Epistemic paternalism is the thesis that a paternalistic interference with an individual's inquiry is justified when it is likely to bring about an epistemic improvement in her. In this article I claim that in order to motivate epistemic paternalism we must first account for the value of epistemic improvements. I propose that the epistemic paternalist has two options: either epistemic improvements are valuable because they contribute to wellbeing, or they are epistemically valuable. I will argue that these options constitute the (...) foundations of a dilemma: either epistemic paternalism collapses into general paternalism, or a distinctive project of justified epistemic paternalism is implausible. (shrink)

Medical practitioners are duty-bound to tell their patients the truth about their medical conditions, along with the risks and benefits of proposed treatments. Some patients, however, would rather not receive medical information. A recent response to this tension has been to argue that that the disclosure of medical information is not optional. As such, patients do not have permission to refuse medical information. In this paper I argue that, depending on the context, the disclosure of medical information can undermine the (...) patient’s ability to exercise her autonomy or have therapeutically detrimental effects. In the light of these insights I go on to develop a context-sensitive approach to medical disclosure. The advantage of this account is that it addresses concerns on both sides of the debate; whilst it acknowledges that patients do not have an exercisable ‘right not to know,’ it allows that in some cases medical information ought to be withheld. (shrink)

In this paper, I argue that a definition of paternalism must meet certain methodological constraints. Given the failings of descriptivist and normatively charged definitions of paternalism, I argue that we have good reason to pursue a normatively neutral definition. Archard's 1990 definition is one such account. It is for this reason that I return to Archard's account with a critical eye. I argue that Archard's account is extensionally inadequate, failing to capture some cases which are clear instances of paternalism. I (...) refine each of his three conditions, ultimately providing an improved definition of paternalistic interference. This revised definition meets specific methodological constraints, offering a definition that is both neutral between anti- and pro-paternalistic intuitions, but that also explains why paternalism is normatively significant. Specifically, this definition captures the conflict between interfering with an individual's choices and treating the individual benevolently, without making paternalism permissible or impermissible by definition. (shrink)

In medical practice, the doctrine of informed consent is generally understood to have priority over the medical practitioner’s duty of care to her patient. A common consequentialist argument for the prioritisation of informed consent above the duty of care involves the claim that respect for a patient’s free choice is the best way of protecting that patient’s best interests; since the patient has a special expertise over her values and preferences regarding non-medical goods she is ideally placed to make a (...) decision that will protect her interests. In this paper I argue against two consequentialist justifications for a blanket prioritisation of informed consent over the duty of care by considering cases in which patients have imperfect access to their overall best interests. Furthermore, I argue that there are cases where the mere presentation of choice under the doctrine of informed consent is detrimental to patient best interests. I end the paper by considering more nuanced approaches to resolving the conflict between informed consent and the duty of care and consider the option of permitting patients to waive informed consent. (shrink)

A governing principle in medical ethics is respect for patient autonomy. This principle is commonly drawn upon in order to argue for the permissibility of assisted dying. In this paper I explore the proper role that respect for patient autonomy should play in this context. I argue that the role of autonomy is not to identify a patient’s best interests, but instead to act as a side-constraint on action. The surprising conclusion of the paper is that whether or not it (...) is in the best interests for the patient to die is a morally objective matter. This allows for the possibility that it can be in the best interests of the patient to die even if she autonomously considers it to be in her best interest to continue living. I argue that concerns about ‘mandatory’ euthanasia can be met when patient autonomy is respected as a side-constraint on action. Ultimately, this means that assisted dying is permissible, not because the autonomous patient views her suffering to be unbearable, but because it is in her objective best interests and she permitted it via her consent. (shrink)

On the 13th June 2014, the Centre for the Humanities and Health (CHH) at King’s College London hosted a one-day workshop on ‘Parentalism and Trust.’ This workshop was the sixth in a series of workshops whose aim is to provide a new model for high-quality open interdisciplinary engagement between medical professionals and philosophers. The term ‘Parentalism’ rather than paternalism is chosen and used throughout because of some of the derisory and unfortunate gender connotations associated with paternalism (and/or its counterpart ‘maternalism’). (...) Medical Parentalism is the position that unwanted interference with a patient’s choices and actions in order to protect and promote her best interests is morally justified. Whilst there are many problems with its justification and implementation, the workshop addressed how such interference depends on a trusting relationship between the doctor and patient, and the extent to which parentalist interferences might undermine this trust. (shrink)

On 27 September 2013, the Centre for the Humanities and Health (CHH) at King's College London hosted a 1-day workshop on ‘Medical knowledge, Medical Duties’. This workshop was the fifth in a series of five workshops whose aim is to provide a new model for high-quality, open interdisciplinary engagement between medical professionals and philosophers. This report identifies the key points of discussion raised throughout the day and the methodology employed.

Neil Manson and Onora O’Neill have recently defended an original theory of informed consent in their book Rethinking Informed Consent in Bioethics (2007). The development of their ‘waiver’ model is premised on the failings of the theory of informed consent as disclosure, which is rejected on two counts: firstly, the disclosure model’s implicit reliance upon a ‘conduit-container’ model of communication means that the regulatory requirements of informed consent can rarely be achieved; secondly, the model’s purported ethical justification via a principle (...) of respect for patient autonomy is presented as being vacuous. Despite having laudable motivations for rethinking informed consent, I argue that their theory of informed consent as waiver can be criticised on similar grounds. In order to support this thesis I object that Manson and O’Neill’s developed theory of agential communication is too intricate to easily meet the demands of informed consent as waiver. Secondly, I show that the model appears to be implicitly reliant upon a principle of respect for patient autonomy. Hence, despite improving upon the doctrine of informed consent, the waiver model needs further elucidation in order to avoid the problems mounted against the disclosure model. (shrink)

The acquisition of fully informed consent presents a central ethical problem for the procurement and storage of human tissue in biobanks. The tension lies between the apparent necessity of obtaining informed consent from potential research subjects and the projected future use of the tissue. Specifically, under the doctrine of informed consent medical researchers are required to inform their potential research subjects about the relevant risks and purposes of the proposed research (Declaration of Helsinki, 2008, “Section 24.” Accessed November 1, 2009. (...) http://www.wma.net/en/30publications/10policies/b3/index.html). However, because human tissue – when stored in biobanks – can be put to multifarious uses, the information that medical researchers are expected to divulge to their subjects is epistemologically inaccessible. Biobank researchers are thus thought to be unable to obtain informed consent from their subjects, making the practice ethically suspicious. We propose that such suspicions of ethical failure should be reconsidered by presenting two possible solutions. Firstly we argue that the epistemological difficulty might be partially solved by adopting the “waiver model” of informed consent. Secondly, we put forward an argument that individual consent can be supplemented by group ethical models. We thus conclude that while informed consent is problematic for biobank researchers, alternative ethical solutions are available. (shrink)

Starting with service robotics and industrial robotics, this paper aims to suggest philosophical reflections about the relationship between body and machine, between man and technology in our contemporary world. From the massive use of the cell phone to the robots which apparently “feel” and show emotions like humans do. From the wearable exoskeleton to the prototype reproducing the artificial sense of touch, technological progress explodes to the extent of embodying itself in our nakedness. Robotics, indeed, is inspired by biology in (...) order to develop a new kind of technology affecting human life. This is a bio-robotic approach, which is fulfilled in the figure of the cyborg and consequently in the loss of human nature. Today, humans have reached the possibility to modify and create their own body following their personal desires. But what is the limit of this achievement? For this reason, we all must question ourselves whether we have or whether we are a body. (shrink)

Promoting the use of contact tracing technology will be an important step in global recovery from the COVID-19 pandemic. Across two studies, we assessed two messaging strategies as motivators of intended contact tracing uptake. In one sample of 1117 Australian adults and one sample of 888 American adults, we examined autonomy-supportive and controlling message framing and the presence or absence of information safety as predictors of intended contact tracing application uptake, using an online randomized 2 × 2 experimental design. The (...) results suggested that the provision of data safety assurances may be key in affecting people’s intentions to use contact tracing technology, an effect we found in both samples regardless of whether messages were framed as autonomy-supportive or controlling. Those in high information safety conditions consistently reported higher intended uptake and more positive perceptions of the application than those in low information safety conditions. In Study 2, we also found that perceptions of government legitimacy related positively to intended application uptake, as did political affiliation. In sum, individuals appeared more willing to assent to authority regarding contact tracing insofar as their data safety can be assured. Yet, public messaging strategies alone may be insufficient to initiate intentions to change behavior, even in these unprecedented circumstances. (shrink)

In Searle’s social ontology, collective intentionality is an essential component of all institutional facts. This is because the latter involve the assignment of functions, namely "status functions," on entities whose physical features do not guarantee their performance, therefore requiring our acceptance that it be performed. One counter-example to that claim can be found in Carl Menger’s individualistic account of the money system. Menger’s commitment to the self-interest assumption, however, prevents him from accounting for the deontic dimensions of institutional facts.

This chapter contains sections titled: Note.

William James is known as a nineteenth-century philosopher, psychologist, and psychical researcher. Less well-known are the medical fixations that united his multiple identities and drove his ambition to change the way American society conceived of itself in body, mind, and soul. William James, M.D. offers an account of the development and cultural significance of James's ideas and works, and establishes, for the first time, the relevance of medical themes to his major lines of thought. James lived at a time when (...) old assumptions about faith and the moral and religious possibilities for human worth and redemption were increasingly displaced by a concern with the medically "normal" and the perfectibility of the body. Woven into treatises warning of the degeneration of humanity, these ideas comprised the origins of the eugenics movement and were manifest in a growing social stigma attached to illness and invalidism, a disturbing intellectual current in which James felt personally implicated. Most chronicles of James's life have portrayed a distressed young man, a psychological or spiritual crisis, followed by the emergence of a mature thinker who threw off his pallor of mental sickness for good. In contrast, Emma Sutton draws on his personal correspondence, unpublished notebooks, and diaries to show that James considered himself a genuine invalid to the end of his days. Sutton makes the compelling case that his philosophizing was not an abstract occupation but an impassioned response to his own life experiences and challenges. To ignore the medical James is to misread James altogether. Sales points: First book to map William James's preoccupation with medical ideas, concerns, and values across the disciplinary breadth of his work Reveals how themes of invalidism, health, and healing underpinned the genesis of many of James's major philosophical, psychological, and political ideas Draws on the approximately 9,400 items of Jamesian correspondence, together with his private notes and reading lists. (shrink)

When we accept oppression of some, we feed the oppression of others, and we make space for domination driven by false ideas of inferiority and lesser worth. When we discount the inherent preciousness of animals who think and feel, we erase precious parts of ourselves. When we consider living beings as "livestock," it's no wonder we pillage the unthinking yet irreplaceable living earth. Sub-Human is a robustly researched, sharply critical yet comfortingly human call to arms, diving deeply into the theory (...) behind oppression, liberation, and the intersections within it. Exploring the history of animal consumption and commodification, this book deconstructs the current sociopolitical climate surrounding animal enterprises by looking at how we got here. Most importantly, it unravels how we can work towards a collectively liberated world. (shrink)

Scientists, philosophers, and policymakers disagree about how to define microaggression. Here, we offer a taxonomy of existing definitions, clustering around (a) the psychological motives of perpetrators, (b) the experience of victims, and (c) the functional role of microaggression in oppressive social structures. We consider conceptual and epistemic challenges to each and suggest that progress may come from developing novel hybrid accounts of microaggression, combining empirically tractable features with sensitivity to the testimony of victims.

This paper examines the concept of medical necessity as it relates to mental health care rationing, arguing that the normal functioning model of medical necessity is insufficient because it fails to cohere with an important aim and function of mental health care, which is to provide support for individuals in abusive or otherwise difficult personal relationships.

A nonfiction, alphabet picture book that introduces young readers to New Age/mystical concepts.

EPUB and EPDF available Open Access under CC-BY-NC-ND licence. We tend to hold people responsible for their choices, but not for what they can’t control: their nature, genes or biological makeup. This thought-provoking collection redefines the boundaries of moral responsibility. It shows how epigenetics reveals connections between our genetic make-up and our environment. The essays challenge established notions of human nature and the nature/nurture divide and suggest a shift in focus from individual to collective responsibility. Uncovering the links between our (...) genetic makeup, environment and experiences, this is an important contribution to ongoing debates on ethics, genetics and responsibility. (shrink)

Environmental epigenetics is increasingly employed to understand the health outcomes of communities who have experienced historical trauma and structural violence. Epigenetics provides a way to think about traumatic events and sustained deprivation as biological “exposures” that contribute to ill-health across generations. In Australia, some Indigenous researchers and clinicians are embracing epigenetic science as a framework for theorising the slow violence of colonialism as it plays out in intergenerational legacies of trauma and illness. However, there is dispute, contention, and caution as (...) well as enthusiasm among these research communities.In this article, we trace strategies of “refusal” (Simpson, 2014) in response to epigenetics in Indigenous contexts. Drawing on ethnographic fieldwork conducted in Australia with researchers and clinicians in Indigenous health, we explore how some construct epigenetics as useless knowledge and a distraction from implementing anti-colonial change, rather than a tool with which to enact change. Secondly, we explore how epigenetics narrows definitions of colonial harm through the optic of molecular trauma, reproducing conditions in which Indigenous people are made intelligible through a lens of “damaged” bodies. Faced with these two concerns, many turn away from epigenetics altogether, refusing its novelty and supposed benefit for Indigenous health equity and resisting the pull of postgenomics. (shrink)

In Utopophobia: On the Limits (If Any) of Political Philosophy, David Estlund defends against utopophobia in political philosophy. Estlund claims that it is no defect in a theory of justice if it sets a high standard that has little chance of being achieved by any society. The book does not, however, give similar permission to argue for unrealistically optimistic political proposals. Going beyond Estlund, I consider the possibility that some utopian thinking is warranted not just in the context of formulating (...) a theory of justice, but in the practical context, too. Sometimes theorizers ought to argue for and pursue political proposals that seem unrealistically optimistic. (shrink)

Microaggressions are seemingly negligible slights that can cause significant damage to frequently targeted members of marginalized groups. Recently, Scott O. Lilienfeld challenged a key platform of the microaggression research project: what’s aggressive about microaggressions? To answer this challenge, Derald Wing Sue, the psychologist who has spearheaded the research on microaggressions, needs to theorize a spectrum of aggression that ranges from intentional assault to unintentional microaggressions. I suggest turning to Bonnie Mann’s “Creepers, Flirts, Heroes and Allies” for inspiration. Building from Mann’s (...) richer theoretical framework will allow Sue to answer Lilienfeld’s objection and defend the legitimacy of the concept, ‘microaggression’. (shrink)

In this article, we aim to map out the complexities which characterise debates about the ethics of vaccine distribution, particularly those surrounding the distribution of the COVID-19 vaccine. In doing so, we distinguish three general principles which might be used to distribute goods and two ambiguities in how one might wish to spell them out. We then argue that we can understand actual debates around the COVID-19 vaccine – including those over prioritising vaccinating the most vulnerable – as reflecting disagreements (...) over these principles. Finally, we shift our attention away from traditional discussions of distributive justice, highlighting the importance of concerns about risk imposition, special duties, and social roles in explaining debates over the COVID-19 vaccine. We conclude that the normative complexity this article highlights deepens the need for decision-making bodies to be sensitive to public input. (shrink)