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What the doctor should do: perspectivist duties for objectivists about ought

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Abstract

Objectivism is the view that how an agent ought to act depends on all kinds of facts, regardless of the agent’s epistemic position with respect to them. One of the most important challenges to this view is constituted by certain cases involving specific conditions of uncertainty—so-called three-options cases. In these cases it seems overwhelmingly plausible that an agent ought to do what is recommendable given her limited perspective, even though the agent knows that this is not objectively the best course of action. The standard objectivist response to this challenge relies on a distinction between what one ought to do and what would be blameworthy or unreasonable to do. This response is affected by several problems. In this paper I introduce and defend an alternative objectivist response to the challenge. My proposal admits that in the relevant cases the agent ought to do what is recommendable given her perspective, but maintains that this diagnosis of the cases is fully compatible with objectivism. I argue that this proposal has several advantages over alternative accounts of the cases.

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Notes

  1. Perspectivist views have been defended by, for example, Gibbons (2010, 2013), Jackson (1991), Kiesewetter (2011, 2017), Lord (2015, 2017, 2018), Mason (2013), Prichard (1933), Sidgwick (1907), Zimmerman (2008, 2014). Depending on specific versions of the view, this perspective is constituted by the agent’s reasonable beliefs, knowledge, available evidence or what the agent is in a position to know. The qualification ‘primarily’ is needed in order to accommodate the general assumption that what an agent ought to do doesn’t depend exclusively on the support provided by a set of normatively relevant facts, but also on a range of enabling conditions that do not need to be epistemically accessible. An example is the condition that one is able to do what one ought to do. For similar remarks see, e.g., Graham (2010: 90–91), Kiesewetter (2017: 198).

  2. Another alternative that I shall not consider here consists in denying that there is a single, univocal normative notion of ‘ought’. Instead some philosophers have suggested that there are several qualified senses of the notion, some objective, others perspectival, neither of which takes precedence. ‘Dualists’ about ‘ought’ include R. Feldman (1988), Schroeder (2009), Sepielli (2009), Smith (2018), Wedgwood (2003). See Pittard & Worsnip (2017) for a contextualist approach. A common response from both perspectivists and objectivists consists in specifying a common intelligible sense of ‘ought’ the debate is about, identified by the roles mentioned above. For this and other replies to the dualist view see, e.g., Broome (2013: ch.3), Dancy (2000, 2009), Gibbons (2013: ch.2–3), Graham (2010: 94–95), Jackson (1991), Kiesewetter (2011: 2), Kolodny (2005: 512), Lord (2015: §2.3), Mason (2013: 3), Zimmerman (2008: 6–8 and 15).

  3. Objectivist views have been defended by, e.g., Bykvist (2011), F. Feldman (1986), Graham (2010), Moore (1903, 2005), W. D. Ross (2002), Thomson (1990), Wedgwood (2013).

  4. Graham (2010: 91), Ross (2002: 32), Zimmerman (2014: 26–28).

  5. According to Dancy, ‘‘[w]illfully closing one’s eyes to the facts does nothing to diminish the number of one’s duties’’ (2000: 57). See also Sorensen (1995), Wieland (2015).

  6. For these and other considerations in favor of objectivism see, e.g., Bykvist (2011), F. Feldman (1986), Graham (2010: §2), Kolodny and MacFarlane (2010: §2.2), Littlejohn (2009, 2012: Ch.6), Moore (1903, 2005), Ross (2002), Thomson (1986: 179; 1990), Wedgwood (2013).

  7. This specific case is from Jackson (1991: 462–63). For structurally similar cases see, e.g., Broome (2013: 37–38), Gibbons (2013: 131), Kiesewetter (2011: 5), Parfit (2011: 159–60), Regan (1980: 265), J. Ross (2012), Zimmerman (2006, 2008, 2014).

  8. Graham (2010), Moore (2005), Thomson (2008: 191).

  9. This specific version of the argument is in Kiesewetter (2011: 5–6). For similar argumentative lines see also Broome (2013: 40), Kiesewetter (2017: §8.4), McHugh & Way (2017: §2), Ross (2012: 164), Zimmerman (2008:14–20; 2014). See Graham (2010) for an objectivist reply to the challenge.

  10. In an earlier version of this paper I expressed the relation between requirements and perspectival facts using the notion of supervenience. However, a reviewer convinced me that this terminology could lead to potential problems. The reviewer observes that supervenience is a technical notion standardly used to pick relations between sets or types of properties or facts, such as the mental and the physical, or the moral and the natural. In one respect, the relation I am after is weaker than that: in my view there can be differences in objective conditions required by obligations, such as recklessness and safety, without differences in perspectival facts, and vice versa. In another respect, this relation is stronger: it’s not just that in some occasions certain requirements co-vary with epistemic conditions, but one might have an obligation partly because, or in virtue of, certain features of one’s epistemic position. For instance, one may be obliged to refrain from ϕ-ing because ϕ-ing would be reckless, and in a specific circumstance ϕ-ing would count as reckless in part because one lacks relevant evidence. I still think that a proper specification of the relation in terms of supervenience could capture the core idea of my account: for instance one could say that normatively relevant properties N (e.g., recklessness, safety, respect) supervene on descriptive conditions D, and that the latter are sometimes instantiated in part by certain epistemic conditions. However, I agree with the reviewer that this would risk committing to a technical terminology that could court confusions in the reader and raise distracting questions.

  11. On norms of respect, see for example Darwall (1977), Graham (2014), Sylvan (forthcoming). The relevant sense of respect here is what Darwall calls ‘recognition respect’, directed toward directives such as rules, laws and duties, and compatible with the absence of compliance with a norm. See Dillon (2016) for a classification of various types of respect. On modal norms such as the duty to avoid what could easily or normally lead to bad objective consequences and to violations of other obligations in similar situations, see, e.g., Hawthorne and Stanley (2008: 588–589).

  12. Bear in mind that this label is merely conventional and imprecise to the extent that not all such obligations bear on recklessness.

  13. The conditional formulation is here introduced for the sake of simplicity. It is not a necessary feature of the account that no-recklessness norms have a conditional form. Thanks to Kurt Sylvan for helpful discussions on this point.

  14. An example is the Hippocratic oath, which gives a paramount importance not to cause harm to patients. The modern version of the oath says “Most especially must I tread with care in matters of life and death”.

  15. A terminological remark. In this paper I always use ‘risk’ in a subjective or epistemic sense. This use is common in philosophy but somewhat stipulative. ‘Risk’ is also used in objective senses, especially in professional and technological risk analysis. See Hansson (2004: 10–11).

  16. It is plausible that these details will differ across explanations of specific three-options cases. For example, in Ross (2012)’s Three Envelope case, where professional and altruistic duties are completely absent, prudential considerations seem to play a dominant explanatory role (the risky choice would be reckless and unsafe, would manifest dangerous dispositions, and so on). In contrast, Parfit (2011)’s Mineshaft case seems to be better accounted for by duties of respect, responsibility and sensitivity to further normative considerations. Thanks to Gideon Rosen for helpful discussions on this point.

  17. Notice that the latter claims are in line with a standard way of motivating maximizing expected value in Decision Theory by appeal to objective prudential considerations about long-run average objective value.

  18. At least if the importance of not violating the promise outweighs that of violating no-recklessness norms. This is compatible with other cases in which the order of importance is reversed and the agent shouldn’t all things considered keep the promise. I will come back to this type of case in §3 and §5.

  19. For other examples see Dancy (2000: 55) and Smith (2010: 87–88).

  20. For accounts of safety and danger along the lines discussed here, see, e.g., Williamson (2000: 123–130; 2009). According to Williamson (2009: 13): “[t]o a first approximation, one is safe in a possible world w at a time t from an eventuality if and only if that eventuality obtains in no world ‘close’ to w at t”. Closeness is specified in terms of similarity relations between metaphysical possible worlds. Such models of safety are inspired by David Lewis’s similarity semantics for counterfactuals. Let me stress that the relevant modality for safety is metaphysical. As Williamson observes, “the distinction between safety and danger is not in general an epistemological one” (2009: 11).

  21. It may be objected that in DOCTOR it is not unsafe for the patient to take drug C. In all similar situations in which that patient takes that drug, nothing seriously bad happens. In response, let me stress that the lack of safety I am focusing on here doesn’t concern the fact that that patient takes that drug, but the type of behavior, disposition or habit of prescribing to a patient a cure while being seriously uncertain whether that will cause a patient’s death – or more generally, the habit of randomly picking amongst options one of which would kill someone. In some relevantly similar situation in which a doctor adopts a similar criterion of choice for a cure, some patient will die. In assessing the safety of the doctor’s behavior, we should focus on similar situations in which the same type of behavior is instantiated, and let slightly vary other features of the circumstance, including the cure, the patient, the time and place. Thanks to two anonymous reviewers for encouraging me to clarify this important point.

  22. Conversely, lack of safety is not instantiated by every sort of uncertainty and epistemic shortcoming. In normal circumstances one could act on some degree of uncertainty without manifesting seriously unsafe dispositions.

  23. Dancy (2000: 56–57). See also Kiesewetter (2017: 199–200; 2018a).

  24. E.g., Andrić (2013), Jackson (1991), Kiesewetter (2011), Kolodny & MacFarlane (2010), Mason (2013).

  25. The latter example is from Williams (1981). Another famous example supporting objectivist intuitions is John Broome (2007: 352)’s Salmonella case.

  26. See for example Andrić (2013: 3–4).

  27. According to the Correlativity Thesis, a person, Q, has a moral right against another person, P, that P perform some act, A, if and only if P has an obligation to Q to perform A. For a discussion and defense of the thesis see, e.g., Zimmerman (2014: 119–122).

  28. Zimmerman (2008; 2014) is one of the very few who deny this claim. For a criticism see Littlejohn (2009).

  29. E.g., Gibbons (2013: 5); Lord (2018: 234).

  30. For a discussion see Horty (2012: 18–19, Ch.5) and literature therein.

  31. These considerations can be generalized. Think of pairs of cases involving different stakes levels: first, imagine a case in which two normative considerations are present in the same situation, one intuitively more favourable to perspectivism, the other to objectivism. Then split the case into two scenarios, one in which stakes on discharging the perspectivist (or no-recklessness) commitment are much higher than on discharging the objectivist one, the other in which the opposite is true. Intuitive judgments about what to do in such cases will normally diverge and track the highest stakes commitment. These data further support the thought that no-recklessness norms are of the same sort as other objective obligations and can be weighed against them.

  32. In general, from the first-person perspective, a weighing of considerations based on no-recklessness norms against other kinds of normative considerations (e.g., non-maleficence) could be possible only on condition that the no-recklessness consideration did not depend on a lack of information about some of the other weighed reasons. See the drowning child case discussed below for an example.

  33. One may worry that the claim that the normative weighing in DOCTOR is impossible from a first-person perspective may be in tension with a familiar understanding of this weighing in terms of the weight it would be correct to place on reasons in first-person deliberation. In response, let me first observe that from an objectivist point of view, while weighing mechanisms could be understood as loosely analogous to first-person deliberation, the weighing of reasons occurs at an objective and perspective-independent level. Second, notice that my claim is not that no-recklessness norms cannot ever be weighed against other types of normative considerations. They can in many cases (I shall consider an example below). In three-options cases the impossibility of weighing against each other certain normative considerations from the first-person perspective is due to a specific ‘blindspot’ structure according to which the existence of certain reasons presupposes the ignorance of others. Even philosophers understanding the weighing of reasons in terms of deliberation acknowledge the existence of similar exceptions. For instance, Schroeder (2007: 106) discusses self-effacing reasons, reasons whose existence presupposes their own ignorance. Also such reasons cannot be weighed in first-person deliberation due to their structural features, though they can be weighed both objectively and from a third-person perspective. For discussion see Way and Whiting (2016, §2) and references therein. Thanks to an anonymous reviewer for encouraging me to clarify this point.

  34. For objections to the possibility of such weighing see Fantl & McGrath (2009: 80–82); Kiesewetter (2018b: 105); Smith (2018). For a defense of this possibility see Dancy (2000: 55–56).

  35. Here safety is conceived in the standard way, as an objective modal property concerning the consequences that a type of action or disposition could have in relevantly similar circumstances. See §2 and footnote 20 for discussion.

  36. For other examples of cases in which objective lack of safety obtains in virtue of features of the agent perspective, see Williamson (2009: §5), Hawthorne and Srinivasan (2013: 19). See also discussions in §2 and footnotes 20 and 21.

  37. For versions of this objection see, e.g., Gibbons (2013), Lord (2018: ch.8).

  38. See Lord (2018: 215; and literature quoted in fn17) for a discussion of the difference between being required to do X and being required to do something that guarantees X.

  39. NSO also promises to provide a novel objectivist account of the seemingly normative nature of judgments about rationality. In the wide majority of cases, adopting unreasonable dispositions involves unsafe behaviors, imprudent dispositions and the lack of respect for normative authorities. These conditions are banned by no-recklessness norms. Therefore, in order to comply with these norms, one should be reasonable. While such norms can be defeated, they still provide pro tanto normative reasons. Therefore, according to NSO, it is always pro tanto wrong to be unreasonable (at least as long as being unreasonable leads to conditions forbidden by no-recklessness norms). This account can explain why and how rationality is normative, while preserving the intuitive idea that sometimes what we should do is not what is reasonable. This proposal would have some similarities with those defended by Schroeder (2004), Cheng-Guajardo (2014) and Sylvan (forthcoming). Unfortunately I must postpone a comprehensive discussion of the merits and problems of this account to a future occasion.

  40. For a discussion of similar bootstrapping problems affecting rational requirements see Kiesewetter (2017: §4.2) and Lord (2018: 20).

  41. In particular Zimmerman considers Kantian and Virtue theories that would give more normative weight to showing people due respect, care and compassion.

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Acknowledgments

I would like to thank Daniele Bruno, Benjamin Kiesewetter, Jacques Vollet and two anonymous reviewers for helpful comments on earlier drafts of this article. A special thank goes in particular to Benjamin Kiesewetter for extremely helpful feedbacks and for suggesting the current title. Thanks also to Giulia Felappi, Jie Gao, Alex Gregory, Conor McHugh, Gideon Rosen, Holly Smith, Kurt Sylvan and Daniel Whiting for valuable discussions. Earlier versions of this article were presented at the Humboldt Normativity Conference 2018, the 24th World Congress of Philosophy in Beijing, and the Conference ‘Understanding and making effective use of differences in the judgments and conceptualisations of Asian and Western cultures’, at the University of Southampton. Thanks to the audiences for their helpful feedback.

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Fassio, D. What the doctor should do: perspectivist duties for objectivists about ought. Philos Stud 179, 1523–1544 (2022). https://doi.org/10.1007/s11098-021-01717-x

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