Confiscating Live Body Parts

This posting is based on Fabre C, 2006, Whose Body is it Anyway?, Oxford University Press. In chapter five Fabre argues the following.

1. Justice requires that we must be prepared to give certain of our living organs which we can live without, namely blood, a cornea, part of the liver or a kidney, to others in urgent need of these organs so that they can lead a minimally flourishing life. Provided those in need lead a less than minimally flourishing life due to no fault of their own.
2. She further believes such mandatory donation does not significantly damage someone’s autonomy.

The idea that we can take these organs without the patient’s consent runs counter to our intuitions. Does Fabre really believe justice requires that we can remove organs without a patient’s consent? Forcibly anaesthetise patients and to remove their organs? In this posting I will argue that Fabre’s argument is unsound. I will argue justice does not justify the taking of someone’s organs without her approval.

Fabre adopts a sufficientist account of justice in her argument. I will accept a sufficientist account of justice is the correct one to adopt. Such an account of justice requires we give material resources that others need in order to lead a minimally flourishing life. This requirement is subject to the proviso that those leading a less than minimally flourishing life do so due to no fault of their own. In what follows when I refer to a less than minimally flourishing life I am referring to such a life subject to the above proviso, I will however omit the proviso. Fabre’s arguments seem to roughly follow the route below.

1. Justice requires that we give some material resources to others in order to enable them to lead a minimally flourishing life. I accept this requirement.
2. Justice requires that we give our personal service to others in an emergency in order to enable them to lead a minimally flourishing life. I accept this requirement. We should, for instance, save a child from drowning in a pond.
3. Justice requires that we give our personal services to others in order to enable them to lead a minimally flourishing life. I am doubtful about accepting this requirement.
4. Justice requires that our organs are available to others for transplant when we die in order to enable them to lead a minimally flourishing life. I accept this requirement.
5. Justice requires that we should be prepared to give certain of our living organs, as set out above, to others for transplant in order to enable them to lead a minimally flourishing life.

I will now present an argument to show if we accept a sufficientist account of justice then this does not entail that we should be prepared to give certain of our living organs to others in order to enable them to lead a minimally flourishing life.

I have accepted we have a duty, due to justice, to help others lead a minimally flourishing life. I also agree with Fabre that certain transplanted organs are sometimes necessary in order to achieve this. For instance, someone receiving dialysis may need a kidney and someone involved in a road accident may need a blood transfusion in order to permit them lead a minimally flourishing lives. I further accept that it is possible to lead a minimally flourishing life after giving blood or donating a kidney. I do not accept, as Fabre does, that in certain cases a cornea transplant may be necessary for someone to lead a minimally flourishing life. The blind, for instance, can lead such a life. Let us consider two multi-millionaires John and Jane. John is required to pay£100,000 in tax on his large earnings. Jane has two healthy kidneys and is a good match for a patient urgently in need of a kidney transplant. According to Fabre’s arguments justice requires that Jane must be prepared to donate one of her kidneys in order to help this patient lead a minimally flourishing life. Let it be accepted for the present that Fabre’s arguments are correct. In the above circumstances I would feel no sympathy for John however I would feel a great deal for Jane. Indeed intuitively I would feel Jane is being treated unjustly. It follows, as pointed out above, Fabre’s arguments sometimes reach conclusions that run counter to our intuitive ideas of justice. The fact that Fabre’s arguments sometimes lead to counter intuitive conclusions does not of itself mean these are unsound. Perhaps for instance after some reflection we might alter our intuitions. However it does suggest we should examine the reasons for the differences between Fabre’s conclusions and our pre-reflective intuitions. In order to do this I will now consider why justice requires that we help others to lead a minimum flourishing life.

Fabre believes justice is based on respect for persons. She further believes this respect is based on the recognition of others as persons, page 29. It might be argued that someone who does not have a minimally flourishing life and who has no control over her life is not in the true sense a person. It might then be argued the simple recognition of someone as a person means we have a duty, due to justice, to ensure that she can lead a minimally flourishing life. I believe this account of the basis of justice is too simple. We can recognise certain people, who have certain capabilities and lead a minimally flourishing life, as persons. Secondly we can recognise certain people who have the capacities needed to lead a minimally flourishing life but are unable to lead such a life due to no fault of their own. The simple recognition of this second class of people does not automatically mean we are under a duty to enable them to lead a minimally flourishing life. Simple recognition alone does not give us a motivation to act. However most of us would intuitively feel motivated by a feeling of justice to enable such people lead a minimally flourishing life. The reason why we feel motivated by a feeling of justice is because we feel sympathy or empathy for such people. In what follows I will use the term empathy but this term can be taken to mean either empathic or sympathetic caring. In the light of the above it would seem the basis of justice is the recognition that certain people have the capacities needed to lead a minimally flourishing life together with an empathic caring for them.

I have argued that justice depends, at least in part, on empathy for others. Accepting my argument does not damage the case for adopting a sufficientist account of justice. Indeed it may count in favour of adopting such an approach as we would appear to have a natural empathy for those of us who have a less than minimally flourishing life through no fault of their own. Accepting my argument does not mean the application of the law depends on our sentiments. A just law can be defined as a law that is motivated in part by an empathic caring for others. However the application of a law based on empathic caring for others need involve no sentiments. Let us now reconsider my example of Jane. In the light of the above we can now see, why we intuitively feel Jane is treated unjustly, if the law requires her to make one of her kidneys available for transplant. The reason being we feel more empathy for someone being compelled to do something as opposed to someone which something just happens to. It follows we would naturally feel more empathy for Jane than the patient suffering from kidney failure. Further I believe we would naturally feel more empathy for Jane than John who is required to pay £100,000 in taxes. Let it be accepted my argument that empathy plays a part in deciding which laws are just is correct. Let it be further accepted that we would have empathy for a patient on dialysis. However we would have greater empathy for Jane if she was required by law to donate one of kidneys. It follows because empathy plays a part in deciding what is just that it would be unjust to require Jane to donate one of her kidneys. Accepting my argument shows Fabre is mistaken to conclude that a sufficientist account of justice requires that we must be prepared give certain of our living organs to others in urgent need of these organs to enable them to lead a minimally flourishing life.

Parenting and Excessive Guidance

Phillip Larkin had a bleak view of parents.

‘They fuck you up your mum and dad and give you all the faults they had’

Dov Fox also paints a bleak picture of modern parenting (1). He argues when rearing children parents have a duty to do two things. They have a duty to guide their children, e.g. educate them. They also have a duty to accept them for what they are, e.g. love them. This latter duty means the aspirations of our children impose limits on what we may will for them. There is a tension between these two duties and parents should attempt to balance them. Parental attention deficit disorder occurs when parents do not get this balance correct. Fox points out modern parenting pays too much attention to guidance as opposed to acceptance. It is important to note too much attention can also be paid to acceptance. James Flynn argues that, in part, the gap in the IQ of black and other children may be due excessive acceptance rather than genetic factors (2). However in this posting I want to examine Fox’s point concerning excessive guidance.

Initially parents don’t guide their children. Parents should simply accept, love and nurture them. As a child starts to develop her parents should start to guide her. The emphasis on guidance will grow as the child develops. Perhaps as children become teenagers the balance between guidance and acceptance will shift again with greater emphasis again being placed on acceptance. I agree with Fox that excessive guidance is a bad thing and that parents who give excessive guidance act badly even if their motives are good. However excessive guidance need not always involve good motives and some parents substitute their own motives in place of their children, see substitute success syndrome in (3). The question to be addressed is this if we must guide our children at what stage does good guidance become excessive guidance? I will examine this question, as Fox does, by firstly considering pre natal and secondly post natal guidance.

There may be various forms of pre natal guidance. I will only examine genetic enhancement as I believe my comments on genetic enhancement apply equally to other forms of pre natal guidance. Fox argues that genetic enhancement is unwelcome but not because natural genetic combination is superior to an engineered combination of genes.

‘My argument, to be clear, is not that the randomness of genetic recombination is a moral good in itself.’ (4)

What is wrong with an engineered combination of genes according to Fox is as follows.

‘Rather, it is because genetic engineering is the ultimate manifestation of the triumph of excessive parental guidance that has become all too familiar in our time’ (5).

It might be questioned whether genetic engineering is a form of parental guidance. It is certainly a form of choosing some of the characteristics of an unborn child, perhaps a child that has yet to be conceived, but is choosing a form of guidance? It seems to me that guidance requires something to guide, in this context an existing child. Moreover it seems that, provided a child has a life that is worth living, genetic enhancement does no harm that child. An un-enhanced child would be a different child. An interesting discussion of this issue is found in ‘Parfit (6). It appears to follow that genetic engineering is not the ultimate manifestation of the triumph of excessive parental guidance as Fox argues. Parents may use genetic engineering to choose the kind of children they will have; this choosing is not guidance of any sort. Nonetheless Fox might give a second closely related reason as to why genetic engineering should be discouraged. He might argue even if genetic engineering is not a form of excessive guidance that parents who genetically engineer their children are more likely to excessively guide their children in later life. It might then be further argued for this reason genetic engineering should be discouraged. However even if parents who might genetically engineer their children were discouraged from doing so it does not automatically follow that these parents would be any less likely to excessively guide any children they might have. I accept genetic engineering should be discouraged if it can be shown that it encourages excessive parental guidance. However it seems to me that parents who excessively guide their children would continue to do so even if they were discouraged from genetic enhancement. The reasons, why parents might excessively guide children, lies in the parent’s own psychological makeup rather than whether they are able to genetically engineer their children’s future. The above suggests that Fox is wrong to believe there are reasons based on excessive parental guidance to discourage the genetic enhancement of children. Accepting my argument of course does not mean that genetic engineering is desirable. I agree with Fox when he states

‘Parental attention calls for moral scepticism towards the potential worth of those characteristics parents would seek to target for enhancement or eradication’ (7).

However my scepticism is not based on parental deficit disorder.

Fox approaches post natal enhancement in connection with excessive guidance as follows.

‘The parental attention approach suggests that certain enhancements – practices that aim to modify human form or functioning beyond what is required to sustain good health or restore the normal workings of the human mind and body – call for careful reflection into parental attitudes, depending on the particulars of the child’  (8).

The best way to achieve these ends would usually be to accept the child for what she is. However as Fox points out in certain contexts some interventions are morally required, for instance the removal of a child from a toxic environment caused by lead paint. Such interventions are acceptable even if these cause profound changes in the child’s personality. Fox would regard any intervention which changes a child’s personality but leads to normal functioning as acceptable, perhaps even mandatory. Fox would regard any other intervention which changes a child’s personality as unacceptable. It would seem Fox adopts a similar approach to parental guidance. Any guidance beyond that needed to maintain a child’s normal physical and mental health would be regarded by him as excessive. Moreover he thinks parents should simply accept the personality of a normal child and not attempt to change her personality by any guidance. The trouble with this approach is how to define normal. For instance is the prescription of Ritalin to a child for ADHD a means of aiding the child’s mind to function normally or a failure to accept the child as she is? One way to deal with this problem might be to consider any intervention as undesirable which would impede a child from developing and maintaining a conception of herself as the central character in her life story. It would seem Fox would endorse this approach (9). However it seems to me that excessive guidance does not necessarily destroy a child’s concept of herself as the central character in her own life. An excessively guided child might rationalise the changes brought about in her life in two ways. She may see her character as struggling to achieve these changes. She may see her character as struggling to accommodate these changes. In both of these scenarios her concept of herself as the central character in her life story remains in spite of the excessive parental guidance. However the above approach might be modified as follows. Any intervention would be undesirable if it would impede a child from developing and maintaining a conception of herself as the author, at least in part, of her life story.

This modified approach suggests if parents are to avoid excessive guidance they should accept the things their child sees as central to her life. The reason for this being the things a child sees as central to her life, the things she cares about, are the things she authors her life by. Authorship implies autonomy. It appears if this approach was adopted then parents should respect their child’s autonomy. If parents should respect a child’s autonomy it might also appear to strictly limit the guidance they should give to this child. I believe that this second appearance is illusory. It is generally accepted that people should respect other people’s autonomy. However children are not fully autonomous. Indeed at an early age children are not autonomous at all. A child’s autonomy develops as she matures. I believe good parenting requires that parents should assist their children become autonomous. The question I now wish to address is this, if it is accepted that parents should assist their children become autonomous, how does this affect the balance between accepting their children as they are and giving them guidance?

I have noted above when a child is very young her parents should simply love, nurture and accept her. As the child develops so her parent should start to guide her. Later on as the child starts to become autonomous her parents must again place greater emphasis on accepting her. The above suggests the balance between accepting a child and guiding her changes as the child matures. Good parenting calls for parents to be aware of this fact. It might be thought, if parents assist their children to become autonomous, that as these children mature the need for guidance shrinks dramatically. This is not so. Assisting children become autonomous is not simply achieved by giving more mature children ample choices and accepting these choices. According to Frankfurt,

‘With total freedom there can be no individual identity. This is because an excess of choice impairs the will.’ (10)

Being autonomous means an agent has ideals or something she cares about in order to let her make meaningful choices. It follows assisting children become autonomous involves parents both helping children obtain standards and ideals which permit them to make meaningful choices and the opportunity to make these choices. The process of helping children obtain standards and ideals of necessity involves guidance. It is impossible for a child, or any one else for that matter, to obtain a value simply by choosing randomly without some reference point. Any value obtained in this way is obtained wantonly. It follows if parents simply accept their children and fail to help them obtain some standards and ideals they risk that their children will behave wantonly as noted by Flynn above. Fox is right to note the dangers of excessive guidance but a lack of guidance also involves significant dangers. Competitive parenting of the kind noted by Fox and parenting in which parents seek to attain their own success through their children’s lives should be regarded as unacceptable. Good parenting involves some guidance even as a child matures. How should good parents approach this guidance? There is no algorithm for good parenting. It follows good parenting is akin to a craft that must be learnt in part by experience. It seems self evident that parents should bring good attitudes towards this learning experience. One such good attitude as suggested by Fox is to be aware of the need to balance acceptance and guidance. Another good attitude is to be aware this balance changes as the child matures. Lastly parents must reflect on the guidance they offer. I noted above when considering genetic enhancement Fox thinks parents should be morally sceptical towards these enhancements. I believe parents should adopt this sceptical attitude to any values they seek to inculcate in their children. Nevertheless a failure to inculcate any values in maturing children is a failure in parental attention. If such attitudes are adopted parents then parents should not ‘fuck up’ their children as Larkin suggests they do.

1.      Dov Fox, 2008, Parental Attention Deficit Disorder, Journal of Applied Philosophy 25(3)

2.      Flynn, 2008, Where Have All the Liberals Gone, Race Class and Ideals in America, Cambridge University Press.

3.      Michael Slote, 2007, The Ethics of Care and Empathy, Routledge, page 57.

4.      Fox, page 250.

5.      Fox, page 251.

6.      Parfit, 1984, Reasons and Persons, Oxford, section 122.

7.      Fox, page 248.

8.      Fox, page 252.

9.      Fox, page, 254.

10. Frankfurt, 1999, Necessity Volition and Love, Cambridge, page 110.

The Pharmacological Induction of Emotions

This posting is based on a paper by David Wasserman and Mathew Liao (1). In this paper they question whether the pharmacological induction of the emotions can satisfy reasonable conditions for authenticity. They conclude an induced emotion might well satisfy these conditions. I will argue what is important when considering an induced emotion is not simply whether the emotion is an authentic one but rather the ways in which an emotion might be induced. I will further argue we have no reason to reject some induced emotions which I would class as inauthentic.

Prior to setting out my arguments I first must briefly consider the intuitive meanings of authentic. Firstly we might intuitively say a person is simply authentic provided he is not a wanton. A wanton has no true self and bases his life on whims or the wishes. However this definition of an authentic person is no help in deciding whether an emotion is authentic or inauthentic. Secondly we might intuitively also say an action or an emotion is authentic if it accords, in some way, with the agent’s inner self. I would define someone’s inner self by the things he loves. Frankfurt would define the things someone loves by what he cares about.

“A person who cares about something is, as it were invested in it. He identifies himself with what he cares about in the sense that he makes himself vulnerable to losses and susceptible to benefits depending upon whether what he cares about is diminished or enhanced.”(2)

Let us assume for now that an authentic emotion is one that accords with the things an agent cares about. It follows if we are investigate authentic emotions that we must be clear about the nature of the accordance between someone’s inner self and his authentic emotions if term authentic be useful.

Someone’s actions may be classed as authentic or inauthentic. I have suggested above that intuitively if someone is authentic then he leads his life in accordance with his own inner self. An authentic action might be defined as an action that accords with the agent’s inner self. It seems natural to define an action as according with someone’s inner self if it furthers the ends of his inner self. If this natural definition of accordance is accepted then an authentic action is simply one that furthers the ends of an agent’s inner self. It also seems natural to extend this definition of an authentic action to an authentic emotion. Let us accept our emotions are not just things we experience but reasons for action. This view holds that an emotion is not simply a physical feeling but combination of feelings behaviour and cognitions and is supported by Wasserman and Liao (3). A similar view is held by Michael Brady who argues emotions are analogous to alarms readying us for action (4). An authentic emotion might then be defined as an emotion that furthers the ends of the agent’s inner self.

Let us examine the above definition of an authentic emotion by the use of two examples. Firstly Wasserman and Liao use grief as an example of an emotion that it might not be wrong to induce pharmacologically. Let it be assumed it is possible to induce grief pharmacologically by taking a pill. Let it be further assumed someone does not feel genuine grief at the loss of a family member. However he may be aware society believes it right to grieve at the loss of a close family member. Such a person may care about what society cares about and thinks it right to take a pill to induce grief. In this case using the above definition of an authentic emotion this pharmacologically induced grief might be classed as not inauthentic and there seems to be no reason as to why it should not be induced. However not all authentic emotions using the above definition should be induced. Let us move from considering grief to considering love. Let it be assumed someone lusts after another but fails to love the other. Let it be further assumed he is unable to satisfy his lust because his beloved perceives this lack of love. Let it be still further assumed it is possible to pharmacologically induce love by taking a pill. Lastly let it be assumed this lustful person takes this pill in order to induce love so he can satisfy his lust. This pharmacologically induced love would be an authentic emotion according to the above definition, because it furthers the ends of the lustful lover. However the object of the lustful lover’s lust would not regard his emotion as authentic if she was aware his love was pharmacologically induced. Moreover it would seem wrong to induce love in these circumstances. It follows using my definition of authentic that not all authentic emotions should be induced.

Perhaps someone’s inner self or true self is an illusion. If this is true then there is no need to consider questions of authenticity. I would be reluctant to accept this position. Perhaps our inner self or true self is a purely cognitive construction. Once again there would be no need to consider questions of authenticity. And once again I would be reluctant to accept this position. I have suggested above that we are defined by what we care about. I will now argue we are not defined by all the things we care about. We are defined by those things which we care about and are either proud or would be ashamed of. Someone’s true self need not actually involve feeling shame but must include a disposition to feel shame in certain circumstance. Additionally I have suggested that actions which make someone proud are actions he can defend even if sometimes his defence can sometimes only be mounted retrospectively. Similarly someone must be able to give some reason for his shame, see true selves do they exist. Accepting this definition would mean someone’s true or inner self might include elements of which he is ashamed. Some of his actions might be authentic actions but would nonetheless be actions of which he is ashamed. Adopting this definition would mean someone’s true or inner self concurs better with third party assessments. For instance in my example of the lustful enhanced lover his love might be authentic but it is love he should be ashamed of, his beloved might concur.

How then are emotions linked to someone’s true self as defined above? It might be objected that there is no connection. Someone can have emotions but can’t have emotions about emotions. In reply I would point out pride and shame are meta-emotions. Schadenfreude is pleasure at another’s discomfort is surely an emotion one should feel some shame about. In addition if our lustful lover enhances his love to mislead his beloved then surely he should feel some shame at his tainted love. Let us divide emotions into two types. Firstly emotions we feel no pride or shame about are inauthentic emotions. Secondly emotions we feel some pride or shame about, even if only slightly, are authentic emotions. It might be objected that emotions we feel shameful about feeling, such as schadenfreude, are inauthentic emotions rather than authentic emotions. In response I would point out if we have a disposition to take pleasure at another’s discomfort that this is part of our essential character, even if we wish it wasn’t, and as such is an authentic disposition to feel a particular emotion. Most of us have some incompatible elements in our character and part of being a person is being able to come to care about some things rather than others (5). We want to eat cream cakes and remain thin.

Let us first consider emotions that are inauthentic, emotions that someone feels no pride or shame about. Let us accept that at some future date it is possible to induce love or compassion perhaps by the use of oxytocin. It seems clear that sociopaths lack compassion. Love and compassion are not connected to a sociopath’s true self. Let it be assumed some sociopath is given pharmacologically induced compassion. This induced emotion would be an inauthentic emotion at the time of its induction using the above definition because a sociopath feels no shame at his lack of compassion. However this induced emotion might be regarded as a moral enhancement that appears to benefit both society and the individual concerned. Provided of course the sociopath continues to take his drugs. It therefore seems possible to conclude that some induced emotions which are inauthentic, when they are induced, should be encouraged. Accepting this conclusion does not of course mean that all induced emotions which are inauthentic, when induced, should be encouraged. Consider again the lustful lover. Clearly his induced love should not be encouraged. Let it also be accepted that there some are harmful emotions such as spite and envy should never be induced in anyone. However there are some usually beneficial emotions for which there seems to be no reason, based solely on the nature of emotion, as to why they should not be pharmacologically induced. I suggest that we should permit the pharmacological induction of beneficial emotions which are inauthentic as defined above provided their induction is not intended to deceive. One way of safeguarding against these induced emotions deceiving would be to make the induction public knowledge.

It might be argued my safeguard is unnecessary because an inauthentic pharmacologically induced emotion might become an authentic one over time. Consider again the lustful lover whose love is clearly inauthentic when induced. It might argued, provided this lover persists in taking the drugs that induce his love, that his inauthentic love at the time it was induced becomes authentic love after a period of time. In reply I would suggest a beneficial induced emotion only becomes authentic provided the agent starts to take pride in feeling the emotion; time is irrelevant. I would further suggest authenticity is also irrelevant, all that matters is that the induced emotion is beneficial and does not deceive; my safeguard should help prevent deception.

Lastly I want to consider authentic emotions. These emotions cause the agent to feel some pride or shame. Such emotions cannot be induced but one or more of them might be enhanced. Enhancement might alter the balance between these emotions causing a shift in someone’s true self. It might be argued such a shift causes a change in authenticity, in his character. Is such a shift harmful? People try to change their character and stop doing or feeling the things they are ashamed of. Changing one’s character is hard and most people’s attempts are unsuccessful. I see no reasons why someone’s autonomous decision, driven by his authentic shame, shouldn’t be assisted by pharmacological means. However such enhancement carries dangers. Let us consider a homosexual man. Perhaps he feels shame at his homosexuality and perhaps some sort of emotional enhancement might curtail his desire for other men. Let us accept that homosexuality has some genetic basis it follows any change in sexual orientation is contrary to his nature. In order to safeguard against such dangers we need to be sure such decisions are autonomous and that the shame that drives them is authentic and not induced by others.

1. David Wasserman, Mathew Liao, Issues in the Pharmacological Inductions of Emotions, Journal of Applied Philosophy, 25(3)
2. Harry Frankfurt, 1988, The Importance of What We Care About, Cambridge University Press, page 83.
3. Wasserman and Liao, page 17.
4.  Michael S. Brady, 2013, Emotional Insight; The Epistemic Role of Emotional Experience, Oxford University Press.
5. Bennett Helm, 2010, Love, Friendship & the Self, Oxford.
6.  Frankfurt, 1988, page 91

Living Wills

In this posting I want to explore a familiar theme of this blog respect for autonomy. In previous postings I have stressed the importance of respect for autonomy. However I will now argue in the specific context of living wills respect for a patient’s autonomy is usually misplaced and that as a result the circumstances in which a patient’s living will should be respected are extremely limited.

A legal will states how someone’s goods are to be distributed after her death. A living will states someone’s preferences as to how she wishes be treated if she ceases to able to give fully informed consent for herself. The terms ‘living will’ and ‘last directive’ have the same meaning. In this posting I will use the term ‘living will’ as I believe this term best reflects our intuitive ideas. In the U.K. the validity of living wills is recognised by The Mental Health Act of 2005 and The Department of Health’s ‘Reference Guide to Consent for Examination or Treatment’ page 10. A living will is only valid if it refers to the treatment proposed and the will maker was competent at the time she made her will. If a patient is competent this usually means she meets the requirements of the so called C test (Re C, [1994] 1 All ER 819). However in practice there seems to be no way to assess whether a will maker actually meet the standards laid down by the C test at the time she made her will. When considering a patient’s living will it seems she would be regarded as competent when she made her ‘living will’ provided she was autonomous at the time.

It does not automatically follow from the fact that, we should respect someone’s current autonomous decisions, that we should also respect her past autonomous decisions. Consider the following scenario. Suppose someone is autonomous and signs and gets witnessed a document specifying how her vote should be cast in any future general election if she suffers from dementia at the time. It might be assumed for the sake of argument that this person has always supported only one party. At the date of a future general election such a document would be meaningless even if the person involved actually did suffer from dementia. However such a document seems in some ways to be analogous to a living will. This example suggests that perhaps we need not respect all living wills in all circumstances. I will consider whether we should respect a patient’s will in two sets of circumstances.

1. When a patient has permanently lost her capacity for autonomy. In these circumstances I will argue there are no reasons to respect her living will.
2. When a non-autonomous patient is expected to regain her capacity to make autonomous decisions but has permanently lost her capacity to implement these decisions. In these circumstances I will argue her living will need only be respected when the treatment or non-treatment specified in her will is irreversible.

Consider an elderly patient with dementia who catches pneumonia. Let it be assumed that this patient’s dementia means she has permanently lost her capacity to make or implement autonomous decisions. Clearly such a patient cannot give valid informed consent. Let it be further assumed her doctors believe provided she is placed on a ventilator for a short time she will recover and be able to live in the state she was in immediately prior to catching pneumonia. Let it be still further assumed that prior to her becoming demented this patient made a living will specifying that in these precise circumstances she was not to be placed on a ventilator in order to prolong her life. Lastly let it be assumed that this patient, prior to catching pneumonia, enjoyed simple pleasures such as sitting in the garden even if prior to becoming demented she hated gardens and enjoyed mountaineering. Under current legislation and medical guidelines it would seem such a patient should not be placed on the ventilator even though she had a reasonable quality of life.

I wish to question whether respecting the living will of such a patient is really connected to respecting her autonomy in circumstances when she will never be autonomous again? In what follows accepting or respecting someone’s decisions refers to decisions that do not harm others unless stated otherwise. Let it be accepted the reason why we respect someone’s living will is in order to respect her informed consent decision. Let it be further accepted the reason why we should respect someone’s informed consent decision is in order to respect her autonomy. I have previously argued that making autonomous decisions does not require any great intellect and that autonomous decisions need not of necessity be good decisions, see my posting of 01/07/08. It follows before a doctor thinks about respecting a living will she must first be totally sure the patient is non-autonomous. However let it be assumed our patient is clearly non-autonomous. Does respecting this patient’s living will respect her autonomy? Clearly it does not respect any autonomy she now possesses because she is non-autonomous. Does then respecting her living will respect her previous status as an autonomous person? The answer to this second question is yes. However the answer to this second question suggests a third question. If it is accepted that we should respect someone’s status as an autonomous person does this mean we should also respect her previous status as an autonomous person? In order to answer this third question we should consider a fourth question; why do we respect someone’s status as an autonomous person?

We do not respect someone’s status as an autonomous person on a mere whim but because we believe autonomy has value. Autonomy has both instrumental and intrinsic value. However in the case of a patient who is non-autonomous it is hard to see how her previous status as an autonomous person could possibly have any instrumental value to her now. It follows in the context of living wills if we respect autonomy we do so because of the intrinsic value of someone’s autonomy in the past. I have previously argued the intrinsic value of someone’s autonomy depends upon the recognition of her as the kind of person capable of making her own decisions, see my posting of 23/03/08. It follows respecting the intrinsic value of someone’s autonomy means accepting her decisions that do not harm others. Now that we are clear about why we might respect autonomous decisions, in the context of living wills, we are in a position to tackle the question as to whether we should respect someone’s previous status as an autonomous person. Consider someone who has previously made an autonomous decision to prefer x to y. Let it be assumed she changes her mind and makes a further autonomous decision preferring y to x. Clearly we do not respect her autonomy if we fail to accept her current autonomous decision preferring y to x because we feel we should respect her previous autonomous decision preferring x to y. One reason why we fail to respect her autonomy in this case is that we fail to recognise that she is the kind of person capable of making her own decisions. The above suggests we can only respect the intrinsic value of someone’s autonomy at the time she exercises this autonomy. If my suggestion is correct then there are no reasons based on respect for the intrinsic value of autonomy as to why we should respect someone’s past autonomous decisions. It can then be concluded if respect for living wills is based on respect for the intrinsic value of autonomy there is no reason to respect someone’s living will in circumstances in which she has permanently lost her capacity to make autonomous decisions. It can be further concluded in these circumstances the patient’s doctor should make a decision on her behalf based on what is in the patient’s best interests after consulting her relatives.

I now wish to consider whether we should respect living wills in circumstances in which treatment, or lack of treatment, means the non-autonomous patient is expected to regain her capacity to make autonomous decisions whilst at the same time losing her capacity to implement her decisions. Once again I will use an example. The example I will use will be the case of Ms B (Re B, [2002] All ER 449). Ms B suffered from a cavernous haegmangioma. She recovered but the angioma recurred and she became tetraplegic and was placed on ventilator. Prior to being placed on the ventilator she made a living will stating she wished treatment to be withdrawn if she was suffering from a life threatening condition or permanent mental disability or unconsciousness. Ms B regained consciousness and wished to have her ventilator switched off. The hospital trust in question refused. Eventually The High Court agreed that Ms B had a right to have the ventilator switched off and awarded her a small amount in damages for trespass. I now only consider the question as to whether her doctors were correct in ignoring the wishes she expressed in her living will. I will argue the answer to this question is not as straightforward as it might appear.

Let it be assumed Ms B was fully autonomous when she made her living will. Let it also be assumed after being placed on the ventilator Ms B could again make autonomous decisions but that she could not implement these decisions. I believe whether Ms B’s doctors were correct in ignoring, the wishes expressed in her living will depend on whether the effects of her treatment could be reversed. I will argue in contexts in which the effects of a patient’s treatment can be reversed that even if some treatment is undertaken, which runs contrary to the wishes expressed the patient’s living will, the patient’s autonomy might still respected. When treatment is undertaken, which runs contrary to the wishes expressed the patient’s living will, her doctors cannot ask her if she is sure about these wishes. However once the patient becomes capable again of expressing her autonomous wishes her doctors may ask her if her views are unchanged. Moreover in this context if her views are unchanged her doctors can reverse the treatment. The above position is partly analogous to the position in many other fields. In these fields we can still respect someone’s autonomous decision even if we ask her to think again. Once she has thought again we respect her autonomy by simply accepting her decision regardless of whether she has changed her mind or not. How good this analogy is depends on what is meant by being able to reverse the treatment.

It might be assumed that in the case of Ms B the effects of her treatment could be reversed by simply switching off the ventilator. In practice this would have caused Ms B to suffer. Her ventilation should have been reduced slowly whilst at the same time giving her painkillers. It follows reversing some treatments might mean doctors having to employ their medical skills in assisting this reversal. It follows in practice treatment is only reversible if the following three conditions can be satisfied.

1. It is possible to reverse the treatment and leave the patient in a similar condition to that she was in prior to the commencement of treatment. In most circumstances reversing treatment will mean stopping treatment.
2. It is not illegal to reverse the treatment.
3. Any doctors prepared override a patient’s wishes expressed in a valid living will and treat the patient must also be prepared reverse this treatment. This reversal of treatment might involve taking measures to ensure the reversal does not cause the patient unnecessary suffering once she regains the power to make autonomous decisions.

In the case of Ms B I believe her medical team acted correctly by placing her on a ventilator. However her medical team failed to respect her autonomy because they were not prepared to stop the treatment once she regained the power to make autonomous decisions. It can be concluded there is no reason, based on respect for autonomy for doctors to respect a patient’s living will, in circumstances when she is expected to regain her capacity to make autonomous decision provided the proposed treatment is reversible subject to the three conditions outlined above.

I have argued there are no good reasons based on respect for autonomy to respect the majority of living wills. However there are some circumstances in which living wills should be respected provided respect for living wills is based on respect for patient autonomy. Living wills should be respected in all cases in which a patient is expected to be able to regain the ability to make autonomous decisions and in which the effects of her treatment cannot be reversed. Accepting the above would mean non-autonomous patients who state in their living wills that in certain circumstances they should not be resuscitated and who once are expected to regain the capacity to make autonomous decisions again should have their wishes respected. Further examples might include limb amputation and perhaps, though I write this reluctantly, blood transfusion.

GM CROPS, AUTONOMY AND SATISFICING

In this posting examine the issue of GM crops. In it I will not examine the issues directly concerned with growing of these crops. Instead I will examine the different methods used in evaluating whether GM crops should be grown. Proponents of GM crops hold that the production of these crops would give us greater yields produced in a more efficient and environmentally-friendly way. Opponents of GM crops argue the potential risks associated with these crops to health and the environment mean the growing of GM crops should not be permitted. It seems clear opponents and proponents of GM crops stress the importance of different factors in the debate as to whether these crops should be grown. It seems to me this different stress results from using different methods to address the question of whether GM crops should be grown.


Proponents of the growing of GM crops are concerned with choosing the best available option; their opponents are concerned with choosing a safe option. The opponents of the growing of GM crops appear to be using a satisficing strategy, see satisficing, when making their decision. This satisficing strategy may not be explicit but it is implicit in the way the decision is made. Hebert Simon developed the idea of satisficing due to difficulties associated with maximising utility. One of these difficulties was that people find it hard to assign probabilities to various utilities. This same difficulty seems to apply to the debate concerning the growing of GM crops. In this posting I want to ignore more recent concepts of satisficing, such as those of Slote and Pettit, and concentrate on Simon’s original concept. Simon argued that when making a decision we should choose an option which satisfies two conditions. Firstly all the possible outcomes of the chosen option should satisfy us. Secondly we should choose the first option which satisfies the first condition. For example if it is decided the growing of GM crops should be permitted, one outcome of this decision might be increased yields which would to satisfy me, whilst another possible outcome might be environmental damage which would fail to satisfy me. If it is decided not to grow GM crops then one outcome would be no environmental damage associated with these crops which would satisfy me, whilst another outcome would be no associated increase in yields which might also satisfy me. Remember satisficing deals only with satisfaction. In practice I might have preferred an increase in yield associated with the growing of GM crops. Nonetheless I might still be satisfied with retaining present yields.



Proponents of the growing of GM crops sometimes argue the debate concerning GM crops should be a rational debate and that their opponents often raise false or exaggerated fears. Proponents usually assume if this debate was conducted in a more rational manner that they would win the debate. However I have shown what is at issue is not really about the rationality of any decision concerning the growing of GM crops but the manner in which people decide on this issue. Moreover it seems using a satisficing strategy in some circumstances may be completely rational. The real question that must be addressed is this, should we respect the conclusions people reach, if they adopt a satisficing criterion as opposed to a criterion which maximises utility in order to reach these conclusions? Let it be accepted that we should respect autonomous decisions. I will now argue any decision made using a satisficing methodology is an autonomous decision. Autonomy is sometimes simply defined as the second-order capacity of persons to reflect critically on their first-order desires and the capacity to accept or attempt to change these in the light of higher-order preferences and values (1) An autonomous decision might then be defined as any decision made using this capacity. Consider someone who uses this capacity to decide if he is in favour of permitting the growing of GM crops. Let it be assumed due to the complexities involved he makes a decision but that he remains unhappy with his decision. Using the above definition of an autonomous decision such a decision is an autonomous decision, however intuitively such a decision is not an autonomous decision. The reason being if someone is unhappy with his decision it seems it would be hard for him to identify this decision. It might be objected in reality there are no such thing as autonomous decisions, there is only a capacity for autonomy, meaning this situation couldn’t arise. However accepting this objection would make nonsense of the modern world which relies on autonomous decision-making.



Let it be accepted that in practice there are autonomous decisions and that autonomy does not simply mean a capacity for autonomy. Accepting the above does not automatically mean we must accept our intuitive idea that an agent must identify with his autonomous decision. However autonomous decision-making is about self-government and it is again hard to see in practice how any decision the agent doesn’t care about can be part of his self-governance. It follows the idea of an autonomous decision making seems meaningless if the agent doesn’t care about his decisions. Frankfurt argues if someone cares about something he identifies himself with what he cares about (2). It might be argued Frankfurt sees autonomy as a hybrid concept, a cross between reflection and caring about. He further argues that to identify with something an agent must be wholehearted. He defines wholeheartedness as follows:

In what does his wholeheartedness with respect to these physic elements consist? It consists in his being fully satisfied that they, rather than others that inherently (i.e., non contingently) conflict with them, should be among the causes and considerations that determine his cognitive, affective, attitudinal and behavioral processes (3)

Frankfurt then proceeds to define satisfaction as follows.

What satisfaction does entail is an absence of restlessness or resistance. A satisfied person may be willing to accept a change in his condition, but he has no active interest in bringing about a change.

It seems to me provided someone is satisfied with his choice in the way Frankfurt defines above that he must be satisfied with all the outcomes of his choice. Any agent who was not satisfied with all the outcomes of some choice he makes would surely encounter some lingering desire to alter his choice. Moreover the agent’s choice must the first one he makes for he has no active interest in choosing again. It follows any decision meeting Frankfurt’s criteria for being wholehearted also meets Simon’s satisfying criteria. In the light of the above it might be suggested that any decision made using a satisfying criteria also meets Frankfurt’s criteria for being autonomous. Such a suggestion would be false. It seems it would be perfectly possible for me to make a decision to buy an ice cream using a satisficing strategy. However Frankfurt would argue such a decision was not an autonomous decision. He argues “the notion of caring, implies a certain consistency or steadiness of behaviour, and this presupposes some degree of persistence” (4). A desire for an ice cream usually has no persistence. If I fail to buy one I move on and my desire for ice cream simply fades. It follows any decision meeting Simon’s satisfying criteria does not automatically meet Frankfurt’s criteria for being autonomous. However a persistent decision meeting Simon’s satisfying criteria would also meet Frankfurt’s criteria for being autonomous. It has been accepted above that we should respect autonomous decisions. It can therefore be concluded that should we respect the persistent conclusions of people reach by adopting a satisficing attitude. It can be further concluded that in any debate about the growing of GM crops that it is perfectly legitimate for someone to use a satisficing strategy in order to make his decision even if this means he does not maximise utility.

What lessons can be learned from the above discussion? I myself believe the opponents of the growing GM crops greatly exaggerate the dangers involved. Nonetheless if the proponents of GM crops wish to win the debate their main emphasis in this debate should not be on the benefits of these crops. The proponents of these crops must concentrate on issues directly concerning the safety of growing GM crops. They must concentrate on their opponent’s ground. Moreover the same is true of any advance which the public finds hard to understand the issues, such as the future of nuclear power or human genetic enhancement, see my previous postings.

1. Dworkin, 1988, The Theory and Practice of Autonomy. Cambridge University Press.1988, page 20.
2. Harry Frankfurt, 1988, The Importance of What We Care About. Cambridge University Press, page 83.
3. Frankfurt, 1999, Necessity, Volition, and Love. Cambridge University Press., page 103.
4. Frankfurt, 1988, page 84.

Autonomy and Caring Revisited

In this posting I want to examine whether an ethics based on empathic caring is possible and the relationship between empathic caring and Frankfurt’s ideas of ‘caring about’. Mackenzie and Leach Scully make the following two assumptions (1).

1.      There are no mental events without bodies.

2.      Imaginative prospective is based on personal experience.

I accept both of these assumptions. Mackenzie and Leach Scully then proceed to question whether because any system of morality, based on empathic or sympathetic caring, is possible because our empathic or sympathetic concerns are based on our own bodily experience. Intuitively Mackenzie and Leach seem to be correct for prima facie it seems hard for someone who is healthy and not disabled to imagine the prospective of someone who is in a wheelchair or suffers from dementia.

“The epistemic obstacles to imaging being another are so significant as to make this mode of imaginative engagement highly implausible as a basis for our capacity to morally engage with others.”(2)

They then proceed to argue due to these obstacles we should adopt an attitude of asymmetrical reciprocity towards others. They define asymmetrical reciprocity as the recognition of the other as a person, with distinctive point of view shaped by that person’s history, social situation, life experiences and relationships with others. I accept these obstacles do indeed present significant barriers to a caring morality based on empathy or sympathy. Nonetheless I will argue even if we adopt an attitude of asymmetrical reciprocity towards others that a caring morality is possible. However I will firstly argue these obstacles mean we must give greater importance to autonomy than some people who propose a caring morality, such as Gilligan and Slote, would favour.

Adopting an attitude of asymmetrical reciprocity towards others means we must adopt an attitude of epistemic humility towards others according to Mackenzie and Leach Scully. This attitude means we cannot merely imagine ourselves in someone else’s shoes when trying to understand her attitudes towards events in her life. I will now argue if we adopt this attitude towards someone then we must respect her autonomous decisions. Adopting an attitude of asymmetrical reciprocity towards someone is not the same as uncritically accepting her views for these views may be the result of coercion or delusion. Let it be assumed that the views of someone are not the product of delusion or coercion. Let it be further assumed we recognise these views but see no need to accept any actions that flow from these views even if these actions do not harm others. It seems clear that in this situation we do not have an attitude of epistemic humility. Indeed our attitude might be classed as arrogant. Moreover if we do not have an attitude of epistemic humility towards someone in these circumstances, which involves accepting her views and actions provided her actions do not harm others, then adopting an attitude of asymmetrical reciprocity seems to serve no useful purpose. It follows if an attitude of asymmetrical reciprocity is serve any useful purpose that provided an agent is un-deluded and is un-coerced we should adopt an attitude of epistemic humility towards her views and accept any actions that flow from these views that do not harm others. It follows if we do adopt an attitude of epistemic humility towards someone which involves accepting her views and the actions that flow from them that we of necessity must respect her autonomy.

In a previous posting I argued if I care about an adult in a purely empathic way I must care about what she cares about, rather than what I think might be in her best interests, see caring based solely on empathy . In what follows an adult means an un-deluded and un-coerced adult unless stated otherwise. Caring about such an adult in this way means I have adopted an attitude of epistemic humility towards her. I argued adopting an attitude of empathic caring has two important conditions for respecting someone’s autonomy. It follows these conditions also apply if I have an attitude of epistemic humility towards someone. Firstly even if I believe her best interests clash with her autonomy I must give precedence to respecting her autonomy over acting beneficently towards her. Secondly I must respect someone’s actual decisions rather than just her capacity for autonomy.

Many feminist and other philosophers who favour a caring ethic would find accepting these two conditions difficult. They would argue respecting autonomy does not automatically mean giving preference accepting autonomous decisions over acting in a caring manner, acting beneficently. A philosopher who favours a caring ethic might argue it is still possible to respect autonomy whilst not respecting all autonomous decisions. She might for instance argue one should respect someone’s capacity for autonomy rather than respecting all his autonomous decisions. This might involve helping people to develop the specific capacities needed for good reflective decision making and creating the conditions in which this type of decision-making can flourish. Michael Slote argues that respecting autonomy is like this and somewhat analogous to helping children to become fully independent (2). Let it be accepted that autonomy is simply defined as someone’s second-order capacity to reflect on her desires and to accept or change these desires in the light of her goals and values. Accepting such a definition means it might be possible to respect autonomy whilst not respecting all autonomous decisions. The trouble with accepting such a simple definition of autonomy is that there seems to be very little to differentiate autonomy from an individual’s capacity for practical reason. Using this definition means an autonomous action might be simply defined as the product of extra careful practical reasoning. It can be concluded such a concept of autonomy would be wholly instrumental.

It is usually accepted that autonomy has both intrinsic and instrumental value. I will now argue that to respect autonomy means one must respect the intrinsic value of autonomy and that this cannot be achieved by simply respecting someone’s capacity for autonomy. Harry Frankfurt believes the intrinsic value autonomy depends the recognition of us by others as the distinctive kind of creatures who can determine their own futures (3). It follows respecting the intrinsic value of someone’s autonomy might be defined as us accepting that she is the kind of creature capable of determining her own future. Let the above definition of respecting the intrinsic value of autonomy be accepted. Let it also be accepted that some of an agent’s autonomous decisions are respected and some are not. It follows that the agent is not recognised as someone who is capable of determining her own future and the intrinsic value of her autonomy is not respected. It might be objected that even if this argument is valid the first premise should be amended as follows. The intrinsic value of autonomy might be defined as accepting that someone is the kind of creature capable of only partially determining her own future. It might then be argued even if not all of an agent’s autonomous decisions are respected that nonetheless the intrinsic value of her autonomy might still be respected. However there are two problems with accepting this revised definition. Clearly if none of someone’s autonomous decisions are accepted then her autonomy is not the respected. This raises the practical problem about which of her decisions must be respected. Secondly children can partially determine their own future and are not recognised as fully autonomous creatures. For these reasons it seems the amended definition should be rejected and the original definition accepted. It follows that if an agent is not recognised as someone who is capable of determining her own future that the intrinsic value of her autonomy is not respected.

However feminist and other philosophers, who favour a caring ethic and find giving precedence to respecting someone’s autonomy over acting beneficently towards her, might argue we should only respect the instrumental value of her autonomy. This means helping people to develop the capacities needed for good decision-making and helping create the conditions in which this type of decision-making can flourish. I believe respecting autonomy cannot be simply reduced to respecting the instrumental value of autonomy for three reasons. Firstly someone who does not have her autonomous decisions respected might intuitively feel her autonomy was not being respected. Secondly Mackenzie and Leach Scully suggest we adopt an attitude of asymmetrical reciprocity towards others. It would seem impossible to adopt such an attitude if we fail to recognise the autonomous decisions of others. Indeed by not respecting someone’s autonomous decisions we might be classed as being exhibiting epistemic over-confidence rather than epistemic humility for instead of listening to the needs of others as perceived by them we substitute the needs we perceive them to need. Lastly if we only respect the instrumental value of autonomy it might be questioned if the concept of autonomy plays any useful part in determining our actions for as I argued above respecting our instrumental autonomy seems to differ little from respecting practical rationality. It follows if we regard autonomy simply as instrumental autonomy that we have no use for the concept of autonomy.

I have argued if we adopt an attitude of epistemic humility towards others we must respect their autonomous decisions. It might then be further argued that adopting an attitude of epistemic humility towards others means we are unable to act beneficently towards them. This second argument depends on the assumption that because we cannot imagine ourselves in someone else’s shoes we cannot understand her true interests. Accepting this second argument would of course mean any caring ethic is meaningless. Moreover because someone’s interests are unrecognisable to us respecting her autonomy might also become impossible. In order to examine this second argument we must consider the assumption that because we cannot imagine ourselves in someone else’s shoes we cannot understand her interests. Let us examine a particular case. Consider a soldier who has been returned from the war in Afghanistan after losing both his legs. It seems to me that adopting an attitude of epistemic humility towards him does not mean we cannot understand most of his interests. We can understand his sense of grief at the loss of a friend or at a more mundane level his hunger. It might then be questioned if we understand his needs whether an attitude of epistemic humility is indeed the correct attitude to adopt towards such a soldier. I believe an attitude of epistemic humility is the correct attitude to adopt because even if, we can understand most of his interests, we cannot understand the priorities he gives to these interests. For instance if I was a colleague of this soldier we both may have given a high priority to physical fitness and a low priority to learning in the past. However the soldier’s priorities may now have now changed due to the loss of his legs whilst mine remain the same. It seems possible to conclude using this example that the epistemic obstacles to imaging being another are not that we are unable to understand another’s interests but rather that we are unable to understand the priorities she gives these interests. Accepting the above conclusion means adopting an attitude of epistemic humility towards others does not mean we are unable to act beneficently towards them. It can be further concluded the obstacles raised by adopting an attitude of epistemic humility towards others do not present significant barriers to a caring morality based on empathy or sympathy.

1.      Mackenzie, Leach, Scully, 2007,Moral imagination, Disability and Embodiment; Journal of Applied Philosophy, 24(4)

2.      Michael Slote, 2007, The Ethics of Care and Empathy, Routledge, page 60.

3.      Harry Frankfurt, 1999, Necessity, Volition, and Love, Cambridge University Press, page 163.

Moral Insanity

In this posting I want to examine the moral implications raised by the behaviour of the Austrian man Josef Fritzl who imprisoned and sexually abused his daughter for 24 years. The idea for this posting is “The stain of moral insanity” by A C Grayling and found in the New Scientist of 17/05/08. Grayling suggests evil simply means a great deal of wrong. Moreover he suggests evil is not a useful term and acts as a full stop on our understanding. It follows he argues describing someone as evil does not capture the moral implications his behaviour. He argues it might be better to regard people such as Fritzl as morally insane rather than simply mad or evil. I will use Grayling’s definition of moral insanity to give two further consistent definitions. I will also briefly examine the implications of these two definitions.

Insanity is not now usually regarded as a medical term. Legally insanity means an agent suffers from a mental disease or defect and does not possess the capacity to appreciate the requirements of the law. Moral insanity is defined by Grayling as follows
“Moral insanity is the refusal to act according to important moral dictates the agent fully understands.”
Grayling’s definition makes no mention of mental illness or defect. It follows Grayling’s concept of moral insanity appears to be unattached to the legal concept. This appearance does not of course mean his concept is not useful in examining the moral implications of the behaviour of people such as Fritzl.

It might be Grayling wants to connect the idea of moral insanity to our intuitive ideas of insanity. Intuitively insanity might be simply said to be acting without any regard for rationality. However it is hard to see how any requirement of rationality, other than understanding what society regards as a moral dictate, is needed by Grayling’s definition. Consider the behaviour of someone like Fritzl with regard to Grayling’s definition. Let it be assumed this person fully understands the moral dictates of society. Let it be further assumed that for someone to act rationally simply means to act in such a way as is likely to satisfy his desires and help him attain his goals. It appears to follow such a person may fully understand these moral dictates but have no reasons, other than prudential reasons, to obey them. Grayling argues the elaborate steps Fritzl took to conceal his behaviour showed he believed what was doing was wrong. It seems reasonable to assume Fritzl was aware society would punish him on account of his actions should these be discovered. It follows it is possible to give a different interpretation of Fritzl’s behaviour. Fritzl had good reasons to conceal his behaviour for his prudential interests. It then follows the steps he took were quite rational based purely on serving these prudential interests. It might then be concluded, provided the two above assumptions are accepted, that Fritzl’s behaviour might be better described as a failure to accept generally accepted moral standards rather than acting irrationally.

However it might be possible to connect rationality with moral insanity if Grayling’s definition is slightly amended. His definition might be amended as follows to give my first definition of moral insanity.

Moral insanity is the refusal to act according to important moral dictates the agent fully accepts.

Prima facie using this definition of moral insanity Fritzl’s actions would be irrational provided he fully accepted these important moral dictates. It is important to be clear about what ‘fully accepts’ means in this definition. Fully accepting something in this amended definition doesn’t simply mean that the agent accepts that some moral dictates are society’s moral dictates but rather that these dictates are his dictates. He identifies himself with these dictates. Moreover if someone identifies himself with a course of action in line with these dictates then rationally he should undertake this action in circumstances in which he is able to do so. Using this amended definition it might be useful to class someone, who acts contrary to moral principles he accepts, as morally insane due to his lack of rationality. However in practice such clear cut circumstances are rare. As a consequence it seems doubtful if my first definition of moral insanity would apply in many cases. Moreover whilst it is possible to check if someone acts logically it would seem to be difficult to assess whether someone’s actions are instrumentally rational. It follows in such cases it might be more useful to question whether the perpetrator is autonomous rather than morally insane.

I suggested above that intuitively insanity might be simply defined as someone acting without regard for rationality. I then assumed an agent acts rationally if he acts in such a way as is likely to satisfy his desires and help him attain his goals. However if this assumption is rejected might it be possible to connect an agent’s refusal to act according to important moral dictates with our intuitive ideas of insanity in a more meaningful way? Let it be assumed the above assumption is incorrect by assuming Kant is correct in believing that morality is based on the rational recognition of universal moral norms. It follows Fritzl is defective because he is unable to correctly apply universal rationality. It further follows Fritzl’s actions might be intuitively considered as insane due to this inability to recognise rational moral norms. It still further follows if morality is based on universal rationality that the idea of moral insanity based on rationality might indeed be a useful concept. However the rational recognition of universal moral norms would seem to be something few, if any, could achieve in practice. It follows that in normal circumstances if we question someone’s ability to act rationally we assess his ability to use practical rationality. Let it be accepted if we question someone like Fritzl’s ability to act rationally we should use the same standard as we use to assess the rationality of others. It can then be concluded if we question someone like Fritzl’s ability to act rationally we should assess his ability to use practical rationality.

I have argued someone like Fritzl and sociopaths in general seem perfectly able to use practical rationality. It follows it would be wrong to class such persons as insane, or morally insane, provided they are capable of using practical rationality. However it still seems to me that the idea of moral insanity might be useful. Legal ideas on insanity mean that an insane person suffers from mental disease or defect and does not possess the capacity to appreciate the requirements of the law. I have argued that sociopaths do not usually have a defect of rationality. However sociopaths may be defective in other ways. Sociopaths may be defective because they lack sympathy and empathy for others. Slote argues actions are morally wrong and contrary to moral obligation, if and only if, they reflect or exhibit or express an absence of a fully developed empathic concern for others on behalf of the agent, see previous postings. Provided Slote’s argument is accepted then someone such as Fritzl and sociopaths in general are morally defective because they are unable to feel empathy for others. It follows the whole idea of morality makes no sense to such persons. It is now possible to give a second definition of moral insanity based on an inability to feel empathy for others.

Someone is morally insane if he acts contrary to accepted moral dictates he understands due to his inability to feel empathic concern for others.

It is important to be aware of two important properties of this definition. Firstly this definition makes no mention of rationality. Secondly this definition differs significantly from the legal definition of insanity. Legally in order to be considered insane someone must not only have some mental defect, in our case no capacity to feel empathy, but also not understand what the law requires. A sociopath might well understand the requirements of the law and have a defect in empathy, but is this defect a mental defect? It follows a sociopath might be considered as morally insane but as legally sane, depending on whether we regard an inability to feel empathy as a mental defect or not.

I will now consider the practical implications of accepting this second definition of moral insanity. Firstly it seems to me if we accept this definition then we have a duty to see the circumstances in which moral insanity arises are minimised. In practice this means trying to foster circumstances in which children grow up to be able to empathise with others. To do this we must address social problems such as struggling single parents, social isolation and poverty. Secondly accepting this definition carries certain dangers. If we regard someone as defective because he is incapable of empathic caring then we might also regard him as different from others in a particularly important way. If I lose a leg I am defective with regard to walking but I am not defective with regard to being essentially human. The same does not seem to be true of a sociopath. Furthermore if morality is in some way based on empathy, the fact a sociopath is defective with regard to empathising, might mean we would find it difficult to include him within our sphere of moral concern. See Slote and empathising with an alien, mentioned in an earlier posting. Returning to Grayling’s concerns the term sociopath might indeed act as a full stop on our understanding. Perhaps if evil is also seen as a full stop on our understanding it would be right to describe sociopaths as evil. The dangers of labelling people as evil are all too well illustrated by considering Nazi Germany. The dangers of seeing people as evil and beyond our moral understanding are real and present a challenge to those of us who see morality as based on empathic caring. In this case all that can be done is to admit sociopaths may indeed be evil, beyond our moral understanding, but we should never the less include them in our moral concerns. After all we may be morally concerned about the environment even if the environment has no moral concerns.