A virtual reality translation of Robert Nozick's "Experience Machine" thought experiment from his "Anarchy, State, and Utopia" (1974). These modules are free to download and use in the classroom and for research/x-phi purposes. NPCs are randomized for gender during startup of each run. *Requires an Oculus Rift or HTC Vive and VR capable computer. To open the files, uncompress the downloaded .zip folder and run the executable (.exe) file. -/- V1.2 Fixed missing projector video footage during experience machine sales pitch.

Longtermists have argued that humanity should significantly increase its efforts to prevent catastrophes like nuclear wars, pandemics, and AI disasters. But one prominent longtermist argument overshoots this conclusion: the argument also implies that humanity should reduce the risk of existential catastrophe even at extreme cost to the present generation. This overshoot means that democratic governments cannot use the longtermist argument to guide their catastrophe policy. In this paper, we show that the case for preventing catastrophe does not depend on longtermism. (...) Standard cost-benefit analysis implies that governments should spend much more on reducing catastrophic risk. We argue that a government catastrophe policy guided by cost-benefit analysis should be the goal of longtermists in the political sphere. This policy would be democratically acceptable, and it would reduce existential risk by almost as much as a strong longtermist policy. (shrink)

(1991). Everything is what it is. Inquiry: Vol. 34, No. 4, pp. 525-538.

ABSTRACT The paper is a discussion of moral responsibility and excuses in regard to psychiatric disorders involving abnormal desires (e.g. impulse control disorders such as kleptomania and pyromania, psychosexual disorders such as exhibitionism, obsessive‐compulsive disorder and others). It points out problems with previous approaches to the question of whether or not to excuse persons with these disorders, and offers a new approach based on the concept of duress. There is a discussion of duress in regard to non‐psychiatric cases based on (...) the core notion of duress involving a choice between undesirables, and the paper concludes with an argument that moral blame for individuals with these sorts of disorders should often be lessened and in some cases removed entirely. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Key Concepts: Criminal ResponsibilityCarl Elliott (bio)AbstractMentally disordered persons occasionally do things for which we would ordinarily blame or even punish a non-disordered person. We often do not blame mentally disordered persons for these actions, however, because we regard mental disorders, at least in some circumstances, as an excuse from moral responsibility. For moral philosophy and the law, the challenge is to understand the specific circumstances under which a (...) mental disorder should excuse an offender from responsibility for his or her actions. Because different types of psychopathology influence a person’s intentions and character in very different ways, judgments of responsibility crucially depend upon the specific nature of a mental disorder. They also depend on adequate understandings of concepts such as moral understanding, especially in the case of psychopathy, as well as an understanding of the reasons why mental disorders may excuse a person from responsibility.Keywordsintention, M’Naghten Rules, irresistible impulse, personality disorders, psychopathyThe mentally ill often do things for which they are not responsible. This has long been recognized, by both morality and the law. But just which mentally ill persons should be excused, and under what circumstances, is an altogether more complicated affair.In the Nicomachean Ethics, Aristotle distinguishes two types of involuntary actions, for which (by implication) a person might be excused from responsibility: those done in ignorance, and those that were compelled. Both excuses are variations on the theme of non-intention. If a person did not intend to act as he did—either because he did not know what he was doing, or because he could not help acting as he did—then he is not responsible for the action. Intention is also a key point for the law, which traditionally has said that for a crime to have been committed, it must be accompanied by evil intent, or mens rea (literally, “guilty mind.”)The problem comes in saying how these distinctions play out for the mentally ill offender. The most widely used standards for determining criminal (legal) responsibility are based on the M’Naghten Rules, which excuse a person from responsibility for an act if, as a result of a mental disorder, he did not know the nature and quality of the act, or did not know that the act was wrong. This standard works nicely for the paradigmatic cases of mentally ill offenders; it would excuse, for example, the person with paranoid schizophrenia who strikes out violently at a person he falsely believes is threatening his life. However, it is unclear on several other points, the most famous of which relates to Aristotle’s excusing condition of compulsion. How should we regard those people, for example, whose psychosis impairs their ability to control their behavior, or whose mental disorders involve the control of their unusual desires, such as kleptomania, pyromania, pedophilia and voyeurism? Many of the [End Page 305] latter such persons are aware of the nature and quality of what they desire to do, and they are aware that it is wrong, but they find great difficulty in resisting their desires.One well-known effort to remedy this deficiency was the “irresistible impulse” test, which excused those persons who as a result of their condition had acted on desires that were irresistible. Yet the difference between an irresistible desire and a desire not resisted has proven notoriously difficult to distinguish, in practice as well as in theory.Another chronic source of philosophical controversy is the question of responsibility for one’s character. In psychiatry, this debate surfaces most often with patients who have personality disorders. Ordinarily, since persons cannot control whether they incur a mental illness, they can be excused from responsibility for some actions they have taken while they were mentally ill. However, personality disorders are also (in some sense) beyond a person’s control, being the product of genetic inheritance and upbringing. This raises old issues of psychological determinism: if personality disorders are beyond a person’s control, is it just to hold that person responsible for the actions that result from them?On the other hand, even if personality disorders are within the proper domain of psychiatry, they are obviously quite different from... (shrink)

Since the publication of Listening to Prozac there have been many debates about how and why Prozac and other similar drugs are prescribed. The articles that follow take up debates about what conditions such drugs can and should address, questions about authenticity in using drugs for psychic well‐being, and concerns about what means we morally endorse in projects of self‐creation. The contributions from Carl Elliott, Peter Kramer, James Edwards, and David Healy derive from a project supported by the (...) Social Sciences and Humanities Research Council of Canada, “Enhancement Technologies and Human Identity.” Psychiatry, like the Prozac it prescribes, aims to enhance the patient's internal psychic well‐being. Yet what ails many may be not an internal state like depression or anxiety, but alienation. And the experts of the self to whom we turn cannot “cure” our collective form of life in which alienation takes root. (shrink)

In The Rules of Insanity, Carl Elliott draws on philosophy and psychiatry to develop a conceptual framework for judging the moral responsibility of mentally ill offenders. Arguing that there is little useful that can be said about the responsibility of mentally ill offenders in general, Elliott looks at specific mental illnesses in detail; among them schizophrenia, manic-depressive disorders, psychosexual disorders such as exhibitionism and voyeurism, personality disorders, and impulse control disorders such as kleptomania and pyromania. He takes (...) a particularly hard look at the psychopath or sociopath, who many have argued is incapable of understanding morality. Making extensive use of psychiatric case histories, Elliott explores the various ways in which mental illness can affect a person's intentions and thus excuse him or her from moral responsibility. (shrink)

Living related organ transplantation is morally problematic for two reasons. First, it requires surgeons to perform nontherapeutic, even dangerous procedures on healthy donors—and in the case of children, without their consent. Second, the transplant donor and recipient are often intimately related to each other, as parent and child, or as siblings. These relationships challenge our conventional models of medical decisionmaking. Is there anything morally problematic about a parent allowing the interests of one child to be risked for the sake of (...) another? What exactly are the interests of the prospective child donor whose sibling will die without an organ? Is the choice of a parent to take risks for the sake of her child truly free, or is the specter of coercion necessarily raised? (shrink)

First published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

Lowering compensation to research subjects to protect them from “undue inducement” is a misguided attempt to shoehorn a concern about exploitation into the framework of autonomy. We suggest that oversight bodies should be less concerned about undue influence than about exploitation of subjects. Avoiding exploitation in human subjects research requires not only increasing compensation, but enhancing the dignity of research participation.

Bioethics is now taken seriously. Is there a danger of its being taken in or taken over? Might it be influenced in other ways, less visible and less easily avoided? As private corporations and bioethicists build relationships with each other, bioethicists must ask themselves about the opportunities, the constraints, and the subtle shifts in attitude and focus that such ties might create.

Some people change dramatically over time, and often those changes result partly from what they have chosen to do for a living. Drawing on the work of Richard Sennett and Sandeep Jauhar, I explore how practicing in a market-driven medical system can corrupt the character of doctors.

The diagnosis of psychopathy is controversial largely because of two notions: first, that because of their defects, psychopaths cannot understand morality, and second, that these defects should thus excuse psychopaths from moral responsibility for their actions. However, it is not clear just what is involved in understanding morality. The argument that the psychopath is ignorant of morality in the same way that one might be ignorant of facts is difficult to sustain. However, a closer examination of the psychopath's peculiar deficiencies (...) reveals that the psychopath's understanding of morality might be impaired in other ways. Keywords: disease, ethics, philosophy, psychopathy, psychiatry, responsibility. (shrink)

Pharmaceutical companies have long focused their marketing strategies on getting doctors to write more prescriptions. But they lose billions in potential sales when patients do not take their prescribed drugs. Getting patients to “adhere” to drug therapies that have unpleasant side effects and questionable efficacy requires more than mere ad campaigns urging patients to talk to their doctors. It requires changing patients' beliefs and attitudes about their medications through repeated contact from people patients trust. Since patients do not trust drug (...) companies, these companies are delivering their marketing messages through nurses, pharmacists, and even other patients — leveraging patients' trust in these intermediaries to persuade them to consume more brand name drugs. Armed with the premise that better adherence improves patients' health, drug companies justify manipulating patients by reframing reasonable decisions to decline therapy as pathological, and promote brand loyalty in the guise of offering medical care. (shrink)

About a week after Maran Wolston was prescribed Copaxone, a drug for multiple sclerosis, she got a phone call from a nurse at an organization called Shared Solutions. The organization was familiar to Wolston; when her neurologist had asked permission to share her health information with Shared Solutions, Wolston had agreed, assuming it was connected to her health insurance.The nurse who called Wolston was checking in to see how the treatment was going. It was not going well. While Copaxone is (...) not typically associated with some of the unpleasant side effects of other MS drugs, it does have at least one serious drawback: the drug must be injected every day. The injections can be brutally painful. “No matter where I injected the drug each day, the injection site swelled up into a huge welt and felt like a gigantic bee sting,” Wolston writes. (shrink)

In a recent issue of The Lancet, the historian Roger Cooter predicted that the field of bioethics will soon die of self-inflicted wounds. “Conspiring against it,” he wrote, “is exposure of the funding of some of its US centres by pharmaceutical companies; exclusion of alternative perspectives from the social sciences; retention of narrow analytical notions of ethics in the face of popular expression and academic respect for the place of emotions; divisions within the discipline ; and collusion with, and appropriation (...) by, clinical medicine.” Cooter's prognosis? “Hardly wet behind the ears, bioethics seems destined for a short lifespan.”. (shrink)

_Slow Cures and Bad Philosophers_ uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to Wittgenstein’s concern with the thick context of moral problems, his suspicion of theory, and his belief in description as the real aim of philosophy. Their aim is (...) not to examine Wittgenstein’s personal moral convictions but rather to explore how a deep engagement with his work can illuminate some of the problems that medicine and biological science present. As Elliott explains in his introduction, Wittgenstein’s philosophy runs against the grain of most contemporary bioethics scholarship, which all too often ignores the context in which moral problems are situated and pays little attention to narrative, ethnography, and clinical case studies in rendering bioethical judgments. Such anonymous, impersonal, rule-writing directives in which health care workers are advised how to behave is what this volume intends to counteract. Instead, contributors stress the value of focusing on the concrete particulars of moral problems and write in the spirit of Wittgenstein’s belief that philosophy should be useful. Specific topics include the concept of “good dying,” the nature of clinical decision making, the treatment of neurologically damaged patients, the moral treatment of animals, and the challenges of moral particularism. Inspired by a philosopher who deplored “professional philosophy,” this work brings some startling insights and clarifications to contemporary ethical problems posed by the realities of modern medicine. _Contributors._ Larry Churchill, David DeGrazia, Cora Diamond, James Edwards, Carl Elliott, Grant Gillett, Paul Johnston, Margaret Olivia Little, James Lindemann Nelson, Knut Erik Tranoy. (shrink)

The psychopathic personality disorder historically has been thought to include an insensitivity to morality. Some have thought that the psychopath's insensitivity indicates that he does not understand morality, but the relationship between the psychopath's defects and moral understanding has been unclear. We attempt to clarify this relationship, first by arguing that moral understanding is incomplete without concern for morality, and second, by showing that the psychopath demonstrates defects in frontal lobe activity which indicate impaired attention and adaptation to environmental conditions (...) which are relevant to the formation of complex intentions. We argue that these frontal lobe defects can help to explain both the psychopath's apparent insensitivity to morality and his characteristic imprudence. (shrink)

In September 2006, a small start-up company in Cambridge, MA called Sermo, Inc., launched a social networking site with an unusual twist: only physicians practicing medicine in the United States would be allowed to participate. Sermo, which means “conversation” in Latin, marketed its website as an online community exclusively for doctors that would allow them to talk openly about a range of topics, from challenging and unusual medical cases to the relative merits of one treatment versus another. “Sermo enables the (...) private and instant exchange of knowledge among MDs,” the company announced in its first press release. Even better, participation was free and the site carried no advertising. (shrink)

Libertarians often portray the decision to use enhancement technologies purely as a matter of individual choice, affecting the person who uses them but no one else. Yet individual choices often add up to large social changes that profoundly affect the lives of other people, effectively pushing individual choices in a particular direction. It seems plausible that self-reinforcing loops such as those that have driven the adoption of technologies like cars and air-conditioners might also play a role in the adoption of (...) enhancement technologies, effectively exerting pressure on people to use a technology that they might otherwise resist. (shrink)

The practical difficulty with applying ethical theories to particular problems is that ordinarily people pay little attention to theories when they make moral decisions. Instead, we are guided by our ethical beliefs, which are primarily the result of cultural factors beyond our reach—factors subject to rational scrutiny and to change, but largely out of our control.

The ethical experience and lessons of China’s and the world's response to COVID-19 will be debated for many years to come. But one feature of the Chinese authoritarian response that should not be overlooked is its practice of silencing and humiliating the whistle-blowers who told the truth about the epidemic. In this article, we document the humiliation of Dr Li Wenliang, the most prominent whistle-blower in the Chinese COVID-19 epidemic. Engaging with the thought of Israeli philosopher Avishai Margalit, who argues (...) that humiliation constitutes an injury to a person’s self-respect, we discuss his contention that a decent society is one that abolishes conditions which constitute a justification for its dependents to consider themselves humiliated. We explore the ways that institutions humiliate whistle-blowers in Western countries as well as in China. (shrink)

Book Reviws in this ArticleThe Human Body and the Law, 2nd edition by D.W. Meyers, Edinburgh University Press, 1990Classic Cases in Medical Ethics by Gregory E. Pence. New York: McGraw‐Hill Publishing Co. 1990Changing Values in Medical and Health Care Decision Making, edited by Uffejuul Jensen and Gavin Mooney. Chichester: John Wiley & Sons, 1990IVF and Justice by Teresa Iglesias, London: The Linacre Centre For Health Care Ethics, 1990The Practical, Moral and Personal Sense of Nursing: A Phenomenon‐ological Philosophy of Practice by (...) Anne H. Bishop and John R. Scudder, Jr. New York: State University of New York Press, 1990A Companion to Ethics, edited by Peter Singer. Oxford and Cambridge, Mass: Basil Blackwell, 1991.Ethics and Law in Health Care and Research edited by Peter Byrne, Chichester, UK: 1990The Human Embryo edited by G.R. Dunstan, Exeter: Exeter University Press, 1990Everyday Ethics: Resolving Dilemmas in Nursing Home Life by Rosalie A. Kane and Arthur L. Caplan. N.Y.: Springer Publishing Company, 1990Psychiatric Ethics, 2nd edition, edited by S. Bloch and P. Chodoff. Oxford, Oxford University Press, 1991Health Care and Gender by Charlotte Muller. New York: Russell Sage Foundation, 1990. (shrink)

For the past two years, I have taught a seminar on medical research scandals. The syllabus looks like a highlight reel of exploitation and abuse: children fed plutonium-laced breakfast cereal, prisoners dosed with the active ingredient in Agent Orange, mental patients given psychedelic drugs and massive electroconvulsive therapy before being sent into curare-induced paralysis and a coma. I designed the seminar to crush the idealism of future physicians by illuminating the dark patterns that research scandals typically follow. The most recent (...) scandal we examined happened to be one of the most lurid. (shrink)

A growing number of doctors in the United States are joining online professional networks that cater exclusively to licensed physicians. The most popular are Sermo, with more than 135,000 members, and Doximity, with more than 100,000. Both companies claim to offer a valuable service by enabling doctors to “connect” in a secure online environment. But their business models raise ethical concerns. The sites generate revenue by selling access to their large networks of physician-users to clients that include global pharmaceutical companies, (...) market research and consulting firms, and hedge funds and other investors. In exchange for a fee, these clients are offered a variety of tools to monitor, analyze, and solicit physicians’ opinions. In Sermo's case, clients are also offered opportunities to conduct “awareness campaigns” on the site that are aimed at influencing physician sentiment about specific drugs and medical devices. In effect, these online networks have created an even more efficient means for the pharmaceutical industry to track physician sentiment, disseminate messages, and cultivate key opinion leaders. This paper argues that the dual nature of these sites (a) undermines their integrity and transparency as forums for the exchange of medical opinion and (b) presents an ethical conflict for the doctors who use them. (shrink)

Several years ago, the University of Minnesota hosted a lecture by Alan Milstein, a Philadelphia attorney specializing in clinical trial litigation. Milstein, who does not mince words, insisted on calling research studies “experiments.” “Don't call it a study,” Milstein said. “Don't call it a clinical trial. Call it what it is. It's an experiment.” Milstein's comments made me wonder: when was the last time I heard an ongoing research study described as a “human experiment”? The phrase is now almost always (...) associated with abuses. Asking a prospective subject to sign up for a medical experiment would probably get roughly the same response as asking him or her to sign up for a police interrogation. It wasn't always this way. In the early days of American bioethics, scholars used the word “experimentation” in the same neutral way that they later began to use “research study” and “clinical trial.”. (shrink)

A virtual reality module that incorporates a training room (for subjects to become accommodated to virtual environments) and VR translations of Philippa Foot's Trolley Problem and Judith Thomson's Violinist thought experiment. -/- These modules are free to use for classroom or research/x-phi purposes. This set of modules is optimized for the HTC Vive. If you have an Oculus Rift, please see our VR modules optimized for the rift. -/- *Requires an HTC Vive and VR capable computer. To access the simulation, (...) uncompress the .zip folder and run the executable (.exe) file. (shrink)