Sven Nyholm

In a recent article, Sabine Müller, Merlin Bittlinger, and Henrik Walter launch a sweeping attack against what they call the "personal identity debate" as it relates to patients treated with deep brain stimulation (DBS). In this critique offered by Müller et al., the so-called personal identity debate is said to: (a) be metaphysical in a problematic way, (b) constitute a threat to patients, and (c) use "vague" and "contradictory" statements from patients and their families as direct evidence for metaphysical theories. In this response, I critically evaluate Müller et al.'s argument, with a special focus on these three just-mentioned aspects of their discussion. My conclusion is that Müller et al.'s overall argument is problematic. It overgeneralizes criticisms that may apply to some, but certainly not to all, contributions to what they call the personal identity-debate. Moreover, it rests on a problematic conception of what much of this debate is about. Nor is Müller et al.'s overall argument fair in its assessment of the methodology used by most participants in the debate. For these reasons, we should be skeptical of Müller et al.'s claim that the "personal identity debate" is a "threat to neurosurgical patients".

The growth of self-tracking and personal surveillance has given rise to the Quantified Self movement. Members of this movement seek to enhance their personal well-being, productivity, and self-actualization through the tracking and gamification of personal data. The technologies that make this possible can also track and gamify aspects of our interpersonal, romantic relationships. Several authors have begun to challenge the ethical and normative implications of this development. In this article, we build upon this work to provide a detailed ethical analysis of the Quantified Relationship. We identify eight core objections to the QR and subject them to critical scrutiny. We argue that although critics raise legitimate concerns, there are ways in which tracking technologies can be used to support and facilitate good relationships. We thus adopt a stance of cautious openness toward this technology and advocate the development of a research agenda for the positive use of QR technologies.

The Ethics of Human Enhancement: Understanding the Debate has two chief aims. These aims are to help readers understand the existing debate and to move the debate forward. The book consists of an introductory chapter by Alberto Giubilini and Sagar Sanyal (which lays out some prominent bioconservative objections to enhancement), eight essays grouped under the theme of "Understanding the Debate" (Section I), and eight devoted to "Advancing the Debate" (Section II). In this review, we offer brief summaries of each essay and ask whether the book successfully advances the debate.

This book offers new readings of Kant’s “universal law” and “humanity” formulations of the categorical imperative. It shows how, on these readings, the formulas do indeed turn out being alternative statements of the same basic moral law, and in the process responds to many of the standard objections raised against Kant’s theory. Its first chapter briefly explores the ways in which Kant draws on his philosophical predecessors such as Plato (and especially Plato’s Republic) and Jean-Jacque Rousseau. The second chapter offers a new reading of the relation between the universal law and humanity formulas by relating both of these to a third formula of Kant’s, viz. the “law of nature” formula, and also to Kant’s ideas about laws in general and human nature in particular. The third chapter considers and rejects some influential recent attempts to understand Kant’s argument for the humanity formula, and offers an alternative reconstruction instead. Chapter four considers what it is to flourish as a human being in line with Kant’s basic formulas of morality, and argues that the standard readings of the humanity formula cannot properly account for its relation to Kant’s views about the highest human good.

Hübner and White argue that we should not administer DBS to psychopathic prisoners. While we are sympathetic to their conclusion, we argue that the authors’ two central arguments for this conclusion are problematic. Their first argument appeals to an overly restrictive conception of individual medical benefit: namely, that an individual medical benefit must alleviate subjective suffering. We highlight cases that clearly constitute individual medical benefits although there is no relief of subjective suffering. The second argument depends on an overly restrictive conception of the sort of motivation needed to ground consent to a medical procedure. It is also too quick to treat it as unproblematic to consider psychopaths as fully competent. We argue that this view overlooks certain kinds of internal motivation. It also overlooks the possibility that after successful activation of underactive brain-regions, a former psychopath might become a better representative of his or her “true self.”

Besser-Jones holds that well-being consists in having the experience of satisfying three innate psychological needs at the core of human nature: "relatedness," "autonomy," and "competence." Of these three, the first is the most central one, and we satisfy it by interacting with our fellows in caring and respectful ways: by "acting well." To act well, we need, Besser-Jones argues, a virtuous character: we need certain moral beliefs, and we need those to interact with our intentions in ways that reliably lead us to act in ways that satisfy our psychological needs. Besser-Jones’s theory has many virtues, but appears overly narrow. The theory ignores the importance of bodily, or physical, well-being. It is also overly restrictive to base an account of virtue wholly upon the agent’s own psychological well-being. If we possess qualities of mind or character that do or would make us into good friends or associates, this appears to be a sufficient reason for counting these qualities as virtues of ours. And giving others due care and respect is surely worthwhile in itself, not only as a means to our own psychological well-being.

Some critics of sex-robots worry that their use might spread objectifying attitudes about sex, and common sense places a higher value on sex within love-relationships than on casual sex. If there could be mutual love between humans and sex-robots, this could help to ease the worries about objectifying attitudes. And mutual love between humans and sex-robots, if possible, could also help to make this sex more valuable. But is mutual love between humans and robots possible, or even conceivable? We discuss three clusters of ideas and associations commonly discussed within the philosophy of love, and relate these to the topic of whether mutual love could be achieved between humans and sex-robots: (i) the idea of love as a “good match”; (ii) the idea of valuing each other in our distinctive particularity; and (iii) the idea of a steadfast commitment. We consider relations among these ideas and the sort of agency and free will that we attribute to human romantic partners. Our conclusion is that mutual love between humans and advanced sex-robots is not an altogether impossible proposition. However, it is unlikely that we will be able to create robots sophisticated enough to be able to participate in love-relationships anytime soon.

In this paper, I discuss practical reasons and value, assuming a coexistence thesis according to which reasons and value always go together. I start by doing some taxonomy, distinguishing among three different ways of accounting for the relation between practical reasons and the good. I argue that, of these views, the most plausible one is that according to which something’s being good just consists in how certain facts about the thing in question – other than that of how it is good – give us reasons to want it. It has been argued that this reasons-based account of goodness is open to various counter-examples. I consider a few, and argue that they misfire.

Persson argues that common sense morality involves various “asymmetries” that don’t stand up to rational scrutiny. (One example is that intentionally harming others is commonly thought to be worse than merely allowing harm to happen, even if the harm involved is equal in both cases.) A wholly rational morality would, Persson argues, be wholly symmetrical. He also argues, however, that when we get down to our most basic attitudes and dispositions, we reach the “end of reason,” at which point we simply must accept our basic attitudes and dispositions as given, or as being beyond rational criticism. Since many of the “asymmetries” in our moral attitudes that Persson argues against depend on our most basic dispositions, his own overall framework implies that these asymmetries in our moral attitudes and dispositions are beyond rational criticism, and that we must simply accept them as given elements of human life. Persson therefore seemingly faces a choice: either he revises his view of the reach of reason, or else he must scale back his views about the degree to which our most basic moral attitudes are proper subjects of rational criticism.

It is widely recognized that lives and activities can be meaningful or meaningless, but few have appreciated that they can also be anti-meaningful. Anti-meaning is the polar opposite of meaning. Our purpose in this essay is to examine the nature and importance of this new and unfamiliar topic. In the first part, we sketch four theories of anti-meaning that correspond to leading theories of meaning. In the second part, we argue that anti-meaning has significance not only for our attempts to theorize about meaning in life, but also for our ability to lead meaningful lives in the modern world.

Recent research suggests that “smart drugs” don’t make healthy individuals who use them smarter. The main effects are instead on levels of motivation and interest. So the main ethical question here is not whether there is anything wrong or regrettable about healthy individuals’ using these drugs to make themselves smarter. It is rather whether there is anything problematic about their using these drugs to control or modulate their levels of motivation and interest. This question can either be discussed on a wholly general level or be related to the values and goals characteristic of specific domains of human activity. This essay considers the use of motivation-modulators within the academic domain, and suggests two ways in which such enhancements might conflict with the values distinctive of this domain.

Self-driving cars hold out the promise of being safer than manually driven cars. Yet they cannot be a 100 % safe. Collisions are sometimes unavoidable. So self-driving cars need to be programmed for how they should respond to scenarios where collisions are highly likely or unavoidable. The accident-scenarios self-driving cars might face have recently been likened to the key examples and dilemmas associated with the trolley problem. In this article, we critically examine this tempting analogy. We identify three important ways in which the ethics of accident-algorithms for self-driving cars and the philosophy of the trolley problem differ from each other. These concern: the basic decision-making situation faced by those who decide how self-driving cars should be programmed to deal with accidents; moral and legal responsibility; and decision-making in the face of risks and uncertainty. In discussing these three areas of disanalogy, we isolate and identify a number of basic issues and complexities that arise within the ethics of the programming of self-driving cars.

According to Haidt’s “social intuitionist model”, empirical moral psychology supports the following conclusion: intuition comes first, strategic reasoning second. Critics have responded by arguing that intuitions can depend on non-conscious reasons, that not being able to articulate one’s reasons doesn’t entail not being responsive to reasons, and that the relations between intuitions and reasoning can be truth-tracking and principled in ways overlooked by Haidt. This debate involves a false dichotomy: that either reasoning is truth-tracking, or else our reasoning is purely strategic and manipulative in nature. Reason-giving also, I argue, performs other important functions in moral and social life. A robust willingness to offer reasons in favor of our convictions is itself a virtue we seek and appreciate in others. Others’ willingness to reason with us is itself a good we enjoy at their hands, or that they confer upon us. What we give each other in being willing and determined to reason together is, among other things, respect for, and good-will towards, each other.

In Just Freedom, Pettit presents a powerful new statement and defense of the traditional “republican” conception of liberty or freedom. And he claims that freedom can serve as an ecumenical value with broad appeal, which we can put at the basis of a distinctively republican theory of justice. That is, Pettit argues that this “conception of freedom as non-domination allows us to see all issues of justice as issues, ultimately, of what freedom demands.” It is not, however, clear that liberty is the only value that Pettit (a) actually appeals to and (b) should be appealing to. He seems to be as much a defender of relational equality and legal dignity as he is a defender of liberty. And he must either (it seems) make the implausible claim that the basic requirements of justice only apply to able-minded adults, or else admit that justice at bottom consists in something wider than just securing liberty as non-domination for all able-minded adults. For by his own admission, Pettit’s theory of justice as republican freedom “ignores issues of justice in relation to children and the intellectually disabled.” It would be better to say, therefore, that the promotion of freedom as non-domination constitutes one, but not the only, requirement of justice.

One of the topics that often comes up in ethical discussions of deep brain stimulation (DBS) is the question of what impact DBS has, or might have, on the patient’s self. This is often understood as a question of whether DBS poses a “threat” to personal identity, which is typically understood as having to do with psychological and/or narrative continuity over time. In this article, we argue that the discussion of whether DBS is a “threat” to continuity over time is too narrow. There are other questions concerning DBS and the self that are overlooked in discussions exclusively focusing on psychological and/or narrative continuity. For example, it is also important to investigate whether DBS might sometimes have a positive (e.g. a rehabilitating) effect on the patient’s self. To widen the discussion of DBS, so as to make it encompass a broader range of considerations that bear on DBS’s impact on the self, we identify six features of the commonly used concept of a person’s “true self”. We apply these six features to the relation between DBS and the self. And we end with a brief discussion of the role DBS might play in treating otherwise treatment-refractory anorexia nervosa. This further highlights the importance of discussing both continuity over time and the notion of the true self.

Whereas the universal law formula says to choose one’s basic guiding principles (or “maxims”) on the basis of their fitness to serve as universal laws, the humanity formula says to always treat the humanity in each person as an end, and never as a means only. Commentators and critics have been puzzled by Kant’s claims that these are two alternative statements of the same basic law, and have raised various objections to Kant’s suggestion that these are the most basic formulas of a fully justified human morality. This dissertation offers new readings of these two formulas, shows how, on these readings, the formulas do indeed turn out being alternative statements of the same basic moral law, and in the process responds to many of the standard objections raised against Kant’s theory. Its first chapter briefly explores the ways in which Kant draws on his philosophical predecessors such as Plato (and especially Plato’s Republic) and Jean-Jacque Rousseau. The second chapter offers a new reading of the relation between the universal law and humanity formulas by relating both of these to a third formula of Kant’s, the “Law of Nature” formula, and also to Kant’s ideas about laws in general and human nature in particular. The third chapter considers and rejects some influential recent attempts to understand Kant’s argument for the humanity formula, and offers an alternative reconstruction instead. Chapter four considers what it is to flourish as a human being in line with Kant’s basic formulas of morality, and argues that the standard readings of the humanity formula cannot properly account for its relation to Kant’s views about the highest human good.

Stephen Campbell, Connie Ulrich, and Christine Grady argue that we need to a broader understanding of moral distress – broader, that is, than the one commonly used within nursing-ethics and, more recently, healthcare ethics in general. On their proposed definition, moral distress is any self-directed negative attitude we might have in response to viewing ourselves as participating in a morally undesirable situation. While being in general agreement with much of what Campbell et al. say, I make two suggestions. First, in order to distinguish moral distress that is specifically related to the roles and responsibilities of healthcare-workers from other kinds of moral distress, it would be useful for the broadened definition to contain an explicit reference to the distinctive situation and challenges faced by healthcare-workers. Second, whereas Campbell et al. write in a manner that suggests that there is very little that is positive or redeeming about moral distress, we should also ask if there is anything morally good about such distress. I suggest that the disposition to respond with moral distress to situations that call for it can plausibly be seen as a virtue on the part of healthcare-workers. The moral value of responses of appropriate moral distress is positive (because it is a display of virtue on the part of the healthcare-worker), whereas the state of affairs that moral distress is called for is bad and regrettable.

Would a “medicalization” of love be a “good” or “bad” form of medicalization? In discussing this question, Earp, Sandberg, and Savulescu primarily focus on the potential positive and negative consequences of turning love into a medical issue. But it can also be asked whether there is something intrinsically regrettable about medicalizing love. It is argued here that the medicalization of love can be seen as an “evaluative category mistake”: it treats a core human value as if it were mainly a means to other ends . It is also argued that Earp et al’s closing argument can be seen as involving another evaluative category mistake: it treats an object of desire and practical interest as if it mainly were an object of scientific contemplation and theoretical interest. It is concluded that, to relate love to health and well-being in a more satisfying way, we should construe the latter two in broader ways, whereby love is itself a component or element of human flourishing

Kantians are increasingly deserting the universal law formula in favor of the humanity formula. The former, they argue, is open to various decisive objections; the two are not equivalent; and it is only by appealing to the humanity formula that Kant can reliably generate substantive implications from his theory of an acceptable sort. These assessments of the universal law formula, which clash starkly with Kant's own assessment of it, are based on various widely accepted interpretative assumptions. These assumptions, it is argued in this article, depend on misleading translations of key terms; selective attention to Kant's concrete examples; not taking seriously Kant's theoretical claims about the relations among his various ideas; and a failure to take into account Kant's idiosyncratic definitions of key concepts. The article seeks to right these interpretative wrongs, and finds that the universal law formula is not open to many of the standard objections.

In this paper, we engage in dialogue with Jonathan Pugh, Hannah Maslen, and Julian Savulescu about how to best interpret the potential impacts of deep brain stimulation on the self. We consider whether ordinary people’s convictions about the true self should be interpreted in essentialist or existentialist ways. Like Pugh et al., we argue that it is useful to understand the notion of the true self as having both essentialist and existentialist components. We also consider two ideas from existentialist philosophy – Jean-Paul Sartre and Simone de Beauvoir’s ideas about “bad faith” and “ambiguity” – to argue that there can be value to patients in regarding themselves as having a certain amount of freedom to choose what aspects of themselves should be considered representative of their true selves. Lastly, we consider the case of an anorexia nervosa-patient who shifts between conflicting mind-sets. We argue that mind-sets in which it is easier for the patient and his or her family to share values can plausibly be considered to be more representative of the patient’s true self, if this promotes a well-functioning relationship between the patient and the family. However, we also argue that families are well-advised to give patients room to figure out what such shared values mean to them, since it can be alienating for patients if they feel that others try to impose values on them from the outside.