate that the design argument need not be framed in terms of the fitness of the universe for humanity. Lastly, some say the design argument requires a (...) picture of value according to which it was true, prior to the coming-into-being of the universe, that our sort of universe is worthy of creation. Such a picture, they say, is mistaken, though our attraction to it can be explained in terms of anthropocentrism. This is a serious criticism. To respond to it, proponents of the design argument must either defend an objectivist conception of value or, if not, provide some independent reason for thinking an intelligent designer is likely to create our sort of universe. (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)

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)

Philosophers, especially in recent years, have engaged in reflection upon the nature of experience. Such reflections have led them to draw a distinction between conscious and unconscious mentality in terms of whether or not it is like something to have a mental state. Reflection upon the history of psychology and upon contemporary cognitive science, however, identifies the distinction between conscious and unconscious mental states to be primarily one which is drawn in epistemic terms. Consciousness is an epistemic notion marking the (...) special kind of first-person knowledge we have of our own mental states. Psychologists have found it expedient, for explanatory reasons, to ignore or reject the assumption that we have exhaustive first-person knowledge of our mental states and, in doing so, use the term ‘unconscious’ to indicate the peculiar epistemic status of certain mental states.It is argued that epistemic consciousness is distinct from the subjective-experiential notion of consciousness, from ‘access-consciousness’ and from higher-order thought conceptions of mental state consciousness, and that epistemic consciousness has an important role to play in philosophy of mind and in the history of psychology.Author Keywords: Consciousness; Unconscious mental states; Self-knowledge; History of psychology; Freud; Chomsky. (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)

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)

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)

Onora O’Neill is one of the foremost moral philosophers writing today. Her work on ethics and bioethics, political philosophy and the philosophy of Kant is extremely influential. Her landmark Reith Lectures on trust did much to establish the subject not only on the philosophical and political agenda but in the world of media, business and law more widely. Reading Onora O’Neill is the first book to examine and critically appraise the work of this important thinker. It includes specially commissioned chapters (...) by leading international philosophers in ethics, Kantian philosophy and political philosophy. The following aspects of O’Neill’s work are examined: global justice Kant the ethics of the family bioethics consent trust. Featuring a substantial reply to her critics at the end of the book, Reading Onora O’Neill is essential reading for students and scholars of ethics and political philosophy. (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)

Nonanthropocentric environmental philosophy is a response to two kinds of anthropocentrism: personal anthropocentrism, according to which being human involves the possession of some or all of a set of properties typical of persons, and biological anthropocentrism, according to which being a human involves being a member of the species Homo sapiens. Nonanthropocentric environmental philosophy itself becomes problematic when it is viewed in terms of two arguments that it often seems to imply: the “Planetary Perspective Argument,” which rejects both forms of (...) anthropocentrism and seeks to maximize good outcomes and minimize bad outcomes in terms of life’s point of view, the land’s point of view, or the global ecosystem’s point of view, and the “Cosmic Perspective Argument,” which is structurally analagous to the planetary perspective argument but has much more sweeping empirical premises driven by recent work in cosmology, astrobiology, and exoplanet science. The ultimate problem for environmental philosophers is to find a way to remain nonanthropocentric without succumbing to the indifference of the cosmic perspective. (shrink)

This volume addresses the role value judgments play in science. It is my contention that a particular research programme in modern physical cosmology rests crucially on a value judgment. Before making my case, let me introduce the following abbreviations for the following propositions.

In this paper I state and reject two of the most commonly given arguments for regulating access by insurance companies to the results of genetic tests. I then argue that since we cannot assume a priori that those genetically predisposed to disease will have worse health outcomes than those not so disposed, we cannot know a priori that genetic discrimination will emerge as a major problem in a free market health insurance system. Finally, I explore the possibility of a free-market (...) solution to the problem of genetic discrimination:genetic insurance. (shrink)

In this book Niall Shanks aims to debunk thoroughly “intelligent design theory” (henceforth IDT). The aim of proponents of IDT, Shanks warns us (p. xi), “is to insinuate into public consciousness a new version of science – supernatural science – in which the God of Christianity (carefully not directly mentioned for legal and political reasons) is portrayed as the intelligent designer of the universe and its contents.” He thinks the answer to the two basic questions about IDT – “Is intelligent (...) design theory a scientific theory? Is there any credible evidence to support its claims?” (p. xii) – is an emphatic “no.” Such a response, Shanks thinks, is urgent, because IDT is just the thin edge of a wedge; “at the fat end of the wedge lurks the specter of a fundamentalist Christian theocracy” (p. xii). (shrink)