Sven Nyholm

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.

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.

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.”