Mark Alfano

The concepts of placebos and placebo effects refer to extremely diverse phenomena. I recommend dissolving the concepts of placebos and placebo effects into loosely related groups of specific mechanisms, including (potentially among others) expectation-fulfillment, classical conditioning, and attentional-somatic feedback loops. If this approach is on the right track, it has three main implications for the ethics of informed consent. First, because of the expectation-fulfillment mechanism, the process of informing cannot be considered independently from the potential effects of treatment. Obtaining informed consent influences the effects of treatment. This provides support for the authorized concealment and authorized deception paradigms, and perhaps even for outright deceptive placebo use. Second, doctors may easily fail to consider the potential benefits of conditioning, leading them to misjudge the trade-off between beneficence and autonomy. Third, how attentional-somatic feedback loops play out depends not only on the content of the informing process but also on its framing. This suggests a role for libertarian paternalism in clinical practice.

Gone are the heady days when Bernard Williams (1993) could get away with saying that “Nietzsche is not a source of philosophical theories” (p. 4). The last two decades have witnessed a flowering of research that aims to interpret, elucidate, and defend Nietzsche’s theories about science, the mind, and morality. This paper is one more blossom in that efflorescence. What I want to argue is that Nietzsche theorized three important and surprising moral psychological insights that have been born out by contemporary empirical psychology. The first Nietzschean insight is the disunity of the self. The second, connected, Nietzschean insight is the primacy of affect. This primacy is expressed by what I have called elsewhere (Alfano 2010, 2013a) the tenacity of the intentional, and what Nietzsche calls the Socratic equation (TI Socrates 4, 10; WP 2:432-3). The third major Nietzschean insight is the social construction of character, which presupposes a wild diversity within the extensions of trait-terms and the dual direction of fit of character trait attributions. This last point is somewhat in tension with the only other published defense of the empirical credentials of Nietzsche’s moral psychology (Knobe & Leiter 2007), so I will make a few remarks about the contrast between my view and theirs.

Virtue ethics has been challenged on empirical grounds by philosophical interpreters of situationist social psychology. Challenges are necessarily challenges to something or other, so it’s only possible to understand the situationist challenge to virtue ethics if we have an antecedent grasp on virtue ethics itself. To this end, I first identify the non-negotiable “hard core” of virtue ethics with the conjunction of nine claims, arguing that virtue ethics does make substantive empirical assumptions about human conduct. Next, I rearticulate the situationist challenge in light of these nine claims. I then turn to a discussion of specifications of several responses typically made by defenders of virtue ethics against the situationist challenge, arguing that most of them either are unsound or give up one of the elements in the hard core. A few, however, survive this criticism, and so I conclude by suggesting ways in which the situationist challenge might be not so much resisted as co-opted. Situational influences can be used to help people simulate virtue, a phenomenon I call factitious virtue.