Philosophers and social scientists have focussed a great deal of attention on our human capacity to trust, but relatively little on the capacity to hope. This is a significant oversight, as hope and trust are importantly interconnected. This paper argues that, even though trust can and does feed our hopes, it is our empowering capacity to hope that significantly underwrites—and makes rational—our capacity to trust.
This paper is divided into two parts. In Section 1, I explore and defend a “regulative view” of folk-psychology as against the “standard view”. On the regulative view, folk-psychology is conceptualized in fundamentally interpersonal terms as a “mind-making” practice through which we come to form and regulate our minds in accordance with a rich array of socially shared and socially maintained sense-making norms. It is not, as the standard view maintains, simply an epistemic capacity for coming to know about the (...) mental states and dispositions already there. Importantly, the regulative view can meet and beat the standard at its own epistemic game. But it also does more. In Section 2, I show how the regulative view makes progress on two other problems that remain puzzling on the standard view: the problem of “first-person authority” – accounting for the special features of self-knowledge; and the problem of “reactive.. (shrink)
Prenatal screening, consisting of maternal serum screening and nuchal translucency screening, is on the verge of expansion, both by being offered to more pregnant women and by screening for more conditions. The Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists have each recently recommended that screening be extended to all pregnant women regardless of age, disease history, or risk status. This screening is commonly justified by appeal to the value of autonomy, or women's (...) choice. In this paper, I critically examine the value of autonomy in the context of prenatal screening to determine whether it justifies the routine offer of screening and the expansion of screening services. I argue that in the vast majority of cases the option of prenatal screening does not promote or protect women's autonomy. Both a narrow conception of choice as informed consent and a broad conception of choice as relational reveal difficulties in achieving adequate standards of free informed choice. While there are reasons to worry that women's autonomy is not being protected or promoted within the limited scope of current practice, we should hesitate before normalizing it as part of standard prenatal care for all. (shrink)
This paper examines the methodological claim made famous by P.F. Strawson: that we understand what features are required for responsible agency by exploring our attitudes and practices of holding responsible. What is the presumed metaphysical connection between holding responsible and being fit to be held responsible that makes this claim credible? I propose a non-standard answer to this question, arguing for a view of responsible agency that is neither anti-realist (i.e. purely 'conventionalist') nor straightforwardly realist. It is instead ‘constructivist’. On (...) the ‘Scaffolding View’ I defend, reactive attitudes play an essential role in developing, supporting, and thereby maintaining the capacities that make for responsible agency. While this view has relatively novel implications for a metaphysical understanding of capacities, its chief virtue, in contrast with more standard views, is providing a plausibly defensible account of how so-called responsible agents genuinely deserve to be treated as such. (shrink)
Sex selection technologies have become increasingly prevalent and accessible. We can find them advertised widely across the Internet and discussed in the popular media—an entry for “sex selection services” on Google generated 859,000 sites in April 2004. The available services fall into three main types: preconception sperm sorting followed either by intrauterine insemination of selected sperm or by in vitro fertilization ; preimplantation genetic diagnosis, by which embryos created by IVF are tested and only those of the desired sex are (...) transferred to the woman's uterus; and prenatal testing of fetuses through ultrasound or chromosomal analysis, followed by selective abortion of fetuses detected to be of the undesired sex. (shrink)
The UK’s National Institute for Health and Care Excellence is responsible for conducting health technology assessment on behalf of the National Health Service. In seeking to justify its recommendations to the NHS about which technologies to fund, NICE claims to adopt two complementary ethical frameworks, one procedural—accountability for reasonableness —and one substantive—an ‘ethics of opportunity costs’ that rests primarily on the notion of allocative efficiency. This study is the first to empirically examine normative changes to NICE’s approach and to analyse (...) whether these enhance or diminish the fairness of its decision-making, as judged against these frameworks. It finds that increasing formalisation of NICE’s approach and a weakening of the burden of proof laid on technologies undergoing HTA have together undermined its commitment to EOC. This implies a loss of allocative efficiency and a shift in the balance of how the interests of different NHS users are served, in favour of those who benefit directly from NICE’s recommendations. These changes also weaken NICE’s commitment to AfR by diminishing the publicity of its decision-making and by encouraging the adoption of rationales that cannot easily be shown to meet the relevance condition. This signals a need for either substantial reform of NICE’s approach, or more accurate communication of the ethical reasoning on which it is based. The study also highlights the need for further empirical work to explore the impact of these policy changes on NICE’s practice of HTA and to better understand how and why they have come about. (shrink)
ObjectiveTo examine health and social care professionals’ understanding of the legislation governing research involving adults lacking mental capacity in England and Wales.MethodsA cross-sectional online survey was conducted using a series of vignettes. Participants were asked to select the legally authorised decision-maker in each scenario and provide supporting reasons. Responses were compared with existing legal frameworks and analysed according to their level of concordance.ResultsOne hundred and twenty-seven professionals participated. Levels of discordance between responses and the legal frameworks were high across all (...) five scenarios. Nearly half of the participants provided responses that were discordant in all scenarios. Only two participants provided concordant responses across all five scenarios.DiscussionParticipants demonstrated a lack of knowledge about the legal frameworks, the locus of authority and the legal basis for decision-making. The findings raise concern about the accessibility of research for those who lack capacity, the ability to conduct research involving such groups and the impact on the evidence base for their care.ConclusionThis is the first study to examine health and social care professionals’ knowledge and understanding of the dual legal frameworks in the UK. Health and social care professionals’ understanding and attitudes towards research involving adults with incapacity may warrant further in-depth exploration. The findings from this survey suggest that greater training and education is required. (shrink)
In Building Better Beings, Vargas develops and defends a naturalistic account of responsibility, whereby responsible agents must possess a feasibly situated capacity to detect and respond to moral considerations. As a preliminary step, he also offers a substantive account of how we might justify our practices of holding responsible—viz., by appeal to their efficacy in fostering a ‘valuable form of agency’ across the community at large, a form of agency that precisely encompasses sensitivity to moral considerations. But how do these (...) accounts relate to one another? Though I find much that is appealing in Vargas’s general approach, I challenge his insistence that these accounts should be treated as ‘conceptually independent’, arguing that this generates an objectionable “justification gap”: on his analysis, someone could remain an appropriate target of our responsibility practices and yet fail to be a morally responsible agent. In closing, I offer a potential solution to this problem, though it means re-visioning how the account of moral responsibility is conceptually tied to the justification of our responsibility practices. (shrink)
Society is failing in its moral obligation to improve the standard of healthcare provided to vulnerable populations, such as people who lack decision making capacity, by a misguided paternalism that seeks to protect them by excluding them from medical research. Uncertainties surround the basis on which decisions about research participation is made under dual regulatory regimes, which adds further complexity. Vulnerable individuals’ exclusion from research as a result of such regulation risks condemning such populations to poor quality care as a (...) result of ‘evidence biased’ medicine. This paper explores the research regulation provisions for proxy decision making for those unable to provide informed consent for themselves, and the subsequent legal and practical difficulties for decision-makers. There are two separate regulatory regimes governing research involving adults who lack capacity to consent in England and Wales. The Mental Capacity Act 2005 governs how incapacitated adults can be involved in research, however clinical trials of medicinal products are separately regulated by the Medicines for Human Use Regulations 2004. There are significant differences under these dual regimes in the provisions for those lacking capacity to participate in medical research. The level of risk permitted differs, with a greater requirement for justification for participation in a clinical trial than other types of research. Who acts as proxy decision maker, how much information is provided to the person lacking capacity, and whether they retain the power of veto also significantly differs. The development of two separate regulatory regimes has resulted in significant differences between the provisions for clinical trials and other forms of research, and from usual medical practice. The resulting uncertainty has reinforced the tendency of those approving and conducting research to exclude adults lacking capacity to avoid difficult decisions about seeking consent for their participation. Future developments, such as the incoming EU Regulations, may address some of these differences, however the justification and level of risk permitted requires review to ensure that requirements are appropriate and proportionate to the burdens and risks for the individual, and also to the benefits for the wider population represented. (shrink)
This paper describes a live ethics case project that can be used to teach ethics in a broad variety of business classes. The live case differs from regular cases in that it involves a current situation. Students select an on-going or current event that involves ethical violations and write a case about it. They then present their case and run a debate about the challenges and issues outlined in the case and the actions that could have or should have been (...) taken. The dynamic project fulfills the key criteria for effective ethics education since it increases awareness of the complexity of ethical challenges, allows application of concepts, creates a personal emotional engagement in the case, is relevant, holds students accountable for their position, and creates a setting that encourages students to think critically about ethics. (shrink)
In The Concept of Mind, Gilbert Ryle argued that a more sophisticated understanding of the dispositional nature of ‘intelligent capacities’ could bolster philosophical resistance to the tempting view that the human mind is possessed of metaphysically ‘occult’ powers and properties. This temptation is powerful in the context of accounting for the special qualities of responsible agency. Incompatibilists indulge the temptation; compatibilists resist it, using a variety of strategies. One recent strategy, reminiscent of Ryle’s, is to exploit a more sophisticated understanding (...) of dispositional properties to account for these qualities. But ‘new dispositionalists’ run up against a ‘hard problem’ that threatens the approach. This paper argues that the threat may be averted by embracing a yet more radical ‘Rylean’ view of the distinctive dispositional nature of ‘intelligent capacities’. (shrink)
In this article, we discuss the challenges facing humanities researchers approaching studies in clinical and community health settings. This crossing of disciplines has arguably been less often explored in the countries we discuss—Kenya, Tanzania and South Africa—but our experiences also speak to broader trouble with disciplinary ‘ethnocentrism’ that hampers the development of knowledge. After a brief contextualising overview of the structures within our universities that separate or link the humanities, medicine and social science, we use case studies of our experiences (...) as an arts researcher, an anthropologist and a historian to draw attention to the methodological clashes that can hobble research between one disciplinary area and another, whether this manifests in the process of applying for ethical clearance or a professional wariness between healthcare practitioners and humanities scholars in health spaces. We argue overall for the great potential of humanities in the health ‘space’—as well as the need for improved dialogue between the disciplines to bring a diverse community of knowledge to bear on our understandings of experiences of health. And we suggest the need for a robust awareness of our own positions in relation to medicine, as humanities scholars, as well as a patient persistence on both sides of the humanities–health science equation to create a broader and ultimately more effective research system. (shrink)
What is hope? Though variously characterized as a cognitive attitude, an emotion, a disposition, and even a process or activity, hope, more deeply, a unifying and grounding force of human agency. We cannot live a human life without hope, therefore questions about the rationality of hope are properly recast as questions about what it means to hope well. This thesis is defended and elaborated as follows. First, it is argued that hope is an essential and distinctive feature of human agency, (...) both conceptually and developmentally. The author then explores a number of dimensions of agency that are critically implicated in the art of hoping well, drawing on several examples from George Eliot’s Middlemarch. The article concludes with a short section that suggests how hoping well in an individual context may be extended to hope at the collective level. (shrink)
Analyzes the origin, structure and resolution of Kant's antinomies of reason from a systematic rather than a historical perspective, exploring the relationship between the theoretical antinomies and the practical antinomy in order to indicate their similarities and differences and to suggest the dependence of the latter on the former.
This narrative review summarizes the empirical literature on children's competence for consent and assent in research and treatment settings. Studies varied widely regarding methodology, particularly in the areas of participant sampling, situational context studied (e.g., psychological versus medical settings), procedures used (e.g., lab-based vs. real-world approaches), and measurement of competence. This review also identified several fundamental dilemmas underlying approaches to children's informed consent. These dilemmas, including autonomy versus best interests approaches, legal versus psychological or ethical approaches, child- versus family-based approaches, (...) and approaches that emphasize consent versus those that emphasize assent, have implications for the measurement of children's competence and interpretation of findings. Recommendations for future research in the area of children's informed consent include the use of diverse samples and control groups, development of multidimensional and standardized measures of competence, utilization of observational methods and longitudinal designs, examination of noncognitive aspects of children's competence, and comparison of children's competence for treatment and research decisions. (shrink)
Two experiments investigated the factors that people consider when evaluating informal arguments in newspaper and magazine editorials. Experiment 1 showed that subjects were more likely to object to the truth of the premises and the conclusions of an argument than to the strength of the link between them. Experiment 1 also revealed two manipulations that helped subjects object to the link between premises and conclusions: rating how well the premises support the conclusions and rating the believability of the premises and (...) conclusions. Experiment 2 further demonstrated that subjects who identified the premises and conclusions of an argument were better at formulating objections to the link between premises and conclusions. Moreover, subjects in Experiment 2 were better and faster at formulating objections to the truth of the premises and conclusions than to the link between premises and conclusions. The results are discussed in terms of the constraints they pose for developing a cognitive theory of informal reasoning. (shrink)
In the United States a rapidly increasing regulatory burden for life scientists has led to questions of whether the increased burden resulting from the Select Agent Program has had adverse effects on scientific advances. Attention has focussed on the regulatory “fit” of the Program and ways in which its design could be improved. An international framework convention to address common concerns about biosecurity and biosafety is a logical next step.
Until recently philosophy of religion has been almost exclusively focused upon the analysis of western religious ideas. The central concern of the discipline has been the concept God , as that concept has been understood within Judaeo-Christianity. However, this narrow remit threatens to render philosophy of religion irrelevant today. To avoid this philosophy of religion should become a genuinely multicultural discipline. But how, if at all, can philosophy of religion rise to this challenge? The paper considers fictionalism about religious discourse (...) as a possible methodological standpoint from which to practice a tradition-neutral form of philosophy of religion. However, after examining some of the problems incurred by fictionalism, the paper concludes that fictionalism and religious diversity are uneasy bedfellows; which implies that fictionalism is unlikely to be the best theory to shape the practice of philosophy of religion in a multicultural context. (shrink)
In this paper, we draw on our own cross-cultural experience of engaging with different incarnations of the medical and health humanities in the UK and South Africa to reflect on what is distinct and the same about MHH in these locations. MHH spaces, whether departments, programmes or networks, have espoused a common critique of biomedical dualism and reductionism, a celebration of qualitative evidence and the value of visual and performative arts for their research, therapeutic and transformative social potential. However, there (...) have also been differences, and importantly a different ‘identity’ among some leading South African scholars and practitioners, who have felt that if MHH were to speak from the South as opposed to the North, they would say something quite different. We seek to contextualise our personal reflections on the development of the field in South Africa over recent years within wider debates about MHH in the context of South African academia and practice, drawing in part on interviews conducted by one of the authors with South African researchers and practitioners and our own reflections as ‘Northerners’ in the ‘South’. (shrink)
The republican revival in political philosophy, political theory, and legal theory has produced an impressive range of novel interpretations of the historical figures of the republican tradition. It has also given rise to a variety of contemporary neo-republican theories that build on its historical themes. Although there have been some feminist discussions of its historical representatives, neo-republicanism has not generated a great deal of enthusiasm among feminists. The present paper examines Phillip Pettit's theory of freedom as nondomination in order to (...) assess its potential usefulness for those with feminist goals. It defends Pettit's account of interpersonal domination from certain feminist objections, but argues that his account of state domination needs to be amended if it is fully to protect the interests of women and other groups. (shrink)
Alcibiades is one of the most explicitly sexualized figures in fifth-century Athens, a "lover of the people" whom the demos "love and hate and long to possess" (Ar. Frogs 1425). But his eros fits ill with the normative sexuality of the democratic citizen as we usually imagine it. Simultaneously lover and beloved, effeminate and womanizer, Alcibiades is essentially paranomos, lawless or perverse. This paper explores the relation between Alcibiades' paranomia and the norms of Athenian sexuality, and argues that his eros (...) reveals an intrinsic instability within the sexual economy of the democracy: the desire he embodied blurred the categories that defined Athenian masculinity; the desire he inspired rendered the demos passive and "soft." This same instability can be seen in Thucydides' juxtaposition of the mutilation of the Herms and the legend of Harmodius and Aristogeiton. These two episodes (obscurely linked by Thucydides) together tell of an idealized citizen body under threat. The tyrannicide story figures the democratic citizen as an elite lover, whose sexual dominance is vital to his political autonomy. The Herms, with their prominent phalloi, symbolized this citizen-lover, and thus their mutilation was an assault on the masculinity, as well as political power, of the demos. The tyrannicide legend seems to promise a defense against this threat of civic castration; but instead of shoring up the sexually-dominant citizen, Thucydides' version of the legend merely reveals his frailty and fictionality: even in Athens' heroic past there is no inviolable democratic eros to cure the impotence of mutilation and tyranny. Reading these two episodes against the backdrop of Alcibiades' paranomia (as described by Plutarch and Plato), this paper examines the nature of democratic masculinity, the (eroticized) relation between demagogue and demos, and the place of perverse desire within the protocols of sex. (shrink)