Neil Manson

Informed consent is a central topic in contemporary biomedical ethics. Yet attempts to set defensible and feasible standards for consenting have led to persistent difficulties. In Rethinking Informed Consent in Bioethics Neil Manson and Onora O'Neill set debates about informed consent in medicine and research in a fresh light. They show why informed consent cannot be fully specific or fully explicit, and why more specific consent is not always ethically better. They argue that consent needs distinctive communicative transactions, by which other obligations, prohibitions, and rights can be waived or set aside in controlled and specific ways. Their book offers a coherent, wide-ranging and practical account of the role of consent in biomedicine which will be valuable to readers working in a range of areas in bioethics, medicine and law.

Abstract: “Consciousness” seems to be a polysemic, ambiguous, term. Because of this, theorists have sought to distinguish the different kinds of phenomena that “consciousness” denotes, leading to a proliferation of terms for different kinds of consciousness. However, some philosophers—univocalists about consciousness—argue that “consciousness” is not polysemic or ambiguous. By drawing upon the history of philosophy and psychology, and some resources from semantic theory, univocalism about consciousness is shown to be implausible. This finding is important, for if we accept the univocalist account then we are less likely to subject our thought and talk about the mind to the kind of critical analysis that it needs. The exploration of the semantics of “consciousness” offered here, by way of contrast, clarifies and fine-tunes our thought and talk about consciousness and conscious mentality and explains why “consciousness” means what it does, and why it means a number of different, but related, things

It is widely held that there is an important distinction between the notion of consciousness as it is applied to creatures and, on the other hand, the notion of consciousness as it applies to mental states. McBride has recently argued in this journal that whilst there may be a grammatical distinction between state consciousness and creature consciousness, there is no parallel ontological distinction. It is argued here that whilst state consciousness and creature consciousness are indeed related, they are distinct properties. Conscious creatures can have, at one time, both conscious and unconscious mental states. This raises the question of what distinguishes the conscious from unconscious mental states of a subject: a question about what state consciousness consists in. Whilst the state/creature distinction may not be of use in explaining every aspect of a subject's consciousness, it does provide a key part of the explanandum for theories of consciousness and mind. The state/creature consciousness distinction is a real one and should not be dropped from our psychological taxonomy

There is an ongoing debate about the “ontology” of consent. Some argue that it is a mental act, some that it is a “hybrid” of a mental act plus behaviour that signifies that act; others argue that consent is a performative, akin to promising or commanding. Here it is argued that all these views are mistaken—though some more so than others. We begin with the question whether a normatively efficacious act of consent can be completed in the mind alone. Standard objections to this “mentalist” account of consent can be rebutted. Here we identify a much deeper problem for mentalism. Normatively transformative acts of consent change others’ reasons for acting in a distinctive—“robust”—way. Robust reason-changing involves acts aimed at fulfilling a distinctive kind of reflexive and recognition-directed intention. Such acts cannot be coherently performed in the mind alone. Consent is not a mental act, but nor is it the signification of such an act. Acts of consent cannot be “completed” in the mind, and it is a mistake to view consent behaviour as making known a completed act of consent. The robust reason-changing account of consent developed here shares something with the performative theory, but is not saddled with a label whose home is philosophy of language. Certain kinds of performative utterance may change reasons robustly, but not all robust reason-changing involves or requires acts of speech, and consent can be effected by a wide range of behavioural acts.

In recent years there has been wide-ranging discussion of epistemic virtues. Given the value and importance of acquiring knowledge this discussion has tended to focus upon those traits that are relevant to the acquisition of knowledge. This acquisitionist focus ignores or downplays the importance of epistemic restraint: refraining from seeking knowledge. In contrast, in many periods of history, curiosity was viewed as a vice. By drawing upon critiques of curiositas in Middle Platonism and Early Christian philosophy, we gain useful insights into the value and importance of epistemic restraint. The historical discussion paves the way for a clarification of epistemic restraint, one that distinguishes the morally relevant features of epistemic process, content, purpose, and context. Epistemic restraint is identified as an important virtue where our epistemic pursuits pose risks and burdens, where such pursuits have opportunity costs, where they are pursued for vicious purposes. But it is in the social realm where epistemic restraint has most purchase, epistemic restraint is important both because privacy is important and because being trusted are important. Finally, some suggestions are offered as to why epistemic restraint has not received the contemporary attention that it deserves

Philosophers, especially in recent years, have engaged in reflection upon the nature of experience. Such reflections have led them to draw a distinction between conscious and unconscious mentality in terms of whether or not it is like something to have a mental state. Reflection upon the history of psychology and upon contemporary cognitive science, however, identifies the distinction between conscious and unconscious mental states to be primarily one which is drawn in epistemic terms. Consciousness is an epistemic notion marking the special kind of first-person knowledge we have of our own mental states. Psychologists have found it expedient, for explanatory reasons, to ignore or reject the assumption that we have exhaustive first-person knowledge of our mental states and, in doing so, use the term ‘unconscious’ to indicate the peculiar epistemic status of certain mental states.It is argued that epistemic consciousness is distinct from the subjective-experiential notion of consciousness, from ‘access-consciousness’ and from higher-order thought conceptions of mental state consciousness, and that epistemic consciousness has an important role to play in philosophy of mind and in the history of psychology.Author Keywords: Consciousness; Unconscious mental states; Self-knowledge; History of psychology; Freud; Chomsky

The fact that we can engage in first-person discourse about our own mental states seems, intuitively, to be bound up with consciousness. David Rosenthal draws upon this intuition in arguing for his higher-order thought theory of consciousness. Rosenthal's argument relies upon the assumption that the truth-conditions for "p" and "I think that p" differ. It is argued here that the truth-conditional schema debars "I think" from playing one of its roles and thus is not a good test for what is asserted when "I think" is employed in making an assertoric utterance. The critique of Rosenthal's argument allows us to make explicit the intuitions which shape higher-order representation theories of consciousness in general. Consciousness and first-person mental discourse seem to be connected primarily because consciousness is an epistemic term, used to denote first-person knowledge of minds. Higher-order thought theories of consciousness draw upon this epistemic notion of consciousness, and because self-knowledge seems to involve higher-order representation, the higher-order theorist can deploy what is in effect an "error theory" about conscious experience disguised as a kind of conceptual analysis of our ordinary concept of a conscious mental state. The conclusion reached is that there is unlikely to be a simple or direct path from considerations about mental discourse to conclusions about the nature of consciousness

The multiverse hypothesis is one of the leading proposed explanations of cosmic fine-tuning for life. One common objection to the multiverse hypothesis is that, even if it were true, it would not explain why this universe, our universe, is fine-tuned for life. To think it would so explain is allegedly to commit “the inverse gambler's fallacy.” This paper presents what the inverse gambler's fallacy is supposed to be, then surveys the discussion of it in the philosophical literature of the last 35 years.

The modern vat-brain debate is an epistemological one, and it focuses on the point of view of a putatively deceived subject. Semantic externalists argue that we cannot coherently wonder whether we are brains in vats. This paper examines a new experimental paradigm for cognitive neuroscience—the neurally-controlled animat (NCA) paradigm—that seems to have a great deal in common with the vat-brain scenario. Neural cells are provided with a simulated body within an artificial world in order to study the brain both in vitro and in vivo. Given the similarity between the NCA scenario and the vat-brain scenario, semantic externalism seems to undermine the utility of the NCA methodology. Three initial responses to the externalist challenge are offered. A fourth response clarifies the distinctive theoretical background to the NCA in ‘artificial life’ and, in doing so, we uncover an anti-representationalist conception of the NCA. This distances the NCA paradigm from externalist objections and casts cognitive neuroscience, and the vat-brain debate, in a new light. # 2004 Published by Elsevier Ltd.

Is genetic information of special ethical significance? Does it require special regulation? There is considerable contemporary debate about this question (the genetic exceptionalism debate). Genetic information is an ambiguous term and, as an aid to avoiding conflation in the genetic exceptionalism debate, a detailed account is given of just how and why genetic information is ambiguous. Whilst ambiguity is a ubiquitous problem of communication, it is suggested that genetic information is ambiguous in a particular way, one that gives rise to the problem of significance creep (i.e., where claims about the significance of certain kinds of genetic information in one context influence our thinking about the significance of other kinds of genetic information in other contexts). A contextual and contrastive methodology is proposed: evaluating the significance of genetic information requires us to be sensitive to the polysemy of genetic information across contexts and then examine the contrast in significance (if any) of genetic, as opposed to nongenetic, information within contexts. This, in turn, suggests that a proper solution to the regulatory question requires us to pay more attention to how and why information, and its acquisition, possession and use, come to be of ethical significance

Contrary to certain rumours, the mind-body problem is alive and well. So argues Joseph Levine in Purple Haze: The Puzzle of Consciousness . The main argument is simple enough. Considerations of causal efficacy require us to accept that subjective experiential, or 'phenomenal', properties are realized in basic non-mental, probably physical properties. But no amount of knowledge of those physical properties will allow us conclusively to deduce facts about the existence and nature of phenomenal properties. This failure of deducibility constitutes an explanatory problem - an explanatory gap - but does not imply the existence of immaterial mental properties. Levine introduced this notion of the explanatory gap almost two decades ago. Purple Haze allows Levine to situate the explanatory gap in a broader philosophical context. He engages with those who hold that the explanatory gap is best understood as implying anti-materialist metaphysical conclusions. But he also seeks to distance himself from contemporary naturalistic philosophical theorizing about consciousness by arguing that reductive and eliminative theories of consciousness all fail. Levine's work is best seen as an attempt to firmly establish a definite status for the mind-body problem, i.e. that the mind-body problem is a real, substantive epistemological problem but emphatically not a metaphysical one. Because Levine's work is tightly focused upon contemporary Anglophone analytic philosophy of mind, there is little discussion of the broader conceptual background to the mind-body problem. My aim here is to place Levine's work in a broader conceptual context. In particular, I focus on the relationship between consciousness and intentionality in the belief that doing so will allow us better to understand and evaluate Levine's arguments and their place in contemporary theorizing about mentality and consciousness

There is empirical evidence that many patients want information about treatment options even though they do not want to take a full part in decision-making about treatment. Such evidence may have considerable ethical implications but is methodologically problematic. It is argued here that, in fact, it is not at all surprising that patients' informational interests should be separable from their interests in decision-making. A number of different reasons for wanting information are offered, some to do with the content of information; some with the process, others with the fact or occasion of informing. This philosophical clarification leads to some suggestions for further empirical study.

It is widely held that some kinds of deception into sex (e.g., lying about what pets one likes) do not undermine the moral force of consent while other kinds of deception do (e.g., impersonating the consenter’s partner). Tom Dougherty argues against this: whenever someone is deceived into sex by the concealment of a “deal breaker” fact, the normative situation is the same as there being no consent at all. Here it is argued that this conclusion is unwarranted. Dougherty’s negative arguments against alternative theories of the deceptive undermining of consent are flawed, and his two positive arguments are unjustified.

Some self-ascriptions of belief, desire and other attitudes exhibit first-person authority. The aim here is to offer a novel account of this kind of first-person authority. The account is a development of Robert Gordon's ascent routine theory but is framed in terms of our ability to bring it about that others know of our attitudes via speech acts which do not deploy attitudinal vocabulary but which nonetheless ‘show’ our attitudes to others. Unlike Gordon's ascent routine theory, the theory readily applies to attitudes other than belief, avoids a need to appeal to processes of making up one's mind, and does not rest upon a distinction between ‘outward looking’ and ‘inward looking’ processes

“Spin” is a pejorative term for a ubiquitous form of communication. Spin is viewed by many as deceptive, and by others as bending or twisting the truth. But spin need not be deceptive and the metaphors are less than clear. The aim here is to clarify what spin is: spin is identified as a form of selective claim-making, where the process of selection is governed by an intention to bring about promotional perlocutionary effects. The process of selection may pertain to aspects of some situation or phenomenon,; or to the lexis used in making the claims. Not all selective promotional communication is spin. Spin involves a distinctive kind of dissociation between the speaker’s first-order interpretation and the constructed interpretation or claim offered to others. With these clarifications in place the discussion turns to the complex connections between spin, truthfulness and deception. Aspect-selective spin can be truthful, and it need not be deceptive in its intentions or effects, but may risk deceiving audiences. Lexical spin is less readily truthful, and both forms of spin prudentially require a distinctive kind of concealment of the speaker’s intentions. The account developed here does not address normative questions about whether, or how, spin might be wrong, but aims to provide a clear and adequate account of spin as a basis for addressing normative questions about spin.

If we are to understand why psychoanalysis extends ordinary psychology in the precise ways that it does, we must take account of the existence of, and the interplay between, two distinct kinds of explanatory concern: functional and idiographic. The form and content of psychoanalytic explanation and its unusual methodology can, at least in part, be viewed as emerging out of Freud's attempt to reconcile these two types of explanatory concern. We must also acknowledge the role of the background theoretical context that shapes Freud's functional thinking about the mind. A neglect of the role of the background theory in shaping the extension of ordinary psychology leaves us with puzzles about the nature and direction of the psychoanalytic extension and gives rise to an unbelievable history of psychoanalysis

In many jurisdictions, adolescents acquire the right to consent to treatment; but in some cases their refusals – e.g. of life-saving treatment – may not be respected. This asymmetry of adolescent consent and refusal seems puzzling, even incoherent. The aim here is to offer an original explanation, and a justification, of this asymmetry. Rather than trying to explain the asymmetry in terms of a variable standard of competence – where the adolescent is competent to consent to, but not refuse, certain interventions – the account offered here focuses more closely on the normative power to render actions permissible. Where normative powers are shared they can readily give rise to an asymmetry between consent and refusal. We then turn to why it is justifiable that normative powers be shared in adolescence. Transitional paternalism holds that the acquisition of normative powers by competent adolescents should not be an instant one, achieved in a single step, but that there should be a transitional period where paternalistic protection is rolled back, but not entirely withdrawn until a later date. Transitional paternalism could be implemented without generating the asymmetry between consent and refusal but, it is argued, the asymmetric version of transitional paternalism is to be preferred insofar as it offers a greater respect for the adolescent's decisions than the symmetrical alternative

How do reason explanations explain? One view is that they require the deployment of a tacit psychological theory; another is that even if no tacit theory is involved, we must still conceive of reasons as mental states. By focusing on the subjective nature of agency, and by casting explanations as responses to 'why' questions that assuage agents' puzzlement, reason explanations can be profitably understood as part of our traffic in first-order content amongst perspectival subjects. An outline is offered of such an account of reason explanation, one that fully acknowledges the distinctive first-order first-person normative perspective of agency.

The idea of individual responsibility for action is central to our conception of what it is to be a person. Behavioural genetic research may seem to call into question the idea of individual responsibility with possible implications for the criminal justice system. These implications will depend on the understandings of the various agencies and professional groups involved in responding to violent and anti-social behaviour, and, the result of negotiations between them over resulting practice. The paper considers two kinds of approaches to the question of responsibility and ‘criminal genes’ arising from a sociological and philosophical perspective respectively. One is to consider the social context and possible practical implications of research into ‘criminal genes’ which will later be examined through interviews and discussions with a range of experts including lawyers and social workers. A second and different kind of approach is to ask whether the findings of behavioural genetics ought to have implications for attributions of responsibility. Issues of genetic influence are central to both approaches

Over the past couple of decades, there has been an ongoing, often fierce, debate about the ethics of biobank participation. One central element of that debate has concerned the nature of informed consent, must specific reconsent be gained for each new use, or user, or is broad consent ethically adequate? Recently, Thomas Ploug and Søren Holm have developed an alternative to both specific and broad consent: what they call a meta-consent framework. On a meta-consent framework, participants can choose the type of consent framework they require, for different kinds of use, different types of user and so on. Meta-consent involves a distinctive kind of design of the consent process. Here it is argued, first, that although a meta-consent framework does not wrong participants, Ploug and Holm understate the likely costs and burdens of such a framework, so there are good practical reasons not to offer it. Second, although Ploug and Holm allude to some ethical considerations that might seem to ground an ethical argument for providing meta-consent, they do not offer any sound argument, and it does not wrong participants in any way to fail to offer them the opportunity to design their own consent process.

abstract Allen Buchanan argues that conventional applied ethics is impoverished and would be enriched by the addition of social moral epistemology. The aim here is to clarify this argument and to raise questions about whether such an addition is necessary about how such enrichment would work in practice. Two broad problems are identified. First, there are various kinds and sources of epistemic inertia, which act as an obstacle to epistemic change. Religion is one striking example and seems to pose a deep problem for Buchanan's liberal social moral epistemology. Philosophy also exhibits a distinctive kind of epistemic inertia (metaphilosophical beliefs about the impropriety of applying philosophy are hard to shift), but also suffers from epistemic isolationism: (its arguments and conclusions are isolated from practical influence). It is concluded that not only will a liberal social moral epistemology have to overcome a pernicious epistemic inertia with regard to religious belief, but also a different kind of epistemic inertia closer to home.

abstract Allen Buchanan argues that conventional applied ethics is impoverished and would be enriched by the addition of social moral epistemology. The aim here is to clarify this argument and to raise questions about whether such an addition is necessary about how such enrichment would work in practice. Two broad problems are identified. First, there are various kinds and sources of epistemic inertia, which act as an obstacle to epistemic change. Religion is one striking example and seems to pose a deep problem for Buchanan's liberal social moral epistemology. Philosophy also exhibits a distinctive kind of epistemic inertia (metaphilosophical beliefs about the impropriety of applying philosophy are hard to shift), but also suffers from epistemic isolationism: (its arguments and conclusions are isolated from practical influence). It is concluded that not only will a liberal social moral epistemology have to overcome a pernicious epistemic inertia with regard to religious belief, but also a different kind of epistemic inertia closer to home.

If we are to understand why psychoanalysis extends ordinary psychology in the precise ways that it does, we must take account of the existence of, and the interplay between, two distinct kinds of explanatory concern: functional and idiographic. The form and content of psychoanalytic explanation and its unusual methodology can, at least in part, be viewed as emerging out of Freud's attempt to reconcile these two types of explanatory concern. We must also acknowledge the role of the background theoretical context that shapes Freud's functional thinking about the mind. A neglect of the role of the background theory in shaping the extension of ordinary psychology leaves us with puzzles about the nature and direction of the psychoanalytic extension and gives rise to an unbelievable history of psychoanalysis.