Samuel Reis-Dennis

Abstract: Contemporary analytic philosophers of the “reactive attitudes” tend to share a simple conception of guilt as “self-directed blame”—roughly, an “unpleasant affect” felt in combination with, or in response to, the thought that one has violated a moral requirement, evinced substandard “quality of will,” or is blameworthy. I believe that this simple conception is inadequate. As an alternative, I offer my own theory of guilt’s logic and its connection to morality. In doing so, I attempt to articulate guilt’s defining thought or proposition through an extended investigation and analysis of guilt’s many competing metaphors, which I trace from the Hebrew Bible to the New Testament to Shakespeare to contemporary vernacular. My interpretation of this literary genealogy offers a way to understand guilt’s seemingly disparate metaphors in terms of a single master-image that illuminates our self-conceptions and our relationship to morality. I conclude by making a very brief start toward a moral vindication of guilt against the backdrop of Nietzschean and Freudian analyses that explicitly call guilt’s place in a healthy social and personal life into question. I suggest that once guilt’s logic is made explicit, we can see that it makes sense of, honors, and addresses some of our deepest aspirations and needs.

In 2011, bioethicists turned their attention to the question of whether prisoners on death row ought to be allowed to be organ donors. The discussion began with a provocative anti‐procurement article by Arthur Caplan and prompted responses from an impressive lineup of commentators. In the 10 years since, the situation for death‐row inmates seeking to donate has hardly changed: U.S. prison authorities consistently refuse to allow death‐row procurement. We believe that it is time to revisit the issue. While Caplan's commentators rebutted his narrow contention that organ procurement would undermine the goals of deterrence and retribution, none of them attempted to make a positive, nonconsequentialist case for organ donation as a right of death‐row inmates. That is the task we take up in this paper. After sketching and briefly defending a theory of punishment, we show how denial of organ donation is inconsistent with punishment's basic logic.

In this article, I reject the “principlism” of Tom Beauchamp and James Childress and argue that respect for autonomy is, and ought to be, the fundamental value of bioethics. To do so, I offer a reconstruction of what I call the field's “founding myth,” a genealogy that affords primacy to the right to be respected as a human being with dignity. Next, I examine the relationship between this basic right and a derivative right of autonomy. I suggest that principlism has promulgated an uncharitable understanding of respect for autonomy, one that ensures that the principle cannot occupy the central position I claim for it. Finally, I sketch a more plausible understanding of respect for autonomy and explore its implications.

This chapter argues that adequately facing and responding to medical error requires making space for blame. In vindicating blame as a response to medical error, this essay does not advocate a return to a “bad apple” blame culture in which unlucky practitioners are unfairly scapegoated. It does, however, defend the targeted feeling and expression of angry, and even resentful, blaming attitudes toward health-care providers who make at least certain kinds of mistakes. The chapter makes the case that the angry and resentful feelings associated with blame reflect a conception of oneself as a person worthy of consideration, and that expressing these feelings allows victims and families to fight for their dignity and self-respect. Along the way, it distinguishes between shaming and blaming, explaining that blaming, unlike shaming, characteristically aims to draw offenders into a moral dialogue. As a result, a good blaming practice can provide a logic within which providers who make costly errors may seek forgiveness, reconciliation, and healing.

In this paper, I argue that the principle of respect for autonomy can serve as the basis for laws that significantly limit conduct, including orders mandating isolation and quarantine. This thesis is fundamentally at odds with an overwhelming consensus in contemporary bioethics that the principle of respect for autonomy, while important in everyday clinical encounters, must be 'curtailed', 'constrained', or 'overridden' by other principles in times of crisis. I contend that bioethicists have embraced an indefensibly 'thin' notion of autonomy that uproots the concept from its foundations in Kantian ethics. According to this thin conception, respect for autonomy, if unconditioned by competing principles (beneficence, justice, non-maleficence) would give competent adults the right to do anything they desired to do so long as they satisfied certain baseline psychological conditions. I argue that the dominant 'principlist' model of bioethical reasoning depends on this thin view of autonomy and show how it deprives us of powerful analytical tools that would help us to think seriously about the foundations of human rights, justice, and law. Then, I offer a brief sketch of a 'thick', historically grounded notion of autonomy and show what we could gain by taking it seriously.

In this paper, we argue that providers who conscientiously refuse to provide legal and professionally accepted medical care are not always morally required to refer their patients to willing providers. Indeed, we will argue that refusing to refer is morally admirable in certain instances. In making the case, we show that belief in a sweeping moral duty to refer depends on an implicit assumption that the procedures sanctioned by legal and professional norms are ethically permissible. Focusing on examples of female genital cutting, clitoridectomy and ‘normalizing’ surgery for children with intersex traits, we argue that this assumption is untenable and that providers are not morally required to refer when refusing to perform genuinely unethical procedures. The fact that acceptance of our thesis would force us to face the challenge of distinguishing between ethical and unethical medical practices is a virtue. This is the central task of medical ethics, and we must confront it rather than evade it. There are no data in this work.

Recent years have seen a surge of interest in implicit bias. Driving this concern is the thesis, apparently established by tests such as the IAT, that people who hold egalitarian explicit attitudes and beliefs, are often influenced by implicit mental processes that operate independently from, and are largely insensitive to, their explicit attitudes. We argue that implicit bias testing in social and empirical psychology does not, and without a fundamental shift in focus could not, establish this startling thesis. We suggest that implicit bias research has been conducted in light of inadequate theories of racism and sexism. As a result, such testing has not sufficiently controlled for subjects’ prejudiced explicit beliefs and emotions, and has not ruled out the possibility that explicit prejudice best explains test subjects’ discriminatory associations and behavior.

I argue that fitting resentment tracks unacceptable ‘ecological’ imbalances in relative social strength between victims and perpetrators that arise from violations of legitimate moral expectations. It does not respond purely, or even primarily, to offenders’ attitudes, and its proper targets need not be fully developed moral agents. It characteristically involves a wish for the restoration of social equilibrium rather than a demand for moral recognition or good will. To illuminate these contentions, I focus on cases that I believe demonstrate a corollary thesis, namely, that strength, broadly construed, is a necessary condition of resentment-worthiness. I argue that weakness can make resentment unfitting in two ways. First, weakness may prevent a wrongdoer from shifting the balance of social power. Second, a weak wrongdoer may do social damage but be so lowly that resentment, which would represent him as excessively strong, would be inapt. Finally, I consider how accepting the ecological view might affect our theorizing about moral responsibility and the ethics of blame.

Recent years have seen the rise of ‘Just Culture’ as an ideal in the patient safety movement, with numerous hospitals and professional organisations adopting a Just Culture response to incidents ranging from non-culpable human error to intentional misconduct. This paper argues that there is a deep problem with the Just Culture model, resulting from its impoverished understanding of the value of punitive, fundamentally backward-looking, practices of holding people accountable. I show that the kind of ‘accountability’ and ‘punishment’ contemporary Just Culture advocates endorse disrespects both patients and providers. I claim, first, that punishment is good because it respects participants in the healthcare system by restoring an equilibrium of social and moral status that wrongdoing disturbs, and, second, that it only does so when it communicates a backward-looking message of resentful blame.

There's no doubt that reproductive technologies can transform lives for the better. Infertile couples and single, lesbian, gay, intersex, and transgender people have the potential to form families in ways that would have been inconceivable years ago. Yet we are concerned about the widespread commercialization of certain egg‐freezing programs, the messages they propagate about motherhood, the way they blur the line between care and experimentation, and the manipulative and exaggerated marketing that stretches the truth and inspires false hope in women of various ages. We argue that although reproductive technology, and egg freezing in particular, promise to improve women's care by offering more choices to achieve pregnancy and childbearing, they actually have the potential to be disempowering. First, commercial motives in the fertility industry distort women's medical deliberations, thereby restricting their autonomy; second, having the option to freeze their eggs can change the meaning of women's reproductive choices in a way that is limiting rather than liberating.

Contemporary philosophers of moral responsibility are in widespread agreement that we can only be blamed for actions that express, reflect, or disclose something about us or the quality of our wills. In this paper I reject that thesis and argue that self disclosure is not a necessary condition on moral responsibility and blameworthiness: reactive responses ranging from aretaic appraisals all the way to outbursts of anger and resentment can be morally justified even when the blamed agent’s action expresses or discloses nothing significant about his or her “deep self,” judgments and cares, or the quality of his or her will. I argue that the self-disclosure requirement on responsibility overestimates the extent to which our blaming practices and responsibility judgments are responsive to agents as opposed to actions, and that this mistake has the potential to distort both our reactive responses and our understanding of blamed agents’ characters.