Nathan Stout

This case study examines the circumstance of a patient who has clearly articulated non-treatment preferences and who then later becomes incapacitated. The patient's wife as well as a consulting physician both expressed a preference for full treatment at the time of this incapacity. The analysis of this circumstance is pertinent given misinformed beliefs by health care providers that once a patient is incapacitated, the family is free to override prior values and preferences. The analysis discusses the autonomy, beneficence, and virtue-based considerations as to why a formerly capacitated patient who has not recanted his non-treatment preferences should be obeyed.

Pandemic can prompt a variety of human motives, ranging from a desire for security to altruism. In our current perilous times, some patients have voiced a desire to help others. Such action can result in self-peril, and, as a result, their motives may be questioned. One health system now has a pandemic-based advance directive that queries patients about their value preferences regarding care that is directed toward others. Some object to this action because it may evoke patients to altruism. We examine both remote and recent examples of altruism, in which coercion could have played a major role. We next consider concerns based on aspects of the process of “inquiry versus evocation,” slippery-slope claims, and inherent manipulation, and conclude that patients should be allowed to be asked about their preferences and values regarding altruism.

When a patient's treatment decisions are the product of delusion, this is often taken as a paradigmatic case of undermined decisional capacity. That is to say, when a patient refuses treatment on the basis of beliefs that in no way reflect reality, clinicians and ethicists tend to agree that their refusal is not valid. During the COVID-19 pandemic, however, we have witnessed many patients refuse potentially life-saving interventions not based on delusion but on conspiracy beliefs. Importantly, many of the beliefs espoused by conspiracy theorists resemble delusions in a number of relevant ways. For instance, conspiracy beliefs often posit states of affairs that could not possibly exist in the world, they are recalcitrant in the face of disconfirming evidence, and they tend to put the believer in a state of paranoia. Given these similarities, how should we think about conspiracy theorists' capacity for making clinical decisions? In this paper, I attempt to answer this question by first offering an account of just what makes some set of beliefs count as a conspiracy theory. Second, I attempt to disambiguate conspiracy beliefs from delusions by exploring important conceptual and psychological features of both. Finally, I apply standard criteria for assessing a patient's decision-making capacity to instances of conspiracy beliefs and argue that, although the picture is muddy, there may be cases in which conspiracy beliefs undermine capacity. I end by exploring the implications that this might have for surrogate decision-making and addressing potential objections.

The Substituted Judgment Standard for surrogate decision-making dictates that a surrogate, when making medical decisions on behalf of an incapacitated patient, ought to make the decision that the patient would have made if the patient had decisional capacity. Despite its intuitive appeal, however, SJS has been the target of a variety of criticisms. Most objections to SJS appeal to epistemic difficulties involved in determining what a patient would have decided in a given case. In this article, I offer an alternative standard for surrogate decision-making that avoids these difficulties. I then offer an account of its theoretical underpinnings which shows that it preserves the central moral justification for SJS, namely, respect for patient autonomy.

In recent years there has been an explosion of philosophical work on blame. Much of this work has focused on explicating the nature of blame or on examining the norms that govern it, and the primary motivation for theorizing about blame seems to derive from blame’s tight connection to responsibility. However, very little philosophical attention has been given to praise and its attendant practices. In this paper, I identify three possible explanations for this lack of attention. My goal is to show that each of these lines of thought is mistaken and to argue that praise is deserving of careful, independent analysis by philosophers interested in theorizing about responsibility.

ABSTRACT:Many ‘deep self’ theories of moral responsibility characterize the deep self as necessarily requiring that an agent be able to reflect on her own cognitive states in various ways. In this paper, I argue that these metacognitive abilities are not actually a necessary feature of the deep self. In order to show this, I appeal to empirical evidence from research on autism spectrum disorders that suggests that individuals with ASD have striking impairments in metacognitive abilities. I then argue that metacognitive conceptions of the deep self are implausible insofar as they fail to give a satisfactory account of the responsibility of persons with autism.

This paper aims to further examine the relationship between self-awareness and agency by focusing on the role that emotional awareness plays in prominent conceptions of responsibility. One promising way of approaching this task is by focusing on individuals who display impairments in emotional awareness and then examining the effects that these impairments have on their apparent responsibility for the actions that they perform. Individuals with autism spectrum disorder as well as other clinical groups who evince high degrees of the personality construct known as alexithymia, I will argue, do, in fact, display impairments in emotional self-awareness, and, so, may provide some insight into the relationship between this awareness and the capacity for responsible agency. More specifically, individuals with ASD may provide us with evidence that robust emotional self-awareness is not a necessary condition for responsible agency or that lacking such a capacity could undermine some otherwise plausible sufficient conditions for responsibility. The aim of the paper, then, is twofold. First, it will aim to show that ASD ought to be understood, in part, as a disorder of emotional self-awareness. Section 2 presents evidence relating to the emotional profile characteristic of individuals with ASD and argues that the most striking feature of this profile is the way in which the individual seems to be separated from his or her emotions in an important sense. Second, the paper aims to show that this distinctive feature of the emotions in ASD casts serious doubt on some prominent accounts of moral responsibility. To this end, section 3.1 presents a challenge to some widely accepted “subjective conditions” for responsibility, namely those articulated by John Martin Fischer and Ravizza and makes a case, based on the empirical data regarding autism, that these conditions actually are not necessary for one’s being a responsible agent. Section 3.2 then presents a challenge for theories of responsible agency which assign primary importance to the connection between an agent’s actions and her judgment-sensitive attitudes. I argue there that the evidence from autism suggests that these theories fail in their efforts to provide sufficient conditions for responsibility.

In this paper, I present a challenge for Michael McKenna’s conversational theory of moral responsibility. On his view, to be a responsible agent is to be able to engage in a type of moral conversation. I argue that individuals with autism spectrum disorder present a considerable problem for the conversational theory because empirical evidence on the disorder seems to suggest that there are individuals in the world who meet all of the conditions for responsible agency that the theory lays out but who are nevertheless not responsible agents. Attending to the moral psychology of such individuals will, I think, help shed light on an important gap in the conversational theory.

In this paper, I take up the task of further examining the ticking bomb argument in favor of the use of torture. In doing so, I will focus on some recent scholarship regarding ticking bomb methodology introduced by Fritz Allhoff. I will then propose a set of ticking bomb variations which, I believe, call into question some of Allhoff's conclusions. My goal is to show that ticking bomb methodology is misguided in its attempt to justify torture insofar as its proponents seem to ignore certain nonconsequentialist factors that are latent in the various types of uncertainty in real-world ticking bomb cases. Once this fact is recognized, I claim, the normative claims about torture that follow can be denied by appealing to it. I then argue that, even if we grant a certain level of uncertainty within the ticking bomb argument, torture is not justified. Rather, the implementation of torture, even if it yields positive results, is nothing more than a case of moral luck. In other words, the supposed "success" of torture in the ticking bomb cases lies entirely outside the agent's control. Thus, if the outcome of the use of torture is in no way controlled by the agent, then the agent's actions cannot be justified by appealing to that outcome

In this paper, I consider a novel challenge to John Martin Fischer and Mark Ravizza’s reasons-responsiveness theory of moral responsibility. According to their view, agents possess the control necessary for moral responsibility if their actions proceed from a mechanism that is moderately reasons-responsive. I argue that their account of moderate reasons-responsiveness fails to provide necessary and sufficient conditions for moral responsibility since it cannot give an adequate account of the responsibility of individuals with autism spectrum disorder. Empirical evidence suggests that autistic individuals demonstrate impairments in counterfactual thinking, and these impairments, I argue, are such that they cast doubt on Fischer and Ravizza’s construal of moderate reasons-responsiveness. I then argue that modifying the view in order to accommodate individuals with ASD forces them to defend a strong reasons-responsive account despite the fact that they explicitly deny that such an account can adequately characterize what it is to be morally responsible for one’s actions.

One key desideratum of a theory of blame is that it be able to explain why we typically have differing blaming responses in cases involving significant degrees of luck. T.M. Scanlon has proposed a relational account of blame, and he has argued that his account succeeds in this regard and that this success makes his view preferable to reactive attitude accounts of blame. In this paper, I aim to show that Scanlon's view is open to a different kind of luck-based objection. I then offer a way of understanding moral luck cases which allows for a plausible explanation of our differential blaming responses by appealing to the salience of certain relevant features of the action in question.

ABSTRACTThe aim of this paper is to draw attention to an issue which has been largely overlooked in contemporary just war theory – namely the impact that the conditions under which an army is assembled are liable to have on the judgments that are made with respect to traditional principles of jus ad bellum and jus in bello. I argue that the way in which an army is assembled can significantly alter judgments regarding the justice of a war. In doing so, I present and defend a principle of ‘just assembly’ and argue that satisfying this principle is an essential part of any deliberation regarding the justice of a particular conflict.

This paper presents a challenge for exemplar theories of moral concepts. Some have proposed that we acquire moral concepts by way of exemplars of actions that are prohibited as well as of actions that are required, and we classify newly encountered actions based on their similarity to these exemplars. Judgments of permissibility then follow from these exemplar-based classifications. However, if this were true, then we would expect that individuals who lacked, or were deficient in, the capacity to form or access exemplars of this kind would be similarly deficient in the ability to classify new actions according to them, and this relative inability would be manifested in the moral judgments made by such individuals. However, there is reason to suspect, I think, that a number of individuals who have been diagnosed with Autism Spectrum Disorder actually have the deficiencies I have described here but are nevertheless fully able to make sound moral judgments. If this is so, then it must be th...