Ian D. Dunkle

Abilities, in contrast to mere dispositions, propensities, or tendencies, abilities seem to be features of agents that put the agent herself in control. But what is the distinguishing feature of abilities vis‐à‐vis other kinds of powers? Our aim in this paper is to point, in answer to this question, to a crucial feature of abilities that existing accounts have tended to neglect: their adaptivity. Adaptivity is a feature of how abilities are exercised. The main reason for its relative neglect has been that most extant accounts have focused solely on whether abilities are exercised successfully in certain possible situations and have mostly understood the exercise of an ability in terms of complete successful performance. We begin by pointing out two aspects of abilities with regard to which current accounts seem (at best) incomplete: control and exercise. We then introduce adaptivity as we understand it, and end by putting it to work in developing a fuller understanding of abilities that does better than current accounts.

This paper introduces the line-drawing challenge for ability-based accounts of health. What degree of which abilities is required for complete health? I argue that the answers provided by existing theories are flawed and propose the Blueprint View. On this view, an organism is completely healthy if and only if it has the abilities it would have in its design state, where design is determined by the etiology of its traits. This view provides an objective, naturalistic distinction between health and non-health. It strikes a balance between pure physiology and well-being, and distinguishes treatment from enhancement, as well as real pathology from pathologized variation.

This paper advances a theory of disease as domino dysfunction. It is often argued that diseases are biological dysfunctions. However, a theory of disease as biological dysfunction is complicated by some plausible cases of dysfunction, which seem clearly non-pathological. I argue that pathological conditions are not just dysfunctions but domino dysfunctions, and that domino dysfunctions can be distinguished on principled biological grounds from non-pathological dysfunctions. I then show how this theory can make sense of the problem cases; they are not diseases because they are not domino dysfunctions.

Each of us ought to decide what others can do to our bodies. This is so obvious it does not cry out for explanation; and philosophers have not given it much. What few philosophical explanations there are of our rights in our bodies tend to appeal to claims about identity—my body, so they say, is mine because it is me, or is part of something that is me. I argue that, given the kind and degree of metaphysical specificity that would be required to make it work, this “Identity-Based” view is prima facie inconsistent with plausible constraints against introducing controversial metaphysics into public reasoning. In the second half I consider and reject recent Kantian attempts to frame an Identity-Based view of our body rights without reference to fundamental metaphysics. Then, drawing on what still seems right in these Kantian proposals, I sketch a view of how public reason can construct persons as loci of body rights, on the analogy of how international public reason constructs its constituent “peoples” as the loci of territorial sovereignty. The result is an argument for a novel view of our rights in our bodies, a view that, among other things, provides materials to defend public reason liberalism against the charge that issues around embodiment make contentious metaphysics unavoidable in politics.

A common‐sense view of mammalian pregnancy treats the fetus as (a) an organism and (b) co‐extensive with the approximately baby‐shaped entity developing in the uterus. In this paper, I draw on metabolic accounts of the organism to show that (a) and (b) cannot both be correct: either the fetus is not an organism, or it is considerably more extensive than we tend to think, overlapping considerably—perhaps completely—with its mother. Although other accounts of organisms may have different consequences, I argue that they are all likely to put pressure on the idea that the fetus is a roughly baby‐shaped organism. I show that this has consequences for understanding the metaphysics of birth, our nature and persistence, and the ethical dynamics of pregnancy.

Recent criticisms of medicine converge on fundamental questions about the aim of medicine. The main task of this paper is to propose an account of the aim of medicine. Discussing and rejecting the initially plausible proposal according to which medicine is pathocentric, the paper presents and defends the Autonomy Thesis, which holds that medicine is not pathocentric, but sanocentric, aiming to promote health with the final aim to enhance autonomy. The paper closes by considering the objection that the Autonomy Thesis is overly permissive and allows many highly controversial procedures as legitimate parts of medicine.

When a person is competent, they can exercise their autonomy rights, including waiving claims against interference by giving consent. Non-competent persons, by contrast, lack these autonomy rights, which means that others are permitted to make certain decisions for them. What grounds this gulf between the rights of competent and non-competent persons? In this paper, we present a novel account of the capacities that underlie competence. Competence comprises two distinct rights: a power to alter claims and a claim against paternalistic interference with one’s decisions. While existing accounts appear to assume that the same capacities underlie both features of agential control, we argue that they have separate grounds. The capacity that grounds the power to alter claims is the capacity to value, whereas the capacity that grounds the claim against paternalistic interference is the more substantial capacity to be responsible for one’s actions. By separating these normative grounds, we solve a problem that plagues Common Grounds views. Our Separate Grounds account can explain why and in what way the decisions of persons with marginal autonomy should be respected without sacrificing the need to protect them from harm.