Torbjörn Tännsjö

Being targeted by Nir Eyal's ingenious argument,1 I am pleased to have the opportunity to respond. It is fairly obvious that my utilitarian argument accomplishes what it is supposed to accomplish, namely a defence of the idea that the notion of informed consent should take roughly the form it takes in Western medicine. But does it fly in the face of commonsense moral thinking? I will argue that it does not.My argument is based on hedonistic utilitarianism.2 This means that it is an instance of the general pattern of argumentation that Eyal presents. It takes slightly different forms in its defence of the place of informed content in research and in the clinic. For reasons of space I will focus exclusively on the clinic.The thrust of the argument is as follows. In many cases, we should allow people to refuse treatment for the simple reason that they presumably know best what is in their interest. As J S Mill used to argue, each person has a privileged position with respect to her own life, which, as it were, she experiences from the inside, and from which she cannot walk away. …

A simple hedonistic theory allowing for interpersonal comparisons of happiness is taken for granted in this article. The hedonistic theory is used to compare utilitarianism, urging us to maximize the sum total of happiness, with prioritarianism, urging us to maximize a sum total of weighed happiness. It is argued with reference to a few thought experiments that utilitarianism is, intuitively speaking, more plausible than prioritarianism. The problem with prioritarianism surfaces when prudence and morality come apart

In the Fall of 1997 the leading Swedish newspaper, Dagens Nyheter, created a media hype over the Swedish policy of compulsory sterilisation that had been in operation between 1935 and 1975. In the discussion that followed the moral condemnation of our medical past was unanimous. However, the reasons for rejecting what had gone on were varied and mutually inconsistent. Three strands of criticism were common: the argument from autonomy, the argument from caution, and the argument from biological scepticism. In the paper it is argued that what point of departure you choose in your criticism of the past should be of consequence also for your ideas about present and future medical practice. In particular, if you rely on the argument from autonomy, you should be prepared to accept a liberal (present and future) use of reproductive techniques.

To resort to hypoxic air machines—would that be to cheat? This clearly depends on whether such machines are prohibited or not. So the important question is this: Should sport authorities prohibit them or not?One way of approaching this question may be to argue casuistically. Erythropoietin is prohibited. Blood doping is prohibited. Training at high altitude is allowed. Does the hypoxic air machine bear more resemblance to training at high altitude than to the use of EPO? If that is the case it should not be prohibited. If, on the other hand, it bears more resemblance to the use of EPO, then it should be prohibited.However, to argue casuistically is not entirely satisfactory. Even if, through such reasoning, we reach an answer, we do not obtain a principled explanation of the answer. We may get a hint at what to do , but not at why we should do so.1 So the question need to be posed at a more principled level: If rules against doping in sport are to be …

In principle, there seem to be three main ways in which society can react when people commit crimes under influence of mental illness. (1) The standard model. We excuse them. If they are dangerous they are detained in the interest of safety of the rest of the citizens. (2) The Swedish model. We hold them responsible for their criminal offence, we convict them, but we do not sentence them to jail. Instead, we sentence them to psychiatric treatment. (3) My model. We sentence them to jail, but offer them (voluntary) psychiatric treatment. The advantages of my model are obvious. We get a clear delineation of roles. We allow the psychiatrist to be just a doctor, not a warden. We liberate psychiatry of the objective of deciding whether people who were mentally ill when they committed criminal offences ‘could have acted otherwise’— a hopeless task. We allow that psychiatrists live up to their professional ethical code (the Hawaii Declaration). We treat psychically ill persons as ‘normal’, we allow them to repent their crimes, which renders easier their recovery. However, two objections to my model come to mind. First of all, is it not unfair to sentence people to jail who could not help doing what they did? And, secondly, the question of fairness set to one side, is it not inhumane to sentence mentally ill persons to jail? Is it not inhumane to the mentally ill persons themselves, and does it not mean that they will be a burden to other prisoners? In my paper I show that, if our system of criminal punishment takes a civilised form, neither of these objections carries any weight.

Particularism is in vogue in ethics today. Particularism is sometimes described as the idea that what is a sufficient moral reason in one situation need not be a sufficient moral reason in another situation. Indeed, it has been held, on particularism, what is a reason for an action in one situation might be a reason against the same type of action, or might not be a reason at all, in another situation. However, this description is insufficient. Even a generalist, such as a utilitarian, may admit that, what is in one situation a sufficient reason for the rightness of an action may, in another situation, be a sufficient reason for its wrongness. For example, the fact that if I shoot at a certain person, I kill him, may, in one situation, be a sufficient reason not to shoot at him. It is sufficient for the wrongness of shooting at him if, in the situation, shooting at him suffices to guarantee that welfare does not get maximized. He is killed, say, and deprived of future pleasure, with no positive ‘side-effects’ whatever.