Walter Sinnott-Armstrong

Scrupulosity is a form of OCD where patients obsess about morality and sometimes compulsively confess or atone. It involves chronic doubt and anxiety as well as deviant moral judgments. This chapter argues that Scrupulosity is a mental illness and that its distortion of moral judgments undermines, or at least reduces, patients’ moral responsibility. The authors go on to argue that this condition challenges popular deep-self theories of responsibility, which assert that one is only blameworthy or praiseworthy for actions that arise from one’s deep self, from what one truly values. Patients with ego-syntonic Scrupulosity, however, identify with their condition and seem to have cares that reflect their deep selves, yet do not seem fully responsible for their actions or their consequences, such as neglecting the needs of their loved ones. Other theories, particularly reasons-responsiveness theories, better capture the ways in which responsibility in Scrupulosity is reduced.

When two people need a kidney transplant, but only one kidney is available, we need to decide who gets it. If one of the potential recipients needs the kidney because of their own voluntary behavior, but the other is not at all responsible for needing a kidney, then we need to decide whether this fault should be a consideration in favor of the other patient getting the kidney. While there has been considerable philosophical debate on this issue, there is far less research into the views of the public. To explore opinions on these issues, we first asked survey participants to ascribe or deny responsibility for the risky behavior for kidney disease, and for being deprived of a kidney in cases of drinking alcohol, drug abuse, smoking and unhealthy eating when the patient did or did not stop the risky behavior after being diagnosed with kidney disease. Next, we asked participants who should get the kidney when the patient who engaged in risky behavior did or did not know, or have easy access to, the information that the behavior was risky. We found that participants generally ascribed responsibility on the basis of knowledge but allocated the kidney on the basis of access to information. These findings have important implications for moral theories as well as medical policies.