Respect for other selves

Philosophers have mostly advocated that advance directives should bear the same authority, with regard to refusal of life-extending treatment, as a patient's contemporaneous consent or refusal. Such authors typically support this position through a theory of persistent personal identity. I agree that the loss of mental competence does not render someone a moral stranger to their prior goal but argue that equating advance direction with consent is to ignore the capacity of nonpersons to attribute and withhold moral value. A distinction should be drawn between advance directives that seek to pursue deeply held goals and those that express contempt for the mentally incompetent.     

Precedent autonomy and personal identity

Debates on precedent autonomy and some forms of paternalistic interventions, which are related to questions of personal identity, are analyzed. The discussion is based on the distinction between personal identity as persistence and as biographical identity. It first is shown that categorical objections to advance directives and "Ulysses contracts" are based on false assumptions about personal identity that conflate persistence and biographical identity. Therefore, advance directives and "Ulysses contracts" are ethically acceptable tools for prolonging one's autonomy. The notions of personality and biographical identity are used to analyze the ethically relevant features. Thereby, it is shown that these concepts are operative in and useful for thinking in biomedical ethics. The overall conclusion is that categorical arguments against precedent autonomy or "Ulysses contracts" are based on misleading theories of personal identity and that advance directives are an ethically respectable tool for prolonging individuals' autonomy in cases of dementia and mental illness.     

Personal Identity, Autonomy and Advance Statements

abstract    Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal identity initially appear to provide a sound basis for extending the moral autonomy of an individual — and hence their autonomous wishes expressed through an advance statement — past the point of severe psychological decline. I argue that neither the traditional psychological account nor the more recent Animalist account of personal identity manage to provide a sufficient basis for extending our moral autonomy past the point of incapacity or incompetence. I briefly explore how analogies to similar areas in law designed to facilitate autonomous decision, such as wills and trusts, provide at best only very limited scope for an alternative justification for granting advance statements any legal or moral authority. I conclude that whilst advance statements play a useful role in formulating what treatment is in a patient's best interests, such statements do not ultimately have sufficient moral force to take precedence over paternalistic best interests judgements concerning an individual's care or treatment.     

Advance directives and the personal identity problem

The value and authority of advance directives such as the living will and the durable power of attorney are discussed, as well as the dangers of loss of personal identity and psychological continuity that these directives present. Differing theories of the degree of psychological continuity necessary for the preservation of personal identity are examined, concluding with the author's "compromise position" that cases of permanent unconsciousness and neurological dementia destroy some of the preconditions for personhood and thereby negate the choice between respecting the wishes of the formerly competent person and the new, different person's life because such beings are not persons at all.     

Some reflections on the problem of advance directives, personhood, and personal identity

In this paper, I consider objections to advance directives based on the claim that there is a discontinuity of interests, and of personal identity, between the time a person executes an advance directive and the time when the patient has become severely demented. Focusing narrowly on refusals of life-sustaining treatment for severely demented patients, I argue that acceptance of the psychological view of personal identity does not entail that treatment refusals should be overriden. Although severely demented patients are morally considerable beings, and must be kept comfortable whilst alive, they no longer have an interest in receiving life-sustaining treatment.     

Sharing Responsibility and Holding Responsible

Who, in particular, may hold us responsible for our moral failings? Most discussions of moral responsibility bracket this question, despite its obvious practical importance. In this article, I investigate the moral authority involved and how it arises in the context of personal relationships, such as friendship or family relations. My account is based on the idea that parties to a personal relationship not only share responsibility for their relationship, but also — to some degree that is negotiated between them — for one another's lives. In sharing these responsibilities, we grant people a particular authority to respond to us. By highlighting the responsibility that we assume when we hold someone responsible, I also suggest that this analysis contains important lessons for thinking about responsibility in other contexts.     

Taylor and Parfit on personal identity: a response to Lötter

In this paper the author attempts to show that Lötter is not justified in ignoring orthodox views of personal identity on the basis of arguments offered by Taylor. It is argued that Taylor's arguments against the orthodoxy do not establish what he, and Lötter, hope they establish, namely, that the orthodox position, represented by the work of Parfit, fails to account for personal identity. The author also attempts to show the importance of this area of debate between orthodox theories of personal identity and the concept of personal identity offered by Taylor, Lötter, and others.     

Cognitive Transformation,Dementia, and the Moral Weight of Advance Directives

Abstract

Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient’s preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients.     

Moral Compromises, Moral Integrity and the Indeterminacy of Value Rankings

Though the art of compromise, i.e. of settling differences by mutual concessions, is part of communal living on any level, we often think that there is something wrong in compromise, especially in cases where moral convictions are involved. A first reason for distrusting compromises on moral matters refers to the idea of integrity, understood in the basic sense of 'standing for something', especially standing for the values and causes that to some extent confer identity. The second reason points out the objective nature of moral values, which seems to make them immune from negotiation and barter. If one sincerely holds some moral conviction to be true, than compromising on that belief must be a sign of serious confusion.In order to reach a better understanding of these two reasons, I analyse what is involved in personal integrity and how this relates to moral integrity. I argue that the search for moral integrity naturally brings us to the question of how one could accept moral compromises and still uphold the idea that moral values and principles have an objective authority over us. To address this question I will present a version of moral pluralism which tries to capture the enormous complexity of what should matter to us as moral persons, and which explains why value-rankings are often deeply indeterminate. The general position I defend in this paper is that compromises involving moral values and norms may be morally required and, therefore, be laudable. To sustain this position I will arrive at a view of ethical objectivity that allows the possibility to negotiate about the truth of moral beliefs.     

Aid and bias

Over the last few decades, psychologists have amassed a great deal of evidence that our thinking is strongly influenced by a number of biases. This research appears to have important implications for moral methodology. It seems likely that these biases affect our thinking about moral issues, and a fuller awareness of them might help us to find ways to counteract their influence, and so to improve our moral thinking. And yet there is little or no reference to such biases in the philosophical literature on many pressing, substantive moral questions. In this paper, I make a start on repairing this omission in relation to one such question, the 'Aid Question', which concerns how much, if anything, we are morally required to give to aid agencies. I begin by sketching a number of biases that seem particularly likely to affect our thinking about that question. I then go on to review the psychological research on 'debiasing' - that is, on attempts to counteract the influence of such biases. And finally I discuss and illustrate certain strategies for counteracting the influence of the biases in question on our thinking about the Aid Question.     

Compatibilism and personal identity

Compatibilists disagree over whether there are historical conditions on moral responsibility. Historicists claim there are, whilst structuralists deny this. Historicists motivate their position by claiming to avoid the counter-intuitive implications of structuralism. I do two things in this paper. First, I argue that historicism has just as counter-intuitive implications as structuralism when faced with thought experiments inspired by those found in the personal identity literature. Hence, historicism is not automatically preferable to structuralism. Second, I argue that structuralism is much more plausible once we accept that personal identity is irrelevant to moral responsibility. This paves the way for a new structuralist account that makes clear what it takes to be the diachronic ownership condition (which is normally taken to be personal identity) and the locus of moral responsibility (which is normally taken to be ‘whole’ person), and helps to alleviate the intuitive unease many have with respect to structuralism.     

Common and Personal Values in Moral Education

It is arguable that beneath the fast and loose surface of recent official and/or semi-official documentation devoted to advice and guidance on moral education, there lurks systematic error about the bases of moral authority - turning upon a distinction between common and personal values. In what follows, it is claimed that the heart of this error lies in mistaking a logical distinction between different levels of moral evaluation for a statistical distinction concerned more with the distribution of moral values. To the extent that common value is identified with ideas of consensus or agreement, and personal value with values clarification and personal search, it seems that no coherent or viable conception of moral reason could possibly be constructed on the basis of currently available official guidance.     

Deference as a normative power

Much of the literature on practical authority concerns the authority of the state over its subjects—authority to which we are, as G. E. M. Anscombe says, subject “willy nilly”. Yet many of our “willy” (or voluntary) relationships also seem to involve the exercise of practical authority, and this species of authority is in some ways even more puzzling than authority willy nilly. In this paper I argue that voluntary authority relies on a form of voluntary obligation that is akin (in some respects) to the kind of obligation one undertakes in making a promise. Voluntary authority depends, that is, on the possibility of taking on certain obligations more or less at will. It is generated through an interpersonal transaction that involves a directed act of deference, on one side, paired with appropriate uptake of that deference, on the other. Deference, in the relevant sense, should be understood as a normative power that is exercised when agents transfer deliberative discretion to others, undertaking directed obligations to treat others’ directives as content-independent and peremptory reasons. Voluntary authority, thus understood, is both grounded in and constrained by the equal moral authority or autonomy of the participants, since only autonomous agents have the standing to defer in a normatively significant way.     

Thinking through thinking: Deleuze and “the dogmatic image of thought”

In my philosophical thinking, I have followed many of those influenced by Heidegger and Nietzsche (particularly Derrida, Lacan and Deleuze) who argue that philosophy has been colonised from its inception by a specific understanding of what thinking entails. Deleuze articulates this form of colonisation in terms of the eight postulates of “the dogmatic image of thought”. This article responds to the disconcerting realisation, elicited by three encounters, that despite my “philosophising about” a disruptive thinking in the name of complexity, my practice of thinking remains deeply habituated by “the dogmatic image of thought” and I have yet to begin thinking as “habitual disturbance” and an “adventure of learning”. To show why an effort to think through thinking remains important for philosophy in South Africa, I tie this reflection to specific provocations (a conference theme entitled “Philosophy in/as Translation”; a pointed remark that “there is no African word for ‘identity’”). However, the topic of the provocations should not mislead readers to expect scholarship about general relationships between philosophy, translation and decolonisation, although these terms are entangled. Instead, I focus on “thinking”. I discuss a personal response to the remark regarding the untranslatability of “identity” through the lens of Deleuze’s critique of “the dogmatic image of thought”, and reminded by the conference theme that this response is situated in the South African academic context where issues of decolonisation form the underlying fabric of intellectual work. From out of this entanglement I consider what philosophy’s internal decolonisation might entail.

“Thus, to ‘philosophize’ about being shattered is separated by a chasm from a thinking that is shattered” (Heidegger, “Letter on Humanism”).     

Morality,Inescapable Rational Authority,and a God's Wishes

It is a supposed conceptual truth about moral norms that we have reason to comply with them even if we desire not to. This combination of rational authority and inescapability is thought to be incompatible with instrumentalism about practical reason. This essay argues that there are ways in which norms with inescapable rational authority can exist alongside instrumentalism about practical reason. One way involves positing an afterlife and a powerful supernatural agency—so, a kind of god—who has total control over our welfare in that afterlife. I go on to argue that the attitudes of this god would also provide something answering to our impressions of moral desert.     

Culture wars: American moral divisions across the adult lifespan

Sociologists have argued that the public moral debate in contemporary America is characterized by a “culture war,” pitting “orthodox” and “progressivist” groups against one another (Hunter, 1991). This study addressed whether the culture war is evident in the moral thinking of ordinary Americans, and whether age-related patterns exist. Sixty fundamentalist Baptists (orthodox) and 60 mainline Baptists (progressivist) evaluated and reasoned about moral issues such as divorce and abortion. Each group was divided evenly into three age groups copsisting of young, midlife, and older adults. Moral reasoning was analyzed in terms of Shweder's (1990) ethics of autonomy, community, and divinity. Within all three age groups, progressivists used the ethic of, autonomy more than orthodox participants. Orthodox participants used the ethic of divinity more than progressivists. Orthodox and progressivist groups did not differ much in their use of the ethic, of community. Very few age group differences were found within the orthodox and progressivist groups. It is concluded that morality is conceived of in markedly different wasy by orthodox and progressivist groups, and that these conceptions are consistent across age groups.     

True to oneself? Broad and narrow ideas on authenticity in the enhancement debate

Our knowledge of the human brain and the influence of pharmacological substances on human mental functioning is expanding. This creates new possibilities to enhance personality and character traits. Psychopharmacological enhancers, as well as other enhancement technologies, raise moral questions concerning the boundary between clinical therapy and enhancement, risks and safety, coercion and justice. Other moral questions include the meaning and value of identity and authenticity, the role of happiness for a good life, or the perceived threats to humanity. Identity and authenticity are central in the debate on psychopharmacological enhancers. In this paper, I first describe the concerns at issue here as extensively propounded by Carl Elliott. Next, I address David DeGrazia’s theory, which holds that there are no fundamental identity-related and authenticity-related arguments against enhancement technologies. I argue, however, that DeGrazia’s line of reasoning does not succeed in settling these concerns. His conception of identity does not seem able to account for the importance we attach to personal identity in␣cases where personal identity is changed through enhancement technology. Moreover, his conception of authenticity does not explain the reason why we find inauthentic values objectionable. A broader approach to authenticity can make sense of concerns about changes in personal identity by means of enhancement technologies.     

Nietzsche's place in nineteenth century German philosophy

I describe two ways of thinking about what constitutes a knowledgeable assertion – the ‘orthodox view’ and the ‘isomorphic view’. I argue that we should discard the orthodox view and replace it with the isomorphic view. The latter is more natural and has greater theoretical utility than the former.     

There is no moral authority in medicine: response to Cowdin and Tuohey.

Central to the Cowdin-Tuohey paper is the concept of a moral authority proper to medical practitioners. Much as I agree with the authors in refusing to degrade doctors to the status of mere technicians, I argue that one does not succeed in retrieving the moral dimension of medical practice by investing doctors with moral authority. I show that none of the cases brought forth by Cowdin-Tuohey really amounts to a case of moral authority. Then I try to explain why no such cases can be found. Developing an insight that is common to all the major moral thinkers in the philosophia perennis, I show that doctors are professionally competent with respect only to a part of the human good; morally wise persons are competent with respect to that which makes man good as man. I try to show why it follows that a) professional expertise has no natural tendency to pass over into moral understanding, and that b) doctor and non-doctor alike start from the same point in developing their understanding of medical morality. It follows that the authors fail in their attempt to de-center the moral magisterium of the Church by setting up centers of moral authority outside of the Church.