When philosophers address personal identity, they usually explore numerical identity: what are the criteria for a person's continuing existence? When non-philosophers address personal identity, they often have in mind narrative identity: Which characteristics of a particular person are salient to her self-conception? This book develops accounts of both senses of identity, arguing that both are normatively important, and is unique in its exploration of a range of issues in bioethics through the lens of identity. Defending a biological view of our (...) numerical identity and a framework for understanding narrative identity, DeGrazia investigates various issues for which considerations of identity prove critical: the definition of death; the authority of advance directives in cases of severe dementia; the use of enhancement technologies; prenatal genetic interventions; and certain types of reproductive choices. He demonstrates the power of personal identity theory to illuminate issues in bioethics as they bring philosophical theory to life. (shrink)

Transcending the overplayed debate between utilitarians and rights theorists, the book offers a fresh methodological approach with specific constructive conclusions about our treatment of animals. David DeGrazia provides the most thorough discussion yet of whether equal consideration should be extended to animals' interests, and examines the issues of animal minds and animal well-being with an unparalleled combination of philosophical rigor and empirical documentation. This book is an important contribution to the field of animal ethics.

The enhancement of human traits has received academic attention for decades, but only recently has moral enhancement using biomedical means – moral bioenhancement (MB) – entered the discussion. After explaining why we ought to take the possibility of MB seriously, the paper considers the shape and content of moral improvement, addressing at some length a challenge presented by reasonable moral pluralism. The discussion then proceeds to this question: Assuming MB were safe, effective, and universally available, would it be morally desirable? (...) In particular, would it pose an unacceptable threat to human freedom? After defending a negative answer to the latter question – which requires an investigation into the nature and value of human freedom – and arguing that there is nothing inherently wrong with MB, the paper closes with reflections on what we should value in moral behaviour. (shrink)

Some people contend that fetuses have moral status but less than that of paradigm persons. Many people hold views implying that sentient animals have moral status but less than that of persons. These positions suggest that moral status admits of degrees. Does it? To address this question, we must first clarify what it means to speak of degrees of moral status. The paper begins by clarifying the more basic concept of moral status and presenting two models of degrees ofmoral status. (...) It then sketches several significant considerations in favor of, and several against, the assertion of degrees of moral status. The paper concludes by drawing lessons from the discussion. (shrink)

This paper defends a qualified version of moral vegetarianism. It defends a weak thesis and, more tentatively, a strong thesis, both from a very broad basis that assumes neither that animals have rights nor that they are entitled to equal consideration. The essay's only assumption about moral status, an assumption defended in the analysis of the wrongness of cruelty to animals, is that sentient animals have at least some moral status. One need not be a strong champion of animal protection, (...) then, to embrace moral vegetarianism. One need only assume some reasonable view of animals' moral status. (shrink)

The overarching aim of this book is to illuminate a broad array of issues connected with reproduction and ethics through the lens of moral philosophy. With novel frameworks for understanding prenatal moral status and human identity, DeGrazia sheds new light on the ethics of abortion and embryo research, genetic enhancement and prenatal genetic interventions, procreation and parenting, and decisions that affect the quality of life of future generations.

This article examines basic interests that animals have in liberty—the absence of external constraints on movement. It takes liberty to be a benefit for sentient animals that permits them to pursue what they want and need. Obviously farms, zoos, pets in homes, animals for sale in stores, circuses, and laboratories all involve forms of confinement that restrict liberty. The discussion aims to know the conditions, if there are any, under which such liberty-limitation is morally justified. It first lays out the (...) harms caused by confinement. It then examines and evaluates five possible standards for the justification of confinement: a basic-needs requirement; a comparable-life requirement; a no-unnecessary-harm standard; a worthwhile-life criterion; and an appeal to respect. (shrink)

As the President's Council on Bioethics emphasized in a recent report, rapid growth of biotechnologies creates increasingly many possibilities for enhancing human traits. This article addresses the claim that enhancement via biotechnology is inherently problematic for reasons pertaining to our identity. After clarifying the concept of enhancement, and providing a framework for understanding human identity, I examine the relationship between enhancement and identity. Then I investigate two identity-related challenges to biotechnological enhancements: (1) the charge of inauthenticity and (2) the charge (...) of violating inviolable core characteristics. My thesis is that a lucid, plausible understanding of human identity largely neutralizes these charges, liberating our thinking from some seductive yet unsound objections to enhancement via biotechnology. (shrink)

This volume provides a general overview of the basic ethical and philosophical issues of animal rights. It asks questions such as: Do animals have moral rights? If so, what does this mean? What sorts of mental lives do animals have, and how should we understand welfare? By presenting models for understanding animals' moral status and rights, and examining their mental lives and welfare, David DeGrazia explores the implications for how we should treat animals in connection with our diet, zoos, and (...) research. Animal Rights distinguishes itself by combining intellectual rigor with accessibility, offering a distinct moral voice with a non-polemical tone. (shrink)

David DeGrazia’s stated purposes for Taking Animals Seriously are to apply a coherentist methodology to animal ethics, to do the philosophical work necessary for discussing animal minds, and to fill in some of the gaps in the existing literature on animal ethics.

In this paper, we present three necessary conditions for morally responsible animal research that we believe people on both sides of this debate can accept. Specifically, we argue that, even if human beings have higher moral status than nonhuman animals, animal research is morally permissible only if it satisfies (a) an expectation of sufficient net benefit, (b) a worthwhile-life condition, and (c) a no unnecessary-harm/qualified-basic-needs condition. We then claim that, whether or not these necessary conditions are jointly sufficient conditions of (...) justified animal research, they are relatively demanding with the consequence that many animal experiments may fail to satisfy them. (shrink)

Some people contend that fetuses have moral status but less than that of paradigm persons. Many people hold views implying that sentient animals have moral status but less than that of persons. These positions suggest that moral status admits of degrees. Does it? To address this question, we must first clarify what it means to speak of degrees of moral status. The paper begins by clarifying the more basic concept of moral status and presenting two models of degrees ofmoral status. (...) It then sketches several significant considerations in favor of, and several against, the assertion of degrees of moral status. The paper concludes by drawing lessons from the discussion. (shrink)

Might it be morally wrong to procreate? David Benatar answers affirmatively in Better Never to Have Been , arguing that coming into existence is always a great harm. I counter this view in several ways. First, I argue against Benatar’s asserted asymmetry between harm and benefit—which would support the claim that any amount of harm in a human life would make it not worth starting—while questioning the significance of his distinction between a life worth starting and one worth continuing. I (...) further contend that his understanding of hedonism and desire-fulfillment theories distorts their implications for the quality of human life; as for objective-list theories, I rebut his critique of their human-centered basis of evaluation. Notwithstanding this multi-tiered challenge to Benatar’s reasoning, I conclude with praise for his work and the intellectual virtues it embodies. (shrink)

This volume presents a framework of general principles for animal research ethics together with an analysis of the principles' meaning and moral requirements. Tom L. Beauchamp and David DeGrazia's comprehensive framework addresses ethical requirements pertaining to societal benefit and features a thorough, ethically defensible program of animal welfare. The book also features commentaries on the framework of principles by eminent figures in animal research ethics from an array of relevant disciplines: veterinary medicine, biomedical research, biology, zoology, comparative psychology, primatology, law, (...) and bioethics. (shrink)

This volume offers a carefully argued, compelling theory of bioethics while eliciting practical implications for a wide array of issues including medical assistance-in-dying, the right to health care, abortion, animal research, and the definition of death. The authors' dual-value theory features mid-level principles, a distinctive model of moral status, a subjective account of well-being, and a cosmopolitan view of global justice. In addition to ethical theory, the book investigates the nature of harm and autonomous action, personal identity theory, and the (...) 'non-identity problem' associated with many procreative decisions. Readers new to particular topics will benefit from helpful introductions, specialists will appreciate in-depth theoretical explorations and a novel take on various practical issues, and all readers will benefit from the book's original synoptic vision of bioethics. This title is also available as Open Access on Cambridge Core. (shrink)

The idea of a patient's best interests raises issues in prudential value theory–the study of what makes up an individual's ultimate good or well‐being. While this connection may strike a philosopher as obvious, the literature on the best interests standard reveals almost no engagement of recent work in value theory. There seems to be a growing sentiment among bioethicists that their work is independent of philosophical theorizing. Is this sentiment wrong in the present case? Does value theory make a significant (...) difference in interpreting best interests? In pursuing this question, I begin with a quick sketch of broad kinds of value theories, identifying representatives that are plausible enough to count as contenders. I then explore what each account suggests in neonatal treatment decisions, and decisions for patients in persistent vegetative states. I conclude that while these accounts converge somewhat in their interpretations of best interests, they also have importantly different implications. (shrink)

The creation of chimeras by introducing human stem cells into nonhu- man animals has provoked intense concerns. Addressing objections that appeal to human dignity, I focus in this essay on stem cell research intended to generate human neurons in Great Apes and rodents. After considering samples of dignity- based objections from the literature, I examine the underlying assumption that nonhuman animals have lower moral status than personsFwith particular attention to what it means to speak of higher and lower moral statusFbefore (...) evaluating the chimera research in question. I argue that (1) such experiments involving Great Apes should be prohibited out of respect for the research subjects and (2) such experiments involving rodents may or may not be permissible, depending on how we answer unresolved questions regarding rodents’ moral status. In the end, concerns about human dignity prove insignificant. (shrink)

Advance directives permit competent adult patients to provide guidance regarding their care in the event that they lose the capacity to make medical decisions. One concern about the use of advance directives is the possibility that, in certain cases in which a patient undergoes massive psychological change, the individual who exists after such change is literally a (numerically) distinct individual from the person who completed the directive. If this is true, there is good reason to question the authority of the (...) directive Ð which is supposed to apply to the individual who completed it, not to someone else. This is `the someone else problem'. After briefly introducing advance directives as a basis for medical decision-making, this paper elaborates `the someone else problem' in the context of severe dementia. The paper then reconstructs the reasoning that leads to this putative problem and exposes the important underlying assumption that we are essentially persons. An alternative view of what we are, one that regards personhood as inessential, is then considered, before several arguments are advanced in favor of that alternative view. The paper next explores implications for advance directives: `The someone else problem' is effectively dissolved, while it is noted that a related problem (one beyond the paper's scope) may persist. A few implications beyond advance directives are also identified. (shrink)

Kagan argues that human beings who are neither persons nor even potential persons — if their impairment is independent of genetic constitution — are modal persons: individuals who might have been persons. Moreover, he proposes a view according to which both personhood and modal personhood are sufficient for counting more, morally, than nonhuman animals. In response to this proposal, I raise one relatively minor concern about Kagan's reasoning — that he judges too quickly that insentient beings can have interests — (...) before engaging the appeal to modal personhood. I challenge the thesis that modal personhood is relevant to one's moral status, first, by way of analogy to a kicker who misses a field goal though he might have made it; second, by casting doubt on implications for two impaired infants ; and, finally, by examining implications for dogs who would count as modal persons when genetic enhancements are capable of transforming them into persons. (shrink)

The field of bioethics has deployed different models of justification for particular moral judgments. The best known models are those of deductivism, casuistry, and principlism (under one, rather limited interpretation). Each of these models, however, has significant difficulties that are explored in this essay. An alternative model, suggested by the work of Henry Richardson, is presented. It is argued that specified principlism is the most promising model of justification in bioethics. Keywords: casuistry, deductivism, ethical theories, intuition principlism, specified principlism, specification (...) CiteULike Connotea Del.icio.us What's this? (shrink)

: The fifth edition of Beauchamp and Childress's Principles of Biomedical Ethics is distinguished by its emphatic embrace of common morality as the ultimate source of moral norms. This essay critically evaluates the fifth edition's discussion of common morality and, to a lesser extent, its treatment of coherence (both the model of ethical justification and the associated concept). It is argued that the book is overly accommodating of existing moral beliefs. The paper concludes with three suggestions for improving this leading (...) text. (shrink)

Implicit in our everyday attitudes and practices is the assumption that death ordinarily harms a person who dies. A far more contested matter is whether death harms sentient individuals who are not persons, a category that includes many animals and some human beings. On the basis of the deprivation account of the harm of death, I argue that death harms sentient nonpersons. I next consider possible bases for the commonsense judgment that death ordinarily harms persons more than it harms sentient (...) nonpersons. Contrary to what some philosophers believe, it is doubtful that the familiar resources of prudential value theory can vindicate this judgment. I show that the approach that at first glance seems most promising for supporting this judgment – namely, invoking an objective account of well-being – faces substantial challenges, before arguing that McMahan's time-relative interest account supplies the needed theoretical basis. I then go on to extract a significant practical implication of the first thesis, that death ordinarily harms sentient nonpersons: We should find a way to discontinue the routine killing of animal subjects following their use in experiments. (shrink)

Volume 20, Issue 3, March 2020, Page 71-73.

Responding to several leading ideas from a paper by Allen Buchanan, the present essay explores the implications of genetic enhancement for moral status. Contrary to doubts expressed by Buchanan, I argue that genetic enhancement could lead to the existence of beings so superior to contemporary human beings that we might aptly describe them as post-persons. If such post-persons emerged, how should we understand their moral status in relation to ours? The answer depends in part on which of two general models (...) of moral status—one based on respect and one based on interests—is more adequate. Buchanan tentatively argues that a respect-based model is preferable. I challenge Buchanan's view, along these lines: If we embrace a respect-based model of moral status featuring a threshold that divides persons, who are thought to have full and equal moral status, from sentient nonpersons, thought to have less moral status, then we should acknowledge a second threshold and a level of moral status higher than ours. A better option, I tentatively suggest, is to drop the idea of levels of moral status, accept that all sentient beings have moral status, and allow that some differences in interests and capacities justify some significant differences in how we should treat beings of different kinds. (shrink)

Few human uses of nonhuman animals have incited as much controversy as the use of animals in biomedical research. The political exchanges over this issue tend to produce much more heat than light, as representatives of both biomedicine and the animal protection community accuse opponents of being and the like. However, a healthy number of individuals within these two communities offer the possibility of a more illuminating discussion of the ethics of animal research.

When it comes to caring about and helping those in need, our imaginations tend to be weak and our motivation tends to be parochial. This is a major moral problem in view of how much unmet need there is in the world and how much material capacity there is to address that need. With this problem in mind, the present paper will focus on genetic means to the enhancement of a moral capacity—a disposition to altruism—and of a cognitive capacity that (...) facilitates use of the moral capacity: the ability to grasp vividly the needs of individuals who are unknown and not present. I will address two questions, with more extensive attention to the first question. First, assuming we had excellent reason to believe that the enhancements were safe, effective, and available to all who desired them, would seeking these enhancements be inherently morally acceptable—that is, free of inherent wrongness? Second, would it be wise for a society to pursue these enhancements? I will defend an affirmative answer to the first question while leaving the second question open. (shrink)

In addressing the shape of appropriate gun policy, this essay assumes for the sake of discussion that there is a legal and moral right to private gun ownership. My thesis is that, against the background of this right, the most defensible policy approach in the United States would feature moderate gun control. The first section summarizes the American gun control status quo and characterizes what I call “moderate gun control.” The next section states and rebuts six leading arguments against this (...) general approach to gun policy. The section that follows presents a positive case for moderate gun control that emphasizes safety in the home and society as well as rights whose enforcement entails some limits or qualifications on the right to bear arms. A final section shows how the recommended gun regulations address legitimate purposes, rather than imposing arbitrary restrictions on gun rights, and offers concluding reflections. (shrink)

Guns occupy a major—sometimes terrible—place in contemporary American life. Do Americans have not only a legal right, but also a moral right, to own handguns? After introducing the topic, this paper examines what a moral right to private handgun ownership would amount to. It then elucidates the logical structure of the strongest argument in favor of such a right, an argument that appeals to physical security, before assessing its cogency and identifying two questionable assumptions. In light of persisting reasonable disagreement (...) about the argument’s soundness, the paper identifies two gun control measures—demonstrated need for a gun as a condition of eligibility and the requirement to pass a rigorous gun safety course—that reasonable disputants on both sides of the issue have principled reasons to accept. The paper also advances the thesis that, if anyone has an undefeated moral right to own handguns, it is precisely those individuals who have a special need and demonstrate the relevant safety-related competence. (shrink)

“The Ethics of Infection Challenges in Primates,” by Anne Barnhill, Steven Joffe, and Franklin Miller, is an exceptionally timely contribution to the literature on animal research ethics. Animal research has long been both a source of high hopes and a cause for moral concern. When it comes to infection challenge studies with nonhuman primates, neither the hope—to save thousands of human lives from such diseases as Ebola and Marburg—nor the concern—the conviction that primates deserve especially strong protections—could be much higher. (...) Coming just a few years after the National Institutes of Health adopted the Institute of Medicine's recommendations regarding chimpanzees, Barnhill and colleagues attempt to nudge the clarification and specification—one might say the evolution—of NHP research ethics and regulation. They assert that NHP challenge studies “are not justified by marginal gains in human safety or by efficacy gains that are unlikely to translate directly into saving human lives or preventing morbidity.” How, in turn, is their standard—which, although stringent, does permit causing NHPs to suffer and die for human benefit—to be justified? (shrink)

This paper defends a qualified version of moral vegetarianism. It defends a weak thesis and, more tentatively, a strong thesis, both from a very broad basis that assumes neither that animals have rights nor that they are entitled to equal consideration. The essay's only assumption about moral status, an assumption defended in the analysis of the wrongness of cruelty to animals, is that sentient animals have at least some moral status. One need not be a strong champion of animal protection, (...) then, to embrace moral vegetarianism. One need only assume some reasonable view of animals' moral status. (shrink)

Agnieszka Jaworska and Julie Tannenbaum address a central problem confronting efforts to understand moral status: the Problem of Nonparadigm Humans. The authors contend that human infants and cognitively disabled human beings whose capacities are comparable to those of dogs nevertheless have higher moral status. In this discussion, I will first reconstruct the authors’ assumptions and argumentative goals. In the article’s two major sections, I will examine the authors’ reasoning in pursuit of those goals and contend that the chain of argumentation (...) contains several weak links. The discussion will close with brief reflections on how the problem might be addressed. (shrink)

_ Source: _Page Count 21 Guns occupy a major—sometimes terrible—place in contemporary American life. Do Americans have not only a legal right, but also a moral right, to own handguns? After introducing the topic, this paper examines what a moral right to private handgun ownership would amount to. It then elucidates the logical structure of the strongest argument in favor of such a right, an argument that appeals to physical security, before assessing its cogency and identifying two questionable assumptions. In (...) light of persisting reasonable disagreement about the argument’s soundness, the paper identifies two gun control measures—demonstrated need for a gun as a condition of eligibility and the requirement to pass a rigorous gun safety course—that reasonable disputants on both sides of the issue have principled reasons to accept. The paper also advances the thesis that, if anyone has an undefeated moral right to own handguns, it is precisely those individuals who have a special need and demonstrate the relevant safety-related competence. (shrink)

Regarding the sinking lifeboat scenario involving several human beings and a dog, nearly everyone agrees that it is right to sacrifice the dog. I suggest that the best explanation for this considered judgment, an explanation that appears to time-relative interests, contains a key insight about prudential value. This insight, I argue, also provides perhaps the most promising reply to the future-like-ours argument, which is widely regarded as the strongest moral argument against abortion. Providing a solution to a longstanding puzzle in (...) value theory across species while illuminating the morality of abortion, the time-relative interest account proves worthy of sustained theoretical attention. (shrink)

_ Source: _Page Count 21 Guns occupy a major—sometimes terrible—place in contemporary American life. Do Americans have not only a legal right, but also a moral right, to own handguns? After introducing the topic, this paper examines what a moral right to private handgun ownership would amount to. It then elucidates the logical structure of the strongest argument in favor of such a right, an argument that appeals to physical security, before assessing its cogency and identifying two questionable assumptions. In (...) light of persisting reasonable disagreement about the argument’s soundness, the paper identifies two gun control measures—demonstrated need for a gun as a condition of eligibility and the requirement to pass a rigorous gun safety course—that reasonable disputants on both sides of the issue have principled reasons to accept. The paper also advances the thesis that, if anyone has an undefeated moral right to own handguns, it is precisely those individuals who have a special need and demonstrate the relevant safety-related competence. (shrink)

This best-selling anthology of readings with case studies provides insightful and comprehensive treatment of ethical issues in medicine. Appropriate for courses taught in philosophy departments as well as in schools of medicine and nursing, the collection covers provocative topics such as conflicts of interest in medicine, advance directives, physician-assisted suicide, and the rationing of health care. The text's effective pedagogical features include chapter introductions, argument sketches, explanations of medical terms, headnotes, and annotated bibliographies.

In the literature on persons and their identity, it is customary to distinguish the issue of the nature of personhood—“What is a person?”—from the issue of per- sonal identity—“What are the persistence conditions of a person over time?” In recent years, Eric Olson and Lynne Rudder Baker have brought to the forefront of discussion the related, but often neglected, issue of our essence: “What are we, most fundamentally (essentially)—human animals, persons, or something else?” -/- Attacking what he calls the Standard (...) View of personal identity, according to which personal identity consists in some type of psychological continuity, Olson contends that this thesis has highly implausible implications. Attributing the claim that we are essentially persons to the Standard View, Olson defends the alterna- tive thesis that we are essentially (living) human animals, members of the species Homo sapiens, and that our persistence conditions are biological, having nothing to do with psychology. At the heart of his critique is the contention that the Standard View lacks a plausible account of the relationship between a person and the human animal associated with her. Defending “person essentialism” and defining persons as beings with first-person perspectives, Lynne Rudder Baker responds to Olson’s challenge with the Constitution View: We (human) persons are constituted by, but not identical to, human animals. -/- After reconstructing Olson’s critique of the Standard View, I argue that Baker goes a long way toward meeting his challenge to account plausibly for the relationship between persons and human animals. Then I contend that her person-based Constitution View nevertheless has major difficulties: a “newborn problem”; a dubious ontology; and a problematic account of personal identity. I conclude with general reflections about this dialectic. (shrink)

Underlying President Bush's view regarding stemcell research and cloning are two assumptions: we originate at conception, and we have full moral status as soon as we originate. I will challenge both assumptions, argue that at least the second is mistaken, and conclude that the President's approach is unsustainable.

We attempt to bring the concepts of pain, suffering, and anxiety into sufficient focus to make them serviceable for empirical investigation. The common-sense view that many animals experience these phenomena is supported by empirical and philosophical arguments. We conclude, first, that pain, suffering, and anxiety are different conceptually and as phenomena, and should not be conflated. Second, suffering can be the result — or perhaps take the form — of a variety of states including pain, anxiety, fear, and boredom. Third, (...) pain and nociception are not equivalent and should be carefully distinguished. Fourth, nociception can explain the behavior of insects and perhaps other invertebrates (except possibly the cephalopods). Fifth, a behavioral inhibition system associated with anxiety in humans seems to be present in mammals and most or all other vertebrates. Based on neurochemical and behavioral evidence, it seems parsimonious to claim that these animals are capable of experiencing anxious states. (shrink)

We argue that the current ethical and regulatory framework for permissible risk levels in pediatric research can be helpfully understood in terms of children’s moral right to adequate protection from harm. Our analysis provides a rationale for what we propose as the highest level of permissible risk in pediatric research without the prospect of direct benefit: what we call “relatively minor” risk. We clarify the justification behind the usual standards of “minimal risk” and “a minor increase over minimal risk” and (...) explain why it is permissible to impose any risks at all on child participants who do not stand to benefit directly from enrollment in research. Finally, we illuminate some aspects of the concept of “best interests.”. (shrink)

Walter Sinnott-Armstrong and Frank Miller's article is an intelligent, interesting and important discussion.1 Its central thesis is that what makes killing wrong is not that killing causes death or loss of consciousness, but that killing causes an individual to be completely, irreversibly disabled. The first of two main implications is that it is not even pro tanto wrong to kill someone who is already in such a thoroughly disabled state. The second is that the dead donor rule in the context (...) of vital organ transplantation should be abandoned.I embrace the second main implication. As the authors argue, the dead donor rule is routinely violated in contemporary vital organ procurement; but what should change are not the standard practices in which the rule is violated, but the rule itself. In general, I believe that the practical implications of the authors’ account of the wrongness of killing are more justified than the account itself. My judgment is possible because their account has mostly the same implications as what I take to be the best account—at least regarding the killing of human beings. I turn now to points of disagreement.First, the authors argue that the wrongness of killing is a function of harming and that, because ‘a loss of autonomy is a kind of harm, broadly construed…,’ …. (shrink)

Discussions of patient-centred care and patient autonomy in bioethics have tended to focus on the decision-making context and the process of obtaining informed consent, leaving open the question of how patients ought to be counselled in the daily maintenance of their health and management of chronic disease. Patient activation is an increasingly prominent counselling approach and measurement tool that aims to improve patients’ confidence and skills in managing their own health conditions. The strategy, which has received little conceptual or ethical (...) analysis, raises important questions about how clinicians ought to foster confidence and a sense of control in their patients without exposing them to blame, stigma and other harms. In this paper, we describe patient activation, discuss its relationship to personal responsibility, autonomy and health disparities, and make recommendations regarding its use and measurement. (shrink)