Drug use and drug addiction are severely stigmatised around the world. Marc Lewis does not frame his learning model of addiction as a choice model out of concern that to do so further encourages stigma and blame. Yet the evidence in support of a choice model is increasingly strong as well as consonant with core elements of his learning model. I offer a responsibility without blame framework that derives from reflection on forms of clinical practice that support change and recovery (...) in patients who cause harm to themselves and others. This framework can be used to interrogate our own attitudes and responses, so that we can better see how to acknowledge the truth about choice and agency in addiction, while avoiding stigma and blame, and instead maintaining care and compassion alongside a commitment to working for social justice and good. (shrink)

Addiction is standardly characterized as a neurobiological disease of compulsion. Against this characterization, I argue that many cases of addiction cannot be explained without recognizing the value of drugs to those who are addicted; and I explore in detail an insufficiently recognized source of value, namely, a sense of self and social identity as an addict. For people who lack a genuine alternative sense of self and social identity, recovery represents an existential threat. Given that an addict identification carries expectations (...) of continued consumption despite negative consequences, there is therefore a parsimonious explanation of why people who identify as addicts continue to use drugs despite these consequences: they self‐identify as addicts and that is what addicts are supposed to do. I conclude by considering how it is nonetheless possible to overcome addiction despite this identity, in part by imagining and enacting a new one. Importantly, this possibility requires the availability of social support and material resources that are all too frequently absent in the lives of those who struggle with addiction. (shrink)

When philosophers want an example of a person who lacks the ability to do otherwise, they turn to psychopathology. Addicts, agoraphobics, kleptomaniacs, neurotics, obsessives, and even psychopathic serial murderers, are all purportedly subject to irresistible desires that compel the person to act: no alternative possibility is supposed to exist. I argue that this conception of psychopathology is false and offer an empirically and clinically informed understanding of disorders of agency which preserves the ability to do otherwise. First, I appeal to (...) standard clinical treatment for disorders of agency and argue that it undermines this conception of psychopathology. Second, I offer a detailed discussion of addiction, where our knowledge of the neurobiological mechanisms underpinning the disorder is relatively advanced. I argue that neurobiology notwithstanding, addiction is not a form of compulsion and I explain how addiction can impair behavioural control without extinguishing it. Third, I step back from addiction, and briefly sketch what the philosophical landscape more generally looks like without psychopathological compulsion: we lose our standard purported real-world example of psychologically determined action. I conclude by reflecting on the centrality of choice and free will to our concept of action, and their potency within clinical treatment for disorders of agency. (shrink)

My first experience as a clinician was in a Therapeutic Community for service users with personality disorder. As well as having personality disorder, many of the Community members also suffered from related conditions, such as addiction and eating disorders. Broadly speaking, these conditions are what we might call ‘disorders of agency’. Core diagnostic symptoms or maintaining factors of disorders of agency are actions and omissions: patterns of behaviour central to the nature or maintenance of the condition. For instance, borderline personality (...) disorder is diagnosed in part via deliberate self-harm and attempted suicide, reckless and impulsive behaviour, substance use, violence, and outbursts of anger; addiction is diagnosed via maladaptive patterns of drug consumption; eating disorders involve eating too much or too little. If a service user is to improve let alone recover from these disorders, they must change the diagnostic or maintaining pattern of behaviour (cf. Pearce and Pickard, 2010). For instance, service users with borderline personality disorder must stop self-harming; addicts need to quit using drugs or alcohol; anorexics must eat. (shrink)

I argue that addiction is not a chronic, relapsing, neurobiological disease characterized by compulsive use of drugs or alcohol. Large-scale national survey data demonstrate that rates of substance dependence peak in adolescence and early adulthood and then decline steeply; addicts tend to “mature out” in their late twenties or early thirties. The exceptions are addicts who suffer from additional psychiatric disorders. I hypothesize that this difference in patterns of use and relapse between the general and psychiatric populations can be explained (...) by the purpose served by drugs and alcohol for patients. Drugs and alcohol alleviate the severe psychological distress typically experienced by patients with comorbid psychiatric disorders and associated problems. On this hypothesis, consumption is a chosen means to ends that are rational to desire: Use is not compulsive. The upshot of this explanation is that the orthodox view of addiction as a chronic, relapsing neurobiological disease is misguided. I delineate five folk psychological factors that together explain addiction as purposive action: strong and habitual desire; willpower; motivation; functional role; and decision and resolve. I conclude by drawing lessons for research and effective treatment. (shrink)

I clarify some ambiguities in blame-talk and argue that blame's potential for irrationality and propensity to sting vitiates accounts of blame that identify it with consciously accessible, personal-level judgements or beliefs. Drawing on the cognitive psychology of emotion and appraisal theory, I develop an account of blame that accommodates these features. I suggest that blame consists in a range of hostile, negative first-order emotions, towards which the blamer has a specific, accompanying second-order attitude, namely, a feeling of entitlement—a feeling that (...) these hostile, negative first-order emotions are what the blamed object deserves. (shrink)

I argue that denial plays a central but insufficiently recognized role in addiction. The puzzle inherent in addiction is why drug use persists despite negative consequences. The orthodox conception of addiction resolves this puzzle by appeal to compulsion; but there is increasing evidence that addicts are not compelled to use but retain choice and control over their consumption in many circumstances. Denial offers an alternative explanation: there is no puzzle as to why drug use persists despite negative consequences if these (...) consequences are not straightforwardly known. I describe the nature of the causal knowledge that one's drug use is causing negative consequences; map the conceptual landscape of denial and explain how it can block such knowledge; and explore some of the processes and mechanisms that have been studied by philosophy and the cognitive sciences and which may underpin denial in addiction, including well-established information-processing biases, motivational influences on belief formation and self-deception, and cognitive deficits with respect to insight and self-awareness. I conclude by suggesting that addiction is as much a disorder of cognition as a disorder of conation. (shrink)

This chapter offers a novel defence of Szasz’s claim that mental illness is a myth by bringing to bear a standard type of thought experiment used in philosophical discussions of the meaning of natural kind concepts. This makes it possible to accept Szasz’s conclusion that mental illness involves problems of living, some of which may be moral in nature, while bypassing the debate about the meaning of the concept of illness. The chapter then considers the nature of schizophrenia and the (...) personality disorders (PDs) within this framework. It argues that neither is likely to constitute a scientifically valid category, but that nonetheless their symptoms can be scientifically explained. It concludes with a discussion of the way in which Cluster B or ‘bad’ PDs involve failures of virtue or character, and argues that this does not preclude them from being appropriately treated within contemporary, multidisciplinary, mental health services. (shrink)

The problem of addiction is one of the major challenges and controversies confronting medicine and society. It also poses important and complex philosophical and scientific problems. What is addiction? Why does it occur? And how should we respond to it, as individuals and as a society? The Routledge Handbook of Philosophy and Science of Addiction is an outstanding reference source to the key topics, problems and debates in this exciting subject. It spans several disciplines and is the first collection of (...) its kind. Organised into three clear parts, forty-five chapters by a team of international contributors examine key areas, including: the meaning of addiction to individuals conceptions of addiction varieties and taxonomies of addiction methods and models of addiction evolution and addiction history, sociology and anthropology population distribution and epidemiology developmental processes vulnerabilities and resilience psychological and neural mechanisms prevention, treatment and spontaneous recovery public health and the ethics of care social justice, law and policy. Essential reading for students and researchers in addiction research and in philosophy, particularly philosophy of mind and psychology and ethics, The Routledge Handbook of Philosophy and Science of Addiction will also be of great interest to those in related fields, such as medicine, mental health, social work, and social policy. (shrink)

This paper argues that perception of one's body ‘from the inside’ provides one with an awareness of acting, and that this awareness explains a previously overlooked feature of one's knowledge of one's own actions. Actions are events: they occur during periods of time. Knowledge of such events must be sensitive to their course through time. Perception of one's body ‘from the inside’ allows one to monitor one's actions as they unfold, thereby sustaining one's knowledge of what one is doing over (...) the period of time in which one is doing it. (shrink)

Variation in addiction suggests that a good definition will be précising: it should serve a purpose. The authors canvass the various purposes served by a definition of addiction in psychiatric, social, legal, economic, interpersonal and scientific contexts. They argue that addiction is a strong and habitual want that significantly reduces control and leads to significant harm. What counts as significant varies relative to purpose and context. The authors offer a basic account of the nature of control and how and why (...) it can be reduced. The chapter explores the nature of harm and why it is part of the definition. And it concludes by suggesting that progress in understanding addiction depends on bearing in mind the various purposes and contexts of enquiry, together with the common-sense but often neglected point that both control and harm come in degrees. (shrink)

Popular and neurobiological accounts of addiction tend to treat it as a form of compulsion. This contrasts with personality disorder, where most problematic behaviours are treated as voluntary. But high levels of co-morbidity, overlapping diagnostic traits, and the effectiveness of a range of comparable clinical interventions for addiction and personality disorder suggest that this difference in treatment is unjustified. Drawing on this range of clinical interventions, we argue that addiction is not a form of compulsion. Rather, the misuse of drugs (...) and alcohol is like many of the problematic behaviours associated with personality disorder: it is typically a way of coping with psychological distress. We suggest that a satisfying explanation of why many addicts struggle to control their use can be given without departing from concepts employed in our basic folk psychological understanding of agency. In particular, we appeal to five rough-and-ready folk psychological factors to explain addiction: (i) strength of desire and habit; (ii) willpower; (iii) motivation; (iv) functional role; and (v) decision and resolve. (shrink)

Extant philosophical accounts of schizophrenic alien thought neglect three clinically signifi cant features of the phenomenon. First, not only thoughts, but also impulses and feelings, are experienced as alien. Second, only a select array of thoughts, impulses, and feelings are experienced as alien. Th ird, empathy with experiences of alienation is possible. I provide an account of disownership that does justice to these features by drawing on recent work on delusions and selfknowledge. Th e key idea is that disownership occurs (...) when there is a failure of rational control over one’s mind. Th is produces a clash between the deliverances of introspection and practical enquiry as ways of knowing one’s mind. Th is explanation places disownership on a continuum with more common aspects of our psychological life, such as addiction, akrasia, obsessional thinking, and immoral, selfi sh or shameful thoughts. I conclude by addressing objections, and exploring the relevance of my account to questions in the philosophy of psychiatry concerning the validity of our current taxonomy of symptoms, and the nature of psychiatric classifi cation.. (shrink)

The landscape of addiction is dominated by two rival models: a moral model and a model that characterizes addiction as a neurobiological disease of compulsion. Against both, I offer a scientifically and clinically informed alternative. Addiction is a highly heterogenous condition that is ill‐characterized as involving compulsive use. On the whole, drug consumption in addiction remains goal directed: people take drugs because drugs have tremendous value. This view has potential implications for the claim that addiction is, in all cases, a (...) brain disease. But more importantly, it has implications for clinical and policy interventions. To help someone overcome addiction, you need to understand and address why they persist in using drugs despite negative consequences. If they are not compelled, then the explanation must advert to the value of drugs for them as an individual. What blocks us from acknowledging this reality is not science but fear: that it will ignite moralism about drugs and condemnation of drug users. The solution is not to cleave to the concept of compulsion but to fight moralism directly. (shrink)

Effective treatment of disorders of agency presents a clinical conundrum. Many of the core symptoms or maintaining factors are actions and omissions that cause harm to self and others. Encouraging service users to take responsibility for this behavior is central to treatment. Blame, in contrast, is detrimental. How is it possible to hold service users responsible for actions and omissions that cause harm without blaming them? A solution to this problem is part conceptual, part practical. This chapter offers a conceptual (...) framework that clearly distinguishes between ideas of responsibility, blameworthiness, and "detached" and "affective" blame. It argues that affective blame is detrimental to effective treatment. And it suggests that affective blame can be avoided by attention to service users' past history, which directly evokes compassion and empathy. Finally, the chapter briefly considers whether the clinical stance of responsibility without blame should be adopted in non-clinical interpersonal and social contexts. (shrink)

“Don’t be jealous of your sister.” “Don’t be angry with your father.” “You should be more forgiving.” “You ought to feel terrible for what you’ve done.” “You ought to feel ashamed of yourself!” It is common practice within our society to morally reprimand people for their emotions, thereby expressing a kind of moralism: the idea that there are morally right and morally wrong ways to feel. Drawing on an alternative way of engaging with emotions derived from my experience working clinically (...) with people with personality disorders, I argue against the value of this common practice and the moralization of emotions that underpins it. Stop telling people what to feel! (shrink)

Can consideration of the emotions help to solve the problem of other minds? Intuitively, it should. We often think of emotions as public: as observable in the body, face, and voice of others. Perhaps you can simply see another's disgust or anger, say, in her demeanour and expression; or hear the sadness clearly in his voice. Publicity of mind, meanwhile, is just what is demanded by some solutions to the problem. But what does this demand amount to, and do emotions (...) actually meet it? This paper has three parts. First, I consider the nature of the problem of other minds. Second, I consider the publicity of emotions. And third, I bring these together to show how emotions can help to solve the problem. (shrink)

The DSM-IV-TR (American Psychiatric Association 1994, 689) defines personality disorder (PD) as: An enduring pattern of experience and behavior that deviates markedly from the expectations of an individual’s culture. This pattern is manifested in two (or more) of the following areas: 1 Cognition (i.e., ways of perceiving and interpreting self, other people, and events); 2 Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response); 3 Interpersonal functioning; and 4 Impulse control. B The enduring ..

The image of craving as a desire of unimaginable and irresistible force is poised to solve the puzzle of addiction: persistent drug use despite severe negative consequences. But the image is flawed. Drawing on science, philosophy, and first‐person testimony, I argue against irresistibility and develop a more nuanced, heterogeneous account of craving for drugs. Craving comes in three varieties, each corresponding to a kind of answer to the question why people crave drugs: cue‐induced, goal‐focused, and attachment‐based. This in turn grounds (...) an approach to addressing addiction that is humane and heterogeneous, moving beyond strategies that are fundamentally controlling. (shrink)

In a welcome broadening of the discussion surrounding responsibility in healthcare, Rebecca Brown and Julian Savulescu propose that standard philosophical accounts of responsibility are too narrow to be useful. Although these accounts of course differ with respect to the exact conditions they posit as necessary and sufficient for responsibility, they are nonetheless relatively united in their focus on a single individual at a single moment in time. Suppose a subject S performs an action a at a time t that has (...) harmful consequences for their health. Is S responsible for a and derivatively their condition? Brown and Savulescu argue that answers to this question that fail to consider both what S was or was not doing at times other than t and what people other than S were doing to encourage or discourage S from performing a cannot do justice to actions which are habitual and socially influenced—such as unhealthy patterns of eating, exercise and substance use. Given that it is precisely these kinds of patterns of behaviour that typically inflame the discussion of responsibility in healthcare, Brown and Savulescu’s insistence on the need for a diachronic and socially contextualised account of responsibility is essential— if we are to consider the issue of responsibility in healthcare at all. But should we and, if so, why? With respect to this question, Brown and Savulescu hope to sit on the fence. This is both because they recognise the complexity and balance of arguments for and against the view …. (shrink)

Effective treatment of personality disorder (PD) presents a clinical conundrum. Many of the behaviours constitutive of PD cause harm to self and others. Encouraging service users to take responsibility for this behaviour is central to treatment. Blame, in contrast, is detrimental. How is it possible to hold service users responsible for harm to self and others without blaming them? A solution to this problem is part conceptual, part practical. I offer a conceptual framework that clearly distinguishes between ideas of responsibility, (...) blameworthiness, and blame. Within this framework, I distinguish two sorts of blame, which I call ‘detached’ and ‘affective’. Affective, not detached, blame is detrimental to effective treatment. I suggest that the practical demand to avoid affective blame is largely achieved through attention to PD service users’ past history. Past history does not eliminate responsibility and blameworthiness. Instead, it directly evokes compassion and empathy, which compete with affective blame. (shrink)

The claim that non-addictive drug use is instrumental must be distinguished from the claim that its desired ends are evolutionarily adaptive or easy to comprehend. Use can be instrumental without being adaptive or comprehensible. This clarification, together with additional data, suggests that Müller & Schumann's (M&S's) instrumental framework may explain addictive, as well as non-addictive consumption.

Within contemporary penal philosophy, the view that punishment can only be justified if the offender is a moral agent who is responsible and hence blameworthy for their offence is one of the few areas on which a consensus prevails. In recent literature, this precept is associated with the retributive tradition, in the modern form of ‘just deserts’. Turning its back on the rehabilitative ideal, this tradition forges a strong association between the justification of punishment, the attribution of responsible agency in (...) relation to the offence, and the appropriateness of blame. By contrast, effective clinical treatment of disorders of agency employs a conceptual framework in which ideas of responsibility and blameworthiness are clearly separated from what we call ‘affective blame’: the range of hostile, negative attitudes and emotions that are typical human responses to criminal or immoral conduct. We argue that taking this clinical model of ‘responsibility without blame’ into the legal realm offers new possibilities. Theoretically, it allows for the reconciliation of the idea of ‘just deserts’ with a rehabilitative ideal in penal philosophy. Punishment can be reconceived as consequences—typically negative but occasionally not, so long as they are serious and appropriate to the crime and the context—imposed in response to, by reason of, and in proportion to responsibility and blameworthiness, but without the hard treatment and stigma typical of affective blame. Practically, it suggests how sentencing and punishment can better avoid affective blame and instead further rehabilitative and related ends, while yet serving the demands of justice. (shrink)

Moral and legal philosophy are too entangled: moral philosophy is prone to model interpersonal moral relationships on a juridical image, and legal philosophy often proceeds as if the criminal law is an institutional reflection of juridically imagined interpersonal moral relationships. This article challenges this alignment and in so doing argues that the function of the criminal law lies not fundamentally in moral blame, but in regulation of harmful conduct. The upshot is that, in contrast to interpersonal relationships, the criminal law (...) cannot lose its standing to blame through institutional analogues of hypocrisy, complicity, and meddling. Rather, certain forms of structural and severe historical and contemporary injustice point to the question of the overall legitimacy of state authority. (shrink)

Philosophy of psychiatry is on the rise. The last decade has seen an explosion in philosophical interest in psychiatric disorder, supported by flourishing research in adjacent disciplines, particularly clinical and cognitive psychology, neuroscience, and, of course, psychiatry itself. The publication of the first edition of The Mind and its Discon- tents in 1999 helped spark this explosion. The publication of this second edition is a welcome addition to OUP’s blossoming International Perspectives in Philosophy and Psychiatry Series.

This paper provides a response to Hanna Pickard and Stephen Pearce’s paper ‘Balancing costs and benefits: a clinical perspective does not support a harm minimisation approach for self-injury outside of community settings.’ This paper responded to my article ‘Should healthcare professionals sometimes allow harm? The case of self-injury.’ There is much in the paper that I would agree with, but I feel it is important to respond to a number of the criticisms of my paper in order to (...) clarify my position and to facilitate ongoing debate in relation to this important issue. (shrink)

The target of Hanna Pickard's very erudite and thought-provoking article is compulsion. She argues that “addiction is not a form of compulsion” and that “addictive desires are not irresistible” (Pickard 2012, 40). However, I fear that compulsion as she presents it is ultimately a metaphysical straw figure, trapped in a false metaphysical dichotomy. What is lacking is a proper attention to specific individual clinical cases, examined over time. At the same time, Pickard's discussion is extremely important (...) because of the manner in which it highlights both the merits and the perils of philosophical inquiry into the nature of addiction... (shrink)

I think that Hanna Pickard and I are in agreement that the dichotomy between ‘having’ and ‘not having’ control and conscious knowledge should be rejected. Personality disordered (PD) service users, like the rest of us, have degrees of not knowing and knowing, controlling and not controlling, such that pinpointing exactly when assignment of responsibility should enter into judgments of service users is murky and difficult. This position includes both metaphysical and epistemological issues in that it is a separate (...) question whether or not we can know someone is responsible from the question of whether or not someone is responsible and to what degree. Because Pickard focuses on metaphysical questions, I raise some .. (shrink)

Abstract: In this article, we explore what are ethical forms of holding service users responsible in mental health care contexts. Hanna Pickard has provided an account of how service users should be held responsible for morally wrong or seriously harmful conduct within contexts of mental health care, called the clinical stance. From a clinical stance one holds a person responsible for harm, but refrains from emotionally blaming the person and only considers the person responsible for this conduct in (...) a detached sense. Her account is based on what are considered best practices in the treatment of people with borderline personality disorder and addiction. We ask if this account generalizes across different diagnostic criteria and different clinical contexts. To begin to answer this question, we compare the clinical stance to an account of what are considered best practices in the treatment of service users at a specialized clinic for people with autism spectrum disorder in the Netherlands. We refer to this alternative account as the nurturing stance and highlight relevant similarities and differences between the clinical stance and the nurturing stance. We conclude with suggestions for further research and theorizing. (shrink)

A recent strand in the philosophical literature on addiction emphasizes problems with diachronic self-control. Hanna Pickard, for example, argues that an important aspect of addiction consists in inability to identify with a non-addicted future self. This literature sits alongside another that treats addiction as the product of neural changes that “hijack” mechanisms of reward prediction, habit formation decision making and cognitive control. This hijacking literature originates in accounts that treat the neural changes characteristic of addiction as a brain (...) disease. This paper provides a framework based on predictive processing accounts of self-awareness that integrates the hijacking and diachronic accounts. I discuss a hijacking account proposed to explain disruption of addiction following lesion to the anterior insula cortex. I show how insula activity contributes to the type of identification implicated in diachronic accounts and how deactivation of the anterior insula can disrupt addiction by alienating the subject from her addictive tendencies. This is consistent with neural evidence but also incorporates the personal level features of addiction that are opaque to neural level explanation. (shrink)

Withdrawal involves emotional pain that motivates much addictive behavior. In this paper, I argue that the emotional pain of withdrawal compels much addictive behavior. Researchers have noticed this possibility but it is widely underappreciated. Among philosophers, only Hanna Pickard has discussed emotional compulsion in addiction, and the emotional aspect of withdrawal has been almost completely neglected. Accounts of emotional compulsion in the philosophical literature (from Tappolet, Elster, and Furrow) probably do not capture how the distress of withdrawal compels, (...) so I propose a more suitable account of “pathodoxastic” compulsion in addiction. On this account, the emotional pain of withdrawal compels when it undermines the ability to believe that one can continue to endure it, and therefore the ability to intend abstinence. (shrink)

Let us first thank the four commentators who have taken the time to read and thoughtfully reflect on our paper. In that paper, we discuss how responsibility concepts must be sensitive to the temporal ( diachronic ) and social ( dyadic ) aspects of health-related behaviour, if responsibility is to play a role in health policy. This ‘if’ is a big one, and Hanna Pickard rightly challenges our position of neutrality with regard to whether or not responsibility should (...) be incorporated into health policy.1 Pickard proposes that responsibility should play a forward-looking role in health policy—used as a tool to facilitate and encourage healthy behaviours where it is reasonable to expect people to adopt such behaviours. While the conditions for such responsibility are similar to those involved in the backward-looking, desert-based responsibility we invoke, they do not warrant responses such as praise, blame, reward and punishment that may follow from desert-based responsibility. Pickard argues that even asking the question of ‘what would desert-based responsibility look like in these health contexts’ risks encouraging moralisation, stigma and blame, all of which have no place in healthcare. We agree that forward-looking responsibility could be an important tool in healthcare. We have offered …. (shrink)

Withdrawal involves emotional pain that motivates much addictive behavior. In this paper, I argue that the emotional pain of withdrawal compels much addictive behavior. Researchers have noticed this possibility but it is widely underappreciated. Among philosophers, only Hanna Pickard has discussed emotional compulsion in addiction, and the emotional aspect of withdrawal has been almost completely neglected. Accounts of emotional compulsion in the philosophical literature (from Tappolet, Elster, and Furrow) probably do not capture how the distress of withdrawal compels, (...) so I propose a more suitable account of “pathodoxastic” compulsion in addiction. On this account, the emotional pain of withdrawal compels when it undermines the ability to believe that one can continue to endure it, and therefore the ability to intend abstinence. (shrink)

Bioethicists have sometimes regarded the opioid epidemic as a problem with obvious answers and thus no need for the field's conceptual analysis. Yet, as three essays in the July‐August 2020 issue of the Hastings Center Report demonstrate, the opioid crisis contains a knot of distinctions and puzzles to be sorted out. Travis N. Rieder examines, for example, what is fundamentally driving the crisis—access to the drugs or large societal problems such as poverty and joblessness. The role of choice in addiction, (...) the effects of moral condemnation on approaches to addiction, and what treatment should look like are among the puzzles Hanna Pickard explores, while Daniel S. Goldberg focuses on the common and harmful conflation of the public health problems of substance misuse and pain. These philosophical and bioethical questions point in widely different directions, lying both inside and outside bioethics. They point toward systemic societal factors that determine health and well‐being yet have seemed outside bioethics' largely clinical boundaries. And they point toward a deeper look at the very idea of autonomy—an examination of a topic clearly within bioethics yet occurring at the fringes of its usual constructs. (shrink)

In the study reported in their rich article, Brandenburg and Strijbos investigate the attitudes of clinicians, in a facility for adults with autism, to norm transgressions by service users. In doing so they interrogate Hanna Pickard’s responsibility without blame approach to therapy and ask whether it applies across different clinical settings.Pickard draws a distinction between responsibility for an action in the sense of being the agent of the action and so, by definition, having some control over it, (...) and moral responsibility for an action which includes being blameworthy for it. For Pickard, you can be responsible for a harmful action without being morally responsible and therefore blameworthy. You might... (shrink)

Hanna Pitkin has made key contributions to the field of political philosophy, pushing forward and clarifying the ways that political theorists think about action as the exercise of political freedom. In so doing, she has offered insightful studies of the problems of modern politics that theorists are called to address, and has addressed them herself in a range of theoretical genres. She is an innovator in bringing conceptual work inspired by ordinary language philosophy to the field of political philosophy, (...) as well as a penetrating and exacting interpreter of texts who draws on the insights of psychoanalysis, gender, and historical study. This collection of her works approaches each of these dimensions of Pitkin's contributions in turn, recognizing that she typically blends these modes of engagement in much of her political theorizing. The Modern Condition and the Impetus to Theorize. At several moments in her career, Pitkin has offered sustained reflection on what aspects of modern political life prompt the impulse to theorize politics. She has also drawn out with great nuance the pitfalls that modern life and philosophy also present for that enterprise, for example, in attempts to naturalize human community or in turning to theoretical abstraction. Her study of Wittgenstein in particular structured her most penetrating study of these questions. Pitkin suggests an agenda for political theorizing to engage the dilemmas of modernity in ways that grasp the importance of paradox as a portal of insight into the modern condition, and eschews attempts at easy resolution. In keeping with this, Pitkin has herself explored a variety of conceptual paradoxes that arise in the work of other theorists (e.g., regarding freedom, interest, and obligation), each as symptomatic of modern dilemmas. In each encounter, Pitkin offers a clearer picture of the problems of political modernity and the outlines of political responses to them. Moral Philosophy, Judgment, Justice: Pitkin has turned at several points in her career to the concept of justice as one that particularly brings together questions of agency and responsibility, the insights of moral philosophy, and judgment. Characteristic of her work, her engagements with justice have drawn upon a variety of methodological resources and theoretical inspirations. Her work engages ordinary language philosophy, pedagogical practice, and textual study, to yield a complex and subtle set of observations, all of which open moral philosophy and matters of judgment to questions of action and responsibility in the exercise of political freedom. Action: Political agency and its obstacles are a key theme in Pitkin's work and a main area of her theoretical innovation. She has approached the question of political agency from several directions. In some works, she has examined the appeal of autonomy as a picture of political agency, probing in particular the gendered dimension of the fantasy of autonomy. In other works - perhaps most famously, in her work on representation - Pitkin has explored the ways that the institutional arrangements of modern liberal societies attempt to link of individual and political agency--and the pitfalls of these approaches. Finally, Pitkin has offered a picture of political freedom as maintaining the tension, between individual "parts" and collective "wholes," that these modern institutional arrangements attempt to resolve. Finally, through her groundbreaking and definitive work on Hannah Arendt, Pitkin has meditated on the political and social conditions that most impede our ability to grasp agency as a practice of political freedom, and gestured to paths that may lead forward. (shrink)

A recent article argued for the immorality of abortion regardless of personhood status by comparing the impairment caused by fetal alcohol syndrome to the impairment caused by abortion. I argue that two of the premises in this argument fail and that, as such, one cannot reasonably attribute moral harms to abortion on the basis of the moral harms caused by fetal alcohol syndrome. The impairment argument relies on an inconsistent instantiation, which undermines the claim that personhood is irrelevant, and it (...) does not fulfill its own ceteris paribus clause, which demands that no additional benefit be gained from abortion that would not be gained from causing fetal alcohol syndrome. (shrink)

The use of patient restrictions (e.g. involuntary admission, seclusion, restraint) is a complex ethical dilemma in psychiatric care. The present study explored nurses’ (n = 22) and physicians’ (n = 5) perceptions of what actually happens when an aggressive behaviour episode occurs on the ward and what alternatives to seclusion and restraint are actually in use as normal standard practice in acute psychiatric care. The data were collected by focus group interviews and analysed by inductive content analysis. The participants believed (...) that the decision-making process for managing patients’ aggressive behaviour contains some in-built ethical dilemmas. They thought that patients’ subjective perspective received little attention. Nevertheless, the staff proposed and appeared to use a number of alternatives to minimize or replace the use of seclusion and restraint. Medical and nursing staff need to be encouraged and taught to: (1) tune in more deeply to reasons for patients’ aggressive behaviour; and (2) use alternatives to seclusion and restraint in order to humanize patient care to a greater extent. (shrink)

Robert Hanna presents a fresh view of the Kantian and analytic traditions that have dominated continental European and Anglo-American philosophy over the last two centuries, and of the connections between them. But this is not just a study in the history of philosophy, for out of this emerges Hanna's original approach to two much-contested theories that remain at the heart of contemporary philosophy. Hanna puts forward a new 'cognitive-semantic' interpretation of transcendental idealism, and a vigorous defense of (...) Kant's theory of analytic and synthetic necessary truth, making this compelling reading for all who are interested in these fundamental philosophical issues. (shrink)

In dynamical multi-agent systems, agents are controlled by protocols. In choosing a class of formal protocols, an implicit choice is made concerning the types of agents, actions and dynamics representable. This paper investigates one such choice: An intensional protocol class for agent control in dynamic epistemic logic (DEL), called ‘DEL dynamical systems’. After illustrating how such protocols may be used in formalizing and analyzing information dynamics, the types of epistemic temporal models that they may generate are characterized. This facilitates a (...) formal comparison with the only other formal protocol framework in dynamic epistemic logic, namely the extensional ‘DEL protocols’. The paper concludes with a conceptual comparison, highlighting modeling tasks where DEL dynamical systems are natural. (shrink)