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Introduction
Published in David Bain, Michael Brady, Jennifer Corns, Philosophy of Suffering, 2019
David Bain, Michael Brady, Jennifer Corns
This ‘stickiness’ of suffering cannot, the authors argue, be reduced to more familiar phenomena such as akrasia or non-intentional action. In Vaccination, they argue, you do not ‘give in’ to the anti-pain desire against your better judgement, but ‘fight against’ it. And even had you acted on the anti-pain desire, your pulling away from the vaccination would not have been a ‘pain-induced reflex’, since what suffering ‘forces’ is not movements, but decisions to act. So the stickiness of suffering is real, Fulkerson and Cohen conclude. Moreover, it is explanatory. For it contributes, they suggest, to the depression and other ‘secondary suffering’ that chronic pain can induce. Those with chronic pain, on this picture, know their pain serves no purpose and should not motivate them, yet it does, thereby intruding into their thoughts and impeding their actions. (There are connections here to Chapter2 of this volume by McClelland.)
Addiction as a Disorder of Self-Control
Published in Hanna Pickard, Serge H. Ahmed, The Routledge Handbook of Philosophy and Science of Addiction, 2019
If self-control is the contrary of akrasia, it may seem that failures of self-control cannot occur in the absence of akrasia. That is, a person cannot fail to exercise self-control if he acts in conformity with his all things considered, or better judgment. However, this view is problematic. Consider the following example. An alcoholic wishing to stay abstinent may now judge that, all things considered, it would be better to stay home and watch television than go to the pub and have a drink with a friend. But as evening draws near, the temptation to drink increases, making him change his mind about what would be the better course of action – by giving too much weight to certain considerations that appear to provide reasons to meet with his friend, for example – and then revising his all things considered judgment accordingly. Is this a failure of self-control? Not if self-control is the contrary of akrasia. The alcoholic (unlike the akrates) does not act against his all things considered judgment when he chooses to meet up with his friend. Nevertheless, he plausibly exhibits a lack of self-control. This is because he revises his all things considered judgment unreasonably: he revises it, not because of the considerations that give him reasons to join his friend, but because he, at the time of making the choice, has a strong desire to drink – precisely the desire his judgment ruled out as outweighed by his better reasons.
Self-paternalism
Published in Kalle Grill, Jason Hanna, The Routledge Handbook of the Philosophy of Paternalism, 2018
Cases of akrasia are supposed to be cases in which one acts contrary to one’s better judgment. But not all cases of giving in to temptation take this form. In some cases, temptation prompts distortion, and giving in to temptation by, say, X-ing involves revising one’s judgment about what would be best and acting accordingly.6 In such cases, being forced not to give in to temptation occurs not just without one’s current consent, but also without the concurrence of one’s current evaluative judgments. Interestingly, where one’s current evaluative judgments favor the tempting act (in this case X-ing), even voluntarily refraining from X-ing seems problematic, since it seems to qualify as akratic.7
Obesity, Pressure Ulcers, and Family Enablers
Published in The American Journal of Bioethics, 2018
The second reason is the perplexing complexity of the ethical issues. There are many true philosophical questions that are raised: Do these patients have free will? Is this an example of Aristotelian weakness of will, or akrasia? Can these patients be blamed for their overeating? Is it their fault? If so, then is it fair for us to judge them personally responsible? Might we even refuse to continue to see them at some point if they repeatedly refuse our advice? Is nonadherence the right explanation for their behavior? Or, to the contrary, is it possible that they are being stigmatized and treated unfairly as the result of bias? And perhaps the most interesting philosophical question of all: Is this a biomedical illness, or a psychological/psychiatric illness?
Ethical Criteria for Health-Promoting Nudges: A Case-by-Case Analysis
Published in The American Journal of Bioethics, 2019
Next, I provide six well-known examples of health-promoting nudges. Each of these has specific ends (what it aims for), has specific means (how it works; which mechanisms are at play), and is implemented by a specific agent (who implements it). Obviously, nudges can have many more ends, tap into other mechanisms, and be implemented by different agents.Google fridges. Organizations can nudge employees towards healthier consumption patterns to reduce potential weight problems and related health risks. Google saw a 47% increase of water consumption after placing bottled water at eye level in its fridges. Soda consumption decreased 7% after it was placed on the bottom shelves (Kuang 2012). Another example of “physical choice architecture” nudges is the deliberate design of supermarkets and cafeterias.Interactive stairs. Another nudge toward more active lifestyles is “gamifying” people’s choice environment, making it more interactive and fun. Interactive stairs that play notes (piano stairs) or that have a message wall for passersby to post messages have been shown to double the proportion of people taking stairs rather than elevators (Swenson and Siegel 2013).Let’s Move. Next to informing people about health benefits, Michelle Obama’s Let’s Move campaign also nudged people to exercise more by stimulating them to write down their resolutions and have their physicians sign those resolutions. Such precommitment strategies rely on social pressure to counteract laziness and akrasia.Drug intake. Smart packaging of drugs can help avoid predictable mistakes. Most packages of birth control pills have inert pills that allow women to stick to the simple habit of daily intake (Thaler and Sunstein 2008, 89). This nudge taps into people’s routine behavior to avoid errors due to forgetfulness and inattentiveness.Risk information. Physicians can nudge patients by verbally framing the risks and benefits of treatments or screening methods. Framing the risks of chemotherapy in terms of dying (mortality rates) versus surviving (survival rates) has been shown to influence patient decisions (see Blumenthal-Barby and Krieger [2015] for a review of studies on this). Other examples are providing risk information in absolute versus relative terms, ordering treatment options, or making specific pieces of information more salient.Organ donation. In some countries, there is presumed consent for organ donation upon death unless people opt out. In such countries, numbers in donor registers are much higher (90% or more) than in countries with opt-in systems (5 to 30%) (Blumenthal-Barby and Burroughs 2012, 3). Defaults can also be used for flu vaccinations (Chapman et al. 2010) or HIV or cancer screenings. Multiple factors (status quo bias, loss aversion, laziness) cause most people to stick with the default.