Sven Nyholm

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.

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.

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.

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.

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.”

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

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.