Nicholas Makins

This paper presents a unifying diagnosis of a number of important problems facing existing models of rational choice under moral uncertainty and proposes a remedy. I argue that the problems of (i) severely limited scope, (ii) intertheoretic comparisons, and (iii) 'swamping’ all stem from the way in which values are assigned to options in decision rules such as Maximisation of Expected Choiceworthiness. By assigning values to options under a given moral theory by asking something like ‘how much do I desire this option, supposing this theory is true?’ rather than ‘how much value does this theory assign to this option?’ these problems can be avoided, while the appealing features of these accounts can be preserved. This amendment provides a role for the preferences, desires, or goals of rational agents that is curiously absent from the existing discussion of what individuals rationally ought to do when they are uncertain about what they morally ought to do.

In my feature article in this issue, ‘Doctors, patients and risk attitudes’, I argue that considerations of both autonomy and beneficence support the practice of healthcare professionals deferring to their patients’ reflectively endorsed risk attitudes when making decisions under uncertainty.1 The commentaries written in response to this article present many interesting criticisms, limitations and applications of the view, and I am grateful to all of the commentators for their engagement with this topic. I cannot possibly do justice to all of the points they have raised in this brief response, so I will address two common themes that appear in a number of the commentaries: first, whether the view I have proposed goes too far or not far enough in deferring to individual patients; and second, the epistemic challenge that would be faced when trying to put this approach into practice. Theoretical accounts of the link between preferences and either well-being or autonomy face a familiar tension: if well-being or autonomy are tied too closely to individuals’ actual preferences, one must contend with examples of preferences that seem obviously bad for a person or disconnected from their status as …

The aim of this paper is to provide a detailed characterisation of some ways in which our preferences reflect our reasons. I will argue that practical reasons can be characterised along two dimensions that influence our preferences: their balance and their weight. This is analogous to a similar characterisation of the way in which probabilities reflect the balance and weight of evidence in epistemology. In this paper, I will illustrate the distinction between the balance and weight of reasons, and show how this is crucial for an adequate account of preference and choice. The upshot is a more complete picture of a particular kind of decision, labelled by Isaac Levi and, more recently, Ruth Chang as ‘hard choices’. These are choices in which one option is better than another in some ways, the other is better than the first in some ways, but neither seems better overall. The distinction between the balance and weight of reasons presents a new way of understanding how hard choices vary by degree and what it is that makes them so hard.

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in a decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are.

This thesis is comprised of four papers that explore the nature and practical implications of moral doubt. It starts from the observation that the appropriate way to understand and handle moral doubt will depend on the nature of our moral judgements themselves. The first and second papers take a cognitivist view of moral judgements and analyse moral doubt in terms of partial degrees of belief in moral propositions. The first, The Relevance of Belief: Subjective Norms Under Empirical and Moral Uncertainty, argues that this form of moral uncertainty is relevant to our choices and that the norms most directly relevant to choice under moral uncertainty are the action-guiding subjective norms of instrumental rationality. The second, Preference and Commitment Under Moral Uncertainty, proposes a particular way of accommodating moral uncertainty within a decision theoretic model of rational choice, and shows that this has substantial advantages over existing alternatives. The third paper, Attitudinal Ambivalence: Moral Uncertainty for Non-cognitivists, provides an account of moral doubt that is consistent with non-cognitivism, by analysing the phenomenon in terms of ambivalence in one’s moral attitudes. The fourth and final paper, The Balance and Weight of Reasons, draws out some implications of ambivalence, by exploring the way in which the overall weight of reasons are reflected in the preferences of rational agents.

In many situations, people are unsure in their moral judgements. In much recent philosophical literature, this kind of moral doubt has been analysed in terms of uncertainty in one’s moral beliefs. Non-cognitivists, however, argue that moral judgements express a kind of conative attitude, more akin to a desire than a belief. This paper presents a scientifically informed reconciliation of non-cognitivism and moral doubt. The central claim is that attitudinal ambivalence—the degree to which one holds conflicting attitudes towards the same object—can play the role of moral doubt for non-cognitivists. I will demonstrate that ambivalence has all of the features that we would expect it to have in order to play the role of moral doubt. It is gradable, can vary through time, covaries with strength of motivation, and is suitably distinct from the other features of our moral judgements. As well as providing a defence of non-cognitivism, this insight poses a new challenge for the view: deciding how to act under moral ambivalence.