Anthony Wrigley

In this paper I provide an account of the metaphysical foundations of mental illness in terms of a realism debate. I motivate the importance of such metaphysical analysis as a means of avoiding some intractable problems that beset discussion of the concept of mental illness. I apply aspects of the framework developed by Crispin Wright for realism debates in order to examine the ontological commitments to mental illness as a property that humans may exhibit and to examine the various arguments that realists and anti-realists can use to defend their position on mental illness. I pay particular attention to characterising Szasz's account of mental illness as that of an anti-realist error-theory and present ways in which a realist may counter such a position. Ultimately I argue that in order to hold a realist position on mental illness one would have to adopt some form of realism towards values, such as moral realism

Parfit’s (1984) Non-Identity Problem provides a strong line of argument that we cannot be harmed by pre-conception choices or actions. I argue that we can no longer appeal to the Non-Identity problem in order to justify using pre-conception genetic screening and selection techniques as a harmless tool to determine the genetic constitution of future individuals. My criticism of the Non-Identity problem is based on a rejection of the metaphysical foundations of Parfit’s argument - Kripke’s (1980) essentialist arguments for the necessity of origin. I offer an alternative account of modal harms based on counterpart theory such as that offered by David Lewis (1986). On this account, individuals can make legitimate harm claims in regard to pre-conception choices made in determining their genetic constitution by appeal to their counterparts across possible worlds.

NThere are many problems with Levi and Green’s (2010) suggestion that a computer-based decision aid will overcome the major objections to advance directives (ADs). We focus on just two here. First, we argue that the key assumption underlying Levi and Green’s paper, that autonomy always ought to take priority over other values, is false. Second, we argue that the paper misses the point of the most telling objections to the use of ADs: they lack the relevant moral authority to determine treatments. It is not that they are merely subject to a set of contingent problems related to capturing the wishes of individuals or being open to misinterpretation by others.We conclude that the plug should be pulled on Levi and Green’s computer-based proposal.