Libertarian paternalism's notion of “nudging” refers to steering individual decision making so as to make choosers better off without breaching their free choice. If successful, this may offer an ideal synthesis between the duty to respect patient autonomy and that of beneficence, which at times favors paternalistic influence. A growing body of literature attempts to assess the merits of nudging in health care. However, this literature deals almost exclusively with health policy, while the question of the potential benefit of nudging (...) for the practice of informed consent has escaped systematic analysis. This article focuses on this question. While it concedes that nudging could amount to improper exploitation of cognitive weaknesses, it defends the practice of nudging in a wide range of other conditions. The conclusion is that, when ethically legitimate, nudging offers an important new paradigm for informed consent, with a special potential to overcome the classical dilemma between paternalistic beneficence and respect for autonomy. (shrink)

ABSTRACTThis paper introduces the category of ‘non-deceptive manipulation that causes false beliefs’, analyzes how it narrows the traditional scope of ‘deception’, and draws moral implications.

“de-extinction” refers to the process of resurrecting extinct species by genetic methods. This science-fiction-sounding idea is in fact already in early processes of scientific implementation. Although this recent “revival of the dead” raises deep ethical questions, the ethics of de-extinction has barely received philosophical treatment. Rather than seeking a verdict for or against de-extinction, this paper attempts an overview and some novel analyses of the main ethical considerations. Five dimensions of the ethics of de-extinction are explored: (a) the possible contribution (...) of de-extinction to promoting ecological values, (b) the deontological argument that we owe de-extinction to species we rendered extinct, (c) the question of “playing God” through de-extinction, (d) the utilitarian perspective, and (e) the role of aesthetic considerations in the ethics of de-extinction. A general feature arising from the paper’s discussion is that, due to de-extinction’s special character, it repeatedly tests the limits of our ethical notions. (shrink)

The nocebo effect, the mirror-phenomenon to the placebo effect, is when the expectation of a negative outcome precipitates the corresponding symptom or leads to its exacerbation. One of the basic ethical duties in health care is to obtain informed consent from patients before treatment; however, the disclosure of information regarding potential complications or side effects that this involves may precipitate a nocebo effect. While dilemmas between the principles of respect for patient autonomy and of nonmaleficence are recognized in medical ethics, (...) there has not yet been an ethical discussion focused on the potential dilemma raised by the nocebo effect of informed consent. This dilemma is especially pernicious, since it involves a direct causality of harm by the caregiver that is unparalleled by other potential harmful effects of information disclosure. This paper articulates the dilemma of the NEIC and offers a seminal ethical analysis. (shrink)

Moral reflection and deliberation on both deception and manipulation is hindered by lack of agreement on the precise meanings of these concepts. Specifically, there is disagreement on how to understand their relation vis-à-vis each other. Curiously, according to one prominent view, all deceptions are instances of manipulations, while according to another, all manipulations are instances of deceptions. This paper makes that implicit disagreement explicit, and argues that both views are untenable. It concludes that deception and manipulation partially overlap, and takes (...) further steps in delineating the border between these concepts. The paper ends with the conclusion that moral judgments regarding either manipulation or deception cannot be transferred wholesale from the one concept to the other just by virtue of the relations between the concepts. (shrink)

There is a disturbing kind of situation that presents agents with only two possibilities of moral action—one especially praiseworthy, the other condemnable. I describe such scenarios and argue that moral action in them exhibits a unique set of parameters: performing the commendable action is especially praiseworthy; not performing is not blameworthy; not performing is wrong. This set of parameters is distinct from those which characterize either moral obligation or supererogation. It is accordingly claimed that it defines a distinct, yet unrecognized, (...) deontic category, to which the name ‘Forced Supererogation’ is appropriate. The moral parameters of Forced Supererogation and the relations between them are discussed, especially the divergence of wrongness and blame. I argue that this new category allows a more accurate classification of moral actions than that imposed by the strained dichotomy of obligation versus supererogation. (shrink)

Anyone who is not a deontological absolutist regarding truthfulness will readily agree with Christopher Meyers’s thesis that there are cases in which...

The nonidentity problem is a deep puzzle challenging the moral intuition that what is bad must be bad for someone. The first part of the paper constructs a new theory of harming, whereas the second part builds on the conclusions of the first to offer a new solution to the NIP. The first part discusses the neglected question of when a burden inflicted in the context of overall benefitting can be discretized as a separate entity—only when it can, is it (...) possible to identify the burden as harm, and only then is it possible to harm in bringing into overall good existence. The second part explains how, in those cases where creating is indeed harming, we can use the logic of concept expansion to construct a concept of wronging that applies to creation cases. (shrink)

Recent research, especially with functional brain imaging, demonstrated cases where the administration of a placebo produces objective effects in tissues that are indistinguishable from those of the real therapeutic agents. This phenomenon has been shown in treatments of pain, depression, Parkinsonism, and more. The main ethical complaint against placebo treatment is that it is a kind of deception, where supposedly we substitute what works just psychologically for a real drug that actually works on the tissue level. We claim that the (...) scientific findings bring to a new level the seeming deconstruction of the distinction between “placebo” and “real” drugs, and that instances of placebo treatment which fulfill this criterion should be recognized as a unique category—we call it “comparable placebo treatment” (CPT). The paper uses an analysis of the notion of deception to argue that CPT does not amount to deception; that it can preserve patient autonomy; and that it is therefore morally legitimate. (shrink)

A central debate in the ethics of deception concerns the moral comparison among the three media through which deception is executed: lying, falsely implicating, or nonlinguistic deception. The two prominent views are that lying is morally worse or that the choice of medium is morally insignificant. This article refutes both and argues for a new position. The article first presents a theory on the moral significance of the medium of deception as such: it argues that the medium of communication affects (...) the reliability of beliefs formed through it, which amounts to gradations in the warrant of truth of different media. Breach of lower warrant of truth is a lesser breach of trust; it therefore deserves lighter condemnation. Consequently, the article shows that, morally speaking, lying is either worse than or equal to falsely implicating and that there is no a priori gradation between nonlinguistic deception and the two linguistic media. (shrink)

Beneficence and respect for autonomy are two of the most fundamental moral duties in general and in bioethics in particular. Beyond the usual questions of how to resolve conflicts between these duties in particular cases, there are more general questions about the possible forms of the interactions between them. Only recognition of the full spectrum of possible interactions will ensure optimal moral deliberation when duties potentially conflict. This paper has two simultaneous objectives. The first is to suggest a typological scheme (...) of all possible modes of interaction; these will be classified under the “discrete,” “semi-discrete,” and “non-discrete” categories, according to whether the meaning and/or forms of expression of each duty are treated as independent from or rather as constrained by the other. The second objective is to show that all logical possibilities of interaction indeed have real expressions in medical ethics, to provide clear illustrations of each, and in particular to stress those that have usually escaped recognition. (shrink)

Zealous nudging can deteriorate into paternalistic bullshitting. To the extent that William Simkulet’s paper is a reminder against that danger, it does us good service.1 Simkulet, however, makes the far bolder claims that nudging just is bullshitting and that—since bullshitting deviates from truthfulness, and truthful disclosure is essential for valid consent—nudging invalidates informed consent. These bolder claims involve a set of errors. The problem starts with Simkulet’s formal definition of ‘bullshit’, which says that conveying x while intending one’s audience to (...) believe y is sufficient for bullshit. This, however, is not true since the bullshitter’s not caring whether x is true is constitutive of bullshitting, and hence a necessary condition. Why, we then ask, must such lack of care be the case with the doctor who nudges? It is at least prima facie easy and intuitive to think of scenarios in which the ethical doctor is staunchly committed to telling the truth while simultaneously acting on additional motives regarding the expected effects of what is said. If the doctor cares about saying only truths, he is not a bullshitter. Having communicative motivations that transcend the trivial motive of transmitting the truth of the literal content of what is said is normal and indeed normative in conversations of regular people.2 …. (shrink)

Significant advancements towards a future of big data genomic medicine, associated with large-scale public dataset repositories, intensify dilemmas of genomic privacy. To resolve dilemmas adequately, we need to understand the relative force of the competing considerations that make them up. Attitudes towards genomic privacy are complex and not well understood; understanding is further complicated by the vague claim of ‘genetic exceptionalism’. In this paper, we distinguish between consequentialist and non-consequentialist privacy interests: while the former are concerned with harms secondary to (...) exposure, the latter represent the interest in a private sphere for its own sake, as an essential component of human dignity. Empirical studies of attitudes towards genomic privacy have almost never targeted specifically this important dignitary component of the privacy interest. In this paper we first articulate the question of a non-consequentialist genomic privacy interest, and then present results of an empirical study that probed people’s attitudes towards that interest. This was done via comparison to other non-consequentialist privacy interests, which are more tangible and can be more easily assessed. Our results indicate that the non-consequentialist genomic privacy interest is rather weak. This insight can assist in adjudicating dilemmas involving genomic privacy. (shrink)

It is widely agreed that deception of the enemy can be morally permissible in war. However, the question of the morally acceptable limits to deception in war has barely been explored in contemporary ethics. This paper defends the thesis that there are no moral limits on military deception per se, that is, no limits based on the ethics of truthfulness. Rather, all moral restriction against deception in war is based on another moral principle: military deception is morally unacceptable only when (...) it violates the principle of not harming those who do not intend to harm us. (shrink)

This conversation took place in December 2002 but was published much later. It focuses on ethics.

After rightly rejecting the view that all change to the integrity of genomes is intrinsically bad, Rohwer and Marris proceed to contest the view that...

Ideas of nudging, choice architecture, and libertarian paternalism have sparked much controversy. Some find in them a long-sought optimal harmonization of the commitments to beneficent, welfare-increasing influence and to respecting persons, whereas people on the opposite end see in them an especially sinister form of control. One area in which these ideas are of greatest importance is health care, where improving people's decisions, under the constraint of respect for persons, is a vital concern. Nudging Health: Health Law and Behavioral Economics, (...) edited by Glenn Cohen, Holly Fernandez Lynch, and Christopher Robertson, is the first book dedicated to this important topic. This anthology of twenty-four chapters, with section introductions and a foreword by Cass Sunstein, presents a wide spectrum of perspectives on both the promise and the difficulties in applying choice architecture to health care. The short and readable chapters, written for the book, cover questions of public health law and policy, clinical practice, medical ethics, and political philosophy. They present a synopsis of the types of questions that nudging brings up in health care broadly construed, offer new analyses, and provide much fodder for thought. (shrink)

When paternalism is deemed morally justified, weak paternalism—which restricts itself to assisting the target of paternalism realize his own preferences—is the preferred (less problematic) alternative. In determining the appropriateness of weak paternalism, the level of certitude of the paternalist regarding the correctness of her assessment of the true preferences of the one‐paternalized is obviously a crucial factor. Yet in the ethics of paternalism this parameter has escaped systematic treatment. This paper aims to initiate discussion on this indispensable consideration for weak (...) paternalism. Analysing a real‐life dilemma of paternalism in healthcare, the paper focuses on the theoretical question of how the paternalist can optimize her certitude by combining personal knowledge of the individual patient with population data on treatment refusal/consent of patients facing similar decisions. The paper presents an outline of a decision‐making scheme that can be valuable in medical ethics and beyond. (shrink)

The moral comparison of the three venues of deception—lying, falsely implicating, and nonverbal deception—is a central, ongoing debate in the ethics of deception. To date there has been no attempt to advance in the debate through experimental philosophy. Using methods of experimental economics, we devised a strategic game to test positions in the debate. Our article presents the experimental results and shows how philosophical analysis of the results allows drawing valid normative conclusions. Our conclusions testify against the dominant position in (...) the debate—that lying is morally worse than all non-lying deceptions. They offer prima facie support to the view that the venue of deception makes no moral difference. (shrink)