This is a preprint draft. Please cite published version (DOI: 10.1111/mila.12385). The aim of this paper is to provide a novel analysis of anorexia nervosa (AN) in the context of the sense of agency literature. I first show that two accounts of anorexia nervosa that we ought to take seriously— i.e., the first personal reports of those who have experienced it firsthand as well as the research that seeks to explain anorexic behavior from an empirical perspective— appear to be thoroughly (...) in tension with one another in their descriptions of anorexic actions. Rather than proceeding at this point by way of disregarding anorexic testimony as meaningless or insincere, I instead offer a positive account of the sense of agency in anorexia nervosa that renders these two depictions compatible. The resultant picture of anorexic behavior is one that accommodates current empirical findings while also providing valuable insight into how it is that anorexics can sincerely report feeling fully in control over their food restriction. (shrink)

Concerns over medical paternalism are especially salient when there exists a conflict of values between patient and clinician. This is particularly relevant for psychiatry, the field of medicine for which the phenomenon of conflicting values is most present and for which the specter of medical paternalism looms large. Few cases are as glaring as that of anorexia nervosa (AN), a disorder that is considered to be egosyntonic (meaning its symptoms are reflectively endorsed by the patient) and maintained by the presence (...) of pathological values. One might think, given this, that an approach to medicine that foregrounds the role of values in clinical encounters would be particularly well suited to address the problem of medical paternalism in treating AN. As it happens, this is precisely the goal of values-based medicine, an approach to medicine that prioritizes the integration of patients’ unique values into the aims of treatment and that has been touted as being particularly applicable to psychiatric conditions such as AN. Although this strategy may initially appear promising, in this paper I will argue that the directive to incorporate patient values (as dictated by values-based medicine) cannot do the work of mitigating medical paternalism in the treatment of egosyntonic disorders such as AN. Rather than chalking this up as a failure due to AN being a particularly challenging case, I will instead conclude that the failure of values-based medicine in this context cuts to the heart of the limitations of rectifying medical paternalism within psychiatry as it currently exists. (shrink)

(To appear in Philosophy and the Mind Sciences’ Book Symposium for Neuroethics: Agency in the Age of Brain Science (OUP 2023) by Joshua May). In Neuroethics: Agency in the Age of Brain Science (2023), Joshua May arrives at a cautiously optimistic appraisal of deep brain stimulation (DBS) for brain-based disorders. May does not, however, distinguish between disorders that are properly considered neurological and those that are properly considered psychiatric (or psychopathological). After motivating this distinction, I argue that May’s discussion of (...) DBS fails to account for the added complexities and potential ethical harms of DBS for psychiatric conditions. (shrink)

In 2017 and 2018, the English courts were asked to decide whether continued life‐sustaining treatment was in the best interests of three infants: Charlie Gard, Alfie Evans and Isaiah Haastrup. Each infant had sustained catastrophic, irrecoverable brain damage. Dignity played an important role in the best interests assessments reached by the Family division of the High Court in each case. Multiple conceptions of dignity circulate, with potentially conflicting implications for infants such as Charlie, Alfie and Isaiah. The judgements do not (...) explicate the conceptions of dignity upon which they rely. This article reconstructs the conceptions of dignity invoked in these judgements, finding that a broadly Kantian, agential conception dominates, under which human dignity requires the prospect of agency. This conception is situated within the broader body of thought on dignity, and the potentially adverse implications of applying the reconstructed conception in best interests assessments for infants with severely restricted consciousness are discussed. (shrink)

Tim Bayne and Elisabeth Pacherie (2007) propose an integrated model for agentive awareness that incorporates features from both the narrator and the comparator-based accounts found in the literature. Although they think the comparator system is responsible for generating the bulk of agentive experience, they believe the narrator module is responsible for forming agentive judgments and conceptually-laden intentions. Crucially, they also suggest that in some instances the narrator module may “override” the deliverances of the low-level comparator mechanisms. In this paper, I (...) apply Bayne and Pacherie’s integrated model to account for an issue in the psychopathology literature, namely the presence of anosognosia (i.e. ignorance with respect to one’s illness) in anorexia nervosa. In particular, I show that by implementing the integrated model we can solve a problem that arises out of a recent advancement in the empirical literature concerning anorexia’s pathogenesis and persistence. If my proposal is correct, the explanatory power of implementing an integrated model for agentive awareness would bolster Bayne and Pacherie’s account. It may also be of use to researchers seeking to develop a better understanding of anosognosia in anorexia nervosa, which remains a poorly understood feature of the disorder. (shrink)