Although I agree with Sabine Muller’s conclusion that we should first seek to find alternatives to amputation for patients suffering from Body Integrity Identity Disorder (BIID), I disagree with one of the major premises that she uses to argue for her claim. Muller argues that patients with BIID are likely not autonomous when they request that the limb be amputated. Muller’s argument that BIID suffers are not autonomous is flawed because she conflates philosophical conceptions of autonomy with the conception of (...) autonomy that is operative in the context of medicine. (shrink)
The phenomenon of ambivalence is an important one for any philosophy of action. Despite this importance, there is a lack of a fully satisfactory analysis of the phenomenon. Although many contemporary philosophers recognize the phenomenon, and address topics related to it, only Harry Frankfurt has given the phenomenon full treatment in the context of action theory - providing an analysis of how it relates to the structure and freedom of the will. In this paper, I develop objections to Frankfurt's account, (...) all revolving around the charge that his account contains a serious ambiguity between willing and identifying. With such objections in place, I then develop an analysis that avoids the difficulties and ambiguities that Frankfurt's analysis is prey to. I briefly distinguish ambivalence from other types of internal conflict. This paper aims to offer conceptual clarification on the phenomenon of ambivalence, which will then allow for discussions about the normative merits and demerits of ambivalence, the effects of ambivalence on autonomous action, and methods of resolution of ambivalence. (shrink)
An analysis of the identity issues involved in facial allograft transplantation is provided in this paper. The identity issues involved in organ transplantation in general, under both theoretical accounts of personal identity and subjective accounts provided by organ recipients, are examined. It is argued that the identity issues involved in facial allograft transplantation are similar to those involved in organ transplantation in general, but much stronger because the face is so closely linked with personal identity. Recipients of facial allograft transplantation (...) have the potential to feel that their identity is a mix between their own and the donor’s, and the donor’s family is potentially likely to feel that their loved one ‘‘lives on’’. It is also argued that facial allograft transplantation allows the recipients to regain an identity, because they can now be seen in the social world. Moreover, they may regain expressivity, allowing for them to be seen even more by others, and to regain an identity to an even greater extent. Informing both recipients and donors about the role that identity plays in facial allograft transplantation could enhance the consent process for facial allograft transplantation and donation. (shrink)
Taking Ourselves Seriously and Getting It Right is written in a manner that is accessible to all. Frankfurt’s arguments are, as usual, clear and persuasive. Korsgaard’s, Bratman’s, and Dan-Cohen’s comments are thought provoking. There are, however, two main areas in which Frankfurt’s arguments need clarification (the notion of wholehearted identification, and the concept of ambivalence), and there are misunderstandings of Frankfurt at work in Korsgaard’s (relationship between the self and the will, and concept of the will for Frankfurt) and Bratman’s (...) (meaning of "necessity" for Frankfurt) comments. (shrink)
In their paper, “Behavioral Equipoise: A Way to Resolve Ethical Stalemates in Clinical Research, “ Peter Ubel and Robert Silbergleit (2011) propose that we adopt another principle, the principle of behavioral equipoise, whereby RCTs are also morally justified in cases where they are expected to address the controversy, disagreement, or behavioral resistance surrounding a particular treatment. Adopting this ethical standard would allow for research to move forward and, as a result, for the resolution of stalemates between clinicians who hold opposing (...) views. There are two points that I would like to make in terms of objections to Ubel and Silbergleit’s argument, and then I want to emphasize what I think is particularly valuable about their argument. First, I dispute the move from the claim that the principle of clinical equipoise creates (or does not resolve) stalemates to the conclusion that adopting the principle of behavioral equipoise would dissolve stalemates. My second objection concerns the distinctness of the concept of behavioral equipoise fromthe concept of clinical equipoise. That said, I do think that Ubel and Silbergleit make an important point, and that is that one cause of equipoise is the behavioral and psychological factors of those responding to data. (shrink)
Epicurus on Freedom has considerable merit, but there are some elements of OKeefes argument that are worthy of a second thought. Two of OKeefes major claims are that Epicuruss proposal of swerves as an answer to the problem of whether we have the ability to do otherwise would be an inadequate answer, and that Epicurus should be concerned with the problem of openness and contingency of the future, not the problem of our ability to do otherwise. I address each of (...) these claims. (shrink)
The past four decades of research in the social sciences have shed light on two important phenomena. One is that human decision-making is full of predicable errors and biases that often lead individuals to make choices that defeat their own ends (i.e., the bad choice phenomenon), and the other is that individuals’ decisions and behaviors are powerfully shaped by their environment (i.e., the influence phenomenon). Some have argued that it is ethically defensible that the influence phenomenon be utilized to address (...) the bad choice phenomenon. They propose that “choice architects” learn about the various ways in which choices can be influenced and directed by the environment, and then work to design environments, broadly construed, that influence individuals towards choices that make them better off. Those who advocate intentionally creating choice environments that lead people to better choices believe that doing so is ethically permissible because (1) it makes people better off, and (2) it does so in a way that is entirely compatible with individual liberty. The evaluation of these two claims is the main focus of this paper. (shrink)
Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for (...) the utilization of each principle. (shrink)
In their article “The Concept of Voluntary Consent,” Robert Nelson and colleagues (2011) argue for two necessary and jointly sufficient conditions for voluntary action: intentionality, and substantial freedom from controlling influences. They propose an instrument to empirically measure voluntariness, the Decision Making Control Instrument. I argue that (1) their conceptual analysis of intentionality and controlling influences needs expansion in light of the growing use of behavioral economics principles to change individual and public health behaviors (growing in part by the designation (...) of “The Science of Behavior Change” as a new National Institutes of Health [NIH] Roadmap Activity); and (2) that their measure of voluntariness that relies on self-perceived intentionality and extent of control is unreliable, given findings from behavioral economics and cognitive science that show that our perceptions about the intentionality and control of our own and others’ decisions and actions are remarkably skewed and un-insightful. (shrink)
In our commentary we briefly review the work on the neurological differences between the rational ethical analysis used in professional contexts and the reflexive emotional responses of our daily moral reasoning, and discuss the implications for the claim that our normative arguments should not rely on the emotion of repugnance.
J.S. Swindell has argued that Harry Frankfurt's analysis of ambivalence is ambiguous and that it fails to do justice to the full range of this psychological phenomenon. Building on her criticism of Frankfurt, Swindell offers an analysis of ambivalence which is supposed to clarify ambiguities in Frankfurt's analysis and reveal varieties of ambivalence that Frankfurt's analysis allegedly overlooks. In this brief reply, I argue that Frankfurt's analysis of ambivalence is neither ambiguous nor objectionably narrow. I conclude with remarks (...) on Swindell's analysis of the relationship between ambivalence and weakness of the will. (shrink)
