Neil Manson

abstract Allen Buchanan argues that conventional applied ethics is impoverished and would be enriched by the addition of social moral epistemology. The aim here is to clarify this argument and to raise questions about whether such an addition is necessary about how such enrichment would work in practice. Two broad problems are identified. First, there are various kinds and sources of epistemic inertia, which act as an obstacle to epistemic change. Religion is one striking example and seems to pose a deep problem for Buchanan's liberal social moral epistemology. Philosophy also exhibits a distinctive kind of epistemic inertia (metaphilosophical beliefs about the impropriety of applying philosophy are hard to shift), but also suffers from epistemic isolationism: (its arguments and conclusions are isolated from practical influence). It is concluded that not only will a liberal social moral epistemology have to overcome a pernicious epistemic inertia with regard to religious belief, but also a different kind of epistemic inertia closer to home.

With aims to both increase organ supply and better reflect individual donation preferences, many nations worldwide have shifted from ‘opt‐in’ to ‘opt‐out’ systems for post‐mortem organ donation (PMOD). In such countries, while a prospective donor's willingness to donate their organs/tissues for PMOD was previously ascertained—at least partially—by their having recorded positive donation preferences on an official register prior to death, this willingness is now presumed or inferred—at least partially—from their not having recorded an objection to PMOD—on an official organ donation register. Using evidence regarding the presence and prevalence of selective donation preferences, and via exploration of how appeals to donation preferences are used to both motivate and legitimate shifts to opt‐out frameworks, this paper draws attention to a set of previously unexplored problems for opt‐out organ donation arising in contexts where: (a) individuals demonstrate selective post‐mortem organ/tissue donation preferences, (b) legislation provides prospective donors with the opportunity to selectively permit/refuse the donation of certain organs/tissues in line with these preferences. While selective preferences pose few problems for opt‐in systems where a selective occasion is built into the process of signing the donor register, this is not the case for opt‐out systems. The loss of this selective occasion can cause significant problems where appeals to preferences motivate/legitimate shifts to opt‐out but evidence regarding variable preferences does not feed into determinations regarding organ/tissue exclusions. The nature of these problems depends on how the authorization aspect of ‘opt‐out’ systems is framed (e.g. as presumed consent, deemed consent or, given the role of familial consent in many jurisdictions as consent in name only).

In a recent article, I argued that Ploug and Holm’s ‘meta-consent’ proposal should be rejected for biobank governance. This was because, although meta-consent is permissible, it is both burdensome and ethically omissible. There is no ethical reason why funders should undertake the additional costs. Ploug and Holm have sought to respond to these arguments. Here, it is noted that not only do they fail to adequately refuse the case against meta-consent, they fail to even engage with the arguments, either misunderstanding them or ignoring them. In their response, Ploug and Holm unwittingly provide the basis of an even stronger case against meta-consent. They argue that broad consent has a built in tendency to expire, while also holding that broad consent should be one of the options available in meta-consent. Meta-consent thus ends up being more like dynamic consent, but, arguably, even more burdensome and costly.

Informed consent requirements for medical research have expanded over the past half-century. The Declaration of Helsinki now includes an explicit positive obligation to inform subjects about funding sources. This is problematic in a number of ways and seems to oblige researchers to disclose information irrelevant to most consent decisions. It is argued here that such a problematic obligation involves an “informational fallacy.” The aim in the second part of the paper is to provide a better approach to making sense of how a failure to inform about funding sources wrongs subjects: by making appeals to obligations to refrain from misleading by omission. This alternative approach—grounded in a general obligation to refrain from misleading, an obligation that is independent of informed consent—provides a basis for a norm that protects subjects’ interests, without the informational fallacy. The approach developed here avoids the problems identified with the currently specified general obligation to inform about funding sources.

In some jurisdictions there is a puzzling asymmetry between consent and refusal, where, for some kinds of treatment, the adolescent patient has the power to permit her own treatment but her refusal does not have the same kind of normative significance as refusal of treatment by a competent adult. In this journal I recently offered a clarification and defence of this asymmetry in terms of a paternalistic justification of the sharing of normative powers between adolescents and other parties. Lawlor offers a number of objections to this account. Three of his objections can be dealt with quickly. But one of them is much more challenging: the asymmetry of consent and refusal entails a practice of making sham offers. They do not really offer a choice at all. Genuine offers seem to require a commitment to be symmetrically responsive to whatever decision outcome is reached by the recipient of the offer. When we reflect upon the way that offers can be made in complex social contexts, where different parties have a ‘say’ in what ought to be done, the symmetry of responsiveness need not apply. Offers can be genuine, without being symmetrically responsive. Contrary to the seemingly plausible objection, the asymmetry of consent and refusal does not entail sham offers, or the offer of ‘sham choices’.

How do reason explanations explain? One view is that they require the deployment of a tacit psychological theory; another is that even if no tacit theory is involved, we must still conceive of reasons as mental states. By focusing on the subjective nature of agency, and by casting explanations as responses to why questions that assuage agents puzzlement, reason explanations can be profitably understood as part of our traffic in first-order content amongst perspectival subjects. An outline is offered of such an account of reason explanation, one that fully acknowledges the distinctive first-order first-person normative perspective of agency.

Onora O’Neill is one of the foremost moral philosophers writing today. Her work on ethics and bioethics, political philosophy and the philosophy of Kant is extremely influential. Her landmark Reith Lectures on trust did much to establish the subject not only on the philosophical and political agenda but in the world of media, business and law more widely. Reading Onora O’Neill is the first book to examine and critically appraise the work of this important thinker. It includes specially commissioned chapters by leading international philosophers in ethics, Kantian philosophy and political philosophy. The following aspects of O’Neill’s work are examined: global justice Kant the ethics of the family bioethics consent trust. Featuring a substantial reply to her critics at the end of the book, Reading Onora O’Neill is essential reading for students and scholars of ethics and political philosophy

If we are to understand why psychoanalysis extends ordinary psychology in the precise ways that it does, we must take account of the existence of, and the interplay between, two distinct kinds of explanatory concern: functional and idiographic. The form and content of psychoanalytic explanation and its unusual methodology can, at least in part, be viewed as emerging out of Freud's attempt to reconcile these two types of explanatory concern. We must also acknowledge the role of the background theoretical context that shapes Freud's functional thinking about the mind. A neglect of the role of the background theory in shaping the extension of ordinary psychology leaves us with puzzles about the nature and direction of the psychoanalytic extension and gives rise to an unbelievable history of psychoanalysis.

The biobank consent debate is one with deeply held convictions on both the ‘broad’ and ‘specific’ side with little sign of resolution. Recently, Thomas Ploug and Soren Holm have developed an alternative to both specific and broad consent: a meta‐consent framework. The aim here is to consider whether meta‐consent provides a ‘solution’ to the biobank consent debate. We clarify what ‘meta‐consent’ actually is (arguing that the label is a misnomer and ‘consent à la carte’ is more accurate). We identify problems with Ploug and Holm's arguments, and some challenges for meta‐consent. We focus on whether there is any ethical obligation to provide consent à la carte. There may seem to be so, especially if we draw upon an unclear appeal to the ethical significance of ‘respect for autonomy’. Similarly, there might seem to be an intuitive inference from the fact that ethically legitimate research requires informed consent to the conclusion that it thereby requires consent à la carte. It is shown that this line of inference is mistaken.

Is genetic information of special ethical significance? Does it require special regulation? There is considerable contemporary debate about this question. Genetic information is an ambiguous term and, as an aid to avoiding conflation in the genetic exceptionalism debate, a detailed account is given of just how and why genetic information is ambiguous. Whilst ambiguity is a ubiquitous problem of communication, it is suggested that genetic information is ambiguous in a particular way, one that gives rise to the problem of significance creep. A contextual and contrastive methodology is proposed: evaluating the significance of genetic information requires us to be sensitive to the polysemy of genetic information across contexts and then examine the contrast in significance of genetic, as opposed to nongenetic, information within contexts. This, in turn, suggests that a proper solution to the regulatory question requires us to pay more attention to how and why information, and its acquisition, possession and use, come to be of ethical significance.

A short review is given of the Nuffield Council’s report on behavioural genetics. This review is used as an entry point to a discussion of the factors that influence the presentation of behavioural genetics in the media and in the popular scientific press. It is argued that our interest in formulating narrative explanations of our individual lives puts pressure on publishers and editors to present behavioural genetics in a selective, misleading, way. Some other influences on presentation are discussed and it is suggested that the Nuffield report is particularly useful in so far as it lacks these distorting influences

The modern vat-brain debate is an epistemological one, and it focuses on the point of view of a putatively deceived subject. Semantic externalists argue that we cannot coherently wonder whether we are brains in vats. This paper examines a new experimental paradigm for cognitive neuroscience—the neurally-controlled animat paradigm—that seems to have a great deal in common with the vat-brain scenario. Neural cells are provided with a simulated body within an artificial world in order to study the brain both in vitro and in vivo. Given the similarity between the NCA scenario and the vat-brain scenario, semantic externalism seems to undermine the utility of the NCA methodology. Three initial responses to the externalist challenge are offered. A fourth response clarifies the distinctive theoretical background to the NCA in ‘artificial life’ and, in doing so, we uncover an anti-representationalist conception of the NCA. This distances the NCA paradigm from externalist objections and casts cognitive neuroscience, and the vat-brain debate, in a new light.

In some jurisdictions there is a puzzling asymmetry between consent and refusal, where, for some kinds of treatment, the adolescent patient has the power to permit her own treatment but her refusal does not have the same kind of normative significance as refusal of treatment by a competent adult. In this journal I recently offered a clarification and defence of this asymmetry in terms of a paternalistic justification of the sharing of normative powers between adolescents and other parties. Lawlor (2016) offers a number of objections to this account. Three of his objections can be dealt with quickly. But one of them is much more challenging: the asymmetry of consent and refusal entails a practice of making sham offers (offers that purport to be responsive to the patient's choices, but which, in fact, are not). They do not really offer a choice at all. Genuine offers seem to require a commitment to be symmetrically responsive to whatever decision outcome is reached by the recipient of the offer. When we reflect upon the way that offers can be made in complex social contexts, where different parties have a ‘say’ in what ought to be done, the symmetry of responsiveness need not apply. Offers can be genuine, without being symmetrically responsive. Contrary to the seemingly plausible objection, the asymmetry of consent and refusal does not entail sham offers, or the offer of ‘sham choices’.