Evaluating medico-legal decisional competency criteria

In this paper I get clearer on the considerations that ought to inform the evaluation and development of medico-legal competency criteria-where this is taken to be a question regarding the abilities that ought to be needed for a patient to be found competent in medico-legal contexts. In the "Decisional Competency in Medico-Legal Contexts" section I explore how the question regarding the abilities that ought to be needed for decisional competence is to be interpreted. I begin by considering an interpretation that takes the question to be asking about the abilities needed to satisfy an idealized view of competent decision-making, according to which decisional competency is a matter of possessing those abilities or attributes that are needed to engage in good or effective or, perhaps, substantially autonomous or rational decision-making. The view has some plausibility-it accords with the way decisional competency is understood in a number of everyday contexts-but fails as an interpretation of the question regarding the abilities that should be needed for decisional competence in medico-legal contexts. Nevertheless, consideration of why it is mistaken suggests a more accurate interpretation and points the way in which the question regarding the evaluation of medico-legal competency criteria is to be answered. Building on other scholarly work in the area, I outline in the "Primary and Secondary Requirements" section several requirements that decisional competence criteria ought to satisfy. Then, in the "Applying the Framework" section, I say something about the extent to which medico-legal competency criteria, as well as some models of decisional competency proposed in the academic literature, fulfil those requirements

Are emotions perceptual experiences of value?

A number of emotion theorists hold that emotions are perceptions of value. In this paper I say why they are wrong. I claim that in the case of emotion there is nothing that can provide the perceptual modality that is needed if the perceptual theory is to succeed (where by 'perceptual modality' I mean the particular manner in which something is perceived). I argue that the five sensory modalities are not possible candidates for providing us with 'emotional perception'. But I also say why the usual candidate offered - namely feeling or affectivity - does not give us the sought-after perceptual modality. I conclude that as there seems to be nothing else that can provide the needed perceptual modality, we should reject the perceptual theory of emotion. © 2012 Blackwell Publishing Ltd

Traumatic Brain Injury with Personality Change: a Challenge to Mental Capacity Law in England and Wales

It is well documented that people with moderate-to-severe traumatic brain injury (TBI) can undergo personality changes, including becoming more impulsive in terms of how they behave. Legal guidance and academic commentary support the view that impulsiveness can render someone decisionally incompetent as defined by English and Welsh law. However, impulsiveness is a trait found within the healthy population. Arguably, impulsiveness is also a trait that gives rise to behaviours that should normally be tolerated even when they cause harm to the person enacting the behaviours. The purpose of this paper is to show why both of these considerations present as significant challenges to the law in England and Wales

Emotion as the categorical basis for moral thought

© 2018 Informa UK Limited, trading as Taylor & Francis Group. I offer and develop an original answer to the question of whether emotion plays an important role in the formation of moral thought. In a nutshell, my answer will be that if motivational internalism provides us with a correct description of the nature of moral thought, then emotion plays an important role because emotion is required to explain or ground the behavioral dispositions that are involved in moral thought

Sartre, James, and the Transformative Power of Emotion

In Sketch for a Theory of the Emotions, Sartre highlights how emotions can transform our perspective on the world in ways that might make our situations more bearable when we cannot see an easy or happy way out. The point of this chapter is to spell out and discuss Sartre’s theory of emotion as presented in the Sketch with two aims in mind. The first is to show that although emotions have the power to transform our perspectives on the world in ways described by Sartre, Sartre is mistaken to think emotions comprise the cognitive transformations in question. The second aim is to show why on one plausible way of thinking about the relationship holding between emotions and the cognitive transformations they help to bring about, emotions turn out to be the very sort of things that Sartre claims at the outset they are not, namely types of bodily feelings or sensations, a view of emotion that can be credited to William James

Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests

Objective Contemporary approaches to medical decision-making advise that clinicians should respect patients’ decisions. However, patients’ decisions are often shaped by heuristics, such as being guided by emotion, rather than by objective risk and benefit. Risk-reducing mastectomy (RRM) decisions focus this dilemma sharply. RRM reduces breast cancer (BC) risk, but is invasive and can have iatrogenic consequences. Previous evidence suggests that emotion guides patients’ decision-making about RRM. We interviewed patients to better understand how they made decisions about RRM, using findings to consider how clinicians could ethically respond to their decisions. Methods Qualitative face-to-face interviews with 34 patients listed for RRM surgery and two who had decided against RRM. Results Patients generally did not use objective risk estimates or, indeed, consider risks and benefits of RRM. Instead emotions guided their decisions: they chose RRM because they feared BC and wanted to do ‘all they could’ to prevent it. Most therefore perceived RRM to be the ‘obvious’ option and made the decision easily. However, many recounted extensive post-decisional deliberation, generally directed towards justifying the original decision. A few patients deliberated before the decision because fears of surgery counterbalanced those of BC. Conclusion Patients seeking RRM were motivated by fear of BC, and the need to avoid potential regret for not doing all they could to prevent it. We suggest that choices such as that for RRM, which are made emotionally, can be respected as autonomous decisions, provided patients have considered risks and benefits. Drawing on psychological theory about how people do make decisions, as well as normative views of how they should, we propose that practitioners can guide consideration of risks and benefits even, where necessary, after patients have opted for surgery. This model of practice could be extended to other medical decisions that are influenced by patients’ emotions

Emotions as Original Existences: A Theory of Emotion, Motivation and the Self

This book defends the much-disputed view that emotions are what Hume referred to as ‘original existences’: feeling states that have no intentional or representational properties of their own. In doing so, the book serves as a valuable counterbalance to the now mainstream view that emotions are representational mental states. Beginning with a defence of a feeling theory of emotion, Whiting opens up a whole new way of thinking about the role and centrality of emotion in our lives, showing how emotion is key to a proper understanding of human motivation and the self. Whiting establishes that emotions as types of bodily feelings serve as the categorical bases for our behavioural dispositions, including those associated with moral thought, virtue, and vice.The book concludes by advancing the idea that emotions make up our intrinsic nature - the characterisation of what we are like in and of ourselves, when considered apart from how we are disposed to behave. The conclusion additionally draws out the implications of the claims made throughout the book in relation to our understanding of mental illness and the treatment of emotional disorders

The feeling theory of emotion and the object-directed emotions

The 'feeling theory of emotion' holds that emotions are to be identified with feelings. An objection commonly made to that theory of emotion has it that emotions cannot be feelings only, as emotions have intentional objects. Jack does not just feel fear, but he feels fear-of-something. To explain this property of emotion we will have to ascribe to emotion a representational structure, and feelings do not have the sought after representational structure. In this paper I seek to defend the feeling theory of emotion against the challenge from the object-directed emotions. © 2009 Blackwell Publishing Ltd

On the Appearance and Reality of Mind

According to what I will call the “appearance-is-reality doctrine of mind,” conscious mental states are identical to how they subjectively appear or present themselves to us in our experience of them. The doctrine has had a number of supporters but to date has not received from its proponents the comprehensive and systematic treatment that might be expected. In this paper I outline the key features of the appearance-is-reality doctrine along with the case for thinking that doctrine to be true. I also defend the doctrine from some objections. Finally, I spell out the important metaphysical and epistemological implications of the appearance-is-reality doctrine of mind