Lubomira Radoilska

This article offers a critical analysis of David Miller’s proposal that liberal immigration policies should be conceptualized in terms of a quasi-contract between receiving nations and immigrant groups, designed to ensure both that cultural diversity does not undermine trust among citizens and that immigrants are treated fairly. This proposal fails to address sufficiently two related concerns. Firstly, an open-ended, quasi-contractual requirement for cultural integration leaves immigrant groups exposed to arbitrary critique as insufficiently integrated and unworthy of trust as citizens. Secondly, the focus on national culture instead of citizenship obfuscates the close link between political membership and political trustworthiness. An examination of two models of interpersonal trust, affective and cognitive, shows that there is no room for the mid-way position associated with a quasi-contract. The effect of grounding political trust in a shared national culture instead of democratic institutions is to normalize the domination of immigrants and citizens alike.

In a recent Editorial, Kious et al. (2023) put forward the claim that psychiatrists should resist calls to integrate concerns about epistemic injustice into their practice as this concept not only fails to add significantly to the current professional standards but would also lead to deleterious clinical outcomes. We believe their claim is mistaken, as it arises from several misconceptions about both the nature of epistemic injustice, and its clinical relevance. First, epistemic justice is conflated with what the authors term ‘a quest for social justice’ that could ‘sideline principles of good clinical reasoning’ (Kious at al 2023: 4). Second, the claim about the impracticality and/or counterproductivity of epistemic injustice as a critical tool within psychiatric practice reflects a series of misconceptions about the normative framework from which this concept derives, so the standards they evaluate it against are ill-chosen. Pace Kious at al., fostering epistemic justice in any area of knowledge and inquiry could not – unwittingly or otherwise – inhibit the consideration of relevant evidence, restrict sound argument or facilitate the casual treatment of testimonies at face value. Third and final, this claim obfuscates some immediate ways in which a focus on epistemic justice as an integral goal will strengthen psychiatric practice according to its own internal standards.

In this chapter, I explore moral competence as a central condition on moral responsibility. I distinguish two main conceptions. On the first, a morally competent agent is someone who knows right from wrong. On the second, a morally competent agent is someone who responds aptly to reasons. These two conceptions merit separate treatment as they offer different insights on how and why moral competence might be compromised. This distinction is of particular relevance since the chapter critically examines a standard assumption stating that whenever a mental disorder impacts moral competence, it decreases its scope (on the first conception) or precision (on the second). In close conversation with the memoir literatures on bipolar disorder, autism and schizophrenia, I argue that moral competence may also be affected by what looks like increases in scope or precision; moreover, neither impact – decrease or increase – necessarily undermines moral competence in and of itself; oftentimes, either could enhance it in a reliable way. Finally, by critically revisiting the ecological or scaffolding approach to moral responsibility, I show that moral competence is best understood as a practical way of knowing right from wrong embedded in daily routines and habits, and irreducible to propositional understanding or intellectual skills.

This paper identifies a distinctive kind of moral luck, deep circumstantial luck and then explores its effects on moral responsibility. A key feature of the phenomenon is that it is recurrent rather than one-off. It also affects agents across a wide range of situations making it difficult to detect. Deeply unlucky agents are subject to unfavourable moral assessments through no fault of their own both in specific cases and when they try to respond to such initial assessments. In this respect, deep circumstantial luck takes the form of a normative burden that grows over time. A process-oriented conception of moral responsibility as answerability is proposed to explain this phenomenon and highlight its implications for rethinking vicarious responsibility.

This Editorial to the 20th Anniversary Issue of Ethical Theory and Moral Practice outlines key challenges and opportunities arising from the recent explosion of responsibility studies in different areas. The underlying ambition is to counter the trend of fragmenting the philosophical debate around responsibility by bringing together helpful insights on related dimensions. The discussion is organised around three main themes: (1) Accountability, Attributability, Answerability, Liability; (2) Individuals, Collectives, Practices, and Institutions; and (3) Harms and Wrongs.

This article explores the philosophical concept of akrasia, also known as weakness of will, and demonstrates its relevance to clinical practice. In particular, it challenges an implicit notion of control over one’s actions that might impede recovery from substance misuse. Reflecting on three fictional case vignettes, we show how philosophical work on akrasia helps avoid this potentially harmful notion of control by supporting a holistic engagement with people for whom substance misuse is a problem. We argue that such engagement enhances their prospects of recovery by focusing on agency over time, as opposed to individual lapses.

The way in which society views addiction underlies how it treats, understands, blames, or even punishes those with addictive behaviours. This thought-provoking new book presents an original philosophical analysis bringing together addiction and weakness of will. Within the book, the author develops an integrated account of these two phenomena, rooted in a classical conception of akrasia as valuing without intending and at the same time intending without valuing. This fascinating and suggestive account addresses a number of paradoxes faced by current thinking about addiction and weakness of will, in particular the significance of control and intention for responsible action. Addiction and Weakness of Will makes an original contribution to central issues in moral psychology and philosophy of action, including the relationship between responsibility and intentional agency, and the nature and scope of moral appraisal. The book is valuable for philosophers, ethicists and psychiatrists with an interest in philosophy.

Weakness of will, or akrasia, is an exciting issue at the heart of moral psychology and the philosophy of mind and action. This articleoffers a problem-centered guide to the relevant literature in contemporary analytic philosophy with reference to the main classical texts. The topics covered include: contemporary versus classical conceptions of akrasia, the possibility of weakness of will and its significance within instrumental and substantive theories of practical rationality, the nature of akratic actions and akratic attitudes, and the plausibility of a theoretical counterpart of weakness of will, such as epistemic akrasia.

This paper defends a distinctly liberal approach to public health ethics and replies to possible objections. In particular, I look at a set of recent proposals aiming to revise and expand liberalism in light of public health's rationale and epidemiological findings. I argue that they fail to provide a sociologically informed version of liberalism. Instead, they rest on an implicit normative premise about the value of health, which I show to be invalid. I then make explicit the unobvious, republican background of these proposals. Finally, I expand on the liberal understanding of freedom as non-interference and show its advantages over the republican alternative of freedom as non-domination within the context of public health. The views of freedom I discuss in the paper do not overlap with the classical distinction between negative and positive freedom. In addition, my account differentiates the concepts of freedom and autonomy and does not rule out substantive accounts of the latter. Nor does it confine political liberalism to an essentially procedural form.

There is an underlying tension between the notion of cognitive enhancement and the idea that knowledge presupposes creditable agency. By drawing on an Aristotelian theory of action, it becomes clear that cognition is routinely considered as a human activity susceptible to kinds of appraisal, to which mere physiological processes, such as digestion, are not. In essence, we appreciate knowledge as a distinctive achievement. It includes good epistemic outcomes that are also epistemically creditable, as opposed to others that, although attributable to an epistemic agent, are, nevertheless, epistemically null. In contrast, the term “cognitive enhancement” is related primarily to physiological and, more specifically, neuronal processes. It covers various medical techniques, including pharmacological interventions, brain stimulation and genetic manipulation that can modify neuronal functions and, possibly, convey certain epistemic benefits.1 Examples are prolonged attention span and memory retention. As a result, the issue of cognitive enhancement is typically addressed within its dedicated field of neuroethics.2 Considerations of distributive justice, such as fair access to enhancing procedures often come to the forefront of the discussion.3 Further concerns pertain to prospective effects on personal identity and individual freedoms.4 Although such concerns will not be directly addressed in the following discussion, their relevance to the existing debate will be indicated in conclusion. The following analysis builds upon an Aristotelian theory of action as applied to epistemic pursuits.5 In this respect, it shares some background assumptions with virtue epistemology, such as a general understanding of knowledge as an apt, creditable performance.6 This, however, does not confine the conclusions to this particular theory of knowledge. They are consistent with any theory, which distinguishes between the successful exercise of someone’s intellectual abilities and sheer epistemic luck.

Autonomy is a fundamental though contested concept. For instance, most of us place great value on the opportunity to make our own decisions and to be able to lead a life of our own choosing. Yet there is stark disagreement on what is involved in being able to decide autonomously, as well as how important this is compared with other commitments. For example, the success of every group project requires that group members make decisions about the project collectively rather than each on their own. This disagreement notwithstanding, mental disorder is routinely assumed to put a strain on autonomy. However, it is unclear whether this is effectively the case and, if so, whether this is due to the nature of mental disorder or of the social stigma that is often attached to it. Autonomy and Mental Disorder is the first exploration of the nature and value of autonomy with reference to mental disorder. By reflecting on instances of mental disorder where autonomy is apparently compromised, it offers a systematic discussion of the underlying presuppositions of the present autonomy debates. In so doing, it helps address different kinds of emerging scepticism questioning either the appeal of autonomy as a concept or its relevance to specific areas of normative ethics, including psychiatric ethics.

In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the context of decisional capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters.

This paper defends a distinctly liberal approach to public health ethics and replies to possible objections. In particular, I look at a set of recent proposals aiming to revise and expand liberalism in light of public health's rationale and epidemiological findings. I argue that they fail to provide a sociologically informed version of liberalism. Instead, they rest on an implicit normative premise about the value of health, which I show to be invalid. I then make explicit the unobvious, republican background of these proposals. Finally, I expand on the liberal understanding of freedom as non-interference and show its advantages over the republican alternative of freedom as non-domination within the context of public health. The views of freedom I discuss in the paper do not overlap with the classical distinction between negative and positive freedom. In addition, my account differentiates the concepts of freedom and autonomy and does not rule out substantive accounts of the latter. Nor does it confine political liberalism to an essentially procedural form.

In a recent Editorial, Kious et al. (2023) put forward the claim that psychiatrists should resist calls to integrate concerns about epistemic injustice into their practice as this concept not only fails to add significantly to the current professional standards but would also lead to deleterious clinical outcomes. We believe their claim is mistaken, as it arises from several misconceptions about both the nature of epistemic injustice, and its clinical relevance. First, epistemic justice is conflated with what the authors term ‘a quest for social justice’ that could ‘sideline principles of good clinical reasoning’ (Kious at al 2023: 4). Second, the claim about the impracticality and/or counterproductivity of epistemic injustice as a critical tool within psychiatric practice reflects a series of misconceptions about the normative framework from which this concept derives, so the standards they evaluate it against are ill-chosen. Pace Kious at al., fostering epistemic justice in any area of knowledge and inquiry could not – unwittingly or otherwise – inhibit the consideration of relevant evidence, restrict sound argument or facilitate the casual treatment of testimonies at face value. Third and final, this claim obfuscates some immediate ways in which a focus on epistemic justice as an integral goal will strengthen psychiatric practice according to its own internal standards.

In this chapter, I explore moral competence as a central condition on moral responsibility. I distinguish two main conceptions. On the first, a morally competent agent is someone who knows right from wrong. On the second, a morally competent agent is someone who responds aptly to reasons. These two conceptions merit separate treatment as they offer different insights on how and why moral competence might be compromised. This distinction is of particular relevance since the chapter critically examines a standard assumption stating that whenever a mental disorder impacts moral competence, it decreases its scope (on the first conception) or precision (on the second). In close conversation with the memoir literatures on bipolar disorder, autism and schizophrenia, I argue that moral competence may also be affected by what looks like increases in scope or precision; moreover, neither impact – decrease or increase – necessarily undermines moral competence in and of itself; oftentimes, either could enhance it in a reliable way. Finally, by critically revisiting the ecological or scaffolding approach to moral responsibility, I show that moral competence is best understood as a practical way of knowing right from wrong embedded in daily routines and habits, and irreducible to propositional understanding or intellectual skills.

This chapter offers a fine-grained analysis of the relationship between autonomy and responsibility in order to address a challenge according to which considering autonomy and responsibility as closely related is misleading since these concepts serve different normative objectives. In response to this challenge, I first explore two criteria of ascription – rationality and control – that autonomy and responsibility seem to share. I then contrast and compare three pairs of autonomy and responsibility conceptions. Examining these pairs rescues the idea that there are normatively significant connections between autonomy and responsibility, albeit that what that connection is and why it matters is highly sensitive to the different understandings of autonomy and responsibility one might adopt. The first pair, self-governance and accountability, posits a notion of core agency as irreducibly valuable. The second, authenticity and attributability, rests on a shared ideal of actively becoming a distinctive self. The third and final, relational autonomy and answerability, derives from the thought that unequal standing impacts heavily on whether and how the criteria of rationality and control are applied in specific cases. This analysis demonstrates that rationality and control are not independent criteria but always work in tandem. Failing to appreciate these conceptual interactions could obfuscate promising pathways for both supporting personal autonomy and challenging unwarranted responsibility ascriptions.

Contemporary analytic philosophers tend to see akrasia, or acting against one’s better judgement, as a problem of motivation. On this standard view, akratic actions are paradoxical since akratic agents know that they have a better alternative but nevertheless take up the worse, akratic option. In other words, akratic agents know what they are doing. They do not make any epistemic mistakes but – inexplicably – engage in behaviours that they correctly identify as wrong. The thought that akratic agents are not flawed as inquirers and knowers but only as agents plays a key role in turning akrasia into a textbook example of motivational only, or practical irrationality. This paper will aim to revise the standard view by emphasizing the epistemic dimensions of phenomenon, that is, the ways in which akrasia affects both how agents understand their own involvement and how they handle evidence about their prospects of success. The ambition is to show that akratic agents typically rationalise their akrasia. They do not recognise it as paradoxical or irrational. Instead, they reinterpret it as separate goal-directed actions undertaken under conditions that are not ideal for them. This rationalisation of akrasia is closely related to another epistemically deficient habit: akratic agents pay too much heed to evidence that they are unlikely to succeed. In so doing, they display too little of what philosophers have described as ‘epistemic resilience’, or more simply, ‘grit’.

This paper identifies a distinctive kind of moral luck, deep circumstantial luck and then explores its effects on moral responsibility. A key feature of the phenomenon is that it is recurrent rather than one-off. It also affects agents across a wide range of situations making it difficult to detect. Deeply unlucky agents are subject to unfavourable moral assessments through no fault of their own both in specific cases and when they try to respond to such initial assessments. In this respect, deep circumstantial luck takes the form of a normative burden that grows over time. A process-oriented conception of moral responsibility as answerability is proposed to explain this phenomenon and highlight its implications for rethinking vicarious responsibility.

This chapter aims to distinguish between pathologies of agency in the strict sense and mere sources of impediments or distortion. Expanding on a recent notion of necessarily less-than-successful agency, it complements a mainstream approach to mental disorders and anomalous psychological conditions in the philosophy of mind and action. According this approach, the interest of such clinical case studies is heuristic, to differentiate between facets of agency that are functionally and conceptually separate even though they typically come together. Yet, in the absence of independent criterion for a pathology of as opposed to inner obstacle to agency, this heuristic is at risk of becoming circular or uninformative, falling back on a clinical diagnosis it is meant to take as a starting point only. The chapter develops such a criterion and shows how it could work tracking agential achievement across two core dimensions of agency: planning and responsiveness to reasons. The discussion concludes with some implications on assessing decisional capacity and safeguarding agent autonomy in psychiatric settings.