The classification of medical interventions as either invasive or non-invasive is commonly regarded to be morally important. On the most commonly endorsed account of invasiveness, a medical intervention is invasive if and only if it involves either breaking the skin (‘incision’) or inserting an object into the body (‘insertion’). Building on recent discussions of the concept of invasiveness, we show that this standard account fails to capture three aspects of existing usage of the concept of invasiveness in relation to medical (...) interventions—namely, (1) usage implying that invasiveness comes in degrees, (2) that the invasiveness of an intervention can depend on the characteristics of the salient alternative interventions, and (3) that medical interventions can be invasive in non-physical ways. We then offer the beginnings of a revised account that, we argue, is able to capture a wider range of existing usage. Central to our account is a distinction between two properties: basic invasiveness and threshold invasiveness. We end by assessing what the standard account gets right, and what more needs to be done to complete our schematic account. (shrink)

In discussions of nudging, transparency is often taken to be important; it is often suggested that a significant moral consideration to take into account when nudging is whether the nudge is transparent. Another consideration taken to be relevant is whether the nudge is easy to resist. Sometimes, these two considerations are taken to be importantly related: if we have reason to make nudges easy to resist, then we have reason to make them transparent, insofar as a nudge’s transparency is relevant (...) to whether the nudge is easy to resist. In this paper, we critically scrutinize this view. First, we draw out the purported connections between transparency and resistibility, combining them into what we call the Resistibility-to-Transparency Argument (RTA). Then, we do some conceptual groundwork elaborating on different forms of transparency mentioned in the debate. With this in place, we argue that in order to be plausible, the RTA must appeal to certain forms of transparency; those on which the transparency of a nudge depends on the nudgee’s ability to become aware of the relevant facts about the nudge. We then argue against the common assumption that in order for a nudge to be easy to resist for an individual, that individual needs to have the capacity to easily become aware of the relevant nudge facts. We conclude that the connection between the easy resistibility of a nudge and its transparency is, at best, a weak one. (shrink)

As neuroscience progresses, we will not only gain a better understanding of how our brains work, but also a better understanding of how to modify them, and as a result, our mental states. An important question we are faced with is whether the state could be justified in implementing such methods on criminal offenders, without their consent, for the purposes of rehabilitation and reduction of recidivism; a practice that is already legal in some jurisdictions. By focusing on a prominent type (...) of view of free action, which I call bypassing views, this paper evaluates how such interventions may negatively impact the freedom of their subjects. The paper concludes that there will be a tension between the goals of rehabilitation and reduction of recidivism, on the one hand, and the negative impact such interventions may have on free action, on the other. Other things equal, the better that a particular intervention is at achieving the former, the more likely it is to result in the latter. (shrink)

Crutchfield and Redinger argue that consciousness-altering chemical restraints are less “liberty-intrusive” (or as we will sometimes put it, just less “intrusive”) than physical restraints. Physica...

In the theoretical literature on moral responsibility, one sometimes comes across cases of manipulated agents. In cases of this type, the agent is a victim of wholesale manipulation, involving the implantation of various pro-attitudes (desires, values, etc.) along with the deletion of competing pro-attitudes. As a result of this manipulation, the agent ends up performing some action unlike any that she would have performed were it not for the manipulation. These sorts of cases are sometimes thought to motivate historical views (...) of responsibility, on which the agent’s past is relevant to whether she is responsible for a specific action. In a recent paper, Daniel Sharp and David Wasserman bring these theoretical discussions on moral responsibility to bear on practical issues regarding neurological modifications of individuals. After proposing and arguing for a historical view, Sharp and Wasserman offer some insight into how such a view may help us in determining the responsibility of subjects who have undergone Deep Brain Stimulation. This paper aims to join this discussion, by arguing that the correct historical view to be applied will also appeal to the agent’s control over her mental life and the fact that this was bypassed. I conclude with some brief comments on the practical implications of such a historical view. (shrink)

In a recent paper, Kristin Mickelson argues that Alfred Mele’s Zygote Argument, a popular argument for the claim that the truth of determinism would preclude free action or moral responsibility, is not valid. This sort of objection is meant to generalize to various manipulation arguments. According to Mickelson, the only way to make such arguments valid is to supplement them with an argument that is an inference to the best explanation. In this paper, I argue that there are two other (...) ways in which the proponent of such manipulation arguments can modify their argument, neither of which requires an inference to the best explanation. I then briefly consider and respond to a worry with one of these proposed solutions. (shrink)

In discussions on moral responsibility for actions, a commonly discussed case is one in which an agent is manipulated into performing some action. On some views, such agents lack responsibility for those actions partly because they issue from attitudes that were acquired in an inappropriate way. In this paper, it is argued that such views are in need of revision. After introducing a new problematic case of a manipulated agent, revisions are offered for specific views. The paper concludes with a (...) discussion of the views in a broader context, as well as some potential implications of the revisions. (shrink)

Neurointerventions—interventions that physically or chemically modulate brain states—are sometimes imposed on criminal offenders for the purposes of diminishing the risk that they will recidivate, or, more generally, of facilitating their rehabilitation. One objection to the nonconsensual implementation of such interventions holds that this expresses a disrespectful message, and is thus impermissible. In this paper, we respond to this objection, focusing on the most developed version of it—that presented by Elizabeth Shaw. We consider a variety of messages that might be expressed (...) by nonconsensual neurointerventions. Depending on the message, we argue either that such interventions do not invariably express this message, that expressing this message is not invariably disrespectful, or that the appeal to disrespect is redundant. (shrink)

A volume with 14 chapters on various aspects of the relationship between responsibility and healthcare, plus a substantial introduction that offers a comprehensive overview of the relevant debates and how they relate to one another. Questions of responsibility arise at all levels of health care. Most prominent has been the issue of patient responsibility. Some health conditions that risk death or serious harm are partly the result of lifestyle behaviours such as smoking, lack of exercise, or extreme sports. Are patients (...) with such conditions responsible for them? If so, might healthcare providers, be they state-run systems or private entities, be justified in treating such patients differently? And if they are, which forms of differential treatment are justified? Responsibility isn’t just relevant for patients. Even when individuals affect their health through voluntary behaviour, other influences are also at work before, during, and after the patient’s interaction with the health care system. What are the responsibilities of individual clinicians and other medical professionals, when thinking about individual and public health? What about institutions such as governments or national health care services, or society as a whole? This collection brings together work by world-renowned experts in population ethics, distributive justice, philosophy of action, cognitive science, and medical ethics in order to push the debate forward by elucidating our understanding of these questions, their possible answers, and how they are related. (shrink)

We are grateful to the commentators for their close reading of our article 1 and for their challenging and interesting responses to it. We do not have space to respond to all of the objections that they raise, so in this reply, we address only a selection of them. Some commentaries question the usefulness of developing an account of the sort we provide, 2 or of revising the Standard Account (SA) in doing so. 3–5 Our schema is intended to provide (...) a framework for developing a full account of invasiveness that captures existing uses of the term. On the assumption that the term is used somewhat reliably and consistently–and we are inclined to agree with some of our commentators 3 4 that people are not terribly confused or mistaken in how they employ the term–an account that captures these... (shrink)

A common style of argument in the literature on free will and moral responsibility is the Manipulation Argument. These tend to begin with a case of an agent in a deterministic universe who is manipulated, say, via brain surgery, into performing some action. Intuitively, this agent is not responsible for that action. Yet, since there is no relevant difference, with respect to whether an agent is responsible, between the manipulated agent and a typical agent in a deterministic universe, responsibility is (...) not compatible with the truth of determinism. In response, some theorists have argued that there is a relevant difference, and have developed two sorts of accounts of that difference: bypassing views, and manipulator-focused views. Manipulator-focused views suggest that the difference concerns the presence of a manipulator, whereas bypassing views suggest that the relevant difference concerns the fact that the action issues from attitudes that the manipulated agent acquired in a way that bypassed her capacities for control over her mental life. One sort of case used to decide between these sorts of accounts is a case of machine induction, which is just like a manipulation case, yet the change in the agent is the result of some natural force. Against the received view, Xiaofei Liu argues that such cases pose problems for bypassing views, and favor manipulator-focused views instead. This paper addresses Liu’s arguments, as well as a variety of cases, concluding that cases of machine induction do not provide motivation for a bypassing theorist to adopt a manipulator-focused view. (shrink)

The Case of Jim: Jim was arrested arriving at the house of an unattended minor, having brought with him some alcoholic drinks, condoms, and an overnight bag. Records of online conversations Jim was having with the minor give the court strong evidence that the purpose of this meet-up was to engage in sexual relations with the minor. In the course of searching his home computer, investigators also found child pornography. Jim was charged with intent to sexually abuse a child and (...) possession of child pornography. He was given due process, and convicted, by a jury of his peers, on both counts. This is not the first time that Jim has been convicted of a sexual offence. He had been found guilty of possession of child pornography in the past, and served time for it. What should we do with Jim? (shrink)

When it comes to determining how healthcare resources should be allocated, there are many factors that could—and perhaps should—be taken into account. One such factor is a patient’s responsibility for his or her illness, or for the behavior that caused it. Policies that take responsibility for the unhealthy lifestyle or its outcomes into account—responsibility-sensitive policies—have faced a series of criticisms. One holds that agents often fail to meet either the control or epistemic conditions on responsibility with regard to their unhealthy (...) lifestyles or their outcomes. Another holds that even if patients sometimes are responsible for these items, we cannot know whether a particular patient is responsible for them. In this article, we propose a type of responsibility-sensitive policy that may be able to surmount these difficulties. Under this type of policy, patients are empowered to change to a healthier lifestyle by being given what we call a ‘Golden Opportunity’ to change. Such a policy would not only avoid concerns about patients’ fulfilment of conditions on responsibility for their lifestyles, it would also allow healthcare authorities to be justified in believing that a patient who does not change her lifestyle is responsible for the unhealthy lifestyle. We conclude with a discussion of avenues for further work, and place this policy in the broader context of the debate on responsibility for health. (shrink)

This introductory chapter offers an overview of the various ways that responsibility may be relevant to health care, in order to situate the chapters in this volume in their broader context. The chapter begins by outlining relevant concepts, and explaining why it is worth considering the role of responsibility in health care. The chapter then turns to various ways in which patients might be held responsible in a health care system, before considering objections to these practices. Finally, the chapter considers (...) the role of responsibility in health care beyond holding patients responsible, by considering the responsibility of medical professionals, and of institutions. (shrink)

Arguably, agents can be at least partly responsible for their unhealthy lifestyles and/or the health outcomes of said lifestyles. Health care policies that take an agent’s responsibility into account—for example, by reducing priority for treatment, increasing premiums, and so on—face a variety of objections. One of these is the harshness objection: the objection that such policies, and the practices they would justify, are too harsh in the ways that they hold patients accountable. This chapter discusses the harshness objection and evaluates (...) different versions of it. First, I clarify some of the concepts this objection relies on, including “responsibility” and “holding accountable.” Making use of these clarification, I then distinguish between different versions of the objection, which object to different aspects of the policy and practices. Finally, I assess the strength of differing versions of the objection, as well as the strength of some responses to it. I conclude with some thoughts about how such policies will need to be designed to avoid the objection. (shrink)

In a recent book, Ann Whittle develops a view of freedom and responsiblity according to which their attribution to agents is sensitive to the speakers' contexts. This review provides a summary of the main argument, and briefly mentions some points that will be of interest in further developing the view.