Klemens Kappel

Informed consent is considered by many to be a moral imperative in medical research. However, it is increasingly acknowledged that in many actual instances of consent to participation in medical research, participants do not employ the provided information in their decision to consent, but rather consent based on the trust they hold in the researcher or research enterprise. In this article we explore whether trust-based consent is morally inferior to information-based consent. We analyse the moral values essential to valid consent – autonomy, voluntariness, non-manipulation, and non-exploitation – and assess whether these values are less protected and promoted by consent based on trust than they are by consent based on information. We find that this is not the case, and thus conclude that trust-based consent if not morally inferior to information-based consent.

Suppose we have a persistent disagreement about a particular set of policy options, not because of an underlying moral disagreement, or a mere conflict of interest, but rather because we disagree about a crucial non-normative factual assumption underlying the justification of the policy choices. The main question in the paper is what political legitimacy requires in such cases, or indeed whether there are defensible answers to that question. The problem of political legitimacy in fact-dependent policy disagreements has received almost no attention in political philosophy, which has focused mostly on value disagreements and proposed theories of legitimate coercive legislation in valuedependent disagreements. The paper presents an argument showing that under certain plausible assumptions regarding legitimacy, there are serious difficulties in identifying legitimate choices in fact-dependent policy disagreements. This may be unsurprising to political philosophers preoccupied with value-based disagreements, perhaps because it has been assumed that legitimacy-related concerns are irrelevant to fact-dependent policy disagreements. The paper argues that this response is premature. If we should care about legitimacy et al.l, then it is by no means clear why we should ignore issues of legitimacy in policy-disputes that depend on factual disagreements. The paper ends by defining a set of possibilities that merit further exploration in search of a theory of legitimacy in fact-dependent policy disagreements.

The purpose of this paper is to offer a diagnosis and a resolution to generality problem. I state the generality problem and suggest a distinction between criteria of relevance and what I call a theory of determination. The generality problem may concern either of these. While plausible criteria of relevance would be convenient for the externalist, he does not need them. I discuss various theories of determination, and argue that no existing theory of determination is plausible. This provides a case for the no determination view: there are no facts that determine relevant types. This is the diagnosis of the generality problem. The externalist, however, may embrace the no determination view. This is what provides a resolution to the generality problem.

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

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.

Robert Audi's ethical intuitionism (Audi, 1997, 1998) deals effectively with standard epistemological problems facing the intuitionist. This is primarily because the notion of self-evidence employed by Audi commits to very little. Importantly, according to Audi we might understand a self-evident moral proposition and yet not believe it, and we might accept a self-evident proposition because it is self-evident, and yet fail to see that it is self-evident. I argue that these and similar features give rise to certain challenges to Audi's intuitionism. It becomes harder to argue that there are any self-evident propositions at all, or more than just a few such propositions. It is questionable whether all moral propositions that we take an interest in are evidentially connected to self-evident propositions. It is difficult to understand what could guide the sort conceptual revision that is likely to take place in our moral theorising. It is hard to account for the epistemic value of the sort of systematicity usually praised in moral theorising. Finally, it is difficult to see what difference the truth of Audi's ethical intuitionism would make to the way in which we (fail to) handle moral disagreement.

Subjective probabilities play a significant role in the assessment of evidence: in other words, our background knowledge, or pre-trial beliefs, cannot be set aside when new evidence is being evaluated. Focusing on homeopathy, this paper investigates the nature of pre-trial beliefs in clinical trials. It asks whether pre-trial beliefs of the sort normally held only by those who are sympathetic to homeopathy can legitimately be disregarded in those trials. The paper addresses several surprisingly unsuccessful attempts to provide a satisfactory justification for ignoring the pre-trial beliefs of the homeopathic community. The ensuing diagnosis of the difficulties here emphasizes that the reason the arguments for choosing the pre-trial beliefs of the conventional community seem insufficient is not the arguments per se. It is rather that there is no cogent argument for choosing the conventional stance which would at the same time rationally persuade a member of the homeopathic community. The paper concludes that, once we understand that this is the predicament, there is no genuine reason to doubt the reasoning that leads us to reject the pre-trial beliefs of the homeopathic community.

The lifetime equality view has recently been met with the objection that it does not rule out simultaneous inequality: two persons may lead equally good lives on the whole and yet there may at any time be great differences in their level of well-being. And simultaneous inequality, it is held, ought to be a concern of egalitarians. The paper discusses this and related objections to the lifetime equality view. It is argued that rather than leading to a revision of the lifetime equality view, these objections, if taken seriously, should make us account for our egalitarian concerns in terms of the priority view rather than the equality view. The priority view claims that there is a greater moral value to benefiting the worse off. Several versions of the priority view are also distinguished

This paper explores in detail an argument for epistemic expressivism, what we call the Argument from Motivation. While the Argument from Motivation has sometimes been anticipated, it has never been set out in detail. The argument has three premises, roughly, that certain judgments expressed in attributions of knowledge are intrinsically motivating in a distinct way (P1); that motivation for action requires desire-like states or conative attitudes (HTM); and that the semantic content of knowledge attributions cannot be specified without reference to the intrinsically motivating judgments that such attributions express (P2). We argue that these premises entail a version of ecumenical expressivism. Since the argument from motivation has not been explicitly stated before, there is no current discussion of the argument. In this paper we therefore consider and reject various objections that one might propose to the argument, including some that stem from the idea that knowledge is factive, or that knowledge involves evidence that rules out relevant alternatives. Other objections to (P1) specifically might be derived from cases of apparent lack of epistemic motivation considered in in Kvanvig (The value of knowledge and the pursuit of understanding, 2003) and Brown (Nous 42(2):167–189, 2008), as well as from general forms of externalism about epistemic motivation. We consider these and find them wanting. Finally, the paper offers some critical remarks about the prospect of denying (P2)