Justifications for Non-­Consensual Medical Intervention: From Infectious Disease Control to Criminal Rehabilitation

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering a medical intervention is outweighed. For example, if an individual’s refusal to undergo a medical intervention would lead to the transmission of a dangerous infectious disease to other members of the community, one might claim that it would be morally permissible to administer the intervention even in the absence of consent. Indeed, as we shall discuss below, there are a number of examples of public health authorities implementing compulsory or coercive measures for the purposes of infectious disease control (IDC). The plausibility of the thought that non-consensual medical interventions might be justified when performed for the purpose of IDC raises the question of whether such interventions might permissibly be used to realize other public goods. In this article we focus on one possibility: whether it could be permissible to non-consensually impose certain interventions that alter brain states or processes through chemical or physical means on serious criminal offenders. We shall suggest that some such interventions might be permissible if they safely and effectively serve to facilitate the offender’s rehabilitation and thereby prevent criminal recidivism

The Methodological Irrelevance of Reflective Equilibrium

John Rawls’ method of reflective equilibrium is the most influential methodology in contemporary ethics.This paper argues that this influence is undeserved, for two reasons. First, reflective equilibrium fails to accomplish two tasks that give us reason to care about methodology. On the one hand, it fails to explain how (or whether) moral knowledge is possible.This is because the method is explicitly oriented towards the distinct (and less interesting) task of characterizing our moral sensibilities. On the other hand, the method fails to provide an informative way of adjudicating central methodological debates in ethics. Second, where Rawls’ method –and the background methodology he uses to motivate it –do have substance, that substance is implausible. The role of dispositions in the method entails that it endorses obviously irrational inferences. Further, the method makes substantively implausible distinctions between the dispositions that are allowed to play a methodological role. Rawls' background methodology appeals to the idea of a psychology in ‘wide reflective equilibrium’. However, both formal and empirical path-dependence considerations strongly suggest that there is nothing even minimally determinate that is someone’s psychology in ‘wide reflective equilibrium’. I close by exploring salient attempts to salvage the spirit of reflective equilibrium by abandoning elements of Rawls’ approach. I argue that none of these attempts succeed. I conclude that appeal to the method of reflective equilibrium is not a helpful means of addressing pressing methodological questions in ethics. In a slogan, reflective equilibrium is methodologically irrelevant

A Generalized Selected Effects Theory of Function

I present and defend the generalized selected effects theory (GSE) of function. According to GSE, the function of a trait consists in the activity that contributed to its bearer’s differential reproduction, or differential retention, within a population. Unlike the traditional selected effects (SE) theory, it does not require that the functional trait helped its bearer reproduce; differential retention is enough. Although the core theory has been presented previously, I go significantly beyond those presentations by providing a new argument for GSE and defending it from a recent objection. I also sketch its implications for teleosemantics and philosophy of medicine

Knowledge-First Theories of Justification

Knowledge-first theories of justification give knowledge priority when it comes to explaining when and why someone has justification for an attitude or an action. The emphasis of this entry is on knowledge-first theories of justification for belief. As it turns out there are a number of ways of giving knowledge priority when theorizing about justification, and in what follows I offer an opinionated survey of more than a dozen existing options that have emerged in the last two decades since the publication of Timothy Williamson’s Knowledge and Its Limits. I first trace several of the general theoretical motivations that have been offered for putting knowledge first in the theory of justification. I then go on to examine existing knowledge-first theories of justification and their standing objections. These objections are largely, but not exclusively, concerned with the extensional adequacy of knowledge-first theories of justification. There are doubtless more ways of giving knowledge priority in the theory of justification than I cover here, but the resulting survey will be instructive as it highlights potential shortcomings that would-be knowledge-first theorists of justification may wish either to avoid or else to be prepared with a suitable error theory

A Neo-Armstrongian Defense of States of Affairs: A Reply to Vallicella

Vallicella’s influential work makes a case that, when formulated broadly, as a problem about unity, Bradley’s challenge to Armstrongian states of affairs is practically insurmountable. He argues that traditional relational and non-relational responses to Bradley are inadequate, and many in the current metaphysical debate on this issue have come to agree. In this paper, I argue that such a conclusion is too hasty. Firstly, the problem of unity as applied to Armstrongian states of affairs is not clearly defined; in fact, it has taken a number of different forms each of which need to be carefully distinguished and further supported. Secondly, once we formulate the problem in more neutral terms, as a request for a characterization of the way that particulars, universals, and states of affairs stand to one another, it can be adequately addressed by an Armstrongian about states of affairs. I propose the desiderata for an adequate characterization and present a neo-Armstrongian defense of states of affairs that meets those desiderata. The latter relies on an important distinction between different notions of fundamentality and existential dependence

What do you mean “This isn’t the question”?

This is a contribution to the symposium on Tim Scanlon’s Being Realistic about Reasons. We have two aims here: First, we ask for more details about Scanlon’s meta-metaphysical view, showing problems with salient clarifications. And second, we raise independent objections to the view – to its explanatory productivity, its distinctness, and the argumentative support it enjoys

An Epistemic Non-Consequentialism

Despite the recent backlash against epistemic consequentialism, an explicit systematic alternative has yet to emerge. This paper articulates and defends a novel alternative, Epistemic Kantianism, which rests on a requirement of respect for the truth. §1 tackles some preliminaries concerning the proper formulation of the epistemic consequentialism / non-consequentialism divide, explains where Epistemic Kantianism falls in the dialectical landscape, and shows how it can capture what seems attractive about epistemic consequentialism while yielding predictions that are harder for the latter to secure in a principled way. §2 presents Epistemic Kantianism. §3 argues that it is uniquely poised to satisfy the desiderata set out in §1 on an ideal theory of epistemic justification. §4 gives three further arguments, suggesting that it (i) best explains the objective normative significance of the subject's perspective in epistemology, (ii) follows from the kind of axiology needed to solve the swamping problem together with modest assumptions about the relation between the evaluative and the deontic, and (iii) illuminates certain asymmetries in epistemic value and obligation. §5 takes stock and reassesses the score in the debate

Toward a Collectivist National Defense

Most philosophers writing on the ethics of war endorse “reductivist individualism,” a view that holds both that killing in war is subject to the very same principles of ordinary morality ; and that morality concerns individuals and their rights, and does not treat collectives as having any special status. I argue that this commitment to individualism poses problems for this view in the case of national defense. More specifically, I argue that the main strategies for defending individualist approaches to national defense either fail by their own lights or yield deeply counterintuitive implications. I then offer the foundations for a collectivist approach. I argue that such an approach must do justice to the collective goods that properly constituted states make possible and protect through certain acts of defensive war; and that any such picture of national defense must make room for some form of national partiality

Emotional management and biological markers of dietetic regimen in chronic kidney disease patients

The aim of the study was to investigate the association between psychological characteristics and biological markers of adherence in chronic kidney disease patients receiving conservative therapy, hemodialysis, peritoneal dialysis (PD), or kidney transplantation. Seventy-nine adult patients were asked to complete the following questionnaires: Toronto Alexithymia scale, Snaith–Hamilton Pleasure Scale, and Short Form Health Survey. Biological markers of adherence to treatment were measured. Peritoneal dialysis patients showed a lower capacity to feel pleasure from sensorial experience (p = .011) and a higher values of phosphorus compared to the other patients’ groups (p = .0001). The inability to communicate emotions was negatively correlated with hemoglobin levels (r = −(0).69; p = .001) and positively correlated with phosphorus values in the PD patients (r = .45; p = .050). Findings showed higher psychological impairments and a lower adherence to the treatment in PD patients and suggest the implication of emotional competence in adherence to treatment.The aim of the study was to investigate the association between psychological characteristics and biological markers of adherence in chronic kidney disease patients receiving conservative therapy, hemodialysis, peritoneal dialysis (PD), or kidney transplantation. Seventy-nine adult patients were asked to complete the following questionnaires: Toronto Alexithymia scale, Snaith-Hamilton Pleasure Scale, and Short Form Health Survey. Biological markers of adherence to treatment were measured. Peritoneal dialysis patients showed a lower capacity to feel pleasure from sensorial experience (p = .011) and a higher values of phosphorus compared to the other patients' groups (p = .0001). The inability to communicate emotions was negatively correlated with hemoglobin levels (r = -(0).69; p = .001) and positively correlated with phosphorus values in the PD patients (r = .45; p = .050). Findings showed higher psychological impairments and a lower adherence to the treatment in PD patients and suggest the implication of emotional competence in adherence to treatment