Duties to oneself are allegedly incoherent: if we had duties to ourselves, we would be able to opt out of them. I argue that there is a constraint on one’s ability to release oneself from duties to oneself. The release must be autonomous in order to be normatively transformative. First, I show that the view that combines the division of the self with the second-personal characterization of morality is problematic. Second, I advance a fundamental solution to the problem of (...) the incoherence of duties to oneself, one that does not rely on any division of the self, temporal or otherwise. I build upon the prevalent idea that, in releasing others from duties, we exercise the power of consent. The transformative force of consent partly derives from our autonomy. Invoking a plausible characterization of autonomy, I argue that release from duties requires the right kind of mental state. (shrink)

What is the foundation of consent in the criminal law? Classically liberal commentators have offered at least three distinct theories. J.S. Mill contends we value consent because individuals are the best judges of their own interests. Joel Feinberg argues an individual’s consent matters because she has a right to autonomy based on her intrinsic sovereignty over her own life. Joseph Raz also focuses on autonomy, but argues that society values autonomy as a constituent element of individual well-being, which it is (...) the state’s duty to promote. The criminal law’s approach to the problem of non-contemporaneous consent—prospective consent and retrospective consent—casts a unique light on the differences among these three justifications. Peter Westen claims neither Mill’s nor Feinberg’s justifications for consent fully explains how non-contemporaneous consent is treated in the criminal law. Specifically, Mill’s “self-interest” conception explains the criminal law’s limited recognition of prospective consent, but cannot explain its total rejection of retrospective consent. Conversely, Feinberg’s “sovereign autonomy” conception explains why the criminal law rejects retrospective consent, but cannot explain why the law recognizes irrevocable prospective consent only in limited circumstances. I resolve this dilemma by explaining that Raz’s “autonomy is good” conception is consistent with both the criminal law’s limited recognition of irrevocable prospective consent and its total rejection of retrospective consent. This suggests the existing criminal law embodies Raz’s theory that it is the duty of the state to promote morality, in particular the moral good of individual well-being through living autonomously. In contrast, the criminal law’s treatment of consent would have to be modified if it were to reflect Mill’s “self-interest” conception, or Feinberg’s “sovereign autonomy” conception. (shrink)

BackgroundNormally, physicians understand they have a duty to treat patients, and they perform accordingly consistent with codes of medical practice, standards of care, and inner moral motivation. In the case of COVID-19 pandemic in a developing country such as Bangladesh, however, the fact is that some physicians decline either to report for duty or to treat patients presenting with COVID-19 symptoms. At issue ethically is whether such medical practitioners are to be automatically disciplined for dereliction of duty (...) and gross negligence; or, on the contrary, such physicians may legitimately claim a professional right of autonomous judgment, on the basis of which professional right they may justifiably decline to treat patients.MethodsThis ethical issue is examined with a view to providing some guidance and recommendations, insofar as the conditions of medical practice in an under-resourced country such as Bangladesh are vastly different from medical practice in an industrialized nation such as the USA. The concept of moral dilemma as discussed by philosopher Michael Shaw Perry and philosopher Immanuel Kant’s views on moral appeal to “emergency” are considered pertinent to sorting through the moral conundrum of medical care during pandemic.ResultsOur analysis allows for conditional physician discretion in the decision to treat COVID-19 patients, i.e., in the absence of personal protective equipment (PPE) combined with claim of duty to family. Physicians are nonetheless expected to provide a minimum of initial clinical assessment and stabilization of a patient before initiating transfer of a patient to a “designated” COVID-19 hospital. The latter is to be done in coordination with the national center control room that can assure admission of a patient to a referral hospital prior to ambulance transport.ConclusionsThe presence of a moral dilemma (i.e., conflict of obligations) in the pandemic situation of clinical care requires institutional authorities to exercise tolerance of individual physician moral decision about the duty to care. Hospital or government authority should respond to such decisions without introducing immediate sanction, such as suspension from all clinical duties or termination of licensure, and instead arrange for alternative clinical duties consistent with routine medical care. (shrink)

Healthcare in the United States is most often described and experienced as an immense, convoluted industry with a sum greater than its parts. However, it is important to remember that these parts are distinct, autonomous individuals and entities with their own beliefs, customs, and viewpoints. Moral issues surface abundantly in healthcare due to its interconnectedness with human life with enhanced proximity during life’s beginning and end. Therefore, these individual beliefs are prone to clashing as seen in three key relationships: (...) between patient and provider, between providers, and between industry and providers. While this is both to be expected and respected, it is important to remember that all individuals and entities involved in healthcare do have one major duty in common – the welfare of the patient. Unfortunately, legislature at both the state and federal levels and organizational policies have been too willing to endanger the welfare of patients for the sake of balancing the individual consciences involved. (shrink)

Purpose – The purpose of this paper is to consider the question of equipping fully autonomous robotic weapons with the capacity to kill. Current ideas concerning the feasibility and advisability of developing and deploying such weapons, including the proposal that they be equipped with a so-called “ethical governor”, are reviewed and critiqued. The perspective adopted for this study includes software engineering practice as well as ethical and legal aspects of the use of lethal autonomous robotic weapons. Design/methodology/approach – (...) In the paper, the author survey and critique the applicable literature. Findings – In the current paper, the author argue that fully autonomous robotic weapons with the capacity to kill should neither be developed nor deployed, that research directed toward equipping such weapons with a so-called “ethical governor” is immoral and serves as an “ethical smoke-screen” to legitimize research and development of these weapons and that, as an ethical duty, engineers and scientists should condemn and refuse to participate in their development. Originality/value – This is a new approach to the argument for banning autonomous lethal robotic weapons based on classical work of Joseph Weizenbaum, Helen Nissenbaum and others. (shrink)

In the United Kingdom, the question of how much information is required to be given to patients about the benefits and risks of proposed treatment remains extant. Issues about whether healthcare resources can accommodate extended shared decision-making processes are yet to be resolved. COVID-19 has now stepped into this arena of uncertainty, adding more complexity. U.K. public health responses to the pandemic raise important questions about professional standards regarding how the obtaining and recording of consent might change or be maintained (...) in such emergency conditions, particularly in settings where equipment, medicines, and appropriately trained or specialized staff are in short supply. Such conditions have important implications for the professional capacity and knowledge available to discuss the risks and benefits of and alternatives to proposed treatment with patients. The government’s drive to expedite the recruitment to wards of medical students nearing the end of their studies, as well as inviting retired practitioners back into practice, raises questions about the ability of such healthcare providers to engage fully in shared decision-making.This article explores whether the legal duty on healthcare practitioners to disclose the material risks of a proposed medical treatment to a patient should be upheld during pandemic conditions or whether the pre-eminence of patient autonomy should be partly sacrificed in such exceptional circumstances. We argue that measures to protect public health and to respect autonomous decision-making are not mutually exclusive and that there are good reasons to maintain professional standards in obtaining consent to treatment even during acute pressures on public health systems. (shrink)

This paper argues that patients' duties are derivable from the idea which typically grounds the idea of patients' rights: patient autonomy. The autonomous patient, joined in partnership with the health care professional, has self-regarding obligations and obligations to others, including health care professionals. Patients' duties include, but are not limited to: a duty to be honest about why the patient seeks care; a duty to collect information on available treatments and likely side-effects; a duty for a (...) patient who has an infectious condition to act on that information which can best prevent further transmission. Keywords: autonomy, duty, paternalism, patient, rights, self-care CiteULike Connotea Del.icio.us What's this? (shrink)

We have a duty to try to develop and apply safe and cost-effective means to increase the probability that we shall do what we morally ought to do. It is here argued that this includes biomedical means of moral enhancement, that is, pharmaceutical, neurological or genetic means of strengthening the central moral drives of altruism and a sense of justice. Such a strengthening of moral motivation is likely to be necessary today because common-sense morality having its evolutionary origin in (...) small-scale societies with primitive technology will become much more demanding if it is revised to serve the needs of contemporary globalized societies with an advanced technology capable of affecting conditions of life world-wide for centuries to come. (shrink)

A number of companies including Google and BMW are currently working on the development of autonomous cars. But if fully autonomous cars are going to drive on our roads, it must be decided who is to be held responsible in case of accidents. This involves not only legal questions, but also moral ones. The first question discussed is whether we should try to design the tort liability for car manufacturers in a way that will help along the development (...) and improvement of autonomous vehicles. In particular, Patrick Lin’s concern that any security gain derived from the introduction of autonomous cars would constitute a trade-off in human lives will be addressed. The second question is whether it would be morally permissible to impose liability on the user based on a duty to pay attention to the road and traffic and to intervene when necessary to avoid accidents. Doubts about the moral legitimacy of such a scheme are based on the notion that it is a form of defamation if a person is held to blame for causing the death of another by his inattention if he never had a real chance to intervene. Therefore, the legitimacy of such an approach would depend on the user having an actual chance to do so. The last option discussed in this paper is a system in which a person using an autonomous vehicle has no duty of interfering, but is still held responsible for possible accidents. Two ways of doing so are discussed, but only one is judged morally feasible. (shrink)

To many, the idea of autonomous weapons systems (AWS) killing human beings is grotesque. Yet critics have had difficulty explaining why it should make a significant moral difference if a human combatant is killed by an AWS as opposed to being killed by a human combatant. The purpose of this paper is to explore the roots of various deontological concerns with AWS and to consider whether these concerns are distinct from any concerns that also apply to long-distance, human-guided weaponry. (...) We suggest that at least one major driver of the intuitive moral aversion to lethal AWS is that their use disrespects their human targets by violating the martial contract between human combatants. On our understanding of this doctrine, service personnel cede a right not to be directly targeted with lethal violence to other human agents alone. Artificial agents, of which AWS are one example, cannot understand the value of human life. A human combatant cannot transfer his privileges of targeting enemy combatants to a robot. Therefore, the human duty-holder who deploys AWS breaches the martial contract between human combatants and disrespects the targeted combatants. We consider whether this novel deontological objection to AWS forms the foundation of several other popular yet imperfect deontological objections to AWS. (shrink)

Political liberals on the left (e.g., Rawls) and right (e.g., Nozick) have long been concerned with the moral justification of coercive legal structures. I argue that anyone who publicly advocates a new coercive law is under a moral duty to those whom the law might negatively affect. The duty is to say that the law would be impactful and why its impacts (e.g., its coerciveness and welfare effects) are worth having all-things-considered. This is a defeasible duty of (...) transparency and disclosure. By doing their duty, citizens would better respect each other and even transform public discourse as we know it. (shrink)

To be beneficent, that is, to promote according to one's means the happiness of others in need, without hoping for something in return, is every man's duty. Immanuel Kant, The Metaphysics of Morals Almost everyone agrees that we have a moral duty to pull out a drowning child from a shallow pond even if this means getting our clothes muddy. But what are the limits of the duty of beneficence? In “Famine, Affluence and Morality”, which first appeared (...) in 1972, Peter Singer attempted to specify those limits in terms of the following principle: “if it is in our power to prevent something bad from happening, without thereby sacrificing anything of comparable moral importance, we ought, morally, to do it.” Singer went on to use this principle to argue that we ought to be doing all we can to prevent Third World hunger. At the same time, he challenged the well-established Western moral viewpoint that makes it an act of charity rather than a duty for a relatively affluent individual to give money to help feed the world's poor. Singer left open the question of whether the traditional distinction between duty and charity should be redrawn or abolished altogether, although he insisted that giving to others who are starving, even at the cost of giving up luxuries such as new clothes or a new car, is not an act of charity, but a duty. (shrink)

It is now an ethical dictum that patients should be informed by physicians about their diagnosis, prognosis and treatment options. In this paper, I ask: ‘How informed are the ‘informers’ in clinical practice?’ Physicians have a duty to be ‘well-informed’: patient well-being depends not just in conveying adequate information to patients, it also depends on physicians keeping up-to-date about: popular misunderstandings of illnesses and treatments; and the importance of patient psychology in affecting prognosis. Taking the case of depression as (...) an entry point, this paper argues that medical researchers and physicians need to pay serious attention to the explanations given to patients regarding their diagnosis. Studies on lay understanding of depression show that there is a common belief that depression is wholly caused by a ‘chemical imbalance’ that can be restored by chemically restorative antidepresssants, a claim that has entered ‘folk wisdom’. However, these beliefs oversimplify and misrepresent the current scientific understanding of the causes of depression: first, there is consensus in the scientific community that the causes of depression include social as well as psychological triggers ; second, there is significant dissensus in the scientific community over exactly what lower level, biological or biochemical processes are involved in causing depression; third, there is no established consensus about how antidepressants work at a biochemical level; fourth, there is evidence that patients are negatively affected if they believe their depression is wholly explained by of ‘biochemical imbalance’. I argue that the medical community has a duty, to provide patients with adequate information and to be aware of the negative health impact of prevalent oversimplifications—whatever their origins. (shrink)

In chapter 4 of Autonomous Knowledge: Radical Enhancement, Autonomy and the Future of Knowing (OUP, 2021), Carter takes on the question of whether there is an epistemic autonomy condition on know-how, e.g. one that might rule out cases of radical performance enhancement as genuine cases of know-how. In this paper, I examine Carter’s proposal and identify an asymmetry in the way his epistemic autonomy condition is applied to enhanced and non-enhanced instances of know-how. In particular, it seems that either (...) an autonomy condition is required for all forms of knowledge-how or it is not. If it is, then a potential worry is that young children do not manifest their know-how when doing things that we would normally be inclined to say they know how to do. If it is not, then young children do manifest some forms of non-enhanced know-how. While Carter chooses the second option, I argue that it is better to choose the first one, that is, to claim that all know-how needs to be epistemically autonomous along the lines he has described. I also show how this does not exclude young children from knowing how to do things. (shrink)

There is an ongoing debate in medicine about whether patients have a ‘right not to know’ pertinent medical information, such as diagnoses of life-altering diseases. While this debate has employed various ethical concepts, probably the most widely-used by both defenders and detractors of the right is autonomy. Whereas defenders of the right not to know typically employ a ‘liberty’ conception of autonomy, according to which to be autonomous involves doing what one wants to do, opponents of the right not (...) to know often employ a ‘duty’ understanding, viewing autonomy as involving an obligation to be self-governing. The central contribution of this paper is in showing that neither view of autonomy can reasonably be said to support the extreme stances on the right not to know that they are sometimes taken to. That is, neither can a liberty view properly defend a right not to know without limits, nor can a duty view form the basis of an absolute rejection of the right not to know. While there is still theoretical distance between these two approaches, we conclude that the views are considerably closer on this issue than they first appear, opening the way for a possible compromise. (shrink)

The harms associated with wireless mobile devices (e.g. smartphones) are well documented. They have been linked to anxiety, depression, diminished attention span, sleep disturbance, and decreased relationship satisfaction. Perhaps what is most worrying from a moral perspective, however, is the effect these devices can have on our autonomy. In this article, we argue that there is an obligation to foster and safeguard autonomy in ourselves, and we suggest that wireless mobile devices pose a serious threat to our capacity to fulfill (...) this obligation. We defend the existence of an imperfect duty to be a ‘digital minimalist’. That is, we have a moral obligation to be intentional about how and to what extent we use these devices. The empirical findings already justify prudential reasons in favor of digital minimalism, but the moral duty is distinct from and independent of prudential considerations. (shrink)

Happiness today is not just a possibility or an option but a requirement and a duty. To fail to be happy is to fail utterly. Happiness has become a religion--one whose smiley-faced god looks down in rebuke upon everyone who hasn't yet attained the blessed state of perpetual euphoria. How has a liberating principle of the Enlightenment--the right to pursue happiness--become the unavoidable and burdensome responsibility to be happy? How did we become unhappy about not being happy--and what might (...) we do to escape this predicament? In Perpetual Euphoria, Pascal Bruckner takes up these questions with all his unconventional wit, force, and brilliance, arguing that we might be happier if we simply abandoned our mad pursuit of happiness. Gripped by the twin illusions that we are responsible for being happy or unhappy and that happiness can be produced by effort, many of us are now martyring ourselves--sacrificing our time, fortunes, health, and peace of mind--in the hope of entering an earthly paradise. Much better, Bruckner argues, would be to accept that happiness is an unbidden and fragile gift that arrives only by grace and luck. A stimulating and entertaining meditation on the unhappiness at the heart of the modern cult of happiness, Perpetual Euphoria is a book for everyone who has ever bristled at the command to "be happy.". (shrink)

In Western countries a considerable number of older people move to a residential home when their health declines. Institutionalization often results in increased dependence, inactivity and loss of identity or self-worth (dignity). This raises the moral question as to how older, institutionalized people can remain autonomous as far as continuing to live in line with their own values is concerned. Following Walker's meta-ethical framework on the assignment of responsibilities, we suggest that instead of directing all older people towards more (...) autonomy in terms of independence, professional caregivers should listen to the life narrative of older people and attempt to find out how their personal identity, relations and values in life can be continued in the new setting. If mutual normative expectations between caregivers and older people are not carefully negotiated, it creates tension. This tension is illustrated by the narrative of Mr Powell, a retired successful public servant now living in a residential home. The narrative describes his current life, his need for help, his independent frame of mind, and his encounters with institutional and professional policies. Mr Powell sees himself as a man who has always cared for himself and others, and who still feels that he has to fulfil certain duties in life. Mr Powell's story shows that he is not always understood well by caregivers who respond from a one-sided view of autonomy as independence. This leads to misunderstanding and an underestimation of his need to be noticed and involved in the residential community. (shrink)

In a contribution to The Journal of Medicine and Philosophy , Professor Rosamond Rhodes argues that individuals sometimes have an obligation to know about their genetic disorders, because this is required by their status as autonomous persons. Her analysis, which is based on Kant's concept of autonomy and Aristotle's notion of friendship, is extended here to consequentialist concerns. These are of paramount importance if, as we believe and Professor Rhodes herself implies, the Kantian and Aristotelian doctrines can be helpful (...) only in the sphere of private morality, not in the public realm. Better tools for assessing the right to genetic ignorance as an issue of public policy can, we contend, be found in Mill's ideas concerning liberty and the prevention of harm. Our own conclusion, based on the Millian way of thinking, is that individuals probably do have the right to remain in ignorance in the cases Professor Rhodes presents as examples of a duty to know. (shrink)

Based on an empirical study regarding ethical challenges within intercultural health care, the focus of this article is upon autonomy and disclosure, discussed in light of philosophy and anthropology. What are the consequences for patients if the patients’ right to be autonomous and to participate in treatment and care decisions by health care workers is interpreted as an obligation to participate? To force a person to make independent choices who is socio-culturally unprepared to do so, may violate his/her integrity. (...) This may in turn jeopardise the respect, integrity and human worth the principle of autonomy was meant to ensure, and if so, may damage any relationship of trust that may exist between patient and health care worker. There is necessarily a link between autonomy and disclosure. Western disclosure practices may make the relationship between patients and health care workers difficult -- even distrustful. To confront a patient with a very serious diagnosis may be seen not only as a tactless action, but also an unforgivable one. Hence, among many ethnic groups it is a family member’s duty to shield patients from bad or disquieting news, e.g., a cancer diagnosis. If a family member is used to interpret in such situations, will the information given equal the information communicated by that interpreter? Even though respect for a person’s autonomy is part of the respect for a person, one’s respect for the person in question should not depend on his/her ability or aptitude to act autonomously. (shrink)

The idea that a person might have a duty to defer to the moral judgments of others is typically something that arouses our suspicion, in ways that other kinds of deference do not. One explanation for this is the value of autonomy. According to this explanation, people have a duty to be autonomous, and any act of deferring to another person’s moral judgement is not an autonomous action. Call this “the Autonomy Argument” against moral deference. In (...) this article, I criticise the Autonomy Argument. I argue that, even if we accept that an act of moral deference can never be autonomous, those who believe that people have a duty to be autonomous must accept that acts of moral deference are morally necessary. This is because some people are incapable of becoming autonomous by themselves, and deferring to a moral expert is the only way they might ever become autonomous. (shrink)

In 2017, Carson and Flood outlined a general duty to be vaccinated, arguing from Catholic social teaching on justice, love, solidarity and the common good. This necessarily relied on assumptions about the typical nature of vaccination, assumptions which do not always hold true in concrete situations. I identify twelve criteria that, where they hold, strengthen the particular duty to be vaccinated, and, if not met, weaken or reverse it. These pertain to the biological agent which vaccination aims to (...) protect against, the vaccine and its supply, the costs and benefits of vaccination to the individual and society, and the alternative courses of action. The two-way relationship between the moral duty to be vaccinated and vaccine mandates is discussed. Individuals and policy-makers need to know these criteria – and be provided the necessary information to evaluate vaccination against them – in order to make a truly rational judgement. (shrink)

Resnik and Pugh recently explored the ethical implications of routinely integrating environmental concerns into clinical decision-making. While we share their concern for the holistic well-being of patients, our response offers a different clinical and bioethical stance on green informed consent and patient autonomy. Contrary to the authors’ lack of data to support their concerns about provider and patient willingness to engage in climate-related conversations, we provide evidence supporting their sustainability engagement and stress the importance of a proactive, anticipatory approach in (...) healthcare to align with evolving societal values. If climate change is perceived as a politicised issue, though it is not inherently so, healthcare providers are professionally trained to address sensitive subjects and have a duty to inform patients about potential health risks. Recognising the environmental crisis as a health crisis underscores the direct connection between environmental hazards and patients’ well-being. Our perspective advocates for integrating individual considerations, societal responsibilities and systemic changes to promote environmentally sustainable healthcare. (shrink)

In latter-day discussions on corporate morality, duties of commission are fiercely debated. Moral institutionalists argue that duties of commission—such as a duty of assistance—overstep the boundaries of moral duty owed by economic agents. " Moral institutionalism" is a newly coined term for a familiar position on market morality. It maintains that market morality ought to be restricted, excluding all duties of commission. Neo-Classical thinkers such as Baumol and Homann defend it most eloquently. They underpin their position with concerns (...) that go to the core of liberalism—the dominant western political theory that sustains the ideals of both the free market and the free, rational person. Those authors claim that liberalism calls for a fully differentiated market because it resents the politicization of the market. Fully differentiated markets exclude duties of commission. They also claim that full differentiation of the market closes the troublesome gap between moral motivation and moral virtue. Full differentiation redeems the promise of "easy virtue". In this paper moral institutionalism will be rejected from a Kantian point of view, mostly inspired by Herman's thesis on the invisibility of morality. Liberalism may perhaps ban the politicization of the market; it does not forbid its moralization. The idea of a fully differentiated market must also be rejected because it is either morally over-demanding (to the morally autonomous person) or morally hazardous (to the person with failing moral motivation). Contrary to what the moral institutionalists claim, right action, morally, is actually quite difficult in fully differentiated markets. (shrink)

The attention economy — the market where consumers’ attention is exchanged for goods and services — poses a variety of threats to individuals’ autonomy, which, at minimum, involves the ability to set and pursue ends for oneself. It has been argued that the threat wireless mobile devices pose to autonomy gives rise to a duty to oneself to be a digital minimalist, one whose interactions with digital technologies are intentional such that they do not conflict with their ends. In (...) this paper, we argue that there is a corresponding duty to others to be an attention ecologist, one who promotes digital minimalism in others. Although the moral reasons for being an attention ecologist are similar to those that motivate the duty to oneself, the arguments diverge in important ways. We explore the application of this duty in various domains where we have special obligations to promote autonomy in virtue of the different roles we play in the lives of others, such as parents and teachers. We also discuss the consequences of our arguments for employers, software developers, and policy makers. (shrink)

Trust is a complex attitude that has emotional, cognitive and moral dimensions. A difficulty to reduce trust to a simple emotional attitude is that trust raises normative pressures: if someone asks you to be trusted you feel the normative pressure of not letting him or her down, and if someone trusts you, you feel the normative pressure of honoring his or her trust. These normative pressures seem to have an irreducibly social character: pressures are effective insofar as they may raise (...) emotions of shame in those who violate the norm of trust and resentment and contempt in those who are victim of the violation. In this paper I will investigate the relation between the affective dimension of these normative pressures and their moral dimension by arguing that an important moral asymmetry exists between the duty to trust and the duty to be trustful. (shrink)

What are our responsibilities in the face of injustice? How far should we go to fight it? Many would argue that as long as a state is nearly just, citizens have a moral duty to obey the law. Proponents of civil disobedience generally hold that, given this moral duty, a person needs a solid justification to break the law. But activists from Henry David Thoreau and Mohandas Gandhi to the Movement for Black Lives have long recognized that there (...) are times when, rather than having a duty to obey the law, we have a duty to disobey it. -/- Taking seriously the history of this activism, A Duty to Resist wrestles with the problem of political obligation in real world societies that harbor injustice. Candice Delmas argues that the duty of justice, the principle of fairness, the Samaritan duty, and political association impose responsibility to resist under conditions of injustice. We must expand political obligation to include a duty to resist unjust laws and social conditions even in legitimate states. -/- For Delmas, this duty to resist demands principled disobedience, and such disobedience need not always be civil. At times, covert, violent, evasive, or offensive acts of lawbreaking can be justified, even required. Delmas defends the viability and necessity of illegal assistance to undocumented migrants, leaks of classified information, distributed denial-of-service (DDoS) attacks, sabotage, armed self-defense, guerrilla art, and other modes of resistance. There are limits: principle alone does not justify law breaking. But uncivil disobedience can sometimes be not only permissible but required in the effort to resist injustice. (shrink)

Since the global financial crisis in 2008, corporations have faced a crisis of trust, with growing sentiment against ‘elites and ‘big business’ and a feeling that ‘something ought to be done’ to re-establish public regard for corporations. Trust and trustworthiness are deeply moral significant. They provide the ‘glue or lubricant’ that begets reciprocity, decreases risk, secures dignity and respect, and safeguards against the subordination of the powerless to the powerful. However, in deciding how to restore trust, it is difficult to (...) determine precisely what should be done, by whom, and who will bear the cost, especially if any action involves a risk to overall market efficiency and corporate profitability. The paper explores whether corporations have a moral duty to be trustworthy, to bear the cost of being so and thus contribute to resolving the current crisis of trust. It also considers where the state and other social actors have strong reason to protect and enforce such moral rights, while acknowledging that other actors have similar obligations to be trustworthy. It outlines five ‘salient factors’ that trigger specific rights to trustworthiness and a concomitant duty on corporations to be trustworthy: market power, subordination (threat and intimidation), the absence of choice, the need to preserve systemic trust, and corporate political power which might undermine a state’s legitimacy. Absent these factors and corporations do not have a general duty to be trustworthy, since a responsible actor in fair market conditions should be able to choose between the costs and benefits of dealing with generally trustworthy corporations. (shrink)

Happiness today is not just a possibility or an option but a requirement and a duty. To fail to be happy is to fail utterly. Happiness has become a religion--one whose smiley-faced god looks down in rebuke upon everyone who hasn't yet attained the blessed state of perpetual euphoria. How has a liberating principle of the Enlightenment--the right to pursue happiness--become the unavoidable and burdensome responsibility to be happy? How did we become unhappy about not being happy--and what might (...) we do to escape this predicament? In Perpetual Euphoria, Pascal Bruckner takes up these questions with all his unconventional wit, force, and brilliance, arguing that we might be happier if we simply abandoned our mad pursuit of happiness. Gripped by the twin illusions that we are responsible for being happy or unhappy and that happiness can be produced by effort, many of us are now martyring ourselves--sacrificing our time, fortunes, health, and peace of mind--in the hope of entering an earthly paradise. Much better, Bruckner argues, would be to accept that happiness is an unbidden and fragile gift that arrives only by grace and luck. A stimulating and entertaining meditation on the unhappiness at the heart of the modern cult of happiness, Perpetual Euphoria is a book for everyone who has ever bristled at the command to "be happy.". (shrink)

The state has a duty to protect individuals from violations of their basic rights to life and liberty. But does the state have a duty to criminalize such violations? Further, if there is a duty on the part of the state to criminalize violations, should the duty be constitutionally entrenched? This paper argues that the answer to both questions is positive. The state has a duty not merely to effectively prevent violations of our rights to (...) life and liberty, but also to criminalize such violations. Further, the duty to criminalize ought to be constitutionally entrenched. In the absence of criminal prohibitions on violations of the right to life and liberty individuals live ‘at the mercy’ of others. In the absence of a constitutional duty to criminalize, life and liberty of individuals is contingent upon the judgments and inclinations of the legislature. In both cases citizens’ rights are ‘at the mercy of others’. I also show that the decisions of the German Constitutional Court concerning abortion can be justified on such grounds. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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The European Union’s policies regarding genetically modified food are based on the precautionary principle and the requirement of respecting consumers’ autonomy. We ask whether the requirement of respecting consumers’ autonomy regarding GMF implies that both GMF and non-GMF products should be available in the market. According to one line of thought, consumers’ choices may be autonomous even when the both types of products are not available. A food market with only GMF or only non-GMF products does not strictly speaking (...) compel people to buy the type of products available, and a possibility to refuse to buy is enough for consumers’ choice to be autonomous. According to another line of thought, the unavailability of GMF or non-GMF products restricts the autonomy of those consumers who are unwilling to use the only type of products available in the market. From the point of view of autonomy, a food market with only GMF or only non-GMF products does not offer enough alternatives for consumers. Moreover, the whole point of the European Union’s requirement of respecting consumers’ autonomy is to enable an autonomous choice between GMF and non-GMF—not just to give a possibility to refrain from buying. However, this does not imply that producers, processors, wholesalers, retailers, or public authorities have a moral duty to see that there are both GMF and non-GMF products available in the market. The requirement to respect autonomy is prima facie in nature, and in the context of GMF, other prima facie requirements are often stronger and override it. Not only the consumers’ autonomy of choice but also environmental values, other people’s well-being, and the autonomous choice of farmers, retailers, and other relevant parties should be respected. Thus, according to the both lines of thought, the requirement to respect consumers’ autonomy of choice does not imply that there should be both GMF and non-GMF products available in the market. (shrink)

Background: Informed consent is regarded as a contract between autonomous and equal parties and requires the elements of information disclosure, understanding, voluntariness and consent. The validity of informed consent for critically ill patients has been questioned. Little is known about how these patients experience the process of consent.Objective: The aim of this study was to explore critically ill patients’ experience with the principle of informed consent in a clinical trial and their ability to give valid informed consent.Design: 11 stroke (...) patients who had been informed about thrombolytic treatment and had been through the process of deciding whether or not to participate in a thrombolysis trial went through repeated qualitative semistructured interviews.Results: None of the patients had any clear understanding of the purpose of the trial. Neither did they understand the principles of randomisation and voluntariness. Reasons for giving or not giving consent were trust, conceptions of benefits and risks and altruism. Several patients found it immoral to involve patients in the consent procedure and argued that this was the doctors’ responsibility. Others argued that it is a duty to question patients and perceived it as a sign of being treated with respect and dignity. A majority of the patients found the consent process vague and ambiguous.Conclusions: The results indicate that the principle of informed consent from critically ill patients cannot be seen as a contract between equal and autonomous parties. Further studies are needed to explore critically ill patients’ experiences with the process of informed consent. (shrink)

Before commenting on the “Introduction” to Telos 108 by Piccone, Berman and Ulmen, I want to cite two distinctions relevant to my discussion of it. First, federalism and populism are separate concepts, whatever it turns out is the proper meaning of populism and whether or not the intent of the Introduction was to argue for both. Federalism concerns a type of social organization held to be preferable for relatively complex commercial societies; the kind of societies that presently dominate the first (...) world. It consists of relatively autonomous units united under a mutually agreed upon constitutional framework assigning strictly limited responsibilities and duties to a central state authority. (shrink)

That we owe duties to others is a commonplace, the subject of countless philosophical treatises and monographs. Morality is interpersonal and other-directed, many claim. But what of what we owe ourselves? In Duty to Self, Paul Schofield flips the paradigm of interpersonal morality by arguing that there are moral duties we owe ourselves, and that in light of this, philosophers need to significantly rethink many of their views about practical reason, moral psychology, politics, and moral emotions. -/- Among these (...) views is the idea that divisions within a person's life enable her to relate to herself second-personally--that is, as though she were relating to a distinct other person--in the way required by morality. Further, there exist political duties owed to the self, which the state may coerce persons to perform. This amounts to a novel argument for paternalistic law, which appeals to considerations of right, justice, and freedom in order to justify coercing a person for their own sake--a liberal justification for an idea typically thought to be deeply at odds with liberalism. -/- Schofield untangles how this view would impact various issues in applied ethics and political philosophy, for example, financial prudence and risk, the pursuit of the good life, and medical ethics. Duty to Self is essential for anyone working in moral and political philosophy or political theory. (shrink)

In a recent article in the Journal of Medicine and Philosophy , David Ost (1984) claims that patients do not have a right to waive their right to information. He argues that patients cannot make informed rational decisions without full information and thus, a right to waive information would involve a right to avoid one's responsibility to act as an autonomous moral agent. In support of his position, Ost cites a passage from Mill. Yet, a correct interpretation of the (...) passage in question would support one's right to remain uninformed in certain situations. If the information would hurt one's chances for survival or hurt one's ability to make calm, rational decisions, then one not only does not have a duty to find out the information, but one's exercising one's right to remain uninformed may be the only rational course of action to take. Keywords: medical ethics, informed consent, autonomy, information waiver, right, rationality CiteULike Connotea Del.icio.us What's this? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Aesthetics, Education, the Critical Autonomous Self, and the Culture IndustryMarianna Papastephanou (bio)IntroductionE Lucevan le Stelle disconnected both from Tosca and Puccini becomes incidental music and brings strong recollections of the detergent advertisement it once coated. Last Year in Marienbad has caused some of the deepest yawn relief to many hopefuls for the title of the sophisticated who wished to cash out the film's cultural and social capital. A (...) painting by a well-known artist in the living room of a middle-upper-class residence often matches the colors of the carpet, and a piece of African art in the corner testifies to the hosts' cosmopolitan respect for otherness and the proper dose of hybridity in their selfhood. The young of the family are said to search for freedom from the puritan lifestyle in Ecstasis. Or, they rebel against the oppressive order of the system through idolizing music bands of an unconventional style and, as a matter of fact, of "unconventional" wealth accumulated precisely through the systemic exploitation of their idolization. The whole family, including the discontented young, will unite in the enjoyment of a new movie in which, just as in hundreds before it, police detectives can solve cases only after their suspension from duty and foreigners prefer to converse in perfect English when they are alone. What all members of the family are sure of by the end of the day, some of them through the prism of heavy drinking and others in the sober appreciation of the latest reality show, is that they exercised once again their free will in all instances. For they oriented their desires, treated as natural and self-posited, to objects they initially lacked but "autonomously" and "critically" found and selected from a rich and all-encompassing marketplace of culture. [End Page 75]How are art, its education, and its educational ideals of autonomy and critique related to this particular cultural reality that I have highlighted? Pseudo-individualism, escapism, Ersatzbefriedigung, fetishization, reification, and educationalization are some of the terms Adorno employed to approach the reality of artistic production and reception in capitalist times while preserving the distance that art offers for critiquing reality.1 In contrast with the above-sketched reality, in Adorno's ultimate aesthetic vision through art the self is not supposed to "forget in dreams the present world, but to change it by the strength of an image."2 Adorno attacks the drive toward a "totally administered" society—that of late capitalism—which "reduces every aspect of present-day life to the dead level of conformist popular 'taste' as dictated by a wholesale culture industry given over to the purposes of mass indoctrination."3 Fundamentally, the culture industry hinders the formation of autonomous, critical, and independent individuals.4I shall argue that such a theoretical framework gives us additional insight through which to combat what has already been perceived in pedagogical discourse as educational inability to cultivate reflective and critical subjectivities. Instead of autonomy, education nurtures narcissism. and instead of critique, it promotes appeasement5 —all the more so when education succumbs to the culture industry or fails to encourage students' critical stance to its imperatives.My position here is that by reclaiming their own valuable connection to reflective artistic experience and reception, aesthetic theory and art education can contribute to a reconceptualization of autonomy and critique and, perhaps more importantly, to a reorientation of educational practice.6 Adorno's aesthetics is exceptionally relevant to this aim because his work exemplifies in a unique way the necessary awareness of the antinomic qualities of autonomy and critique, their ineluctable dependence on society and culture, and their secret culpability in domination. Moreover, Adorno's cultural criticism comprises an unsurpassable diagnosis of those social pathologies that leads away from critical and reflective subjectivity and offers conceptual means for setting a critical eye on some current impoverished practices of teaching art. Above all, Adorno's aesthetic theory displays a remarkable topicality regarding contemporary positions on purely artistic concerns and contentions. Thus, the current neglect of his work in aesthetic educational theory7 must be dealt with since accommodation of such aesthetics within art educational discourse will serve significantly the latter's... (shrink)

Christian List and Philip Pettit argue that some groups qualify as rational agents over and above their members. Examples include churches, commercial corporations, and political parties. According to the theory developed by List and Pettit, these groups qualify as agents because they have beliefs and desires and the capacity to process them and to act on their basis. Moreover, the alleged group agents are said to be rational to a high degree and even to be fit to be held morally (...) responsible. And the group agents under consideration are autonomous, according to the List-Pettit Theory, because their beliefs and desires cannot easily be reduced to the beliefs and desires of the groups’ members. I want to show that we should not accept the List-Pettit Theory, because it implies the absurd claim that instrument-user units, like car-driver units, are rational agents over and above their user-parts, say drivers. The focus of my argument is on whether instrument-user units are autonomous in relation to their user-parts on the List-Pettit Theory. (shrink)

What are the relationships between value and duty? Which ontic status has a duty and why? This article aims at clarifying these concepts. It is indicated that in Kant’s writings, we come across texts that enable a slightly different interpretation of his philosophy. And so: the ma%er of good will is the goals themselves; good will must act according to the maxim that the members of the kingdom of goals follow. And this is a moral good since the (...) highest principle of morality is the desire for autonomy of will. Thus, the form of universal legislation is a community of autonomous beings in which the humanity of each of them is realized. In such a community, the a priori content – the content of an ethical reality – is created. It can be said that relationships between people are various forms of ontic status of a duty. (shrink)

Forgiveness as a positive response to wrongdoing is a widespread phenomenon that plays a role in the moral lives of most persons. Surprisingly, Kant has very little to say on the matter. Although Kant dedicates considerable space to discussing punishment, wrongdoing and grace, he addresses the issues of human forgiveness directly only in some short passages in the Lectures on Ethics and in one passage of the Metaphysics of Morals. As noted by Sussman, the TL passage, however, betrays some ambivalence. (...) Kant establishes a duty of virtue to be forgiving (TL, 6:460), yet he immediately warns against its excess: meek toleration of recurrent wrongs could manifest a lack of self-respect and a violation of a duty to oneself (TL, 6:461). Sussman claims that this ambivalence ultimately arises from the fact that forgiveness sits uncomfortably in Kant’s moral thought. First, forgiveness has an ‘ineluctably elective aspect’ that makes it, to a certain extent, arbitrary and dependent on particular features of the forgiver’s psychology and, as such, in tension with Kant’s central claims that human beings are autonomous agents capable of determining their own moral status. Second, according to Sussman, Kant’s moral retributivism, i.e. ‘the particular moral position that every moral wrong against another deserves punishment of the wrongdoer’ seems to be in tension with the possibility of a ‘truly redemptive forgiveness’. Moreover, forgiveness also seems to be in tension with a passage of the Religion in which Kant argues that the moral guilt from our original evil disposition cannot be understood as a debt or liability that can be compensated, erased, transferred or otherwise wiped out by others (Rel, 6:72). Thus, to the extent that forgiveness might be thought to involve the forgoing of moral guilt, it seems incompatible with Kant’s views on culpability and punishment. This chapter seeks to clarify Kant’s views on forgiveness in order to show that, although not often appreciated, personal forgiveness plays an important role in the lives of ordinary human agents as understood by Kant. In particular, I aim to show there is a conception of forgiveness available to Kant that is not incompatible with Kant’s views of punishment and culpability. In Section 1, I argue that, for Kant, far from being merely ‘elective,’ forgiveness is, under certain conditions, morally required. I provide a brief summary of an interpretation of Kant’s theory of forgiveness that I have defended in recently published work , in order to argue that Kant’s duty to be forgiving should be understood as an imperfect duty of virtue which is conditional on repentance. Kant is not ambivalent about this duty because he maintains that when the relevant conditions are not met, we have a perfect duty to ourselves not to forgive unrepentant wrongdoers. The TL passage thus identifies two different duties. In Section 2, I show that forgiveness, as conceptualised by Kant, does not require the forgoing of punishment or the overcoming of moral guilt and that this could, in fact, be seen as an attractive feature of Kant’s position. I end by offering a very brief assessment of Kant’s views. (shrink)

This paper argues that public statues of persons typically express a positive evaluative attitude towards the subject. It also argues that states have duties to repudiate their own historical wrongdoing, and to condemn other people’s serious wrongdoing. Both duties are incompatible with retaining public statues of people who perpetrated serious rights violations. Hence, a person’s being a serious rights violator is a sufficient condition for a state’s having a duty to remove a public statue of that person. I argue (...) that this applies no less in the case of the ‘morally ambiguous’ wrongdoer, who both accomplishes significant goods and perpetrates serious rights violations. The duty to remove a statue is a defeasible duty: like most duties, it can be defeated by lesser-evil considerations. If removing a statue would, for example, spark a violent riot that would risk unjust harm to lots of people, the duty to remove could be outweighed by the duty not to foreseeably cause unjust harm. This would provide a lesser-evil justification for keeping the statue. But it matters that the duty to remove is outweighed, rather than negated, by these consequences. Unlike when a duty is negated, one still owes something in cases of outweighing. And it especially matters that it is outweighed by the predicted consequences of wrongful behaviour by others. (shrink)

Background: The coronavirus disease 2019 pandemic is impacting the delivery of healthcare worldwide, creating dilemmas related to the duty to care. Although understanding the ethical dilemmas about the duty to care among nurses is necessary to allow effective preparation, few studies have explored these concerns. Aim: This study aimed to identify the ethical dilemmas among clinical nurses in Spain and Chile. It primarily aimed to (1) identify nurses’ agreement with the duty to care despite high risks for (...) themselves and/or their families, (2) describe nurses’ well-being and (3) describe the associations between well-being and the duty to care. Research design: Cross-sectional self-reported anonymous data were collected between May and June 2020 via electronic survey distribution (snowball sampling). Ethical considerations: The Institutional Ethical Review Committees in both countries approved the study (CHUC_2020_33 and 27/2020). Findings: In total, 345 clinical nurses answered the primary question about the duty to care for the sick. Although in the total sample 77.4% agreed they have a duty to care for the sick, significant differences were found between the Spanish and Chilean samples. Overall, 53.6% of the nurses reported low levels of well-being; however, among those reporting low well-being, statistically significant differences were found between Spanish and Chilean nurses as 19.4% and 37.8%, respectively, disagreed with the statement regarding the duty to care. Discussion: Participants in both countries reported several ethical dilemmas, safety fears, consequent stress and low well-being. These results suggest that prompt actions are required to address nurses’ ethical concerns, as they might affect their willingness to work and psychological well-being. Conclusion: Our findings shed light on the ethical dilemmas nurses are facing related to the duty to care. Not only has the coronavirus disease 2019 pandemic given rise to ethical challenges, but it has also affected nurses’ well-being and willingness to work during a pandemic. (shrink)

One of the most widely accepted views in bioethics is that paternalistic interference in others’ self-regarding decisions is justified only if those decisions are not autonomous. Typically, a decision is autonomous if and only if it satisfies certain psychological criteria. Namely, it must be competent and also voluntary. This latter criterion means, roughly, that the agent herself decided without being controlled or unduly influenced by other persons or impersonal forces, in light her own values.The modern locus classicus of (...) this idea is undoubtedly Beauchamp and Childress ; they claim we have a duty to respect autonomous agents. (shrink)

Kantian deontology is one of three classic moral theories, among virtue ethics and consequentialism. Issues in medical ethics are frequently addressed within a Kantian paradigm, at least – although not exclusively – in European medical ethics. At the same time, critical voices have pointed to deficits of Kantian moral philosophy which must be examined and discussed. It is argued that taking concrete situations and complex relationships into account is of paramount importance in medical ethics. Encounters between medical or nursing staff (...) and patients are rarely symmetrical relationships between autonomous and rational agents. Kantian ethics, the criticism reads, builds on the lofty ideal of such a relationship. In addition to the charge of an individualist and rationalist focus on autonomy, Kantian ethics has been accused of excluding those not actually in possession of these properties or of its rigorism. It is said to be focussed on laws and imperatives to an extent that it cannot appreciate the complex nuances of real conflicts. As a more detailed analysis will show, these charges are inadequate in at least some regards. This will be demonstrated by drawing on the Kantian notion of autonomy, the role of maxims and judgment and the conception of duties, as well as the role of emotions. Nevertheless the objections brought forward against Kantian moral theory can help determine, with greater precision, its strengths and shortcomings as an approach to current problems in medical ethics. (shrink)

Duties to self are commonly considered as incoherent. If I owed a duty to myself, I could release myself from it at will which would be incoherent with it being a duty. Recent years have seen various attempts at defending duties to self against this argument. A common strategy entails that the self is divided. One part of the self owes a duty to another. I argue that understanding duties to self as being owed to a part (...) of the self leads to problems because a person has interests that go beyond those of the single parts. Instead, I suggest that duties to self are owed by a local self (or rather, a local perspective) to an extended or unified self. (shrink)

A Duty to Resist: When Disobedience Should be Uncivil, by DelmasCandice. New York: Oxford University Press, 2018. Pp vii + 295.

In this paper, I argue for two claims. The first is that all social and political thinking lies along a continuum and that the structure of each thought along the continuum is that of a basic desire for self-determination. Self-determination, I argued, occurs in a variety of ways including, importantly, at a variety of levels of intention. On the one hand, there are the relatively unreflective ways of understanding oneself as autonomous. I attributed this way of thinking of the (...) Neo-Aristotelian conception of practical reason which is characteristic of conservatism. On the other side of the continuum, there is a rigoristic version of Kantian moral philosophy in which, to be autonomous, one must act exclusively from duty or from purely economic motivation. The second claims is that populism can be understood as a clash between different practical conceptions of autonomy which are brought into conflict as a result of the process of modern rationalization. This clash can, I argued, be clarified and also alleviated by appreciating that what the values which stand opposed in the “us vs. them” of populism and liberalism are based on a fundamentally similar conception of the value of autonomy but have come into conflict by sometime contingent historical processes which can be undone or steered in a different direction. (shrink)