Terrorism, Love and Self Delusion

Recently Irish republican dissidents have murdered two British soldiers and a policeman. It is important to combat these crimes; this of course involves law enforcement. But these crimes can also be combated by preventing the circumstances in which they are likely to arise. As a philosopher I believe in order to do this it is necessary to try and understand the motives of the people involved. These murders have been condemned as cowardly by Gordon Brown and large sections of the British Press. However if we are to understand the motives of these people then we must be accurate in the way we describe them. It seems to me to be both inaccurate and intellectually lazy to describe such people as cowardly. It takes courage to commit suicide; cold blooded murder, however wrong, also takes courage. In this posting I intend to examine the murderers’ motives from a philosophical standpoint. In particular I will suggest these murderers’ motives are often linked to their self esteem.

Ask these murderers about their motives and they would probably say it is to drive the British out of Ireland and bring about a united state in which all Irish people can live in happy harmony. The question must then be asked can any rational person believe, after truthful reflection, that killing soldiers and police officers is likely to further this cause. The answer is an emphatic no. This no is evidenced by the change in attitude of Gerry Adams, Martin McGuinness and the provisional IRA. It follows our murderers are either not truthful or irrational. They appear to be rational enough to plan and execute their murders. It further follows if they are not irrational then they are untruthful. However they are not untruthful in a straightforward way by lying to others. They are untruthful to themselves. They are deluding themselves as to their true motives.

If we are to understand the motives of these murderers then we must first of all understand them as people. This means we must be careful with our rhetoric and not get carried away by regarding them as cowardly animals totally unlike ourselves. It seems evident such people are failing to flourish and suffer from a poor self image. This failure to flourish may be due in part to a deprived background. This deprivation may be due to poor educational opportunities or a lack of meaningful jobs. However it may also be due to a lack of love. The two are not unconnected poor and poorly educated parents who lack meaningful opportunities may sometimes find it hard to love. The natural response by those suffering from a poor self image is to try and improve it. One way such people may try to improve their self image is by devoting themselves to a cause such as a prosperous United Ireland. By doing so they might see themselves as heroes. I have suggested above if they do so they are dishonest with themselves. The way in which they are dishonest with themselves is that they fail to give adequate weight to all their reasons for action. This failing may be simply due to laziness or self indulgence. A failure to consider all the means that possibly might achieve their goal allows them to select a means specifically intended to indulge an image of themselves as heroes. Moreover this indulgent self image is self deceiving because it is not a true self image. An accurate self image depends on the agent considering all the options open to him, including the unpalatable ones. However an accurate self image is not the one these people seek, rather they seek an image of which they themselves approve.

I have argued these people have the virtue of courage. But courage is a self regarding virtue, an instrumental virtue, that can be used for good or evil. The virtue such people lack is love as they seem unable to feel empathy or sympathy for their victims. It might be objected the above conclusion is false and that they love the cause of a United Ireland. In order to address this objection it is necessary to briefly consider the nature of love. The love in question is not of course erotic love but rather the love of a mother for a child or perhaps, with particular resonance to this posting, the love of a patriot for his country. This type of love is a type of “caring about” in the way considered by Frankfurt.

“Love is, most centrally a disinterested concern for the existence of what is loved, and what is good for it. The lover desires that his beloved flourishes and is not be harmed; and he does not desire this just for the sake of promoting some other goal.” (Frankfurt, H. 2004, The Reasons of Love, Princeton University Press, page 42)

It is important to be clear what is meant by disinterested in this context. Disinterested does not mean the lover is not harmed if his beloved is harmed. It follows natural empathy can be an example of love. Love of this sort is characterised by a kind of satisfaction according to Frankfurt.

“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” (Frankfurt, H. (1999) Necessity, Volition, and Love, Cambridge University Press, page 103)

We are now in a position to see why the sort of love possessed by the people who kill others in the cause of a United Ireland is not a genuine kind of love. The reason being it is not a disinterested kind of love. Their love of Ireland originates in a need to bolster their self image. In addition this love is not characterised by simply being satisfied but rather by a need to be self satisfied.

I have argued that the sort of love possessed by dissident republican killers is not genuine love. However I have also argued it is wrong to characterise such people as cowardly and that indeed they may act bravely. The question might then be raised do these people need the excuse, of loving a United Ireland in order to consider themselves, or to be considered by others, as heroes. It seems clear that bravery alone is not enough for someone to be considered as a hero. Bank robbing is not for the timid. One needs some courage to rob a bank but bank robbers are no heroes. Intuitively a heroic action is an action is carried out for some cause. An agent’s self interest is not a suitable cause. Someone may be a hero for saving someone from drowning none the less he is not a hero for saving himself from drowning. It follows the cause must be something the hero is concerned about in a disinterested way. It further follows if we adopt Frankfurt’s concept of love used above then by definition a hero is someone who acts bravely because of love. It might be objected my definition is too restrictive because it means a soldier fighting for a clearly unjust cause can never be considered to be a hero. I believe this objection to be groundless. A soldier who acts with extreme bravery in the pursuit of unjust cause he does not love is no hero. Indeed it might be questioned whether he is very rational and that his bravery might be better directed elsewhere. Never the less a soldier fighting for unjust cause he does not love may still be a hero. He might act bravely to save colleagues he loves for instance. A dissident republican murderer does not act to save colleagues he loves. It follows if my definition of a hero is accepted that it is not justifiable to consider such people to be heroes as they lack genuine love.

If my analysis of the motivation of these murderers is accepted does it allow us to take any useful steps, in addition to law enforcement, to reduce such crimes? This might be attempted in two ways. Firstly by helping to reduce the number of people suffering from low self esteem. And secondly by showing violence in practice hinders the cause of a United Ireland.

I have argued one of the causes of low self esteem is deprivation. This deprivation may be due to a lack of meaningful opportunities or parental love. It is of course true not all people who lack opportunities or who have suffered from poor parenting lack of self esteem. Never the less deprivation does play some part in the development of low self esteem. All good governments as a matter of course seek to improve the number of meaningful opportunities open to their citizens. It follows my considerations of self esteem are not useful with regard to meaningful opportunities. Self esteem also depends on being loved and wanted. Deprived and inarticulate parents often find it hard to give or to express their love. It is difficult to help deprived parents who are unable to love. However more might be done about inarticulate parents unable to express their love. The government’s SureStart program, the responsibility of the devolved assembly in Northern Ireland, seeks to improve health and emotional development of young children, see www.surestart.gov.uk. This Program seems a good place to help mostly mothers, but also fathers, express their love as the emotional development of children is part of SureStart’s remit. If the SureStart program is to successfully fulfill this part of its remit then any SureStart scheme for pre school children must not be simply seen as a form of childcare enabling mothers to work and get off benefits. It must encourage the mother’s active participation. This participation should mean mothers participating with children and other mothers rather than taking part in any form of administration. Such participation alone might aid inarticulate mothers express their natural love for their children and so foster self esteem.

If parents express love for their children these children will automatically feel wanted. However a few parents even with help might find this hard to do. Perhaps then schools should also help children to feel wanted and by so doing help increase their pupil’s self esteem. Almost all schools have policies concerning pupils respecting other pupils and teachers. It might be argued such a policy of respect naturally fosters self esteem. Any such argument seems to me to be simply rhetoric. Respect is important but self esteem depends on feeling loved and wanted. It is perfectly possible to respect someone without any feelings of love for that person or needing her. Schools are not in the business of loving. It might be objected if loving is the same as Frankfurt’s “caring about” then schools should be in the business of loving. Regardless of whether schools are in the business of loving they can foster a sense of being wanted by their pupils. This sense of being wanted cannot be fostered by only respecting their pupils but must involve actively seeking to include all pupils in a school’s activities. Great stress is now placed on pupils achieving five good GCSE passes. Helping pupils obtain such passes is important but it does not contribute to making them feel wanted. To make pupils feel wanted schools must have a broad range of activities so at least one of these activities will be of interest to most of their pupils. If pupils can contribute to something which interests them then they are more likely to feel wanted by their school and this in turn might help bolster their self esteem. This range of activities should include drama, sport, music, participation in the community and craft or trade based options for the less academically able. It might be argued this would be difficult to do in the present economic circumstances. I believe this broadening of activities should be attempted even if money has to be diverted from more academic concerns. It might be argued by some that my concern as to whether or not schools make their pupils feel wanted has very little connection with terrorism. I would disagree recent research by Traci Wike and Mark Fraser on American school massacres, suggests the more attached a school’s pupils are to the school, the more they feel needed, the lower the risk of a school massacre, see New Scientist of 21/03/09.

The above measures are long term but none the less it is important that they are implemented now if future generations are to be protected from terrorism. Are there any more short term measures which might prove useful? It seems self evident that a campaign of violence will never result in a United Ireland due to the large number of Protestants living in Ulster; though perhaps a United Ireland might be reached slowly by other means. I have argued that dissident republican killers seek to improve their self image by devoting themselves to the cause of a prosperous United Ireland and by so doing they see themselves as some sort of heroes. In so doing they delude themselves. It is difficult or nigh impossible to reason directly with the deluded. However it is also nigh impossible for someone to delude himself unless he has at least some others supporting his delusion. For instance it would be almost impossible for a paedophile to believe his actions cause no harm due to the lack of any others supporting his belief. The above suggests if those who support the killers’ delusions can be shown, that the cause of a United Ireland is set back by violence and hence cease to give their tacit support for this belief, then perhaps such peoples’ delusions might be indirectly eroded. In conclusion I have dealt only with dissident republican terrorists in this posting but my comments can easily be transferred to other terrorists groups such as Al Qaida.

Assisted Suicide, Slippery Slopes and Empathic Caring

This posting is in part a response to a program on BBC 1 on Sunday 25 January 2009. This program is about the death of Dr Anne Turner who ended her life in Switzerland with the help of the Dignitas clinic. I want to use the death of Dr Turner as a starting point to examine slippery slope arguments. I will argue the success or failure of these arguments depends upon the moral background involved. However before proceeding it is important to make some distinctions. Euthanasia usually means helping severely-ill people die. This can be done at their request, voluntary euthanasia, or by taking a decision to withdraw their life support systems. Voluntary euthanasia can occur in two ways. Firstly actively killing the patient or secondly by providing him with the means by which he can end his own life. The latter might be more accurately described as assisted suicide. Clearly Dr Turner’s death was a case of assisted suicide.

There are generally two types of argument employed against the permissibility of assisted suicide. The first type is faith based. These arguments are usually based on beliefs concerning the sanctity of life or that God alone can decide whether someone should die. It might be remarked that many born again Christians, especially in the USA, have such beliefs but bizarrely also believe in capital punishment. It would seem that to some people such faith based arguments are in reality convenient rather than deeply held. I intend to ignore all faith based arguments and treat them as irrelevant. The second type of arguments, commonly used against the permissibility of assisted suicide, are slippery slope arguments. The central concern of this posting is whether slippery slope arguments against the permissibility of assisted suicide are good arguments.

There are basically two types of slippery slope arguments. Firstly some minor action may be wrong. Tolerating such a minor action leads to a slippery slope opening the way to some unwanted consequences. However it seems provided we ignore faith based reasons against the permissibility of Dr Turner’s assisted suicide that her action was not a wrong action when considered in isolation. Indeed I would argue when considered in isolation her action was both good and brave. Secondly some action, though not wrong in itself, causes other unwanted consequences. For instance it might be argued if we permit people like Dr Turner to undergo assisted suicide then old and vulnerable people will be encouraged to seek assisted suicide even if this contradicts their true wishes. It is only this second type of slippery slope argument I wish to consider.

Let us first consider the validity of the slippery slope argument in the context of a consequentialist account of morality. In this context the unwanted consequences of the slippery slope are harm to others. I will assume that if Dr Turner’s assisted suicide was considered in isolation it would be justified in consequentialist terms. Further it seems clear that the manner of her death cannot be said to directly cause vulnerable old people to seek assisted suicide against their true wishes. However let it be assumed Dr Turner’s assisted suicide means it is more probable that vulnerable people might be encouraged to seek assisted suicide against their wishes. The question to be answered is this, if we accept both the above assumption and adopt a consequentialist account of ethics is the slippery slope argument a good argument? Before answering this question I want to qualify the above assumption. It is clearly dangerous to equate someone’s wishes with his so called ‘true wishes’ when we in part define his ‘true wishes’ to be the wishes he would have had provided he thought more rationally about these wishes (1).  Clearly some people have a wish to end their lives peacefully and we disrespect them if we believe this to be a false wish. However I accept that Dr Turner’s assisted suicide means it is possible that some vulnerable people will be encouraged to seek assisted suicide against their wishes. It follows though Dr Turner’s action was not wrong when considered in isolation it might cause harm to others. Accepting the above leads to the following conclusion; provided the benefits of permitting assisted suicide are outweighed by the harms caused to vulnerable elderly people means the slippery slope argument may well be a good argument in a consequentialist context.

I now want to consider Dr Turner’s action in a different moral context. This context assumes that the basis of morality is based on caring. Further this caring is affective being based on either sympathy or empathy. Once again I will assume that Dr Turner’s action was not wrong in isolation. Is the practice of assisted suicide permissible in this moral context? Michael Slote defines an action to be morally wrong and contrary to moral obligation if and only if it reflects, exhibits or expresses an absence of a fully developed empathic concern for (caring about) others on behalf of the agent (2). I believe this definition adequately defines any system of caring morality subject to suitable substitutions, for instance sympathetic concern might be substituted for empathic concern. Prima facie it might be concluded using the above definition that any action, prohibiting a terminally ill patient who genuinely wishes to undergo assisted suicide from doing so expresses an absence of a fully developed empathic concern for the person involved. It follows in this context prohibiting assisted suicide is wrong and that Anne Turners actions were perfectly justified if we ignore any possible slippery slope arguments.

Are slippery slope arguments good arguments if our moral concerns have an affective basis? It is important to note that in an affective context slippery slope arguments take a slightly different form to the one used in a consequentialist context. In a caring context the unwanted consequences of the slippery slope are actions, not the consequences of actions, which fail to exhibit a fully developed empathic concern for others. It might be objected that in a caring context harm to others should be of prime importance. Prima facie it would seem that if caring actions are of prime importance that harm to others will be automatically considered. I will now consider two objections to the above conclusion. The first objection does not involve any slippery slopes. It might be objected empathic caring involves more than simply helping satisfy someone’s desires. For example desires such as Anne Turner’s desire to be assisted when committing suicide. Empathic caring is a deeper concept than it initially appears to be. Accepting this objection might mean it is possible to prevent someone from undergoing assisted suicide whilst still exhibiting empathic concern towards him. Secondly it might be objected, using a slippery slope type of argument, that if we permit assisted suicide due to our empathic concern for some individual we are lead to exhibit a lack of empathic concern for others in particular old and vulnerable people. I will consider the first objection first. There are two points that count against this objection. I have pointed out above it is dangerous to equate someone’s wishes with his so called ‘true wishes’ when we in part define his ‘true wishes’. If we come to equate empathic caring with being concerned with someone’s deeper desires might we not ourselves be partly defining these desires? In these circumstances might we not be accused of exhibiting epistemic arrogance? See my posting of parenting and excessive guidance . My second point is connected to my first and concerns autonomy. I am happy to concede empathic caring involves more than simply helping satisfy someone’s desires. However I am not prepared to concede empathic caring requires that we might give priority to acting beneficently, as defined by us, towards someone over respecting his autonomy. Indeed true beneficence would seem to be impossible without considering an agent’s autonomous desires, see for instance (3) I believe true empathic caring requires that we must give priority to respecting someone’s autonomy over acting beneficently, as defined by us, towards him; see my posting of caring, empathy and love. Once again if we fail to respect someone’s autonomy and instead satisfy his ‘true needs’ we might be accused of epistemic arrogance. It follows that prohibiting a terminally sick person who genuinely wishes to undergo assisted suicide from doing so expresses an absence of a fully developed empathic concern for that person. However the above arguments would fail if our moral concern was based on sympathy rather than empathy. It is possible to act sympathetically towards someone provided we suffer from epistemic ignorance.

It follows that in an emotive moral context whether assisted suicide is justifiable might depend on whether the emotion involved is sympathy or empathy. My remarks concerning epistemic ignorance suggest I prefer a morality based on empathy. I accept that our natural sympathy is the initial basis on which children start to make moral decisions. However as children develop they acquire greater cognitive skills and empathic caring augments their natural sympathy. Moral development is a natural process. Due to this natural moral development I believe empathic caring can form the basis of our moral concern.

I will now consider the second objection to the above conclusion. This objection argues that if empathic caring forms the basis of our moral concern then we might exhibit a lack of empathic concern for the old and vulnerable by permitting assisted suicide. It might be counter argued empathic caring naturally involves giving more weight to immediate concerns rather than theoretical or distant concerns. For instance we naturally have more empathy for someone we actually know rather than people we just know about. This is true but none the less someone might point out our more limited empathic concern about a large number of distant people might still outweigh our immediate concern for some individual we personally know. It appears to follow even if we have great concern for someone who wishes to undergo assisted suicide we might have greater still concern for the large number of vulnerable people who might be encouraged to seek assisted suicide counter to their actual wishes. However it seems to me anyone who employs this counter argument fails to properly understand empathic caring for two reasons. Firstly anyone weighing concerns as suggested above seems to be doing a calculus of empathic caring. Empathic caring employing such a calculus seems to become merely another form of consequentialism. Empathic caring is not a form of consequentialism, indeed it is partly a reaction to consequentialism. Secondly it might be questioned whether prohibiting assisted suicide is indeed a form of empathic caring for old and vulnerable people. I have suggested above that empathic caring might be a deeper concept than it initially appears to be. It seems to me true empathic caring involves actual involvement with old vulnerable people rather than simply banning some action which might or might not harm them. It follows from the above if our moral concerns are based on empathic caring that slippery slope arguments are not good arguments for the impermissibility of assisted suicide.

1. Berlin,1969, Four essays on liberty, The Clarendon Press, page 32.
2. Slote, 2007. The Ethics of Caring and Empathy, Routledge, page 31
3. Welie and Welie, 2001, Medicine Health Care and Philosophy 4(2), page 130

Evil and Empathy

In my last posting I associated evil with moral disability rather than moral insanity as proposed by Grayling in the New Scientist of 17/05/08. I stated it is hard to be angry with someone who is disabled due to her disability. However it appears to follow if my definition of moral disability is accepted that it becomes hard to associate anger with evil. Intuitively anger seems to be a justified reaction to evil, perhaps even a necessary reaction, see Hugh Thompson's  anger in response to the My Lai massacre during the Vietnam War. Further accepting my definition might imply that if someone is morally disabled it is hard to hold her morally accountable for her actions. In this posting I will further examine the ideas of moral disability and understanding in an attempt to resolve these two problems.

In  moral insanity  I defined someone to be morally insane if she acted contrary to accepted moral dictates she understood due to her inability to feel empathic concern for others. In that posting I argued moral disability is a more useful definition than that of moral insanity. I defined someone to be morally disabled if she did not have the capacity to feel sympathy for others when making moral decisions. Critical to both these definitions is what is meant by moral understanding. I have previously argued moral understanding depends on an affective element. It might be objected of course moral understanding should not be dependant on our emotions. Moral understanding should be based solely on reason. This would certainly be the Kantian position. Let it be accepted that moral understanding is based on reasons. Reason and reasons need not be identical. Reasons may be purely logical or simply based on our feelings, emotions. It follows if moral understanding is based on reasons that moral understanding might at least include an affective element.

In order to get a better grip on the idea of moral understanding we must examine moral reasons. Internalism about moral judgement holds if someone makes a moral judgement that x is wrong then she has a motivation not to do x. I believe internalism concerning moral judgements is true. Moreover I doubt if someone who judges that doing x is wrong but has no motivation not to do x truly understands the meaning of moral judgement. In what follows I hold if I have moral reasons not to do x then I am also motivated not to do x. For instance if I believe stealing is wrong I am motivated not to steal. I have argued moral reasons might include an affective element. This affective element can be incorporated into moral theories in different ways. For instance Shaun Nichols believes we base our moral judgements on a set of moral norms and on an affective response to these norms, he calls this system of moral judgement a sentimental rules system (1). A different approach is taken by Jesse Prinz who argues that a moral judgement is right or wrong simply if the agent has dispositions to feel approbation or disapprobation towards it (2). It is important to note that in all moral theories based on our emotions the affective element plays an essential part in moral understanding, remove the affective element and the theory ceases to be a moral theory. Because our emotions play an essential part in our moral understanding according to these theories it follows these same emotions motivate us morally. It further follows my account of moral disability seems to be a perfectly adequate account. Unfortunately it also appears follow if someone is morally disabled using my definition then it is hard to hold her morally accountable for her actions even if she fully understands that society holds that these actions are morally wrong.

Let it be accepted that internalism concerning moral judgements is true. This means if someone makes a moral judgement that x is wrong she has a motivation not to do x. Let it be assumed someone makes a judgement that x is wrong and she has a non-affective motivation not to do x. The question I wish to explore is whether such a judgement could be regarded as a moral judgement. In order to answer this question we must ask why someone judges doing X is wrong. There would seem to be two possible reasons why she should be motivated not to act. Firstly she might judge doing x is wrong for him due to self interest. For instance he might believe stealing is wrong only because he believes she will be caught and punished. In this context her judgement would not be a moral judgement. I will not pursue this option. Secondly someone might judge doing x is wrong because society says doing x is immoral. In this second context she might also be motivated not to do x out of self interest. The question now becomes this, is she making a moral judgement in this second scenario? The answer to this question is important because if we believe she is making a moral judgement we can hold her morally accountable. If we accept Kohlberg’s account of moral development then she is indeed making a moral decision. Stage one of his account is based on an agent simply acting out of obedience or because she fears punishment. In stage two an agent is acting out of self interest. Accepting Kohlberg’s account of moral development means my account of moral disability would need re-examining. Someone whose moral decisions are affect free might be best described as someone whose moral development is stunted. Moral disability then might be a matter of degree much the same as physical or mental disability. It appears to follow that someone might be held morally accountable for some of his moral decisions and not for others. It further follows that not all moral decisions require an affective element. It would still further follow my account of moral disability is at best an inadequate account.

However accepting Kohlberg’s account of moral development creates a problem. This problem occurs because if decisions are made using the means available at stage 1 and 2 of his system there seems little, if indeed anything, to differentiate moral decisions from more conventional decisions. Consider a child who is taught not to hit his younger sister when she pulls his hair. His parents achieve this by withholding their approval and scolding him when he does so. He learns not to hit his sister because he wants his mum and dad’s approval, he acts out of self-interest. When he decides not to hit his sister if she pulls his hair his decision is a moral decision, albeit a primitive one, according to Kohlberg’s account of moral development. Now let us consider the same boy when he learns to use a knife and fork for eating as opposed to his hands. Once again his parents do so by withholding their approval and scolding him when he eats with his hands. Let it be assumed he decides to use a knife and fork for the same reasons he decides not to hit his sister. It follows the structure of his decision-making is identical in both cases. His decision not to hit his sister is a primitive moral decision according to Kohlberg’s account whilst his second decision appears to be one of simple etiquette. However it seems ridiculous to equate moral decisions with those of etiquette. Moreover children soon learn to distinguish between decisions prohibiting harm and more conventional decisions concerning etiquette at an early age, usually between the age of two and three. Further it seems highly improbable that a child learns to make this distinction due to an increase in her cognitive powers because sociopaths who have much greater cognitive capacities than her seem unable to make this distinction. This leads me to conclude that Kohlberg was mistaken in his belief that decisions motivated simply by obedience or self interest can be moral decisions. Moreover the fact that someone can make understand the difference between moral and more conventional decisions at an early age suggests that Kant was wrong to believe moral decisions must be rational decisions. It would seem that moral decisions must include an affective element. It follows my definition of moral disability might be an adequate definition.

Accepting that a moral decision must include an affective element has important implications. Firstly it would seem that some people are totally morally disabled if they feel no adverse emotions at all when harming others. Sociopaths would seem to be totally morally disabled. Secondly I have argued Kohlberg’s account of moral development at stages one and two does not concur with experimental evidence concerning children’s abilities to distinguish between decisions prohibiting harm and conventional decisions. But accepting my conclusion does not imply moral development doesn’t occur and that people cannot be partially morally disabled. Moral development might still occur in two ways. First we might develop new moral emotions. We might for instance come to have feelings of approbation towards those who act altruistically. Secondly we might learn how to understand the contexts, in which moral decisions are made as our cognitive powers increase, better. For instance we might come to see animals as capable of suffering and hence worthy of inclusion in the moral domain. It therefore seems that my initial account of moral disability is an incomplete account and that moral disability might be better described as follows.

1. Someone is totally morally disabled if she does not have any capacity to feel sympathy when making moral decisions.
2. Someone is partially morally disabled if she has only limited capacity to feel sympathy when making moral decisions or lacks the cognitive abilities to fully understand the contexts in which these decisions are made.

In the light of my revised definitions of moral disability I will now consider the two questions I posed at the start of this posting. Firstly if my revised definition is accepted is it appropriate to express anger when the totally or partially morally disabled commit evil acts? The discussion above suggests this question is inappropriate. I have argued if we judge an act as morally wrong that this judgement must include an affective response. It follows judging an act to be evil means we must of necessity feel some emotion. It seems natural to me that this necessary emotional response should be one of anger. It follows anger is an unavoidable response by us if we judge something as evil.

The second question I posed is this. If someone is morally disabled can I hold her responsible for her evil actions? I will answer this question in two parts. First let it be assumed that someone who is morally disabled acts in a mean or evil manner towards me or others and that her actions are not criminal actions. Perhaps for example they spread malicious gossip about me. Let it be further assumed this person is either totally or partially disabled as defined above, perhaps she is autistic. In such a case I believe I should make allowances for the person concerned and not apportion blame. I will of course be naturally angry as argued above. The second part of my answer to the above question is of much greater practical importance. Should we apportion blame to someone who is morally disabled and commits some evil crime? Our legal system is concerned with whether such a person is responsible for her actions. The cognitively impaired and young children are held to not responsible for their actions. The Courts may still take action even if they do not apportion blame. For example a sociopath may be sent to Broadmoor rather than punished. The criteria used in deciding if attaching blame is appropriate are based on determining whether the defendant has and is capable of using the requisite cognitive powers. Sometimes these cognitive powers may be overwhelmed and the legal system allows for this. For instance the case of B who refused to give informed consent to a caesarean section due to her fear of needles (3). In cases such as that of B the question the Court considered whether the defendant’s passions override her cognitive abilities. However in the light of the above I would suggest someone may have perfectly adequate cognitive powers and these are not overwhelmed yet still be morally responsible for her actions. She is morally disabled because she has limited affective capacities to guide her cognitive capacities. Someone who is cognitively disabled cannot be held responsible for her actions. I would suggest similarly someone who is affectively disabled should not be held fully responsible for her actions I would further suggest our legal system should not only be interested in whether a defendant has excessive passions overwhelming her cognitive capacities but also whether she has only limited affective capacities to guide her cognitive capacities. It might be argued that in practice this assessment is difficult, but is it any more difficult than assessing someone’s cognitive abilities? A defendant might well hide her cognitive abilities in order to be found not guilty due to diminished responsibility.

1. Shaun Nichols, 2004, Sentimental Rules, Oxford University Press.
2. Jesse Prinz, 2007, The Emotional Construction of Morals, Oxford University Press.
3. Re B (Adult; Refusal of medical treatment) [2002] All ER 449

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.