Klemens Kappel

ABSTRACT In this survey we have investigated the experiences and attitudes of Danish physicians regarding end‐of life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered ethically more acceptable, with the informed consent of the patient than without. But both non‐resuscitation decisions, and decisions to provide pain relief in doses that will shorten the patient's life, have been made and found acceptable by at least 50% of the respondents, even when there is no informed consent. Furthermore, 12% have doubled morphine dosages with fixed intervals, thus providing doses substantially higher than that necessary to control pain, without the informed consent of the patient. Two per cent have helped in assisted suicide, and 5% have administered a lethal injection at the patient's request. Respectively 37% and 34% find these last two practices ethically acceptable. Amongst those that do not find them acceptable, the most important reasons to be opposed are, the doctrine of double effect, the doctrine of doing and allowing, and the view that human life is sacred. Amongst supporters, the most important reasons mentioned are, that the patient's right to self‐determination should be respected, the view that a patient should not be forced to suffer, and the view that the patient has a right to be helped to a dignified death.

It seems obvious that informational privacy has an epistemological component; privacy or lack of privacy concerns certain kinds of epistemic relations between a cogniser and sensitive pieces of information. One striking feature of the fairly substantial philosophical literature on informational privacy is that the nature of this epistemological component of privacy is only sparsely discussed. The main aim of this paper is to shed some light on the epistemological component of informational privacy

If we tried, all the time, to do the acts which, according to consequentialism, are right, this would be worse, on consequentialist terms, than if we were less ambitious. In this way consequentialism is indirectly self‐defeating, as Parfit says in Reasons and Persons. But, as Parfit also says, this is not an objection to consequentialism. In a recent contribution, Dancy argues that this is a mistake, however. There is, Dancy suggests, a sense in which consequentialism both recommends that we do certain acts, and that the same time says that we should not do them, and no ethical theory can do so. I discuss Dancy's objection, and argue that there is no way to understand it such that it presents a challenge to consequentialism.

The aim of the paper is to propose a way in which believing on trust can ground doxastic justification and knowledge. My focus will be the notion of trust that plays the role depicted by such cases as concerned Hardwig (J Philos 82:335–49, 1985; J Philos 88:693–708, 1991) in his early papers, papers that are often referenced in recent debates in social epistemology. My primary aim is not exegetical, but since it sometimes not so clear what Hardwig’s claims are, I offer some remarks of interpretation that might be of interest. The main purpose of the paper, however, is this: following various cues in Hardwig’s writing, I specify certain epistemic properties of agents in social systems, such that, roughly speaking, for agents to know (or be justified in believing) what the ‘system knows’, social relations of epistemic trust between agents in the system are necessary. I will suggest that we can view this social form of epistemic trust as non-inferential dispositions to believe what some individual or other source of information asserts or transmits. When this disposition is discriminating and defeater-sensitive, it can ground knowledge and justification. Or, more cautiously, we should be sympathetic to this view if we are inclined to accept the core insight of process reliabilism. Finally, I will offer some remarks about how epistemic trust and epistemic reasons may relate on this picture

In this survey we have investigated the experiences and attitudes of Danish physicians regarding end-of-life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered ethically more acceptable, with the informed consent of the patient than without. But both non-resuscitation decisions, and decisions to provide pain relief in doses that will shorten the patient's life, have been made and found acceptable by at least 50% of the respondents, even when there is no informed consent. Furthermore, 12% have doubled morphine dosages with fixed intervals, thus providing doses substantially higher than that necessary to control pain, without the informed consent of the patient. Two per cent have helped in assisted suicide, and 5% have administered a lethal injection at the patient's request. Respectively 37% and 34% find these last two practices ethically acceptable. Amongst those that do not find them acceptable, the most important reasons to be opposed are, the doctrine of double effect, the doctrine of doing and allowing, and the view that human life is sacred. Amongst supporters, the most important reasons mentioned are, that the patient's right to self-determination should be respected, the view that a patient should not be forced to suffer, and the view that the patient has a right to be helped to a dignified death

What I call hegemonism holds that a satisfactory moral theory must in a fairly direct way guide action. This, the hegemonist believes, provides a constraint on moral theorizing. We should not accept moral theories which cannot in the proper sense guide us. There are two alternatives to hegemonism. One is motivational indirection, which is the idea that while agents remain motivated by a moral theory, they may be only indirectly motivated. The other is non-hegemonism, which holds that a correct moral theory need not in any direct or indirect sense guide or motivate actions. In the main part of the paper I discuss widely endorsed objections to motivational indirection and nonhegemonism, and I argue that these objections all fail. Hence, motivational indirection and non-hegemonism remain viable conceptions of moral theory

Recently Robert B. Talisse has put forth a socio-epistemic justification of liberal democracy that he believes qualifies as a public justification in that it purportedly can be endorsed by all reasonable individuals. In avoiding narrow restraints on reasonableness, Talisse argues that he has in fact proposed a justification that crosses the boundaries of a wide range of religious, philosophical and moral worldviews and in this way the justification is sufficiently pluralistic to overcome the challenges of reasonable pluralism familiar from Rawls. The fascinating argument that Talisse furthers is that when cognitively functional individuals reflect on some of their most basic epistemic commitments they will come to see that, in virtue of these commitments, they are also committed to endorsing key liberal democratic institutions. We argue that the socio-epistemic justification can be reasonably rejected on its own terms and thus fails as a public justification approach. This point is made by illustrating the significance of deep epistemic disagreements in liberal democracies.

The paper addresses the possibility of providing a meta-justification of what appears to be crucial epistemic desiderata involved in the method of reflective equilibrium. I argue that although the method of reflective equilibrium appears to be widely in use in moral theorising, the prospects of providing a meta-justification of crucial epistemic desiderata are rather bleak. Nor is the requirement that a meta-justification be provided obviously misguided. In addition, I briefly note some of the implications of these results for our use of the method of reflective equilibrium and for the best interpretation of the method