written by Ben Davies and Gabriel De Marco Many illnesses that risk death or serious harm are at least partly due to behaviours such as smoking, lack of exercise, or extreme sports. The WHO notes that the global prevalence of preventable, noncommunicable diseases is rising, and accounts for a large proportion of deaths worldwide. Some… Read More »Book Launch: Responsibility and Healthcare
By Gabriel De Marco
Consider the following case:
Classic Food Placement (FP): In order to encourage healthy eating, cafeteria staff place healthy food options at eye-level, whereas unhealthy options are placed lower down. Diners are more likely to pick healthy foods and less likely to pick unhealthy foods than they would have been otherwise.
This intervention is a paradigmatic case of what are often called nudges. Though many will think that it is OK to implement this sort of intervention for these sorts of purposes, there is a large debate about when exactly this is OK.
One common theme is that whether such an influence is easy to resist is going to be relevant to when the intervention is OK. If the intervention is not easy to resist, then, at the very least, this counts as a strike against implementing it. However, though there is often reference to the resistibility of a nudge, there is rarely explicit discussion of what it is for a nudge to be easy to resist, or for it to be easily resistible.
To begin giving an account of what it is for a nudge to be (easily) resistible, we need to figure out what it is an ability to do. So, what is it to resist a nudge?
Written by Gabriel De Marco and Thomas Douglas
This blog post is based on our forthcoming paper: “Nudge Transparency is not Required for Nudge Resistibility,” Ergo.
Consider the following cases:
Food Placement. In order to encourage healthy eating, cafeteria staff place healthy food options at eye-level, whereas unhealthy options are placed lower down. Diners are more likely to pick healthy foods and less likely to pick unhealthy foods than they would have been had foods instead been distributed randomly.
Default Registration. In application forms for a driver’s license, applicants are asked whether they wish to be included in the organ donation registry. In order to opt out, one needs to tick a box; otherwise, the applicant will be registered as an organ donor. The form was designed in this way in order to recruit more organ donors; applicants are more likely to be registered than they would have been had the default been not being included in the registry.
Interventions like these two are often called nudges. Though many agree that it is, at least sometimes ethically OK to nudge people, there is a thriving debate about when, exactly, it is OK.
Some authors have suggested that nudging is ethically acceptable only when (or because) the nudge is easy to resist. But what does it take for a nudge to be easy to resist? Authors rarely give accounts of this, yet they often seem to assume what we call the Awareness Condition (AC):
AC: A nudge is easy to resist only if the agent can easily become aware of it.
We think AC is false. In our forthcoming paper, we mount a more developed argument for this, but in this blog post, we simply consider one counterexample to it, and one response to it.
Read More »Awareness of a Nudge is not Required for Resistance of a Nudge
Written by Gabriel De Marco
This blog post is based on a co-authored paper (w. Tom Douglas and Julian Savulescu) recently published in Ethical Theory and Moral Practice.
When it comes to determining how healthcare resources should be allocated, there are many factors that could—and perhaps should—be taken into account. One such factor is a patient’s responsibility for his or her illness, or for the behavior that caused it; e.g. whether a lifetime smoker is responsible for developing his lung cancer, or whether someone is responsible for heart disease on the basis of having an unhealthy diet. Policies that take responsibility for the unhealthy lifestyle or its outcomes into account—responsibility-sensitive policies, or RSPs, for short—have been a matter of debate for some time.
Read More »Healthcare, Responsibility, and Golden Opportunities
Written by Gabriel De Marco and Tom Douglas
This essay is based on a co-authored paper recently published in Criminal Law and Philosophy
Neurointerventions—interventions that modify brain states—are sometimes imposed on criminal offenders for the purposes of diminishing the risk that they will re-offend or, more generally, of facilitating their rehabilitation. A commonly discussed example is the use of hormonal agents to reduce the sex drive of certain sexual offenders. Some suggest that in the future, we will have a wider range of such interventions at our disposal, possibly including, for instance, treatments to reduce aggression or impulsivity, or treatment to enhance capacities for empathy or sympathy.
In a recent paper, we consider an objection to the imposition of such neurointerventions without the offender’s prior agreement. Some object to these ‘nonconsensual neurointerventions’ (or ‘NNs’) by claiming that they express disrespect for the offender. This, according to the objection, gives us reason not to implement them. On a strong version of the objection, NNs are invariably wrong because they always express disrespect.Read More »Nonconsensual Neurointerventions and Expressed Disrespect: a Dilemma
Written by Ben Davies and Gabriel De Marco
The UK governments in Westminster and the devolved nations (Northern Ireland, Scotland and Wales) have made a recent about-turn regarding Christmas. Where there were previously plans to relax Covid-related restrictions for five days, they will now be relaxed for only Christmas itself, and not at all in some parts of the country.
The planned relaxations were extensive. And even following the recent changes, Christmas is being treated in a way that is considerably different to other major religious festivals: no relaxation of lockdown was seen for Sikh festival Vaisakhi, Muslim celebration Eid (where more extensive lockdowns were announced just the day before), Jewish Hanukkah, or Hindu Diwali.
Although it has not explicitly been posed as such, it seems reasonable to think that saving Christmas has been a long-term plan. The timing of the recent ‘second lockdown’ in England is also suggestive. In order to avoid many going into Christmas with infections, and many leaving with new infections, the thought may have been that we needed this “circuit-breaker”; indeed, when Johnson announced the lockdown at the end of October, one hope he expressed was that “taking action” at that point would make Christmas gatherings more likely. And even amid the recent reversal, communal worship can continue even in the new ‘Tier 4’ locations.
Written by Gabriel De Marco
Suppose that two patients are in need of a complicated, and expensive, heart surgery. Further suppose that they are identical in various relevant respects: e.g., state of the heart, age, likelihood of success of surgery, etc. However, they differ on one feature: for one of these patients, call her Blair, the need for the heart surgery is due to her lifestyle (suppose she was a smoker), whereas the other, Ingrid, has not had this lifestyle, nor any other that would lead to the need for the surgery.
Some people think that:
Some of those people also think that:
For the purposes of this blog post, let’s assume 1 and 2 are true. Commonly, it is thought that, in order to be blameworthy for something, one must be responsible for it. Further, it is commonly thought that, whatever the appropriate response is to blameworthiness for something or other (assuming that there is an appropriate response), it will be negative in some sense or other. Now further suppose that Blair is blameworthy for her illness. Given 1 and 2, this fact about Blair, combined with the fact that Ingrid is innocent with regard to her illness, suggests that, at least in some contexts, we should treat them differently (or at least it would be permissible to do so). Call a healthcare policy that adopts, and reflects, 1 and 2 a Responsibility-Sensitive Policy, or RSP for short.
written by Gabriel De Marco
I recently started to watch The Good Place again, a sitcom by NBC which takes place in the realm of the supernatural. The show has taken us to the good place (somewhat like heaven, where good people go after they have shuffled off their mortal coil), the bad place (the opposite of the good place), and a few others. Although the show is mainly a comedy, it manages to be funny while discussing many interesting ethical questions, and explicitly introducing a variety of ethical views and principles.
In this world there is a system, call it The System, that determines who goes to the good place and who goes to the bad place. The details of The System have never been fully clear, which turns out to be an important part of the show. Yet, there are some things we do know about how The System works. First, it assigns positive or negative points to actions. The points assigned to a given action seem to be a function of a variety of factors, including its use of resources, the intentions behind it, its effects on others. (It has also been suggested in a recent episode that if the only reason one performs an action is to make one’s points go up, one will not receive points). Whether a person ends up going to the good place is a matter of what their overall score is, and this overall score seems to be the sum of the points assigned to one’s actions.
Read More »The Good Place, the Bad Place, and the Ugly Consequences
Written by Gabriel De Marco
Neurointerventions can be roughly described as treatments or procedures that act directly on the physical properties of the brain in order to affect the subject’s psychological characteristics. The ethics of using neurointerventions can be quite complicated, and much of the discussion has revolved around the use of neurointerventions to improve the moral character of the subjects. Within this debate, there is a sub-debate concerning the use of enhancement techniques on criminal offenders. For instance, some jurisdictions make use of chemical castration, intended to reduce the subjects’ level of testosterone in order to reduce the likelihood of further sexual offenses. One particularly thorny question regards the use of neurointerventions on offenders without their consent. Here, I focus on just one version of one objection to the use of non-consensual neurocorrectives (NNs).
According to one style of objection, NNs are always impermissible because they express a disrespectful message. To be clear, the style objection I consider does not appeal to the potential consequences of expressing this message; rather, it relies on the claim that there is something intrinsic to the expression of such a message that gives us a reason (or reasons) for not performing an action that would express this message. For the use of non-consensual neurocorrectives, this reason (or set of reasons) is strong enough to make NNs impermissible. The particular version of this objection that I focus on claims that the disrespectful message is that the offender does not have a right to be listened to.
Read More »Neurointerventions, Disrespectful Messages, and the Right to be Listened to
Written by Gabriel De Marco
Consider a story about Joe, Louie, and Dr. White. Joe is a gambling man and has been for much of his life. In his late twenties, Joe began to gamble occasionally and after a while, he decided that he would embrace this practice of gambling. Although Joe gambles fairly often, he has his limits, and can often resist the desire to gamble.
Louie, on the other hand, is a frugal family man. With his wife, he has been saving money over the last year so that they can take their kids to Disneyland. Dr. White, an evil neurosurgeon who detests the thought of children enjoying themselves at Disneyland, wants to stop this trip. So, Dr. White designs and executes a plan. One night, while Louie is sleeping, Dr. White uses his fancy neuroscientific methods to make Louie more like Joe. He implants in Louie a strong desire to gamble, as well as further attitudes that will help Louie embrace this desire, such that Louie, for example, now values the thrill of gambling, and he desires that his gambling desires are the ones that lead him to action. In order to increase chances of success, Dr. White also significantly weakens some of Louie’s competing attitudes, like some of his family values, or his attitudes towards frugality. When Joe wakes up the next morning, he feels this strong desire to gamble, and although he finds it strange that it has come out of the blue, he fully embraces it (as much as Joe embraces his own gambling desires), having recognized that it lines up with some of his other attitudes about his desires (which were also implanted). Later in the day, while he is “out running errands,” Louie swings by a casino, bets the money he has been saving for the trip, and loses it. “Great success” thinks Dr. White. Since his goal of preventing some children’s joy at Disneyland has been achieved, he turns Louie back into his old self after Louie goes to sleep.
This story is similar to stories sometimes found in the debate about freedom and moral responsibility, though I will focus on moral responsibility. Intuitively, Louie is not morally responsible for gambling away these savings; or, at the very least, he is significantly less responsible for doing so than someone like Joe would be for doing something similar. If we want to make sense of these different judgments about Louie and Joe’s responsibility, we are going to need to find some difference between them that can explain why Louie is, at least, less responsible than regular Joe.
