Locking Down the Elderly

Julian Savulescu and James Cameron argue that a policy which locked down the elderly whilst allowing greater freedom to younger people during the covid-19 pandemic wouldn’t be ageist, see practical ethics . The purpose of such a policy would be to protect health services from being overwhelmed. They further argue if such a policy isn’t ageist that it isn’t wrong. In this posting I will accept their argument but suggest that an alternative policy would be preferable. Before proceeding I must make it clear that I am over seventy and one of the elderly however I hope this doesn’t affect the validity of my argument. In the rest of this posting I will use the term ‘older persons’ rather than elderly as this better reflects that the elderly remain persons.

Before making my argument I will briefly outline that of Savulescu and Cameron. They base their argument on Aristotle’s principle of equality. This requires that we treat like cases alike, unless there is a morally relevant difference. They use two examples to illustrate the principle. Firstly if men were allowed to vote and women weren’t this would be sexist and wrong because differences in sex don’t make any difference to the capacity to vote. Secondly government investment in screening women for breast cancer whilst not doing the same for men who sometimes also develop breast cancer isn’t sexist or wrong because men are far less likely to develop this cancer. Let us turn to Savulescu and Cameron’s argument that it wouldn’t be ageist to lockdown older persons whilst allowing younger people greater freedom. They point out that because the cost of the lockdown is massive it is desirable to lift the lockdown. Unfortunately lifting the lockdown might result in health services being overwhelmed. They further point that older persons are much more likely to require health services due to covid-19 than younger ones. They proceed to argue that because that older persons are much more likely to require health care that it wouldn’t be ageist or wrong to require older persons to remain lockdown whilst lifting the lockdown for others due to Aristotle’s principle of equality. When considering the need for health services due to covid-19 outbreak there is a significant difference between older persons and others. It follows that it wouldn’t be ageist to follow a policy which discriminates against older persons in this way.

Let us accept that the above is a perfectly good argument. However it would appear that BAME people are dying at twice the rate of others in the UK. If we accept Savulescu and Cameron’s argument about lockdown for the elderly then the same argument could be applied to BAME people. If it isn’t ageist to lockdown older persons then it shouldn’t be racist to lockdown BAME people. Most would be uneasy about accepting such a conclusion. Let us now consider a different policy which achieves the same ends and which might alleviate our unease. Let us assume that older persons are warned prior the lockdown being lifted, that if this leads to an increase in covid-19 cases which threaten to overwhelm the health services, that they might receive a lower standard of care compared to others. This lower standard is justified because of the disproportionate burden they place on these services. This policy means that older persons might be denied places in ICU and just receive palliative care. Older persons would face a choice of whether to self-isolate or not in order to protect themselves. Let us further assume that the lockdown is lifted and this leads to an increase in covid-19 cases which threaten to overwhelm the health services and as a result older persons start receiving a lower standard of care. Should this policy be regarded as ageist? Let us consider Aristotle’s principle of equality in this scenario. Clearly older persons are treated differently to others but are there any reasons which might justify this difference? I would suggest that there are two reasons which might justify treating older people differently. Firstly older persons are much less likely to survive treatment in ICU. Secondly if treatment in ICU has to be rationed then saving a younger patients at the expense of the elderly means saving patients who will usually live longer and can be justified by utilitarian principles. It would appear that if we accept Aristotle’s principle of equality then a policy which discriminates against older persons in this way wouldn’t be ageist.

I’m self-isolating and believe it is sensible for most older persons to remain in lockdown even if the lockdown were to be partially lifted. I have outlined two policies to protect our health services from becoming overwhelmed in both of which it wouldn’t be ageist to discriminate against older persons. Let us assume that each of these policies would be equally effective in preventing the health from being overwhelmed. Which of these policies should we choose if we accept that it isn’t a question of whether to discriminate but rather when to discriminate.

Let us accept that we have good reasons why we should adopt the first policy as proposed by Savulescu and Cameron. It might be argued that following such policy would protect older persons better than the second. It might be pointed out that if the second policy was adopted that older persons would have to protect themselves. In response it might be pointed out if the first policy is introduced that older persons would still have to protect themselves by remaining compliant. Nonetheless let us accept that we have good reason to adopt the first policy. However it is important to note that the reason to prefer the first policy over the second has nothing to do with protecting our health services from being overwhelmed, both policies do this adequately, the reason for preferring the first policy is to do with caring for older persons. If we choose the first policy then we are also acting beneficently.

Do we have any reasons to choose the second policy instead?  I would suggest that we have two. Firstly adopting the second policy might be more effective as it might be difficult to ensure that older persons remained in long term lockdown under the first policy. I won’t consider this reason further here. Secondly it might be argued that preferring the second policy protects autonomy better. Adopting the first policy serves the interests of all by protecting the health services but it doesn’t respect the autonomy of older individuals. It might then be argued that if the second policy adequately protects health services and respects autonomy that we have reason to prefer this policy. Two objections might be raised to the above argument. Firstly it might be objected that the first policy does respect autonomy. Secondly it might be objected that in times of extreme crisis such as this we should give preference to acting beneficently over respecting autonomy. I will now consider both objections.

What it means to respect autonomy depends on the concept of autonomy used. It might be suggested that an autonomous decision is one that is rationally made to concur with the agent’s best interests and is freely made. If we accept a substantive account of autonomy then these best interests include generally accepted interests such as safety and good health. If we accept a substantive account of autonomy then it might be argued that adopting the first policy is compatible with respecting the autonomy of older persons. Older people, if given the choice, would make an autonomous decision to remain in lockdown because it is in their best interests to stay safe and protect their health. I myself would make such a choice. However let us consider an elderly widow who lives alone and who is suffering from terminal cancer. Let us assume that she is still able to visit her family. If the first policy was adopted she would have to remain in lockdown whilst the rest of her family were free to socialise. I would suggest that if such a person could make an autonomous decision whether to remain in lockdown or not she would choose to socialise with her family. When she considers her best interests she might prioritise family life over staying safely in lockdown. It follows that in this case adopting the first policy wouldn’t respect her autonomy. It might be objected that I have used an extreme example and that we should still prefer the first policy.  I am prepared to accept that I have used an extreme example to illustrate my point but I still want to argue that if we prefer the first policy that we fail to respect the autonomy of older persons. Older persons in general have less future time to look forward to than younger people and many might make an autonomous decision, if they were able to do so, to prioritise family life over staying safe.

Let us accept that if we prefer the first policy then we must be prepared to accept either that acting beneficently is more important than respecting autonomy or that we can respect autonomy whilst acting beneficently. If we accept the second option then we must also accept a substantive account of autonomy. I have argued elsewhere that if we accept a substantive account of autonomy that autonomous decisions must be good decisions, see wooler.scottus . An autonomous decision cannot be a bad decision, it must concur with what is generally accepted to be in the maker’s best interests. However if autonomous decisions must be good decisions then the entire idea of autonomous decision making becomes redundant. We just need to consider good decisions. It follows that if we accept that autonomy is to remain a meaningful concept that we must be prepared to accept a content neutral account. It further follows that if we don’t accept that acting beneficently should be given priority over respecting autonomy that we should prefer the second policy.

However it might be argued that in times like these that acting beneficently is more important than respecting autonomy. Two objections might be raised to the above. Firstly if we prefer the first policy are we really acting beneficently towards older persons? An older person might well believe that leading a social life is in her best interests rather than remaining safe for her last few years. If we disagree we might be accused of epistemic arrogance. Secondly if we give precedence to acting beneficently we are taking acting beneficently to mean ‘caring for’ rather than ‘caring about’. People don’t want to be ‘cared for’ in much the same way as pets are they want to be ‘cared about’ as persons and this means taking their interests into account. It follows if we want to act truly beneficently that we should prefer the second policy.

Inner Virtue and Private Racist Thoughts

 

In this posting I want to consider Nicolas Bommarito’s idea of inner moral virtue. In doing so I want to examine whether our purely private thoughts matter morally. For instance someone might have private evil thoughts but never express or act on them. In order to make the idea of inner moral virtue clear I will combine my examination with considering whether someone’s purely private racist’s thoughts are wrong and if so why. The thoughts I will be considering will be purely private conscious thoughts which the thinker endorses to some degree rather than simply some unconscious bias.it might be thought that the question of private inner thoughts is interesting but of little importance. However is someone who has private evil thoughts evil even if he never expresses or acts on them perhaps because hr fears punishment? If not do we have to accept that we can force people to be good and that morality doesn’t have an inner component.

Let us start our investigation by considering Galen Strawson’s idea of weather watchers (1). Bommarito describes these as follows,

iant stone monoliths, they are living creatures with mental lives much like our own—own—they have thoughts, memories, desires, emotions, sensations, and even fantasies and dreams. These creatures care very deeply about the weather; they are filled with joy when it is sunny out and melancholy when it rains or snows. Because of their physiology, they are completely incapable of any behavioral action……However, none of their rich mental lives are externally observable and, because of the kind of creatures they are, they are unable to perform overt actions of any kind….. They will even lack the associated intentions.” (2)

It might be objected that the idea of weather watchers is of little moral relevance because they are pure fantasy. However there are human beings who share many of the characteristics of weather watchers, those suffering from locked in syndrome. Someone with locked in syndrome may be happy when he has visitors, unhappy when he hasn’t and dream about having visitors when he is alone in the night. Clearly the mental life of someone with locked in syndrome matters to him but does his purely mental life have any moral relevance

Traditionally moral virtue is linked to character and some someone can be said to be virtuous if he has a disposition or attitudes which cause him to act morally most of the time. Clearly a weather watcher cannot be virtuous in this traditional sense because traditionally being virtuous is connected to action. However Bommarito argues that an inability to act does not preclude someone from having inner moral virtue linked to character. What does Bommarito mean by an inner moral virtue or vice? He argues that whilst weather watchers are incapable of virtue in the traditional sense that nonetheless they are capable of some sort of inner virtue or vice. A Weather Watcher who took pleasure in knowing that another of his kind was experiencing pleasure in the warm sun might be said to be expressing inner virtue. However schadenfreude shows such a definition is too simplistic. Someone might takes pleasure in another’s suffering. If someone else takes pleasure in the pleasure of the person enjoying schadenfreude then he cannot be regarded as being virtuous. Bommarito sees virtuous states as mental manifestations of an underlying moral concern. This definition could be seen as one part of the more traditional definition outlined above which sees someone as virtuous provided he has dispositions or attitudes which cause him to act morally most of the time, his dispositions can be seen as mental manifestations of an underlying moral concern. Accepting such a definition makes inner virtue a possibility. If a weather watcher takes pleasure in another watcher’s pleasure in the warm sun then he is being virtuous provided his pleasure is a manifestation of caring, of moral concern for the other. Similarly someone with locked in syndrome is being virtuous if he takes pleasure when his nurse hums happily to herself, his pleasure is a manifestation of concern for her wellbeing. It might be objected that these examples aren’t really manifestations of moral concern because they are concerned with happiness and someone’s happiness isn’t a moral concern. Two responses are possible to this objection. First someone’s happiness is connected to his wellbeing and someone’s wellbeing is a moral concern. Secondly inner virtue might be defined as manifestations of an underlying caring about someone’s wellbeing rather than moral concern. In the rest of this posting I will adopt this amended definition.

What are the consequences of accepting the above definition for our intuitive ideas concerning virtue? Firstly if we accept the idea of inner virtue then someone can be virtuous without acting. Someone with locked in syndrome who is incapable of action can still be virtuous.  However caution is needed here. In the above definition I intentionally replaced Borramito’s ‘concern’ by ‘caring about’. I did so to exclude someone, who is supposedly concerned about another’s wellbeing and is capable of acting to promote this wellbeing but nonetheless fails to do so from being regarded as virtuous. For instance a parent who is always expressing concern for his children’s wellbeing but fails to attend parent’s evenings, sporting and other events which matter to his children without a genuine excuse. Someone cannot be said to care about the wellbeing of others if he takes no steps to promote their wellbeing when he is able to do so. Secondly it might be pointed out that inner virtue, the manifestation of an underlying caring about someone’s wellbeing, is usually manifested by pleasure and that pleasure is involuntary. It then might be argued that accepting the above definition makes it hard to praise the virtuous and blame the vicious. It might then be concluded that inner virtue isn’t a real virtue because acting virtuously is usually regarded as praiseworthy. We can’t be praised or blamed for things which are beyond our control. Two objections can be raised to this argument. Firstly is more conventionally defined virtue always praiseworthy? Consider a child from an affluent home with good loving parents who grows up to be virtuous because of his background and parental encouragement. Is his virtue praiseworthy? Perhaps we should regard virtue as something to be appreciated rather than praised. We might say someone has a better character than someone else even if he isn’t responsible for his better character and doesn’t deserve to be praised for it. Secondly we might question how we acquire our sense of pleasure. A baby just gets pleasure from certain things but do we acquire all our pleasures in the same way? Do we have any input into our acquisition of some pleasures? For instance if we enjoy classical music did we simply come to enjoy it or does our will play some part in its acquisition? Do we have any control over the maintenance of pleasures? For instance if classical music pleases us we can maintain this pleasure by going to concerts. Do we have higher pleasures based our lower pleasures? Being pleased or displeased about what pleases us. If we have some limited control of some of the pleasures we acquire then perhaps inner virtue and vice should attract some praise and blame. Accepting either of the above arguments would mean inner virtue doesn’t differ significantly from our more accepted ideas of virtue when it comes to praise and blame.

  now want to examine the broader consequences of accepting the idea of inner virtue. I will do so by considering inner virtue in conjunction with private racist thoughts. Racism is wrong but do someone’s unexpressed private racist thoughts do any harm and if so why? Clearly someone with locked in syndrome can have racist thoughts. Equally clearly these thoughts cannot be seen as manifestations of an underlying caring about someone’s wellbeing and if we accept that inner virtue is possible then these thoughts cannot be regarded as virtuous. Indeed I argue that such thoughts show a complete disregard for someone’s wellbeing and might be regarded as vicious. I now want to consider two questions. Firstly do the racist thoughts of someone with locked in syndrome do any harm? Secondly do purely private racist thoughts of someone who can act in the world do any harm?

If someone with locked in syndrome has racist thoughts then he harms no one else because he is incapable of action. It might then be argued that because his thoughts don’t harm others that these thoughts really don’t matter. However would we say that the alcoholism of a private alcoholic who drinks alone and doesn’t harms others doesn’t matter? I would suggest we wouldn’t. His alcoholism matters even if no one else becomes aware of it because he harms himself. It might be objected at this point that the analogy I’m trying to make is a false one because the alcoholic harms his physiological health whilst a racist with locked in syndrome doesn’t. In response I now want to argue that even if a racist with locked in syndrome doesn’t harm his physiological health that nonetheless his racist thoughts harm him by damaging his character. How might a private racist thoughts damage character? My argument will be based on two premises. My first premise is that caring about the welfare of others is a necessary condition for having a good character. Someone who is indifferent to the good of others might have some prudential virtues and be said to have a strong character but it cannot be said he has a good character. It might be objected that someone can have a good character and not care about the welfare of others. For instance he might believe in retributory justice and that some people deserve to suffer. In order to accommodate this objection I will amend the above premise slightly. This amended first premise holds that someone cannot be said to have a good character if he fails to care about the undeserved suffering of others. My second premise is that everyone cares about having a good character. It might be objected that my second premise is an extremely over optimistic one. Nonetheless I wish to defend it. It might now be objected that sadism shows my second premise to be unsound because a sadist clearly doesn’t care about having a good character. In response I would suggest even if a sadist happily enjoys inflicting pain on others and accepts his nature that nonetheless he still believes it would be better not to be a sadist. No one aspires to be a sadist. A sadist values having a good character even if he doesn’t value it enough to change his ways. Let us accept my second premise that everyone cares, at least to some degree, about having a good character. It follows that someone with locked in syndrome who has racist thoughts also cares about having a good character at least to some degree. If he has racist thoughts then these thoughts manifest a lack of caring for the underserved suffering of people of other races. It follows that his racist thoughts damages him, even if they don’t damage anyone else, by splitting his character even if this splitting is of no moral concern. Racist thoughts and the caring about character conflict. However even if we don’t accept my second premise I would still argue that someone who doesn’t care about having a good character damages his character. His character is damaged by a lack of aspiration to be a better person.

I now want to consider more practical matters. Does someone who doesn’t have locked in syndrome but has purely private racist thoughts do any real harm. Clearly as I have argued above he damages himself but are these private thoughts of any moral concern provided that he doesn’t harm others? Clearly a smoker damages his health but his smoking shouldn’t be of concern to others if he is an adult and smokes in a field. It might then be argued by analogy that if someone has private racist thoughts that these thoughts shouldn’t be of concern to others. It might then be concluded that someone could still act virtuously even if he has vicious private racist thoughts. What does it mean to act virtuously?  A behaviourist account of virtue might suggest that someone acts virtuously provided he acts in accordance with moral norms. If we accept such an account then someone could act virtuously if his motive was purely to signal virtue or even if his actions were the result of luck. If we aren’t prepared to accept that actions based on virtue signalling or due to luck are truly virtuous ones then we can’t accept a behaviourist account of virtue. Virtue isn’t a shallow concept but has roots. These roots lie in someone’s disposition to act virtuously most of the time. These dispositions are a result of, or form part of someone’s character. It follows that acting virtuously is rooted in character. We have defined inner virtue above as a manifestation of an underlying caring about someone’s wellbeing. Let us accept that what we care about is linked to our character. It follows that acting virtuously and inner virtue are connected by character. I now want to argue that having private racist thoughts harms someone by damaging his ability to act virtuously. Let us assume that someone wants to act virtuously. I have argued above that if someone wants to act virtuously that he must care about other people unless his motive is purely to virtue signal in which case his actions aren’t virtuous. Let us also assume that he has private racist thoughts. These thoughts manifest a lack of concern for someone’s wellbeing. It follows that his character is divided. This division matters because his purely private racist thoughts make it harder for him to act virtuously. Even if someone’s purely private thoughts are never made explicit they leak out into the world by making behaving virtuously harder. This division matters for another reason. A racist might have purely private racist thoughts which he never expresses but these thoughts might leak out into the world by the way he acts, for instance in the way he votes. It follows purely private racist thoughts should be of moral concern. However accepting the above doesn’t make virtuous action completely impossible. For instance someone might care about being slim and enjoy eating junk food. His divided desires makes it harder for him to diet but not impossible.

 What conclusions can be drawn from the above? I have argued that our purely private thoughts matter. They matter because some of them are connected to inner virtue. Inner virtue is connected to acting virtuously because it is linked to character which in turn is determined by the things we care about. If the things we care about form a consistent set then it is easier to act virtuously. However it is harder to act virtuously if the things we care about form an inconsistent set and we are unable to rank our priorities. Acting virtuous isn’t just a matter of luck, it has roots which are connected to inner virtue. If morality has no roots then mimicking morality is the same as acting morally. Lastly if we are capable of acting in the world our inner virtues or vices are of moral concern because they leak out into the world by making it easier or more difficult it to act virtuously.

1. Strawson, Galen. 1994. Mental Reality. Cambridge, MA: MIT Press.
2. Bommarito, Nicolas. 2017. Inner Virtue (Oxford Moral Theory) (pp. 13-14). Oxford University Press.

Afterthought, It night be objected to the above that any moral system concerned with character is too complicated and that any practical morality should solely be concerned with actions. Intuitively this objection seems sound but can character and actions be easily separate?

Stoicism, Covid-19 and Fortitude

The pandemic caused by the covid-19 virus raises many ethical concerns. In this posting I won’t consider these concerns directly but instead examine the sort of attitude that we should cultivate in the face of the pandemic. Of course the attitude adopted has some ethical implications. In particular I want to examine whether we should cultivate a stoical attitude. At the outset I would make it plain whilst I have a lot of sympathy for some stoic ideas I am at best only a partial stoic. The virus causes health problems for many and for a few death. At present there is no effective treatment available or vaccine available to treat covid-19. An excellent simple explanation of the effects of covid-19 and some of the ethical implications is provided by Massimo Pigliucci in Medium .

Why should we adopt a stoical attitude to the coronavirus outbreak? A stoic might argue that should adopt such an attitude because fear prevents us from thinking rationally and as a result also prevents us from living as well as we might in the face of the outbreak. A stoic tries to rule herself by reason rather than her emotions. To stoics many emotions are illogical. Anger is pointless because anger can’t change the past and fear of the inevitable is also pointless because someone's fate cannot be changed. Let us accept that being fearful means being in an unpleasant state. It follows if a stoic becomes infected by the virus that she should accept this and only concern herself with the things she can change because her fear serves no useful purpose and is harmful. The things she can change include her attitude to the difficulties she faces and anything she can do to mitigate these difficulties. A stoical attitude similar to acceptance and commitment therapy (ACT) in which the client is encouraged to accept her state and commit to changing that which can be changed. The situation is slightly different in the case of a stoic who hasn’t already become infected by the virus. Of course she must accept the fact that she might become infected and not deceive herself by thinking that this is unlikely to happen to her. In this situation is her fear also pointless and should she seek to eliminate it? To say someone might become infected by covid-19 is really to say that there is a probability that she will become infected. Someone might change the probability of contracting cancer by giving up smoking. Similarly someone might change the probability of becoming infected by covid-19 by measures such as effective handwashing, social distancing or self-isolation. If someone becomes paralysed by fear which stops her from taking these measures then she should seek to eliminate her fear. However it might be argued that if fear sometimes helps someone to take these sensible measures then fear is useful and she shouldn’t eliminate it. Fear of lung cancer might help someone give up smoking more effectively than reason alone. Perhaps fear might act as a catalyst. In response a stoic might argue if we eliminate fear rationality alone can give us reason to take these measures.

Let us accept that the stoic is correct in her assertion that being afraid of the inevitable is both harmful and serves no useful purpose. A perfectly rational being shouldn’t fear the inevitable. She might of course consider how she would react to it.  However human beings aren’t perfectly rational creatures. Because of this it might be suggested that a stoic should cultivate courage in order to control her fear. Perhaps, but I will argue that it would be better to cultivate fortitude in response to covid-19 outbreak. Both courage and fortitude are concerned with strength of character. This strength is the ability to face up to dangerous and in some cases difficult situations without becom ing paralysed by fear. However the two aren’t identical. For instance courage is useful to people like soldiers, mountaineers and whistle blowers. Courage is concerned with our actions and is proactive. Fortitude is useful to people facing illness or financial ruin. Fortitude helps people face misfortune and is a reactive rather than a proactive attitude. Someone may also be courageous intermittently but someone can’t be said to have fortitude intermittently. It follows that fortitude is more closely linked to character than courage. How does fortitude help people facing misfortune? If certainly doesn’t simply mean accepting our fate. Exhibiting fatalism isn’t expressing fortitude. Simply accepting our fate is completely compatible with abandoning our values and giving in to sapping self-pity which destroys character. Fortitude is connected to character by helping us hold on to those things we can hold on to and is important in maintaining character. Fortitude helps us to maintain our values, things we can control, and in doing so helps us to maintain value in life. A father who struggles to maintain his family after becoming redundant rather than becoming apathetic would be an example of fortitude. Similarly a mother who continues to care for her family as best she can after becoming infected by covid-19 requires fortitude. Fortitude requires that we keep calm and carry on. Fortitude requires patience and patience might be particularly useful when coming out of lockdown. Easing lockdown too quickly would be imprudent. Fortitude is has similarities to grit a term used by the authentic happiness movement. Grit is described as the tendency to sustain interest in and effort toward very long-standing goals and is often connected to self-control, see authentichappiness.sas.upenn .

Let us accept that fortitude is a useful virtue to cultivate in the face of the coronavirus pandemic. Roughly speaking a stoic seeks to accept the things she can’t change and only concerns herself with the things she can such as her attitude to external events. A stoic seeks to limit her vulnerability. A stoical attitude like one based on fortitude is a reactive attitude rather than proactive one. Moreover I have argued that fortitude is connected to character and we talk of a stoic character. It might appear that a stoic should be able to cultivate the virtue of fortitude with some ease.

However it is important to be clear that even if a stoical person shares some things in common with a fortitudinous person that the two aren’t identical. Central to stoic ideas is accepting our those things we can't change and by doing so limiting our vulnerability. However it is important to be clear accepting our fate isn't the same as as accepting our vulnerability. The stoic ideal is a sage who is impervious to the emotions. This isn’t true of fortitude. A fortitudinous person might see herself as vulnerable but her main drive isn’t to limit to her vulnerability but to accept it whilst moving on. Fortitude is essentially forward looking in helping us maintain our values. It might be objected to the above that stoicism is also forward looking in that a stoic seeks to remain virtuous. I am prepared to accept my objectors point to a certain degree. However I would suggest that whilst a fortitudinous person might look forward to some future event with hope a stoic seeks to avoid hope because by hoping she increases her vulnerability. A stoic seeks to adopt a purely rational approach to future events based on realistic probabilities rather than hopeful ones. However it might be questioned whether a stoic can even value probabilistic outcomes. For a stoic difficulties in assigning values to probabilistic outcomes arise because if she tries to do so she would have to care about some outcomes more than others making herself vulnerable to less favoured outcomes. If we accept that to ‘care about’ is a primitive form of love then a stoic’s reluctance to assign values to probabilistic outcomes damages her capacity to love. Of course Panglossian optimism is harmful but the capacity to hope realistically is needed for the capacity to love and is part of what makes us human, see what do we mean by hope . During the course of the coronavirus pandemic it is inevitable that some of us will feel grief. However to a stoic such as Seneca we should battle grief even if we can’t totally eliminate it. However even for a stoic battling grief is hard. On the death of his brother Cato the younger was overcome by grief and spared no expense on his funeral. I would suggest that when confronted by grief we should seek to control rather than battle it. If we fight or seek to eliminate our grief we are seeking to make ourselves less vulnerable. Unfortunately we become less vulnerable by caring less about the deceased whereby damaging our capacity to love, see grief . Adopting a purely rational attitude, if that is even possible for human beings, damages our capacity to love, to be truly human.

In conclusion I have argued that facing the dangers posed by the covid-19 with fortitude is preferable to facing them stoically. I also suggested that fortitude is connected to character and for that reason is neither quickly nor easily obtained. It follows that if someone doesn’t already possess fortitude it might benefit him to act stoically in the face of the outbreak. However acting stoically is also not easy and carries some dangers outlined above. Some acting stoically must be careful not to become too hard hearted as this will damage his humanity.

Passive Aggression

In this posting I want to investigate the harm caused by passive aggression. However there can also be some benefits of passive aggression and these benefits must be weighed against any harm. In a previous posting I argued that rudeness is harmful because it damages civil discourse. I will attempt to show here that passive aggression is a form of rudeness and as a result damages discourse. I will conclude that in most circumstance any benefits of passive aggression are outweighed by the damage it does to civil discourse. Before commencing my investigation I will examine what is meant by passive aggression and the sort of circumstances in which it might be useful and why.

What is meant by passive aggression? According to Rebecca Roach passive aggression “is an expression of hostility, resentment, contempt, etc, that are indirect.” Hostility, resentment and contempt are all related to anger but it is important to note that acting with passive aggression is not the same as expressing anger. Perhaps passive aggression is a means of expressing repressed anger. Someone’s expression of anger sometimes is also an attempt to elicit a response from those who have angered him. Anger is connected to conflict. Passive aggression tries to avoid conflict by limiting action. Pure anger is an emotion requiring no reflection whilst the passive aggressor has to reflect on how he is going to react. Of course passive aggression might be a manifestation of anger which is an emotion but passive aggression remains a response to an emotion rather than the emotion itself. Roach defines passive aggression as an expression of hostility, resentment and contempt. It might then be argued that because hostility, resentment and contempt are emotions that passive aggression is really a second order emotion and that I am wrong to suggest otherwise. I would reject this argument by suggesting even if hostility, resentment and contempt are emotion passive aggression remains a reaction to these emotions rather than a higher order emotion. Someone can be unemotional when reacting with passive aggression. Lastly I will assume that passive aggression must be verbal because otherwise sullenness could be regarded as a form of passive aggression. Some might disagree with the last point but I won’t pursue it further here.

In what sort of circumstances is passive aggression usually employed? I would suggest that these circumstances fall into two broad sets. Firstly passive aggression is often employed when there is an asymmetry of power making the expression of anger difficult.  For instance an office worker might employ passive aggression towards his tyrannical boss. In these circumstances passive aggression is used because civil discourse appears to be impossible. Secondly passive aggression might be employed by someone who wishes to limit the damage full scale confrontation might do to relationships but also wishes to register his displeasure about someone else’s behaviour. These relationships are usually close relationships. For instance Andrew’s partner Bernice fails to attend Andrew’s sister Clair’s wedding due to some prior commitment. At a later date Clair says he can’t attend the christening of Andrew and Bernice’s baby due to another prior engagement. However had Bernice attended Clair’s wedding then Clair would have been pleased to attend the christening. Clair wishes to register him displeasure whilst at the same time avoiding a family row.

What harm does passive aggression cause? I will now argue that passive aggression harms us in three ways. Firstly I have suggested above that passive aggression is connected to hostility, resentment and contempt. These are harmful emotions. By seeking to avoid conflict passive aggression doesn’t address the issues underlying these emotions resulting in these issues remaining unresolved and the associated harmful emotions retained to some degree. It follows that passive aggression is harmful. Secondly it might be argued that expressing anger sends a message to someone that something is wrong. Repressed anger muddles the message. Expressing anger also focusses our attention on addressing the wrong. Repressed would seem to be less effective in doing so. However when there is an asymmetry of power even the expression controlled anger is difficult. It might then be argued that in these circumstance even if we can’t overtly express our anger that passive aggression enables us to do so covertly. It follows that if passive aggression is the covert expression of our underlying anger that expressing it might be of some limited benefit to us by permitting some limited venting of our feelings. Thirdly it might be argued that passive aggression might harm some people by causing a sense of a loss of agency because they are unable to directly express themselves. In response I would suggest that an asymmetry of power might causes someone feel a loss of a sense of agency and that passive aggression might benefit someone by restoring a limited sense of agency. Some sense of agency, even a limited one, might benefit us more than simply adopting a sullen attitude.

I have argued that passive aggression harms us because it fails to address underlying issues which means we retain harmful emotions, it fails to fully address the perceived wrong and damages agency. I then suggested that the harm of passive aggression might be counterbalanced by allowing us to covertly vent our anger leading to a reduction in the harmful emotions we are experiencing and restore a limited sense of agency. It follows that on balance passive aggression might benefit us. I now want to argue that passive aggression harms us in another way by damaging civil discourse. First I will argue that passive aggression is an indirect form of rudeness. Secondly I will argue that rudeness damages discourse which causes harm.

What do we mean by rudeness? In a previous posting I defined rudeness as someone knowingly not considering the needs, views and wishes of another and at the time of this inconsideration the other being aware of this inconsideration, see wooler.scottus . If we adopt this definition then it isn’t immediately obvious than passive aggression is a form of rudeness. After all passive aggression is triggered by the views and wishes of others. However even if passive aggression is triggered by the views and wishes of others it isn’t concerned with their needs. Passive aggression is only concerned the views and wishes of others in a limited way, it is only concerned with the perceived wrongness of these views. It follows that someone expressing passive aggression fails to properly consider the needs, views and wishes of the person the aggression is directed at. Must someone at whom the aggression is aimed at be aware of the aggression? It might be suggested that passive aggression is an indirect way of expressing hostility, resentment and contempt those who the aggression is aimed need not be aware of it. If this is so then passive aggression is simply a private venting of feelings. I would reject the above suggestion as passive aggression is only indirect aggression because the person expressing the aggression is aware that the person at whom the aggression is aimed is aware of it. Passive aggression is a way of making someone aware of your dissatisfaction with his behaviour whilst at the same time trying to limit the damage done to your relationship with him. In light of the above passive aggression seems to be a form of rudeness.

I now want to briefly argue that rudeness harms someone by damaging civil discourse. It might be argued that rudeness benefits the rude person by enabling him to freely express his true feelings free from the fetters of politeness. It might even be suggested that the free expression of feelings means rudeness is connected to honesty, I would reject this second suggestion because the focus of the rude person is partial and by knowingly ignoring the views of others he might deprive himself of further knowledge of the situation and increase the possibility of self-deception. However let us accept that rudeness can benefit the rude person by simply allowing the unfettered expression of his feelings. Unfortunately rudeness also involves an inattention to the views of others and as a result damages discussion by shifting the focus of our attention from the issues involved to the tone of the discourse. Rudeness means we talk at each other rather than engage in a meaningful civil discussion and fail to address the underlying long term issues. Let us accept that civil discourse promotes the meaningful discussion of difficult issues which benefits individuals. The pleasure of rudeness is short lived whilst the resolution of difficult issues matters in the long term. Issues that aren’t fully addressed can cause long term harm. It follows that the short term pleasure of rudeness is outweighed by the long term damage it does to individuals by a failure to address difficult issues. It further follows that if passive aggression is a form of rudeness it harms us by damaging discourse

It might be objected that in some circumstances civil discourse isn’t possible. For instance if someone has a tyrannical employer then he might be unable to engage in civil discourse about his grievances. In other circumstances someone’s extreme sensitivity might make it difficult for others to engage in meaningful discourse with him. In circumstances like these the pleasure of passive aggression cannot be outweighed by the harm done to civil discourse because civil discourse isn’t possible. Whilst being passively aggressive makes no sense to the powerful it makes perfect sense to the powerless. It follows that passive aggression might benefit some people in some circumstances.

The above conclusion depends on the premise that in some circumstances meaningful civil discourse is impossible. Let us accept this premise. However even if we accept the premise if the above conclusion is to be useful we must define these circumstance more rigidly. I argued above these circumstances in which passive aggression might be useful fall into two broad groups. Let us consider the first of these groups in which there is an asymmetry of power. In a totalitarian regime such as Stalinist Russia discourse about the regime’s policies is impossible and passive aggression might be justified. Jokes at the regime’s expense might be regarded as a form of passive aggression. However I would suggest that in most circumstances where there is an asymmetry of power civil discourse isn’t impossible but merely difficult. I would further suggest that just because civil discourse is difficult we shouldn’t abandon it and fall back on passive aggression to relieve our negative feelings. If we simply use passive aggression then we might be accused of taking the easy option, mental laziness or being lacking in courage. We might also be accused of failing to address the underlying issues which are the cause our passive aggression. How might we engage in civil discourse when there is an asymmetry of power? I would argue that this can be done in two ways. Firstly we should ask those we are aggrieved with simply to confirm what we are aggrieved about. This allows us to be sure our grievance is justified and may also alert those who aggrieve us to the fact that we are aggrieved in a non-confrontational way. Secondly we should ask those who aggrieve us why they are acting this way. We ask them to justify their actions again in a non-confrontational way. This might make those who aggrieve us reflect on their actions. It might also give us reason to question our negative feelings. I have argued elsewhere that such questioning can be repeated, see civil discourse . However all conversations come to an end and if the underlying issues cannot be resolved we should end the conversation by asking the person who has aggrieved us does he really ‘mean that’. It follows in most cases when there is an asymmetry of power civil discourse is possible even it is difficult. It further follows that because passive aggression damages civil discourse that we should try to avoid acting this way. Let us now consider the second group of circumstances in which passive aggression is often employed. These are when someone who wishes to limit the damage full scale confrontation does to close relationships whilst at the same time registering him displeasure. In these circumstances someone tries to limit the damage by avoiding the full expression of his anger. However repressing anger doesn’t eliminate it and it might manifest itself latter. I now want to argue that if when we are aggrieved if we adopt the strategy outlined above of asking for confirmation and then for further explanation then we shouldn’t do any greater harm to relationships than we would by the use of passive aggression. Firstly by simply asking someone to confirm something that aggrieves us might be slightly annoying but doesn’t seem to be confrontational. Secondly asking someone for an explanation might be confrontational to some degree but no more so than employing passive aggression. It would appear that asking for confirmation and explanation is no more confrontational than passive aggression but has the additional benefit of addressing the underlying issues rather than postponing discussion of them.

I have argued that passive aggression damages civil discourse. I also argued that except in exceptional circumstances discourse is possible when conducted carefully. I further argued that even if discourse is difficult it is better to try and engage in meaningful discourse rather than react with passive aggression because discourse helps resolve contentious issues whilst passively aggressive merely postpones addressing them. Lastly I argued that the use of passive aggression is a lazy way of dealing with contentious issues. It follows that except in very limited circumstances we should avoid the use of passive aggression.

Love me for a reason

Love is all around us, love matters to us and we value loving and being loved, but why love matters so much to us isn’t immediately clear. In this posting I want to offer a sketch of why love matters to us. Before proceeding I must consider three question. Love has many variations, we can have erotic love, parental love and affectionate love to name but a few. Are these completely different types of love or have these variations all evolved from a common basis or perhaps these apparently different types of love are in reality different ways of expressing a general idea of love in different domains?

According to Aristotle there are three types of love erotic, philia and agape. If we accept Aristotle’s position then on first appearance it would appear that there isn’t a single unified idea of love. According to Aristotle erotic love is a passionate desire for another, usually a sexual desire. Philia is more a fondness and appreciation of another and is important in friendship. Agape refers to the love of God for man or man for God. However it is still possible to argue that there is a unified concept of love. Firstly it might be suggested that these types of love are in reality identical and that the apparent differences in love might be due to the intensity of loving rather than differences in type. Secondly it might be suggested that apparent differences in love might be due to love being expressed differently in different domains. It seems possible that a more modern version of agape might be that of unconditional love of all. It follows that it is at least possible that there is an underlying unified concept of love.

I now want to argue that there is indeed a unified primitive concept of love. I will argue love isn’t just some concept that arose recently or is limited to human beings. Let us that assume “caring about” is a primitive form of loving. Animals can care about their offspring and if you accept group selection, as Darwin did, then animals which care about their offspring have an evolutionary advantage. It follows that a primitive type of love has a very long history. However even if a plover’s behaviour when it pretends to have a damaged wing in order to lure a predator away from its chicks is a primitive form of love it isn’t what we usually mean by love. Perhaps Aristotle was right after all and there are different types of love. I will now argue that love has evolved some sort of structure rather than being differentiated into different types. Let us accept us accept that many creatures including us possess a primitive kind of love, the ability to “care about”. This basic form of loving need have no affective or cognitive elements and might simply be based on some on ancient neurochemical systems that evolved to serve our ancestors' reproductive needs. It might be objected that such a basic system isn’t what we mean by love. Love as we know it can’t be defined in such a basic way. I accept my objectors point but my acceptance doesn’t mean we no longer retain this basic system. Nature is parsimonious and doesn’t usually replace ancient systems but adapts and modifies them to serve new purposes. It might then be suggested that what we mean by love is this ancient primitive system of “caring about” which has had its structure modified and built upon. It is hard to see how such a simple structure could be modified so let us assume it has been built upon. Firstly our primitive love has been expanded by our capacity to feel empathy. Let us be clear what we mean by empathy. I don’t mean empathic contagion such as that when one baby cries and another simply follows. I also don’t mean the ability just to understand how another feels which can be exploited by a sociopath. I mean having a disposition to feel as another feels. Secondly our primitive love has been expanded by our increasing cognitive abilities. A bird might only care for its chicks and perhaps its mate. Human beings increased cognitive abilities enable them to see others as much the same as themselves allowing them at the very least to question why they shouldn’t care about them hence increasing love’s domain. Lastly our primitive love has been expanded by the culture we live in. Let us accept that love can be regarded as an emotion. According to Lisa Feldman Barrett,

“An emotion is your brain’s creation of what your bodily sensations mean, in relation to what is going on around you in the world.” (1)

If we accept Feldman Barrett’s position then love depends on concepts and our concepts are partly constructed by the culture we live in. Her position can be supported by noticing that the dominant view of love in culture has changed over the last hundred and fifty years from romantic love to parental love. Let us accept that what we mean by love is our ancient capacity to “care about” which has been built on and had its domain extended by our capacity for empathy, our increased cognitive abilities and the culture we inhabit.

Let us now consider why we value love as outlined above. We can care about both loving and being loved. I now want to argue that loving is more important than being loved. The above seems counterintuitive. However we can imagine someone who isn’t loved but loves someone or something living a meaningful even if somewhat unhappy life. We can’t imagine someone living a meaningful life if she doesn’t care about anything at all. Let us assume that we must “care about” our ideals. According to Frankfurt having ideals, “caring about” or loving is essential to being a person.

“He can make whatever decision he likes and shape his will as he pleases. This does not mean that his will is free. It only means that his will is anarchic, moved by mere impulse and inclination. For a person without ideals, there are no volitional laws he has bound himself to respect and to which he unconditionally submits. He has no inviolable boundaries. Thus he is amorphous with no fixed shape or identity.” (2)

If we accept the above then we should value loving firstly because by loving we make ourselves into persons. Secondly what we love defines what sort of persons we are. On a somewhat speculative note it might be suggested children keep teddy for reasons of love. Teddy bears can’t love children so perhaps children keep bears because of their need to love. I have also suggested elsewhere that this need to love is one of the reasons some people keep pets, see the philosopher's dog .

I have argued that it is more important to love than be loved. Nonetheless to human beings and perhaps some other creatures such as dogs being loved is also of major importance. To be loved means that a lover must care about the interests of his loved one. Could someone be said to love another person if he remained completely indifferent to the interests of that person? It follows one reason we value being loved is because it advances our interests. However our interests can be advanced by others acting from duty and doing so needn’t involve love. Moreover even if most people want to be cared about they would nonetheless regard simply being cared for as an incomplete form of love. Husbands, wives, romantic partners, friends and children don’t want to be simply cared for in the way someone cares about a pet, they want to be cared about because of the particular people they are. It would appear that people want to be loved for a reason and they want that reason to be based on the sort person they are, their characteristics. Sven Nyholm expresses this want,

“Love is, in this way, a sort of confirmation that we are, as we might put it, ‘lovable’ in the sense of being able to inspire or call forth such dispositions in another (namely the lover).” (3)

A lover doesn’t love everyone but specific persons. What sort of specific qualities does a loved one need in order to create a disposition in his lover to love her? Prima Facie it might seem what creates such a disposition is the attributes the loved one possesses, for example someone might be loved because of her humour, tenacity and straight talking. 

Unfortunately accepting the above raises three problems. First someone’s loved one might be fungible. They can easily be replaced by someone else who has the same attributes but to a greater degree or someone who has some additional attributes. Using the above example above the loved one might be replaced by someone who is funnier, has greater tenacity and whose conversation is even more to the point. Or alternatively by someone who is just as funny, tenacious and to the point but additionally is courageous. Nyholm seems to be suggesting that someone want to be loveable because of certain attributes she possesses but do we really love her or her attributes? If we love the attributes do we really love the person at all? This echoes Platonic love with all its problems.  Of course it might be suggested that we can’t separate a person from her attributes. A second problem arises if we love someone for her attributes then we should also equally love someone else who possesses identical attributes. Theoretically we could love a very large number of people who possess these attributes. It might be argued that in practice we don’t have the cognitive abilities to assess the attributes of a very large number of people meaning that in practice we are only likely to love a subset of the people who possess the same attributes. The number of people we can love might also be limited by the Dunbar number. Nonetheless in practice we could end up loving several people because they possess identical attributes. Of course such a situation might be perfectly acceptable for the friends we go to watch football with but does the same apply to romantic partners? Lastly do we love our children because of their good qualities or simply because they are our children? If we choose the first option then our love is conditional and I would suggest that this would cause problems with childrearing.

Nonetheless in spite of the above it is natural to see our children as possessing lovable qualities. However more generally do we see these qualities as lovable prior to loving our loved ones? If we don’t then perhaps we are labelling these qualities as lovable partly in order to explain to ourselves why we love our loved ones. Our loved ones don’t naturally possess lovable qualities we create them.

In the light of the above problems it might be suggested either that the account of love I have outlined love above is an inadequate one and that it should be replaced by a more adequate one or that there are different accounts of love in different domains as proposed by Aristotle. I am reluctant to accept either of these suggestions and will now give reasons for my reluctance. According to Simon May love is an ancient emotion but that over the last hundred and fifty years the dominant view of love has changed. Romantic love has been replaced by love of our children, parental love (4). I have suggested above that far from being a modern interpretation of what we mean by love that parental love forms the basis of all other forms of love. Let us accept that parents caring about their young offspring is a basic form of love. It is important to note caring about isn’t equivalent to caring for, someone may care for another without caring about him. Caring about means being vulnerable to the fate of the loved one caring for doesn’t. I will now argue that this primitive form of love when its domain is extended can account for our desire to be loved because of the specific persons we are.

What are the reasons someone has for loving us? It might be suggested that this question splits into two further questions. First, what sort of reasons might someone have for coming to love her loved one? Secondly what sort of reasons might have to continue loving her loved one? It might be objected that the reasons are identical in both situations. Accepting this objection means either that our original question doesn’t really split into two as I have suggested or if it does the same reasons satisfy both questions. Let us accept that the original question might split into two. Someone might come to love her loved one because of his beauty and years later continue loving him for another reason once this has faded. I now want to argue that we need reasons to come to love someone but that once we have done so we just continue loving her. We must have reason to come to love, to bestow love, but that we don’t need reasons to continue loving. Once we come to love someone we are simply satisfied with our love and we would need reasons to come to stopping loving someone, becoming dissatisfied with our love. If we accept the above then it is possible to explain why some people find it hard to stop loving. For instance the mother of a paedophile might continue to love her child in spite of the crimes he has committed. She came to love him because he was her child and once her love was established she became satisfied with her love.

What reasons do we have to come to love someone? I would suggest one sort of reason is the relationship between the lover and the loved one. A parent comes to love her child because he is her child, a friend loves her friend because he is her friend and romantic partners love each other because they are romantic partners. The fact that parents love their own children rather than other children who are just as cute, intelligent and charming seems to support the above. This suggestion is based on Niko Kolodmy’s idea of love as a valuing relationship (5). These reasons define the domain of love rather than love itself. It might be objected that some prior relationship isn’t a necessary condition for coming to love a loved one, one simply does it. Accepting the above raises the possibility of love at first sight. It might be argued that the type of love I have outlined above is unable to explain love at first sight. In response to this objection it might be argued that love at first sight is illusory. However even if we accept that love at first sight exists it can be explained by the type of love outlined above. I have argued above that we have a need both to be loved and to love. I argued above that we have a greater need to love than be loved. It follows that the reason for love at first sight can be satisfied by our need to love.

I have suggested that love was originally a simple emotion which has changed as we have evolved. It has been changed by our empathy, increased cognitive powers and we fact we live in a particular culture. I would now suggest that these changes have altered what we love, expanded the domain of our love, but haven’t changed how we love. I have also suggested that whilst we have reasons why we come to love someone we don’t have any reason to continue loving. Relationships give us reason to love someone but our love simply persists because we are satisfied with our love. If we accept the above what does this mean for Nyholm’s contention that we have a desire to be lovable. It certainly means we can’t be considered lovable because of some of the attributes we possess. But do we really want to be loved for our attributes? If we are wise and loved for our wisdom we would still want to be loved if we lost our wisdom. If we are loved for our caring we would still want to be loved when we become old have to be cared for rather than care for others. Perhaps we simply want to be loved rather than loved for some of our attributes. We simply want to be loved rather than loved for a reason. Accepting the above means there are reasons why we come to be loved but no reasons our continuing to be loved. We come to be loved because of we are the children of someone, the parent of a child or simply a friend. Accepting the above also helps explain why the parents of severely handicapped child love and regard him as irreplaceable even if he possesses few lovable properties. Perhaps we should be grateful for being loved and the benefits it brings.

1. Barrett, Lisa Feldman, 2017, How Emotions Are Made: The Secret Life of the Brain, Pan Macmillan, page 30
2. Harry Frankfurt, 1999 Necessity, Volition, and Love. Cambridge University Press. Page 114
3. Sven Nyholm,‘Love troubles: Human attachment and biomedical enhancements’, Journal of Applied Philosophy, 32, 2 (2015): 190–2
4. Simon May,2019, Love, a New Understanding of an Ancient Emotion, Oxford University Press, page 21[js1] 
5. Niko Kolodny, 2003, Love as Valuing a Relationship, The Philosophical Review, Vol. 112(2).
   

Afterthoughts

the need to love and be loved are both important and are intertwined but perhaps the need to love is the more important. Perhaps loving someone creates a desire for mutual love, a desire to be loved. Does it natter to us if we aren't loved by someone we don't love? Narcissists excepted. Does the need to love explain the difference between a nihilist and a terrorist? Nihilists have lost their need to love and be loved whilst terrorists have retained theirs even if this is misplaced.

 the

Civil Discourse

We live in a fractious age in which people are often rude to those who hold views opposed to their own. Indeed on some social platforms such as Twitter it would seem that being rude is necessary in order to be noticed. In this posting I don’t want to consider the nature or the causes of rudeness. In the philosophy of rudeness I argued that whilst rudeness isn’t immoral that nonetheless it damages discourse and as a result is on the road to immorality. In this posting I want to consider ways in which discourse can be improved with those who hold views which are radically opposed to our own. I will consider how we should talk to our opponents. This isn’t an easy task for as Amy Olberding points out people often enjoy being rude to one another for by being rude they escape from the constraints of politeness. They excuse their escape by believing that they are being true to themselves, being authentic. She suggests such excuses are usually poor excuses and almost all rudeness is unjustified. Moreover if rudeness is ever justified then we should feel regret when doing so rather than smug satisfaction. Olberding also points out that sometimes people are unaware that they are being rude. She advocates that in order to improve civility and reduce rudeness we should respect our opponents by adopting a well-mannered approach. In doing so she is echoing the ancient Chinese philosophy of Confucius and Mengzi. Let us agree with Olberding that being well mannered is a pre-condition for engaging in any meaningful discourse which questions some the views of our opponents. According to Olberding any well-mannered discourse must be pro social and involve respect, consideration and toleration. Perhaps if rudeness damages meaningful discourse civility fosters it. However even if the tone of our discourse is polite what we talk about matters. Even if our arguments are good ones telling people why they are wrong and why we are right is unlikely to be effective. In this posting my arguments will not be primarily about the tone of what we talk to our opponents about but the methods we employ when discussing the issues involved. I will suggest three ways which might make a discourse more meaningful. Firstly I will argue that we should simply and politely explain our own views together with our reasons for holding them. I will then counter argue that such an approach is unlikely to succeed in changing many minds. Secondly I will argue that in certain cases we should simply ask our opponents to confirm their views which we find objectionable, “do you really mean that”. Lastly I will argue that we should politely but firmly press our opponents about what justifies their views. My comments are meant to apply to face to face conversations and those on social media.

Let us briefly examine the first approach. We might try to convince our opponents that our values are sensible values and that the force of our politely expressed arguments will challenge them into changing their own views. We hope that the force of our argument alone will bring about change and that we shouldn’t challenge or directly attempt to discredit our opponents’ views. The hope being that good arguments win out in the long term. For instance, we might challenge opponents of gay marriage by pointing out that gay people have the same rights as other people in most areas of life and suggest that these rights ought to be extended to marriage. We might then hope that the logic of our argument will mean the opponents of gay marriage change their minds. Such a suggestion seems to be hopelessly naive and I am unconvinced that such an approach would be either right or successful. We may be polite to our opponents but we aren’t really trying to improve discourse, indeed it might be questioned whether we are really attempting any sort of meaningful discourse at all because we aren’t paying any attention to the views of our opponents. It might be suggested that we are really doing is preaching and that we aren’t being particularly polite to our opponents by ignoring their views. I would suggest what we wrong our opponents because by not considering their views we fail to respect them as persons. Moreover such an approach is unlikely to be successful because even if we supply good arguments supporting our views we aren’t giving our opponents any reasons to reject their own views. If someone has no reason to reject her current views then she is unlikely to do so. Good arguments don’t alone change minds they must be shown to be better arguments.

A second approach which we might adopt in any discourse questioning the views of our opponents we find objectionable would be simply to ask them to confirm these views, “do you really mean that”. Perhaps we should repeat their views in our own words to ensure clarity. This approach at least has the merit of being directed at their views which our first approach didn’t do. Such an approach seems to morally justifiable because we are being respectful, considerate and tolerant towards our opponents. Unfortunately such an approach seems unlikely to be successful in changing the views of people who are strongly committed to their views. Nonetheless sometimes people express views which reflect underlying unconscious biases. These biases can sometimes come out inadvertently in sexist or racist remarks. If we simply ask the agent “do you really mean that” then this might combat some more mild biases by doing two things. Firstly we are asking the agent to examine her views. If the these views are unconscious views which conflict with her more reflective ones then our question might lead her to reflect more fully on her views by bringing them into focus. Secondly we are expressing our disapproval in a polite manner. If we accept that one form of shame is fear of social disapproval then if the agent feels some shame this might once again cause her to question her views.

However simply asking our opponents to confirm their views which we find objectionable is unlikely to make the majority of them seriously question these views. How then might we more effectively question these views in a polite non-confrontational manner? One approach might be to adopt the position of Socrates and politely ask our opponents why they hold these views, to ask for justification, rather than telling them directly why these views are wrong. Perhaps this approach might be used in conjunction  with the one outlined above of asking out our opponents whether they really mean that. One benefit of such a composite approach is that we are talking with our opponents rather than preaching to them. If someone is asked to provide an explanation in order to help us understand some of her views then the explanation she provides must also offer some sort of justification which she believes supports her views. It might be thought such questioning is a simple task but such a thought would be premature. Our task isn’t simply to listen impatiently and then move on to our own agenda. Out task is to understand our opponent’s views and understanding requires paying attention and listening to her justification with a certain degree of humility. Such a discourse is likely to be a slow one because after listening we must only think of our response after listening. Once again our approach seems to be morally justifiable because it treats our opponents with respect, consideration and toleration. Returning to my example of gay marriage an opponent of gay marriage might justify her views by explaining to us that the purpose of marriage is to provide a safe environment for the creation and rearing of children. We must listen carefully and understand that her opposition to gay marriage is based on a particular view about the purpose of marriage. We might then ask her how this purpose justifies marriage for couples whose children have grown up or are childless. However I would suggest that such an approach is unlikely to change the minds of those who hold strongly held views for three reasons. Firstly the confirmation bias means those such as fervent Brexiteers or Trump supporters instead of changing their minds will seek alternative justifications for their views. Secondly someone’s strongly held views help make someone who she is, help in defining her, and relinquishing them involves a loss of pride. Nonetheless our questioning might help to erode some of our opponent’s most extreme views which would be a useful thing to do. Lastly some people have strongly held views which seem to be based on faith and don’t require justification. This last group is particularly hard to engage in civil discourse because there appears to be no place for the discourse to start. Some might argue that because this approach is unlikely to change many minds that we should adopt a much more aggressive approach towards our opponents in the hope of at least changing a few minds. Perhaps, instead of simply asking our opponents to justify their views, we should robustly tell them why we think these views are unjustifiable. Unfortunately such an approach means we end up simply “talking at” or preaching to our opponents rather than talking with them. Once again such an approach seems to be wrong because we fail to respect our opponents. Moreover the confirmation bias makes it unlikely that it will be successful in changing many minds. However a more strident approach might help convince those who are yet to form a settled view.

What are the consequences of adopting the above approach? One consequence of accepting the above is that we must be prepared to provide justifications for our own views when asked to do so. Moreover, if the justifications we provide seems on reflection to be inadequate ones then we must be prepared to exchange our defective views for more defensible ones. Secondly because we mustn’t simply listen to the justifications of our opponents views but try to understand them then if we find these justifications convincing we must be prepared to accept their views or at the very least amend our own.

1. Amy Olberding, 2019, The Wrongness of Rudeness, Oxford University Press

The Doctrine of Informed Consent and Respect for Autonomy

In this posting I want to examine the relationship, if any, between the doctrine of informed consent and respect for autonomy. In doing so I will try to answer three important questions. Firstly is the doctrine of informed consent based on respecting autonomy or is it a sui generis doctrine? The fact we talk about a doctrine of informed consent seems to suggest the latter. Secondly if informed consent isn’t based on respecting autonomy should it be so based? Lastly if informed consent is based on respecting autonomy what type autonomy should that be?

Is informed consent based on respecting patient autonomy? According to Charles Foster the doctrine of informed consent is in a mess.

“Informed consent, in practice, is a bad joke. It’s a notion created by lawyers, and like many such notions it bears little relationship to the concerns that real humans have when they’re left to themselves, but it creates many artificial, lucrative, and expensive concerns.” Practical Ethics

Let us accept that the principles underlying informed consent are unclear. Let us try to start understanding these underlying principles by examining the process of informed consent in practice. When taking informed consent a patient’s doctors propose some form of treatment and provide the patient with the information he needs in order to make a good decision. The patient then agrees or refuses to agree to this treatment. What is the purpose of this process? The purpose of the agreement part of this process seems clear. The agreement part prevents the patient being treated against his will and his doctors from being accused of assault. The purpose of the information part is different. The purpose of this part is to enable patients to make good decisions. What exactly do we mean by a good decision? A decision which is in the patient’s best interests or an autonomous decision? In a medical setting a decision which is in a patient’s best interests is one which minimises harm to the patient,  maintains or improves his physiological health. The amputation of a patient’s gangrenous leg would be an example of acting in a patient’s best interests by minimising harm. The provision of drugs to control a patient’s blood pressure would be an example of acting in a patient’s best interests by maintaining his physical health. A kidney transplant would be an example of improving a patient’s health. Autonomy is concerned with self-government and very roughly speaking an autonomous decision is one by which someone governs himself. However self-government is simply governing oneself and need not always be good government. We can govern ourselves badly. Let us assume that a patient simply wants to accept his doctors’ judgement about his treatment and doesn’t want to receive any additional information. Intuitively such a decision can be seen as a decision by which he governs himself and as a result is an autonomous decision for after all we can simply choose to follow our lawyer’s advice and most would regard such a decision as autonomous. However under The General Medical Council’s proposed guidelines such a decision might not be seen as a valid informed consent decision.

“If, after discussion, a patient insists that they don’t want even this basic information, you must explain the potential consequences of them not having it. This might include being unable to proceed if you are not confident that their consent would be valid, or if you are not confident that the proposed course of action would be beneficial to the patient overall.” (1)

In the light of the above it would appear that The General Medical Council’s guidelines are not really based on respecting autonomy and the purpose of providing information when taking informed consent is to enable patients make decisions which are in their best interests.

It might be objected that I have only briefly sketched a certain account of autonomy and that a different account might mean that the doctrine of informed consent could be based on respect for autonomy. After all in my brief account the patient in my example above who fully trusted his doctors to make a decision on his behalf might wake up to unexpectedly find himself with only one leg. It might be suggested such a decision isn’t an autonomous one and that we should adopt a more substantive account. For the sake of argument let us assume an autonomous decision must be one that concurs with some generally accepted set of norms. If these norms are to be generally accepted then they must concern what is good for people. Autonomous decisions become linked to good decisions. An autonomous decision must be a good decision and a bad decision cannot be an autonomous one. I now want to argue against accepting such a substantive account of autonomy. If an autonomous decision must be a good decision because it must concur with some accepted norms then it might be questioned whether such an account of autonomy is really doing any useful work. A substantive account of autonomy puts itself out of business because we only need to consider good and bad decisions. We don’t need to consider autonomous decisions at all. Using a substantive account of autonomy an autonomous decision must of necessity be a good decision according to some accepted norms whilst on a content neutral account of autonomy an autonomous decision can be a bad decision. Of course it is preferable that an autonomous decision, using a content neutral account of autonomy, is a good decision which benefits the decision maker but the purpose of respecting autonomy remains simply to respect the decision maker as a person and the actual decision doesn’t of necessity need to be a good one. If we accept the above then we have two options. Firstly we could abandon the pretence that underlying the doctrine of informed consent is respect for autonomy or secondly we could accept that underlying the doctrine of informed consent is respect for a content neutral or primitive account of autonomy and modify the doctrine accordingly.

If we accept the above then there is not only a difference in complexity between substantive and primitive accounts of autonomy but more importantly these different accounts have a different focus. A substantive account focusses on respecting good decisions, a primitive account focusses respecting persons by simply accepting their decisions. Adopting a primitive account requires adopting a certain degree of humility. Let us accept that if the concept of autonomy is to remain a relevant one that it must be a primitive or content neutral concept based on respecting persons. Such a concept might be classed as a Millian concept. In the rest of this posting ‘autonomy’ will refer to such a concept. Let us also accept the first of the above options that the doctrine of informed consent is a doctrine in its own right and isn’t based on respect for autonomy. The informed consent process starts with a patient’s doctors proposing a course of treatment which they believe to be in his best interests, the patient then consents or refuses to consent to the proposed treatment. I argued above that the purpose of informed consent is to get a patient to consent to treatment which his doctors believe to be in his best interests. In almost all cases the patient simply consents and no problems arise. What is interesting are cases in which the patient refuses to consent. In these cases according to the doctrine of informed consent a patient’s doctors must be sure, or take steps to ensure, that the patient knows the consequences of his actions. However let us assume that the patient maintains his refusal of consent. By what standards is his competence to refuse treatment measured by and how is it assessed? If someone takes a driving test his competence to drive is based on his actual driving. This is not true when assessing someone’s ability to give informed consent. Someone’s competence to give informed consent isn’t based on his actual decisions. His decision might of course trigger a competence assessment but his competence isn’t dependent on his actual decision. Someone’s competence to give informed consent is based on his ability to make good decisions based on his best interests. I would suggest that someone who has the ability to make good decisions based on his best interests is self-governing, is autonomous.

As mentioned above the purpose of a driving test is to measure someone’s competence to drive and the criteria by which his competence is measured is by his actual driving. The same isn’t true of informed consent. I have argued above that the purpose of informed consent is to enable patients to make good decisions. I have further argued above that the way in which a patient’s competence to make good decisions is assessed is by his ability to make autonomous decisions. Such a mismatch creates problems and perhaps is one of the reasons why the doctrine of informed consent is in a mess. Two solutions might be suggested to remedy this mismatch. First the purpose of informed consent should be to enable a patient to make a good decision in particular circumstances and the patient’s competence should be assessed by his ability to make a good decision in these circumstances. Secondly the purpose of informed consent is to enable a patient to make an autonomous decisions and his competence to do so should be assessed by his ability to make an autonomous decision.

Let us consider the first of these options. Let us accept that a good decision is one that is in the decision maker’s best interests and that a decision is a competent one only if the decision is in the decision maker’s best interests. Clearly if someone makes a decision to do something which he believes isn’t in his best interests then he isn’t making a good decision. If a patient’s competence depends on him making a good decision then he is incompetent. Perhaps he is paralysed by fear. However in practice most people make decisions which they believe to be in their best interests. Moreover in a medical setting there is usually agreement between the patient and his doctors about what these best interests are. Unfortunately in a few cases in which there might be disagreement about what is in a patient’s best interests. Let us accept that a patient who makes a decision which he believes to be in his best interests, but which is generally believed not to be in his medical interests by his doctors, is making an incompetent decision. In practice if a child or cognitively challenged adult makes a decision which others believe isn’t in his best interests his competence might be questioned and he might be treated against his will. Unfortunately if a competent decision must be a good decision then the same considerations would seem to apply to all patients. Accepting the above would mean that if any patient makes a decision which is generally regarded as not being his best interests then his decision is an incompetent one. In these circumstances the patient’s doctors might be accused of paternalism or even epistemic arrogance. Fortunately in most cases a patient’s medical best interests and what the patient believes are his overall best interests concur. However this isn’t true in all cases. In cases in which these interests don’t concur do we insist that a competent decision is based on a patient’s best medical interests or what he believes to be in his overall best interests? Practical considerations and the need to avoid the charge of paternalism suggest that we should choose the second option. However if we accept that a patient is making a competent decision when it concurs with what he believes are in his overall best interests we are back to assessing a patient’s competence to make a good decision by assessing his ability to make an autonomous one and the above mismatch remains unresolved.

The above difficulties suggest that we should choose the second option. The purpose of informed consent should be to enable patients to make autonomous decisions about their treatment and that any competence assessment should be based on their ability to make autonomous decisions. This provides an answer to the second of my three initial questions. Informed consent should be based on respect for patient autonomy. Moreover if a substantive account of autonomy makes itself redundant as I have argued above the type of autonomy underlying informed consent must be a primitive or Milliian account. This answers the third of my three initial questions. Accepting this option has consequences for the amount of information which needs to be supplied to patients when taking informed consent. In the past under the doctrine of informed consent a patient’s doctors determined what risks the patient should be made aware of. However the Montgomery ruling Montgomery ruling stated that a patient’s doctors must ensure that the patient is aware of any and all the risks involved. If patients are to make informed consent decisions based on respect for autonomy they don’t always need to be aware of any and all the risks and the Montgomery ruling seems to suggest that informed consent shouldn’t be based on respect for a primitive account of autonomy. However if we accept that if an account of autonomy is to remain a meaningful account that it must be a primitive account then if informed consent is based on respect for autonomy  it must be based on a primitive account. Accepting the above means that a patient’s doctors should have a dialogue with him about any suggested medical procedure. How this dialogue proceeds shouldn’t be preordained by some doctrine but driven by the patient’s needs. In most cases this will include informing him about any major risks and life changes he faces. However some patients might need less or more information in order to make an autonomous decision. As mentioned above an autonomous agent can make an autonomous decision to trust the advice of his lawyer or financial advisor. If someone is non-autonomous someone else might be given power of attorney to act on his behalf. Are doctors any less trustworthy than lawyers or financial advisors? It would seem to me they aren’t. Does then the context in which informed consent takes place differ from other contexts such as the law and finance in respect of an agent’s ability to make autonomous decisions? Provided the patient isn’t incapacitated by fear it isn’t. It follows if informed consent is based on respect for autonomy that a patient should be able to make a competent decision simply to take his doctors’ advice. Other patients might need more information than is usually supplied in order to make an autonomous consent decision. Doctors should make it clear that they are willing to supply more information when this is requested. For instance it might matter greatly to a Jehovah’s witness whether there would be any possibility of a blood transfusion however remote this possibility might be.

It might be objected that I have already introduced an example which shows that it would be absurd to base the doctrine of informed consent on a non-substantive or Millian account of autonomy. Let us agree that if we accept such an account that a patient can make a competent decision simply to trust his doctor. Let us recall the patient with the gangrenous leg. Let us assume that this patient simply wants to trust his doctor and refuses to listen to any information provided. He wakes up and unexpectedly finds he has only one leg. Such a scenario seems absurd. Perhaps then the basis of informed consent should be a substantive account or the doctrine of informed consent should be a self-contained doctrine. Let us assume the patient still wants to simply trust his doctors and refuses to listen to any information concerning his procedure. Should he should be forced to listen to brief details connected to his proposed treatment? Do doctors really want to force someone to listen? Is it possible to force someone to listen and digest information? Should he be left to die? In this situation it seems more likely that the patient would be judged as incompetent. He would then be treated in accordance with his best interests and his leg removed. He wakes up with only one leg. In this case adopting a substantive account of autonomy or considering the doctrine of informed consent as a sui generis doctrine changes nothing. It follows that whilst adopting a non-substantive might lead to some highly undesirable consequences in a few rare cases that it doesn’t lead absurd ones.

1. Supporting patient choices about health and care: Draft Guidance for consultation, GMC, 2019, [33]-[35]