Steve Matthews

BackgroundViral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines.Main textIn this article, we critically evaluate the most common ethical arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation.ConclusionsWe argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs.

The quality of our public discourse – think of the climate change debate for instance – is never very high. A day spent observing it reveals a litany of misrepresentation and error, argumentative fallacy, and a general lack of good will. In this paper I focus on a microcosmic aspect of these practices: the use of two types of argument – the argumentum ad hominem and appeal to authority – and a way in which they are related. Public debate is so contaminated by the misuse of the ad hominem tactic that it is important to have an understanding of one of the ways in which its use may be legitimate. So readers who might have expected an analysis of the ad hominem fallacy will, on the contrary, be presented with an account of one of the places for its potential success. In ad hominem, arguers are viewed as legitimate constitutive targets for their own argument; in authority arguments, arguers provide a legitimate constitutive warrant for an argument they deploy. These types of argument are connected in so far as the identities of persons deploying them carry the cognitive weight of the argument. If authority arguments sometimes deserve to succeed, ad hominem attacks on them are potentially legitimate. An important motivation for this analysis is that in identifying the success conditions for one of the ad hominem types we attain some clarity in the evaluation of their use.

It has become quite common for people to develop `personal'' relationships nowadays, exclusively via extensive correspondence across the Net. Friendships, even romantic love relationships, are apparently, flourishing. But what kind of relations really are possible in this way? In this paper, we focus on the case of close friendship. There are various important markers that identify a relationship as one of close friendship. One will have, for instance, strong affection for the other, a disposition to act for their well-being and a desire for shared experiences. Now obviously, while all these features of friendship can gain some expression through extensive correspondence on the Net, such expression is necessarily limited –you cannot, e.g., physically embrace the other, or go on a picnic together. The issue we want to address here however, is whether there might be distinctive and important influences on the structure of interaction undertaken on the Net, that affect the kind of identity ``Net-friends'''' can develop in relation to one another. In the normal case, one develops a close friendship, and in doing so, one''s identity, in part, is shaped by the friendship. To some extent, through extensive shared experience, one comes to see aspects of the world (and of oneself) through the eyes of one''s friend and so, in part, one''s identity develops in an importantly relational way, i.e., as the product of one''s relation with the close friend. In our view, however, on account of the limits of, and/or the kind of, shared contact and experience one can have with another via correspondence on the Net, there are significant structural barriers to developing the sort of relational identity that is a feature of close friendship. In arguing our case here, and by using the case of Net ``friendship'''' as our foil, we aim to shed light on the nature and importance of certain sorts of self-expression and relational interaction found in close friendship.

We argue that contemporary conceptualizations of “persons” have failed to achieve the moral goals of “person-centred care” (PCC, a model of dementia care developed by Tom Kitwood) and that they are detrimental to those receiving care, their families, and practitioners of care. We draw a distinction between personhood and selfhood, pointing out that continuity or maintenance of the latter is what is really at stake in dementia care. We then demonstrate how our conceptualization, which is one that privileges the lived experiences of people with dementia, and understands selfhood as formed relationally in connection with carers and the care environment, best captures Kitwood’s original idea. This conceptualization is also flexible enough to be applicable to the practice of caring for people at different stages of their dementia. Application of this conceptualization into PCC will best promote the well-being of people with dementia, while also encouraging respect and dignity in the care environment.

Dissociative Identity Disorder (DID) (formerly known as Multiple Personality Disorder) is a condition in which a person appears to possess more than one personality, and sometimes very many. Some recent criminal cases involving defendants with DID have resulted in "not guilty" verdicts, though the defense is not always successful in this regard. Walter Sinnott-Armstrong and Stephen Behnke have argued that we should excuse DID sufferers from responsibility, only if at the time of the act the person was insane (typically delusional); otherwise the presumption should be that persons with DID are indeed responsible for their actions. We find their interpretation of DID and of the way in which the requirements for criminal insanity relate to this condition worrying and likely to result in injustice to DID sufferers. Our thesis is that persons with DID cannot be responsible for their actions if the usual features of the condition are present. A person with DID is a single person in the grip of a very serious mental disorder. By focusing on the features of DID which have, as we argue, the effect of deluding the patient, we try to show that such a person is unable to fulfill the ordinary conditions of responsible agency (namely, autonomy and self-control).

In some recent criminal cases in the United States a defense has been mounted based on an affliction known as Dissociative Identity Disorder (DID) (formerly Multiple Personality Disorder). The crux of the defense rests on the proposition that a dominant personality was incapable of appreciating the nature and quality of wrongfulness of conduct caused by an alter personality. This defense has been successful in some cases, but not others, and so philosophers, lawyers, and psychiatrists are now in debate in an attempt to clarify the issues. One of the salient issues involves the question of personal identity between the individual who allegedly committed the offense and the individual who stands accused. Stephen Behnke and Walter Sinnott-Armstrong have recently put forward a test for establishing personal identity in these cases. In this discussion, I present reasons for rejecting their proposal.

The condition known as Multiple Personality Disorder (MPD) or Dissociative Identity Disorder (DID) is metaphysically strange. Can there really be several distinct persons operating in a single body? Our view is that DID sufferers are single persons with a severe mental disorder. In this paper we compare the phenomenology of dissociation between personality states in DID with certain delusional disorders. We argue both that the burden of proof must lie with those who defend the metaphysically extravagant Multiple Persons view and that there is little theoretical motivation to yield to that view in light of the fact that the core symptoms of DID bear remarkable similarity to the symptoms of these other disorders where no such extravagance is ever seriously entertained.

Marya Schechtman argues that psychological continuity accounts of personal identity, as represented by Derek Parfit's account, fail to escape the circularity objection. She claims that Parfit's deployment of quasi-memory (and other quasi-psychological) states to escape circularity implicitly commit us to an implausible view of human psychology. Schechtman suggests that what is lacking here is a coherence condition, and that this is something essential in any account of personal identity. In response to this I argue first that circularity may be escaped using quasi-psychological states even with the addition of the coherence condition. Second, I argue that there is something right about the coherence condition, and a major task of this paper is to identify its proper theoretical role. I do so by reflection on integration therapies for people with multiple personality disorder (MPD). The familiar distinction between the moral and the metaphysical concept of the person is developed alongside such reflection. Connecting these two issues I argue that coherence acts as a normative constraint on accounts of personal identity, but that the normative dimension of personhood is not essential to our notion of a person tout court

Among theories of personal identity over time the simple view has not been popular among philosophers, but it nevertheless remains the default view among non philosophers. It may be construed either as the view that nothing grounds a claim of personal identity over time, or that something quite simple (a soul perhaps) is the ground. If the former construal is accepted, a conspicuous difficulty is that the condition of causal dependence between person-stages is absent. But this leaves such a view open to an objection from the failure to provide a condition of individuation. If, on the other hand something like a soul is said to ground personal identity over time, such an account turns out to be more suited to a kind of continuity view.

Effective agency, according to contemporary Kantians, requires a unity of purpose both at a time, in order that we may eliminate conflict among our motives, and over time, because many of the things we do form part of longer-term projects and make sense only in the light of these projects and life plans. Call this the unity of agency thesis. This thesis can be regarded as a normative constraint on accounts of personal identity and indeed on accounts of what it is to have the life of a person in the broad, rather than narrowly biological sense. It is also a fundamental condition of social life that persons within society fulfill a range of longitudinal roles: parenthood is one such obvious example, as are teachers, health professionals, engineers, artists, and many others. The fulfillment of these and other valuable social roles requires that agents have the capacity to rationally conceive of themselves as engaged in these roles and subject to the demands of them. To be unable to fulfill any such longitudinal social roles is to have a life deficient in value. The unity of agency is thus, we argue, something we rationally strive for, and something to be morally promoted. Psychiatric states that undermine the unity of agency are morally and rationally disvaluable. Using the example of dissociation, we explain how one such state may have this undermining or disruptive effect on the unity of agency. The therapeutic ends for psychiatry in conditions involving such states are thus seen more globally as the restoration of effective agency, that is, unified agency.

_ Source: _Page Count 22 Analysis of the concept of habit has been relatively neglected in the contemporary analytic literature. This paper is an attempt to rectify this lack. The strategy begins with a description of some paradigm cases of habit which are used to derive five features as the basis for an explicative definition. It is argued that habits are social, acquired through repetition, enduring, environmentally activated, and automatic. The enduring nature of habits is captured by their being dispositions of a certain sort. This is a realist account of habits insofar as the dispositions put forward must fit into some recognizable underlying system – in the case of humans a biological system – to fill the role as set out by the definition. This role is wide-ranging; in addition to the familiar cases of habitual behavior, habitual activities also include thinking, perceiving, feeling, and willing.

We have argued elsewhere that moral responsibility over time depends in part upon the having of psychological connections which facilitate forms of self-control. In this chapter we explore the importance of mental time travel - our ordinary ability to mentally travel to temporal locations outside the present, involving both memory of our personal past and the ability to imagine ourselves in the future - to our agential capacities for planning and control. We suggest that in many individuals with dissociative disorders, forms of amnesia, or other frontal lobe damage, our capacity for mental time travel is impaired, resulting in commensurate losses to agency autonomy, and a forensic condition essential for holding persons responsible: in legal terms, the capacity for mens rea.

Defining privacy is problematic because the condition of privacy appears simultaneously to require separation from others, and the possibility of choosing not to be separate. This latter feature expresses the inherent normative dimension of privacy: the capacity to control the perceptual and informational spaces surrounding one’s person. Clearly the features of separation and control as just described are in tension because one may easily enough choose to give up all barriers between oneself and the public space. How could the capacity for privacy give rise to its absence? Yet both the separation and control features of privacy do seem indispensable to any sensible understanding of it. In this paper I set out an approach to defining privacy that keeps these features and avoids the tension between them

Social persons routinely tell themselves and others richly elaborated autobiographical stories filled with details about deeds, plans, roles, motivations, values, and character. Saul, let us imagine, is someone who once sailed the world as a young adventurer, going from port to port and living a gypsy existence. In telling his new acquaintance, Jess, of his former exotic life, he shines a light on his present character and this may guide to some extent their interaction here and now. Perhaps Jess also spent time at one of these port locations; perhaps their paths might even have crossed. They might be drawn into recounting some common events that indeed do establish a common link. Did they visit a certain famous landmark? Did they meet up at the same bars? And so on. When we open up to friends, acquaintances, colleagues, and close others through the stories we tell them, we do so by revealing bits of ourselves.

We will analyze the concept of anonymity, along with cognate notions, and their relation to privacy, with a view to developing an understanding of how we control our identity in public and why such control is important in developing and maintaining our social selves. We will take anonymity to be representative of a suite of techniques of nonidentifiability that persons use to manage and protect their privacy. At the core of these techniques is the aim of being untrackable; this means that others lack the information they would need either to intrude physically upon me or to discover some private facts about me. Anonymity often enough goes together with privacy, but not always. Consider a person walking down a foreign street. It is not a physically private situation but no one there knows who you are. On the other hand, when I cast a postal vote, this act is both private and anonymous. Privacy and anonymity seem to go together because of the way each protects something importantly personal, but their coming apart suggests a difference both in what they mean and in our purposes for securing them. A lot has been written about privacy, and deservedly so; there is reason to think anonymity, and its cognates, important as well

Undercover marketing targets potential customers by concealing the commercial nature of an apparently social transaction. In a typical case an individual approaches a marketing target apparently to provide some information or advice about a product in a way that makes it seem like they are a fellow consumer. In another kind of case, a friend displays a product to you, and encourages its purchase, but fails to disclose their association with the marketing firm. We focus on this second type of case and argue that the constitutive dispositions of friendship that provide for the development and maintenance of intimacy also render friends especially vulnerable to undercover marketing techniques and so to the exploitation of friendship for commercial ends. We show how this is corrupting both of the friendship and the commercial agent.

_ Source: _Page Count 22 Analysis of the concept of habit has been relatively neglected in the contemporary analytic literature. This paper is an attempt to rectify this lack. The strategy begins with a description of some paradigm cases of habit which are used to derive five features as the basis for an explicative definition. It is argued that habits are social, acquired through repetition, enduring, environmentally activated, and automatic. The enduring nature of habits is captured by their being dispositions of a certain sort. This is a realist account of habits insofar as the dispositions put forward must fit into some recognizable underlying system – in the case of humans a biological system – to fill the role as set out by the definition. This role is wide-ranging; in addition to the familiar cases of habitual behavior, habitual activities also include thinking, perceiving, feeling, and willing.

Addictions are commonly accompanied by a sense of shame or self-stigmatization. Self-stigmatization results from public stigmatization in a process leading to the internalization of the social opprobrium attaching to the negative stereotypes associated with addiction. We offer an account of how this process works in terms of a range of looping effects, and this leads to our main claim that for a significant range of cases public stigma figures in the social construction of addiction. This rests on a social constructivist account in which those affected by public stigmatization internalize its norms. Stigma figures as part-constituent of the dynamic process in which addiction is formed. Our thesis is partly theoretical, partly empirical, as we source our claims about the process of internalization from interviews with people in treatment for substance use problems.

In what sense is a person addicted to drugs or alcohol incompetent, and so a legitimate object of coercive treatment? The standard tests for competence do not pick out the capacity that is lost in addiction: the capacity to properly regulate consumption. This paper is an attempt to sketch a justificatory framework for understanding the conditions under which addicted persons may be treated against their will. These conditions rarely obtain, for they apply only when addiction is extremely severe and great harm threatens. It will be argued also that to widen the measures currently in place in some jurisdictions, though philosophically well-motivated, would require very strong evidence of a set of conditions disposing a person to an addictive future. It is doubtful that any such currently available evidence is strong enough to justify coercive treatment. Nevertheless, coercive treatment of addiction is already a reality, with the potential for more, and so some discussion will be presented regarding the extraordinary safeguards necessary to prevent misapplication of such treatment policies.

What is the role and value of pleasure in addiction? Foddy and Savulescu have claimed that substance use is just pleasure-oriented behavior. They describe addiction as "strong appetites toward pleasure" and argue that addicts suffer in significant part because of strong social and moral disapproval of lives dominated by pleasure seeking. But such lives, they claim, can be autonomous and rational. The view they offer is largely in line with the choice model and opposed to a disease model of addiction. Foddy and Savulescu are sceptical of self-reports that emphasize the ill effects of addiction such as loss of family and possessions, or that claim an absence of pleasure after tolerance sets in. Such reports they think are shaped by social stigma which makes available a limited set of socially approved addiction narratives. We will not question the claim that a life devoted to pleasure can be autonomously chosen. Nor do we question the claim that the social stigma attached to the use of certain drugs increases the harm suffered by the user. However our interviews with addicts reveal a genuinely ambivalent and complex relationship between addiction, value, and pleasure. Our subjects did not shy away from discussing pleasure and its role in use. But though they usually valued the pleasurable properties of substances, and this played that did not mean that they valued an addictive life. Our interviews distinguished changing attitudes towards drug related pleasures across the course of substance use, including diminishing pleasure from use over time and increasing resentment at the effects of substance use on other valued activities. In this paper we consider the implications of what drug users say about pleasure and value over the course of addiction for models of addiction. Well don't get me wrong, I love using mate. If I could use successfully I would. I'd still be using. I love using. I just don't like the shit that comes with it.

This entry has two general aims. The first is to profile the practices of neuromarketing (both current and hypothetical), and the second is to identify what is ethically troubling about these practices. It will be claimed that neuromarketing does not really present novel ethical challenges, and that marketers are simply continuing to do what they have always done, only now they have at their disposal the tools of neuroscience which they have duly recruited. What will be presupposed is a principle of proportionality: marketing practices are morally objectionable commensurate with the degree to which they impugn the moral sovereignty of market actors. With this principle in mind, it is important to consider the literature which is sceptical about the potential for neuromarketing to be successful. If its claims are overblown, as will be suggested, then the ethical threat neuromarketing is said to pose, can be viewed also as overblown. An area that has worried many is that neuromarketing poses a threat to brain privacy, and so an analysis will be given of the nature of this threat, given the principle of proportionality. It will be argued that worries about brain privacy seem, prima facie, to be justified, but on closer analysis, fall away. However, a residual threat to privacy does remain: the collection over time, and aggregation of private brain information, where the target loses control over its ownership and distribution.