University of Utrecht, Department of Philosophy, Heidelberglaan 6, 3584 CS Utrecht, The Netherlands. Tel.: +31 30 253 28 74, Email: Thomas.Nys{at}phil.uu.nl ' + u + '@' + d + ' '//-->Measures in public health care seem vulnerable to charges of paternalism: their aim is to protect, restore, or promote people's health, but the public character of these measures seems to leave insufficient room for respect for individual autonomy. This paper wants to explore three challenges to these charges: Measures in PHC (...) are aimed to protect, restore or promote ‘deep autonomy’, Measures in PHC are directed at the public and, as such, they do show respect for autonomy, and Some measures in PHC can be justified on grounds of justice and need not be defended as cases of ‘justified paternalism’. Although charges of unjustified paternalism in PHC might still be relevant, we should at least face these different challenges. CiteULike Connotea Del.icio.us What's this? (shrink)

One of the most pervasive criticisms of nudges has been the claim that they violate, undermine or decrease people’s autonomy. This claim, however, is seldom backed up by an explicit and detailed conception of autonomy. In this paper, we aim to do three things. First, we want to clear up some conceptual confusion by distinguishing the different conceptions used by Cass Sunstein and his critics in order to get clear on how they conceive of autonomy. Second, we want to add (...) to the existing discussion by distinguishing between ‘autonomy’ as the ability to set your own ends and ‘autocracy’ as the ability to actually realize those ends. This will allow for a more careful ethical evaluation of specific nudge interventions. Third, we will introduce the idea of ‘perimeters of autonomy’ in an attempt to provide a realistic account of personal autonomy and we will argue that it can alleviate most of the worries about nudging being autonomy-undermining. (shrink)

This article seeks to explore and analyze the relationship between autonomy and trust, and to show how these findings could be relevant to medical ethics. First, I will argue that the way in which so-called “relational autonomy theories” tie the notions of autonomy and trust together is not entirely satisfying Then, I will introduce the so-called Encapsulated Interest Account as developed by Russell Hardin. This will bring out the importance of the reasons for trust. What good reasons do we have (...) for trusting someone? I will criticize Hardin’s business model as insufficiently robust, especially in the context of health care, and then turn to another source of trust, namely, love. It may seem that trust-through-love is much better suited for the vulnerability that is often involved in health care, but I will also show that it has its own deficiencies. Good health care should therefore pay attention to both models of trust, and I will offer some tentative remarks on how to do this. (shrink)

As a response to Gooskens’ article , this paper offers some further comments on the ethics of violent or immoral video games. After arguing that the appeal of such games actually presupposes an awareness of moral transgression, it considers the desensitization thesis, the argument from catharsis, and the relevance of human flourishing.Although this brief analysis does not provide any clear-cut answer to the question of whether or not such games ought to be frowned upon, it does reveal some possible sources (...) of discomfort. (shrink)

The secret ballot is considered a central feature of free and fair elections all over the world. While the reasons to uphold it seem to be overwhelming, we argue that the secret ballot is only second-best at best and that a modified version of open voting might prove to be more democratic. Instead of denying the various problems and difficulties that an open system might encounter, we want to offer a genuine proposal that can avoid these numerous pitfalls. After rehearsing (...) the various arguments pro and contra open voting, we draw attention to the role of shame, which has been neglected by both sides in the debate. While shame plays a pivotal role in the democratic argument pro open voting, it also brings out new problems that tell against opening up the vote. This means that, if we want to draw on the democratic potential of open voting, we will have to find a system that minimizes the undesirable effects of shame. In the third and final section, we will formulate a concrete proposal of open voting that we believe is more democratic than the current secret ballot and is able to avoid potential worries. Even if this proves to be highly speculative, it serves as an invitation for further empirical research. (shrink)

This book offers a thorough reflection on the relationship between autonomy and paternalism, and argues that, from both theoretical and practical angles, the ...

We argue that contemporary psychiatry adopts a defensive strategy vis-à-vis various external sources of pressure. We will identify two of these sources – the plea for individual autonomy and the idea of Managed Care – and explain how they have promoted a strict biomedical conception of disease. The demand for objectivity, however, does not take into account the complexity of mental illness. It ignores that the psychiatrist’s profession is essentially characterized by fragility: fluctuating between scientific reduction and the irreducible complexity (...) of reality. Therefore, the psychiatrist is not in need of hard and fast rules, but of judgment. At the end, we suggest that philosophy could inject some healthy uncertainty within psychiatry in order to restore its fragile identity. Our examples are drawn from the Dutch situation but we are confident that they apply to other countries as well. (shrink)

In response to Ruud ter Meulen’s contribution, it is argued that, although the relationship between these concepts is both tight and complex, solidarity should be carefully distinguished from justice. Although ter Meulen wants to defend a normative conception of solidarity, the relation to its descriptive component is not always very clear. As a normative concept it should not collapse into that of justice; and as a descriptive notion it is obviously defective. In order to successfully navigate between these unhappy alternatives, (...) ter Meulen rightfully turns to critical theory. But then it is still not entirely clear how the normative considerations that ter Meulen wants to defend follow from this promising framework. (shrink)

According to Stephen Holland, the challenges I mention in my original paper can be met, so that, in a way, the problem of paternalism in public health care—which I intended to put into perspective by drawing out some possible justifications for it—returns in all its might and glory. But of course, as Holland observes, I never suggested that my challenges could never be met. I only wanted to point out that for each and every particular public health policy that should (...) come to our attention we should reflect upon these challenges and see whether they could provide reasons for justification. I believe that the discussion is often stalled because these measures—in the absence of individual consent and in their aim to benefit the public's ‘best interests’—seem to be paternalist by default. In my paper, I wanted to call this assumption into question, but never intended to prove that there is no such thing as unjustified paternalism in public health care. Nevertheless, Holland's criticism is very insightful and he has done a lot to clarify my position. However, he also puts me on the spot by urging me to argue to what extent I can meet his rebuttal, and I am very grateful for that opportunity. (shrink)

Why ought we concern ourselves with understanding a concept of evil? It is an elusive and politically charged concept which critics argue has no explanatory power and is a relic of a superstitious and primitive religious past. Yet its widespread use persists today: we find it invoked by politicians, judges, journalists, and many others to express the view that certain actions, persons, institutions, or ideologies are not just morally problematic but require a special signifier to mark them out from the (...) ordinary and commonplace. Therefore, the question of what a concept of evil could mean and how it fits into our moral vocabulary remains an important and pressing concern. The Routledge Handbook of the Philosophy of Evil provides an outstanding overview and exploration of these issues and more, bringing together an international team of scholars working on the concept of evil. Its 27 chapters cover the crucial discussions and arguments, both historical and contemporary, that are needed to properly understand the historical development and complexity of the concept of evil. The Handbook is divided into three parts: Historical explorations of evil Recent secular explorations of evil Evil and other issues. The Routledge Handbook of the Philosophy of Evil is essential reading for students and researchers in the fields of ethics and philosophy of psychology. It also provides important insights and background for anyone exploring the concept of evil in related subjects such as literature, politics, and religion. (shrink)

Inleiding tot het gedachtegoed van de Amerikaanse filosoof.

This article focuses on the difficult issue of what exactly goes on when an individual tolerates something. It focuses on the problem of why an individual would ever choose to allow for some practice that he deerns unacceptable while having the power to do something about it. After distinguishing between different attitudes (tolerant as well as intolerant), this article argues that individuals can have various reasons for deciding to tolerate what they deern wrong. As such, we defend a broad conception (...) of tolerance, which goes against the grain of recent literature in which tolerance is generally understood as a virtue. (shrink)

In this paper I argue that Isaiah Berlin’s theory of freedom should not be interpreted in a reductive sense. The distinction between negative and positive freedom, as different concepts and possibly conflicting values, truly holds. Moreover, Berlin’s theory as a whole leaves room for both a comprehensive liberalism which advocates autonomy, critical reflection and personal judgement, as well as a liberalism of fear which defends a minimal level of decency and modesty aims at a modus vivendi. I think Berlin’s liberalism (...) is one of hope and fear. (shrink)

In the early 1970s Harry Frankfurt argued that so-called 'coercive threats' cause a violation of their victim's autonomy, thereby excluding him from moral responsibility. A person is therefore not responsible for doing what he is forced to do. Although this seems correct on an intuitive level, I will use Frankfurt's later vocabulary of 'care' and 'love' in order to show that threats essentially involve an abuse of a person's autonomy instead of an infringement or violation thereof. Still, if we want (...) to understand the sense of reluctance that is involved in acting under threat, as well as the sense of responsibility that befalls both the victim as well as the perpetrator, then we have to move beyond the Frankfurtian framework. (shrink)

In this paper I will argue that Mill employs a tacit concept of competence in On Liberty. I will focus on the role of truth and individuality in On Liberty. Competence is a precondition for individuality, and as such, it is a threshold concept: those above the threshold are sensitive to rational argument and should be free to pursue happiness in their own way (because they are guided by the truth), whereas those who fail to meet this threshold should be (...) educated and paternalistically be kept out of harm's way until they are able to find the truth for and by themselves. (edited). (shrink)

This article focuses on the difficult issue of what exactly goes on when an individual tolerates something. It focuses on the problem of why an individual would ever choose to allow for some practice that he deerns unacceptable while having the power to do something about it. After distinguishing between different attitudes , this article argues that individuals can have various reasons for deciding to tolerate what they deern wrong. As such, we defend a broad conception of tolerance, which goes (...) against the grain of recent literature in which tolerance is generally understood as a virtue. (shrink)

Apocalypse, notre amour. An essayThe apocalypse entails the idea of a final judgment. Thinking about the apocalypse then invites us to consider the question of mankind’s goodness. With Immanuel Kant, I will argue, that such reflection warrants a deep pessimism. Humankind falters in light of the moral standard. Yet, such pessimism leaves room for a political optimism in which impartiality and reciprocity are key elements. Even if moral goodness is nigh-impossible to achieve, we can and should strive for minimal decency. (...) Also, I will claim that those who have reason to doubt Kant’s rationalist and metaphysical foundations for such a modest political program, still have reason to endorse a similar political liberalism. We will need confidence in this endeavor to respond to a growing relativism, possibly foreshadowing an Other Apocalypse in which all judgment is judged to be wrong. (shrink)

The aim of this article is to compare the theories of Isaiah Berlin and Charles Taylor with regard to the topic of freedom. I will argue that Berlin’s famous positive-negative distinction still serves an important purpose by maintaining a crucial tension within the concept of liberty. This tension allows ethical pluralism to be taken seriously instead of being covered up by ideological retorics. Berlin held that the implementation of positive liberty – defining the boundaries of true liberty – is always (...) problematic. Taylor, however, tries to by-pass the gap between negative and positive liberty by means of his concept of authenticity. I will argue that this notion is a sound descriptive term for an individual’s entrenchment in community, but that the normative appeal from authenticity amounts to a project of ‘re-sourcing the self’ which is ultimately rooted in an optimist perspective on pluralism and multiculturalism. However, to the extent that there are indeed different communities with different values and different ways of being authentic, it is worthwhile to repeat the Berlinian Grundgedanke that human beings should cope with the inexorable and irreducible tragedy in moral life. (shrink)