Over A Cliff

I’ve been doing some thinking – not a lot, obviously, because one doesn’t want to overdo that sort of thing – about the nature of informed consent. I’m curious about what people think about the following scenario, which is designed to illuminate one aspect of the phenomenon.

You’re on a cliff, and in front of you is a narrow path, to the right of which there is a sheer drop down to the sea. You’re about to choose whether to traverse this path or instead turn back and head for home, when a syringe drops from the sky injecting you with a drug that has the following effect.

You remain aware of all the reasons why the narrow path spells danger. You are also aware that normally you would be very reluctant to traverse the path. However, as a result of the drug, these things no longer have any significant motivational force – they have lost the capacity to bind your behaviour. Put simply, you know that you would be taking a risk by not turning back, but you don’t care – it doesn’t feel as if it is a big deal (although, if asked, you could explain why it was a big deal and would report that previously you would have felt it to be a big deal – but you wouldn’t care about of these things either ).

The question is whether under these circumstances any choice you make is a fully informed choice? Or, to put this question a slightly different way, if I told you that you had to make the choice under these circumstances, would you feel that you were being deprived of something central to the decision-making process?

My tentative view is that would not be a fully informed choice, even though you still have access to all the relevant information.

As I say, I’d be very curious to know what other people think about this…

Leave a comment ?


  1. It sounds like what’s being limited is intuition. Because we have all of the facts and relevant information and what’s missing is how we feel about the situation.

    I would think that it is still an informed decision, though. They’re are people who have limited intuitive capacities that go through life making decisions everyday and I would find it difficult to accuse them of being uninformed.

  2. Neat example. And I agree with Ben M-P, it does look like an informed choice. So if you think something is going wrong in the scenario, it would be more apt to say that the actor has lost their autonomy in some crucial respects.

  3. Thanks guys.

    Two points:

    a) I’m not convinced that the “feel” of how we would normally feel is not a relevant datum (though there is a load of complexity there that would probably get us into an argument about intentionality – in the phenomenological sense – and so on). In other words, I think there’s an argument to the effect that not having access to some data that would otherwise be present is not the same as not having access to the same kind of data because one isn’t wired up for those sorts of experiences).

    2. However, it’s possible that if we explored point 1. at greater length it would fall out to be an issue to do with autonomy, (as Ben N. suggests). Thing is, though, if autonomy is in some way subverted, then arguably there’s no informed choosing – not because it’s not informed, but because choosing requires autonomy; and “arguably” because no decisions are entirely autonomous, obviously.

    Interesting responses, thanks. And I’m slightly annoyed that I didn’t think of Ben M-P’s point. 🙂

  4. It’s informed. The question is, by what? In this case it’s informed by whatever motivation there might be, minus what might be an otherwise ‘normal’ aversion to danger – normal for that person. A decision made under the coercion of blackmail is informed by that state of affairs. An induced hallucination that that leads the subject to think the cliff is only 12 inches high, and that it is safe to step off, is informed by that brain state.

    Incidentally, I would see this quite differently that cases were something was done to the subject – e.g. pushed off the cliff against the subject’s ‘will’.

    This example merely highlights the problem with presuming free-will. These philosophical dilemmas seem problematic only in the context of free-will, and the degrees to which that supposed free-will is deteriorated by the removal of normal modes of being informed.

    This example scenario nicely side-steps the issue of free-will with regard to other parties who are also supposed to have free-will – side-stepped by making the needle appear from the sky magically.

    Some degrees of being informed:

    1) Person A pushed the subject B off the cliff.
    2) Person A drugs B to succumb to persuasion, and asks B to step off – though B still fears it.
    3) Person A drugs B to remove fear of the cliff and asks B to step off.
    4) Person A asks B to step off, with no coercion whatsoever. (B refuses.)

    What we seem to get here is something like a billiard ball example of causation: ball A strikes ball B and causes it to move. But of course B also causes a change in momentum of A.

    The psychological example is more complex, since the way complex brain-body systems respond when interacting depends on so many more complex factors. And we focus only on one of the entities. In case (1) is the causal chain most immediate, and most similar to the billiard ball example. Specifically the scenario as presented removes any similarly complex brain-body system from the immediate causal environment, by invoking a magic needle.

    But by removing the temptation to look at it from a free-will perspective the problem becomes easier to understand, at least conceptually. All that we consider informed consent is still the act of a brain-body system responding to the environment that informs it, that drives it, including its own internal state that may be more or less altered by other environmental events: a push, a drug, a request.

  5. Thank you, 😀

    I think you could take it further even. Look at daredevils or “thrill-seekers.” They seem to lack, or perhaps suspend, their intuition that, say, jumping out of a plane is a bad idea. Would we say that they lack some part of their autonomy? Maybe….

  6. There seems to be several issues here. The first is ethical, the second would seem to be legal.

    If your free will has been tampered with via drugs, then your personal culpability is lessened, because you cannot freely make the decision because of impairment that the drugs cause.

    It is possible to be objectively wrong, while not being guilty of being subjectively wrong.

    Free will, or free choice –that results in complete culpability–is dependent on the ability of the individual to make informed consent, which would generally be regarded to be decisions based on unimpaired choice.

    The legal system takes a less informed view, saying that if you know right from wrong, regardless of being “impaired” you are fully responsible for your actions, for the state is less focused on the intricacies of choice, and more on punishment and retribution. (There are some exceptions, as the state does differentiate between murder and manslaughter, as well as occasionally recognizing crimes of “passion”).

  7. We have two situations here 1/ A person is their usual self. 2/ A person is not their usual self, due to being under the influence of a drug, which can elicit decisions that person would not normally make. So to a significant extent we are considering two different people, not one. The person under the influence of the drug is not responsible for the decision he makes for the simple fact he is functioning abnormally. Were I to inject a person without his/her consent with a drug which caused the person brutally to murder the next person they met I do not think the murderer could be held legally responsible for the act of murder. If you are going to insist on a reply to the question does the man on the cliff make an informed choice I can only reply it is an ill-informed choice. It is asked “would you feel that you were being deprived of something central to the decision-making process?” Yes, because I would be provoked to make make a choice whilst not in my right mind.
    I cannot see that this scenario presents a great problem, but perhaps I have missed something here.
    Personally I would avoid a path of that nature not because I fear falling, but I would fear a temptation to jump, just for the hell of it.

  8. I agree with Don that it is not informed consent because the person is drugged.

    It is true, as Ben says, that people with limited intuitive abilities or capacities consent to things in an informed manner, but their self is a self without intuitive abilities or capacities or with limited intuitive abilities or capacities.

    I assume that the person in question has normal intuitive capacities and thus, at the moment, being drugged, is not their usual self, to use
    Don’s phrase.

    For informed consent to be valid, what is important is that the usual self decides and a drugged person is not the usual self.

  9. The human mind is structured like the scientific method. At the lowest level are observations, which requires paying attention. At the level of inquiry, humans ask questions and extremely intelligent humans invent answers and theories. At the level of reflective judgment, humans marshal evidence and decide whether a theory is true or just probable. The fourth level is deciding what to do with our bodies. This requires being responsible. Humans admit that they have bad memory and are not intelligent. But, no one likes to admit they have bad judgment or are irresponsible.

  10. Interesting because it demonstrates quite clearly that choice is always relative which contrasts or collides with the view of some types of atheists who base their views on a false Darwinism in saying there is no choice at all – we are all at the mercy of our genes and environment.
    The case offered is one of choice impairment because the faculties and ability to make judgments on which choice is based are impaired. That is, the person is not in the optimum state for making a judgment.

  11. Google “capacity of decision” and several interesting articles appear. Here is a systematic approach that provides an algorithm for assessing decision-making capacity. It is limited to a medical definition of informed consent:

    Here is a UK legal approach to capacity of decision:

  12. One can never be fully informed of all the risks associated with an action. So I think a better question might be, how informed must one be to make a decision of this magnitude? In regard to the situation in this particular blog post, a lack of feeling would most definitely hinder one’s ability to assume the risk. There’s something in law that is used a lot called the “assumption of the risk.” This is used to prove, or disprove, that someone assumed the risks associated with their actions. The first element is that one must have knowledge of the risk. The man standing before the cliff has the knowledge he may die, so the first element is met. The second element is that one must voluntarily assume the risk. It does not seem like an external entity is pressuring the man to traverse the path, so the second element is met. The third element states the one must appreciate the magnitude of the risk. This is where the problem lies for the man. Since he is deprived of being able to instinctively and emotionally appreciate the risks of traversing the path, he cannot appreciate the magnitude of the risk. Hence, the man is not able to make an informed decision to traverse the path with the barriers placed on him.

  13. Claire Creffield

    Would it make sense to say that the “feeling” that is lacking might be either one of the two following things?

    (1) You temporarily cease to have your usual goals. Temporarily you aren’t motivated to avoid pain or death or injury — and you also aren’t motivated by the likely preferences of your future self, as you would normally be, even though you know she would want not to be injured, in pain, dead. It isn’t a lack of information at all, but a modified set of preferences. That’s actually a very interesting and important real-life case, of course, because it is the situation of somebody who is severely depressed.


    (2) You still have all your usual goals in place, but the reasoning process doesn’t get a purchase on you. You sift through the premises, make the correct arguments, but …

    What follows the “but”? Is it that you fail to draw the conclusion? In this case the drug has in fact made you irrational: it hasn’t deprived you of information, it has inhibited your reasoning. Or is it, rather, that you draw the conclusion but it just doesn’t “stick”, it doesn’t bind you. It would seem very odd to call that “lacking a feeling”. If there was a “feeling” that would normally be present at this point, but for the drug, then there would also be a “feeling” of accepting, when you do a sum, that, e.g., 24+63=87. So again it doesn’t seem that information is lacking: there is no datum that you are temporarily unreceptive to. It’s hard to think of the lack of “stickiness” as anything other than a lack of motivation — which seems to bring us back to (1).

  14. I can tell by the comments above that this is going to be a great thread.

    For now I’ll just respond to one of Jeremy’s points. Above, he argues that choosing presupposes autonomy, and hence whatever happens afterward is not really a choice.

    I am not sure that choosing requires autonomy. Choosing does indeed require agency, I suppose; but autonomy is not strictly identical to agency. Autonomy is a half-way point between agency and responsibility, in the sense that autonomy is a socially constructed way of mediating between social and personal expectations (responsibility) and actual capacities to make decisions (agency). A person can have their autonomy compromised in some cases, while still having the ability to choose. Agency is necessary for choosing, and it is necessary for autonomy, but autonomy is not necessary for agency. e.g., a person can make a choice based on a lie, and hence some would be willing to say that the person did not make an autonomous choice, but still be willing to say that a choice was made.

  15. Claire Creffield

    Actually, I was wrong, wasn’t I, to say that ‘If there was a “feeling” that would normally be present at this point, but for the drug, then there would also be a “feeling” of accepting, when you do a sum, that, e.g., 24+63=87’ — because this example is a piece of practical reason, and the “stickiness” of the conclusion would be its “action-guidingness” rather than the simple acceptance that comes with drawing a mathematical conclusion.

    But still, it seems plausible to say that the action-guiding character of drawing a conclusion in a piece of practical reasoning is no more likely to be a datum, a “feeling”, than is the simple acceptance of a conclusion in mathematics — unless the “feeling” in question is simply “having a motive”. So, still, it doesn’t seem like information is lacking for the cliff-walker? The only possible deficits are either motives or rationality?

  16. Here’s an analogy which may clarify the difference between a person whose intuition capacity is usually limited and a person whose intuition capacity is reduced by taking a drug.

    I’m very introverted. As a young person, I had a lot of problems when I realized that things that were supposed to be fun, like parties, were not fun for me, etc.

    Nevertheless, with the years I learned how to be introverted and how to deal with situations (like parties) as an introverted person.

    So too a person with limited intuition capacities learns other mechanisms to deal with situations where a person with normal intuition capacity would use their intuition.

    Think of how blind people develop capacities which enable them to deal with the world to compensate for their lack of visual ability.

    Now, if someone were to be given a drug which made them suddenly introverted, they would be in trouble, because they would not have developed the abilities over the years to be deal with life as an introverted person.

    So too with intuition.

    Thus, a drug which suddenly reduces one’s capacity of intuition makes it impossible for one to give informed consent.

  17. Guys

    I’m reading all this with interest, and many thanks for the responses – but I really can’t respond to everybody, there’s too much already.

    @Claire – I’m almost persuaded. I started to explain why I wasn’t quite persuaded, but realized it would take an essay length response, so gave up. Of course, I don’t expect you to be impressed by my suggestion that I could have countered your argument if only I had more time! 🙂

    @Ben N. – I’m not sure about the precise terminology you’re using, but I was gesturing towards those kinds of complications with the “arguably” bit.

  18. J — and that’s fine. My point was “arguably not” — and, indeed, “not”!

  19. @Claire – I feel your argument deserves a response, and I think I’ve got a short version. As I said, I’m almost convinced, but here’s where I need to be persuaded.

    Let’s imagine the drug works by shutting down the fear response & adrenal system.

    So I’m on the cliff, and I do the sort of reasoning you’re talking about in your (2), but it doesn’t bind my behavior. It doesn’t bind my behavior, because I get no fear response.

    I think your argument is that this is a function of the fact that one is no longer motivated by the goals & preferences that existed before the drug was administered. In fact, that there are now different goals & preferences in place.

    But I’m not sure that’s right. I think one cannot conclude from the motivational inefficacy of the goals and preferences that they no longer exist (unless its part of the very nature of goals and preferences that they are motivating – which I think would be a hard sell).

    It appears at least possible what might be going on here is that the original goals and preferences remain in place, but it seems as if they are absent, because there is no fear response when they are threatened.

    So that’s the datum that’s lacking.

    So yes, one is not motivated as before, but this is precisely because the drug has shut down some of the “raw feels” that would drive the motivation to avoid danger (given the existence of the goal to stay alive, avoid danger, etc).

    [Edit: Sorry if that’s a bit garbled!]

  20. Claire wrote:

    You still have all your usual goals in place, but the reasoning process doesn’t get a purchase on you. You sift through the premises, make the correct arguments, but … What follows the “but”? Is it that you fail to draw the conclusion?

    One possible way of making sense of both cases is by making a distinction between practical and theoretical forms of reasoning. The difference is that the conclusion in theoretical reasoning is a proposition, while the conclusion in practical reasoning is an actual action or intention to act. So if we think that the unfortunate cliff-dweller is engaged in theoretical reasoning, then that means that the conclusions of their reasoning will be valid. But if we think that they are engaged in practical reason, then they are supposed to form an action or intention by virtue of their deliberations. In that sense, the cliff-dweller may be practically irrational, while being theoretically rational.

    In this case the drug has in fact made you irrational: it hasn’t deprived you of information, it has inhibited your reasoning.

    That seems right to me — so long as we are speaking within the paradigm of practical reason, and we think that choosing presupposes agency, and that the cliff-dweller’s choices have been inhibited.

    Anyway, though this is a useful distinction, it doesn’t get to the bottom of most of the issues we care about. If we get right down to brass tacks, we have to ask: can a practical reasoner recognize a reason to do a thing, and have an intention to do a thing, without ever thereby producing a desire to do that thing?

  21. The situation here seems simple to me. Any decision made by a person not in their right state of mind must be regarded with suspicion. It is clear from the outset, prior to the administration of the drug, the person was in, what was for him, his normal state of mind and about to choose. Assuming the drug acted instantaneously the person made his/her choice under the influence of a substance having the capacity to elicit from the person a choice which he/she may well have not made, in what would otherwise have been for him/her, a normal mental state. Like for like is not being compared here as the mental states of the person differ as a result of whether or not the drug has been taken. In view of this it is not an informed choice. At best, as I have already said, it is an “ill informed” choice made under the influence of a drug which he would not normally take.
    You have two mental states to choose from one normal the other abnormal. It seems blindingly obvious to me that the decision made under the influence of what has been described as a very powerful drug lacks the essential component of a normal unadulterated neurological state.

  22. Having read the post and some of the comments I have to say informed consent involves things not in the scenario, like motivations. Personally, I have to have a really good reason to risk my life whether my emotions are involved or not. If the reason to take the path is that is the way to food, emotion or no, informed consent has to take survival into account.

    Allow me to turn the scenario around, though, because I suspect this scenario really plays out more often. Suppose you are in a state of severe depression and the experience of emotion is itself excruciating to the point of death clearly FEELING preferable- but you choose to remain alive for the sake of family members. THEN the needle falls from the sky. Now, in which situation were you really able to make an informed consent?

  23. Ron wrote:

    But by removing the temptation to look at it from a free-will perspective the problem becomes easier to understand, at least conceptually. All that we consider informed consent is still the act of a brain-body system responding to the environment that informs it, that drives it, including its own internal state that may be more or less altered by other environmental events: a push, a drug, a request.

    I think you’re quite right to point out that one sense of free will (agency) is a major sticking point in the case. I made the same point upthread (using the term ‘agency’), though it looks like you beat me to the punch!

    However, I am not so sure we can talk about informed consent in the absence of talk about agency or free will. Can robots express informed consent? Probably not in any straightforward sense. It seems to me that you have to be able to look at it from the internal point of view, and not just in terms of a causal or physical description.

    Tim wrote:

    If your free will has been tampered with via drugs, then your personal culpability is lessened, because you cannot freely make the decision because of impairment that the drugs cause.
    It is possible to be objectively wrong, while not being guilty of being subjectively wrong.
    Free will, or free choice –that results in complete culpability–is dependent on the ability of the individual to make informed consent, which would generally be regarded to be decisions based on unimpaired choice.

    You’re on the right track, I think. In this case, it does look as though some part of the person’s freedom has been manipulated or compromised. (Though I will quibble that it is probably not true as a general rule that personal culpability is lessened just in case a person is impaired by drugs. My sense, anyway, is that we think that drunk drivers ought to feel guilty of their actions, and not just ashamed; and justifiable guilt is characteristic of personal culpability, while justifiable shame is characteristic of social or legal culpability.)

    I’m not on board, though, with the idea that free will is dependent upon the ability of the person to make informed consent. When you make a deal with an evil djinn, you’re making a deal without informed consent, but you’re doing so of your own free will.

    Don wrote:

    So to a significant extent we are considering two different people, not one.

    It’s surely right to say that the situation is abnormal. But has the context changed to such a degree that the person is different? If so, what does that entail about what it means to be a person? Do we think that this case is sufficiently similar to cases where it is a bit easier to say that they are different people — say, cases of dissociative (“split”) personality, or cases of amnesia? It does seem as though the cliff-lurker has undergone a kind of trauma, which does give us reason to take your hypothesis seriously. But the cliff-lurker also seems to have a heck of a lot in common with their earlier self.

  24. BLS Nelson,

    My response in turn is that yes, we can use the free-will ‘model’, and talk about informed consent in that framework. But my point is specifically that using a philosophical free-will model can sometimes make the problem seem more intractable.

    If I can change the scenario slightly, to make an analogy easier: both the safe path and the dangerous path lead home, but the latter is quicker.

    By looking at it in terms of autonomous brain-body systems it becomes clearer that we are considering the extent to which a particular brain-body system, the subject, can act autonomously – but then what constitutes autonomous action?

    In machine terms autonomy is the extent to which a system can work in complex ways, typically towards some goal or goals, with or without decision making inputs from external autonomous systems – i.e. humans. A target seeking cruise missile that can manoeuvre over novel terrain is more autonomous than a remote controlled drone.

    In Jeremy’s scenario the subject seems to have had a direct input that has changed the programming of the system. This seems like an injection against his will, and so the scenario seems to make it a free-will issue, at least to some extent. But this needn’t be an immediate input – the needle could have been used at birth to permanently change the subject; or may have been used at any point up to the time on the cliff. This is distinct from the difference between a cruise missile and a drone. No new decisions have been injected into our subject, as opposed to the case where the drone has the remote pilot continuing to control it.

    So, this isn’t about the immediate control of the will, free-will, decision making. Instead, the very nature of the subject has been changed, as if he has been changed from one type of autonomous cruise missile to another. He still seeks the same goal, to get home in our subject’s case, but his programming has been changed so as not to avoid terrain that might endanger the mission to a greater degree. He still has the same degree of autonomy, or ‘free-will’ – no outside prompting to make specific decisions, no remote control; all the decision making is still internal, using whatever internal and external data is available.

    This is why I think the temptation to look at this philosophically is not enough. Think about the physical brain and its programming. We now know that psychopaths have brains that are different from the rest of us. It’s as if they have been injected at birth with something that alters their brain from the normal empathetic programming that most of us enjoy. But when psychopath kills he is still an autonomous system in action, acting in an informed way, but lacking the empathetic aversion to killing.

    So, I still say our subject is making informed decisions. But he is informed not only by his reasoning about which is the quickest route. Even with the fear removed by the drug he might still decide, rationally, that there is a greater chance of falling on the dangerous route that isn’t worth the risk. He is still informed. The only information that is no longer informing him is his biologically driven urge, his fear, to avoid danger. If you prefer the philosophical perspective, he is still acting on his own free-will based on his own decision making capacity and his own biological inhibitions, even if the latter have been changed.

  25. Claire Creffield


    Ah, right, I had assumed that the drug simply “made you not care”, without having any physiological mechanism (or any mechanism at all!) by which it achieved that uncare. I think that I agree that in some cases a fear reaction does constitute part of the information we need for decision-making, and consequently for informed consent. In the cliff case, the fear is likely to be of a very basic kind that floods us with loads of physiological data that have evolved precisely to supply information to us about avoiding certain things — in that sense it is like pain. So, yes, I’d think we lacked information if it was inhibited

    I’m not sure, though, because in the cliff case we wouldn’t normally (i.e. without the drug) observe our fear, take it into account, and then act on the basis of the information it provided: the fear and the aversion to the fearful stimulus don’t seem to have the right kind of separation. I don’t know what to think about that. Is that grounds for saying that loss of fear is, after all, the loss of a motive. I don’t know!

    There are of course cases where we do observe our fear, learn from it, and then act on the basis of the information that it supplies. These are cases where the fear isn’t the basic biological response to threat, but something more nuanced and reflective. Say you apply for a job, and when you find out you’ve been granted an interview you suddenly feel afraid: “Oh no, what if they give me the job!!”. And you thereby learn that you don’t want it after all. Sometimes we learn about our own desires in the same way that we learn about other people’s — by observation. Fear does seem clearly information-supplying here.

  26. Dennis S’s reference (Jones and Holden 2004) specifically includes a phrase “Can the patient assign personal values to the risks and benefits of intervention?”, which kind of addresses this idea of a disconnect with one’s emotions. “Rationality” is their next checklist item. There are plenty of real life situations, eg after receiving shocking information, where you may exhibit a rational understanding of a situation, but not be able to decide in a fully reflective fashion.

    Further tinkering with the setup, what if the drug merely brought back memories of your younger self, when you were less risk averse?

  27. @Claire

    the fear and the aversion to the fearful stimulus don’t seem to have the right kind of separation.

    This point is why I said in my very first comment yesterday (1.18pm) that the position I’m taking would likely result in an argument about intentionality (in the Brentano sense). But yes, you’re right – this objection does have force.

  28. When I first read the example, it struck me that the drug removes inhibitions. The obvious parallel is the person at a party who goes home with a stranger after having too many drinks. In the case of a person who was drugged rather than choosing to get drunk, it seems obvious that it is not informed consent.

    Another thing struck me, though, from the world of insurance. An insurance agent has to determine a person’s risk profile so that they can sell the person suitable products. If the person tries to buy riskier products than the risk profile would suggest, that is a red flag. If the agent discovers a legitimate reason for the riskier than normal behavior (the client won the lottery and now has secure income is an example) then the sale is suitable. However, if it turns out the client was drugged, the agent has a duty to not sell to the client. This is kind of a long way of saying that personality traits are important in decision making and if something changes an aspect of your personality, against your will, then you are not making fully informed decisions.

  29. @Gene

    The obvious parallel is the person at a party who goes home with a stranger after having too many drinks.

    Indeed, I’m writing a piece about more or less that situation, and want to leverage this thought experiment to make the argument that the bar for properly informed consent is much lower than we often assume.

  30. I would say that being deprived of the feelings in question would deprive me of relevant information. To be specific, a reasonable case can be made that how I feel about a situation of this sort is a “report” of sorts from the various subconscious processes ticking away in my mind (the book Blink looks at some of this decision making). So, the feeling I have about falls is not just a matter of emotion but important information about falls (that is, they are bad).

    That said, long distance running has put me in this situation for real. My brain has been in a state of simply not feeling fear because I am so tired and flooded with chemicals. To use a specific example, I’ve been out doing long runs when a major lightning storm rolls in, yet I feel no fear or worry at all. Fortunately, I can still reason it out and decide that even though the storm does not scare me, I should head indoors because I could be killed and I know that I should avoid this.

    So, I’d say that even when my emotional apparatus is distorted, I can still make informed decisions. However, I do suspect that some of the information I use is how I would (and should) feel about the matter, were I in my right mind. But, suppose that I never had emotions? Interesting to speculate on what impact that would have on decision making.

  31. Anyone making decisions based on how they feel is an idiot. The information is there, the decision should be made based on expected outcomes. All that has happened is your risk aversion has been reduced. Dutch courage and all that.

  32. Thor Magnus Tangeraas

    cf “Descartes’ Error”: I think this situation may be analogous to that described by Damasio: he did research on patients who suffer a damage to a particular area of the brain: the ventromedial frontal cortex: Such patients suffered no impairment to their intelligence, and sustained a normal score on all measures of personality and ability tests. But still things went pearshaped: They could not maintain friendships, hold a job, deal with their finances. They consistently made bad practical decisions.
    How was this possible, Damasio asked, when their ability to reason was intact? He found that their rationality lacked a central component: Emotions.
    These patients had no problems recognising that a certain act/behaviour would imply great risk, yet they were unable to feel the implications of this, and did not consider the consequences. Damasio concluded that there are certain areas of the frontal cortex that connect emotions, decision-making and social behaviour.

  33. Keddaw,

    While I am no fan of the “reason is the slave of the passions” view, how a person feels can provide useful information-provided that it is met with proper rational assessment. For example, I play a lot of fast paced computer games and often have to react quickly with no time for reflection or act with very little information. In such cases, how I feel is often a decent guide to how I should act. For example, in Halo 4 multiplayer, something might feel like an ambush-that is, I get a negative feeling that is probably a report from my subconscious operations that warns me that something is up. It makes sense that we would have sub-rational and non-language guides to behavior that can be quite reasonable and non-idiotic to follow.

    Naturally, I do agree that feeling has very clear limits. For example, a situation might feel like an ambush and thus serve as legitimate basis for a decision, but trying to feel one’s way through how to perform surgery would obviously not work.

  34. Can drugs influence decisions? This has been a subject of discussion since then publication of the Ludovico technique in the novel “A Clockwork Orange.” For example, it is claimed Bath Salts can turn people into cannibals, but in the observed situations, the behaviour resulted from a release of inhibitions rather than an absence of feeling or intuition. This brings to the point that although the creation of a “syringe from the sky” does conveniently remove any discussion of free will versus determinism, it is still fictionalization, and will result in a fictitious conclusion. How is it possible derive a conclusion on informed consent based on the predicted results from a drug when there is a disagreement on what behaviour that drug can supposedly alter? The “syringe from the sky” eliminates the possibility of informed consent since the person has not given permission to be drugged.

    There are other difficulties when trying to introduce fictitious claims or dogmatic values into decisions of informed consent. Consider a situation where a person goes to a hospital, sponsored by religious funds, for emergency treatment and is required to sign an informed consent that they believe in the power of the Saints and the everlasting life. Many people would not hesitate to sign the form to save a life. The informed consent is for the purpose of the hospital sponsors and the verification of their beliefs, and not the patient. The first point is that the motivational factors of fear will induce anyone to falsify their beliefs for the satisfaction of others (that theory is IMO and I have not looked if there is any supporting material). The second point is that informed consent exists with reciprocity between two agents, and not specifically in individual rational capacity.

    Mike LaBossiere makes an interesting point about fear. Soldiers and boxers are trained to control fear, not disregard fear. Would a total absence of fear induce a person to not stop at the edge of cliff, but to keep on walking? I tend to think no. There would have to be a motivational factor to induce a person to keep on walking, not an absence of motivational factors.

  35. Rebecca Reilly-Cooper

    I’ve read the post but only briefly skimmed the comments, so apologies if this repeats ground covered by others:

    So the question is, what kinds of attitudes, mental states, beliefs etc have to be absent for us to be justified in concluding that a person’s consent is not ‘informed’ (as opposed to defective in some other way). I am inclined to think that we should only hold that a person is lacking information (as opposed to making some other kind of rational error) when there is some factual information that we could present to her – some evidence, some data, some test we could perform – such that if we presented it, and she were reasoning well, then she would accept the truth of that information. And, for it to be relevant to whether consent is sufficiently well informed, it has to be the case that if we were to present her with this evidence, she would change her mind about what she is about to consent to.

    This does not seem to be the case in this example – the individual in question has all the factual evidence, there is no data we can present her with, no tests we could run and present her with the findings, such that she would change her mind. Therefore, I think we ought to say that her consent is informed.

    However, I still think we ought to stop her proceeding down the path. This means I am committed to thinking that full relevant information is necessary but not sufficient for consent to legitimise action. Presumably there is some other condition that must be met, in addition to full relevant information, before we can conclude that a choice was sufficiently autonomous; though I’m not sure what I would call that condition.

  36. Re:- Rebecca Reilly-Cooper November 15

    “Presumably there is some other condition that must be met, in addition to full relevant information, before we can conclude that a choice was sufficiently autonomous; though I’m not sure what I would call that condition.”

    I would say that condition is the necessity for the person to be in their right mind, which obviously this person under consideration, is not.

  37. Ron, it would be useful to explicitly invoke Daniel Dennett’s stances at this point. As you probably know, Dennett makes a distinction between the stance of the mechanist/physicalist (e.g., your ‘billiard balls’ illustration), the stance of design (e.g., what you refer to as ‘brain-body systems’, analogies to drones and robots), and the intentional stance (e.g., the philosopher’s sense of compatibilist free will or agency).

    You seem to want to say either one of two things: a) “let’s stop thinking about informed consent in terms of the intentional stance, and instead talk about it in terms of the design stance”; or b) “let’s not confine ourselves to the use of the intentional stance”. I would disagree with (a) and agree with (b). I disagree with (a) because the very idea of human autonomy is saturated with moral assumptions. The ‘autonomy’ of the drone has very little in common with human autonomy. And human autonomy is what we seem to be talking about in the OP.

  38. What if we swapped the syringe for a hyper-vivid reoccurring dream. In the dream he desperately needs to go down the narrow path. He doesn’t know why, he just knows he must.

  39. BLS Nelson,

    I’m saying that both the intentional and the design stances prevent us seeing the physical nature of what is happening. Though Dennett’s breakdown can be useful, it has the problem of the intentional stance helping some philosophers retain the traditional perspective of the specialness of humans without taking the physical interpretation seriously.

    I see, for example, that a free-will model is necessary to maintain a traditional moral theory. Whether the moral assumptions come before free-will, and therefore require a free-will interpretation, or the free-will comes first and requires traditional moral theory be heaped on that isn’t important. They go hand in hand. I would suggest we dismiss both, for the purpose of trying to understand what is going on in human brains and the consequential human behaviour we observe.

    Note that it is Jeremy’s introduction of the magic needle, a purely physical system, that helps remove one intentionality perspective from one part of the problem: that of an agent that might be applying the drug. But still the OP continues with an intentional perspective on the subject.

    You seem to have taken it that I wanted to introduce a design stance, based on my analogies. The design stance can be more helpful, but not helpful enough. I am suggesting only a physicalist stance will get us any further.

    In the OP, had the subject been hypnotised or drugged so as to accept instructions without question, and then told to jump off the cliff, then this would be an example of not only lack of informed consent, but lack of consent altogether, the lack of autonomy – it (brain-body subject) would have become a remotely controlled drone.

    But in the OP, with the injection, it is only the nature of the internal processing that has changed. The subject is still an autonomous system making its own decisions. It is still informed. But physically, the processes going on internally (what we, looking at a higher level of intentionality, see as informed decision making) have changed so as to make that physical brain-body system react in a way that it would not otherwise have reacted. It is as ‘informed’ as ever, but only the internal physical biological processing has changed, so as to possibly result in different external behaviour.

    Note how we see physical causes of human behaviour in some cases and not in others. We meet a really grumpy person and dismiss them as such. We feel he could be nicer if he wanted to be, because we know we have some control of our own behaviour (but we over estimate what our autonomy is). But then we learn our new acquaintance used to be very nice, but currently has a brain tumour that has altered his behaviour. We suddenly become sympathetic when we acknowledge what we see as a distinct and identifiable physical cause. But a naturally grumpy person is no less physically caused to be that way. And we are no less physically caused to react to both cases the way we do. Yes, a naturally grumpy person may well be persuaded to re-evaluate their behaviour, through, say, anger management. But underlying that psychological change is real physical brain change.

    Note also how, in some of the above, I have to force myself to use strong physicalist language to make my point. I refer to the subject as a brain-body system, as an ‘it’ to get away from anthropomorphic language. It’s not surprising that the last place we want to cling on to anthropomorphic perspective is with humans. But anthropomorphism of ourselves is a hindrance. You will see in many discussions a keen desire to keep to a human perspective. Some philosophers have a pathological aversion to discussing humans in terms of physical systems, and this prevents them seeing the physical nature of what we are. They must cling to the human, the ‘I’ rather than the ‘it’. They fear the loss of our humanity. We are fighting our own evolved and socially developed perspective, the biggest illusion of all, that we are special, something more important than the mere physical processes that underlie our behaviour.

    We are only self-important, as individuals and as a species. All our intentionality, our humanity, our specialness, our importance, is entirely constructed within the context of our own perspective. It’s a self-contained perspective, a closed system. There is not one jot of evidence to suggest anything else in or out of this universe gives a damn about us. We are just one more physical phenomenon. We may be uncommon in this universe, in that we can look at ourselves and see ourselves as special. But that perspective of ourselves isn’t shared by anything else in this universe, as far as we know. We mistake our uncommon nature for specialness and importance in a wider context than our own.

    If we want to understand our place in this universe we have to take seriously our relationship to it, which is a physical one, as far as we can tell. We need to look at humans as physical systems to see what makes them tick, what makes them behave. Traditional philosophy (and more so theology) fails to do this.

  40. I rather enjoyed this post without sharing full agreement.

    I see a difficulty in describing the universe merely in physical terms. The natural limitations of our intellects is a real problem, and the inability to comprehend and define the transcendence of man in other than physical terms presents unique difficulties. No one philosopher, no one kind of philosophy has ever answered the most pressing questions regarding existence.

    As a philosopher, I have intentionally never published or defended any thesis, for to do so, would acknowledge the untruth that I have achieved pure wisdom. I am interested in philosophy because of my search for wisdom. The Greeks were correct in teaching that the most satisfactory and happy life is the contemplative.

    My experience is that the answers are out there, but biases and personal prejudices of choice, oftentimes obscure reality.

    You post has given me much to consider, and it is very likely I will re-read portions of it hundreds of times.

    Good poat.

  41. Intuitions (how we feel) play an important role in decision making. Only objective information about the situation is not sufficient.

    For example, a person may jump from certain height, say 15 feet, the first time without hesitation; but if he gets injured by this, this experience would go into shaping his intuitions. Intuitions, as we know, is a repertoire of all our experience in the subconscious brain. So the next time this person is on a 15 feet height he will have different intuition about it than he had the first time. This time his intuition will tell him ‘this could be dangerous’, and so he might decide not to jump.

    Note that here objective facts about the situation remain the same, but because of intuition the decision is changed. This is how it happens in every decision that we make.

    I am not sure whether to call it uninformed decision if one makes a decision without the guidance of intuitions. Depends on what me mean by ‘informed’.

    About the legal aspect of this dilemma I would say there can’t be a perfect solution for this. I think we have to discount intuitions from the definition of ‘informed decision’. Because as it is, not all people have same, equally developed intuitions mechanism. If we take this fact into account then for the same crime, different people maybe responsible to different degree based on how developed their intuitions mechanism. It is then impossible to punish anyone because it is not possible to know how developed or undeveloped is the person’s intuitions mechanism. For this reason in law I think we have to keep aside the role of intuitions in decision making — and allow some collateral damage in that the people with less developed intuitions making otherwise informed decisions to commit crime will be punished all the same.

  42. There’s something wrong with the setup here. There is a lack of information that goes way beyond simple feelings to the point where one is not informed.

    If one is aware of the danger but not bound by it that’s fine, but the actual text says “you would be taking a risk by not turning back, but you don’t care”. Not caring is a whole lot different from not reacting viscerally to the danger. I think this should be cleared up.

  43. Darshan, I think you may be overplaying your “feeling make decisions” hand. If one jumps from 15 feet one may well injure oneself which would lead to a fear of being 15 feet up. However, in different circumstances (say jumping onto soft sand) one can overcome this learned fear (intuition) quite easily and correctly. Or an innate fear for that matter. The decision not to jump 15 feet onto concrete (a second time) would just as easily be made by the logical CBA part of the brain as by the more basic emotional part.

  44. RE:-TimrfoNovember 16

    I have sympathy with what you say here. Recently reading the Philosopher C D Broad he suggested that a scientific view of philosophical exposition could well be expressed by saying “He tells us what everybody knows in language that nobody can understand” Not always the case but far more than a grain of truth in it I think. I have, done and still do, find myself trudging through a quagmire of words, which seem to overwhelm and practically eliminate the ideas which the writer wishes to convey. I guess it could be, I am just thick.

  45. That’s funny.

    I am a bipolar/PTSD afflicted disabled veteran, who, the psychiatrists say has an excellent IQ and education.

    I have several degrees, but sometimes, I must read, re-read, and so forth for days before I begun to understand the concept in which it is being used. You aren’t thick, because if you are, then I am really thick…..

    I am not thick, just a little unstable….. 😉

  46. Ron, the trouble is that you’re helping yourself to far more than just the physicalist stance in your description of the brain-body system. The physicalist system does not “process” any representations, for example; molecules interact, neural patterns fire in sequences and at various frequencies. But the idiom of ‘representation’ is verboten; a low-level physical system makes no reference to any kinds of representation processing.

    Unfortunately, the idea of goals, informed consent, and so on is not even intelligible without the processing of representations. Indeed, you yourself relapse into the language of design so often, and self-consciously so, that it is difficult to see how you could make a case for the low-physicalist vocabulary. What you need to do to make your case is offer a concrete account in genuinely physicalistic terms which would answer the inquiry as it was posed, taking special care to make no reference to the idiom of design.

    It could be that one day we’ll have a more sophisticated vocabulary which does not require reference to distinct stances, and instead fully and seamlessly integrates them into a single picture. But I’m not seeing what gets cleared up about informed consent when we toss out higher-level talk about representations right now.

  47. Jeremy’s question is as follows:-
    “if I told you that you had to make the choice under these circumstances, would you feel that you were being deprived of something central to the decision-making process?”
    My reply is yes. This for the simple fact that in order for me to make a decision I need to be in what is for me my normal mental state. Under the influence of the hypodermic I have lost that state and am therefore deprived of something central to my decision making process.
    Is it not reasonable to argue by making an analogy with the state of alcoholic intoxication? A person may accordingly, agree to what will be a disastrous marriage, may take unnecessary risks crossing a road, make a very bad financial investment. Why does he do all these things not typical of him because he has been deprived of his normal reasoning powers. I agree he can still make decisions but they are such that he is not likely to make in make in a normal mental state. People say of him “he is not the same person when he is drunk”. This is the central point of my argument the man has been deprived of his normal mental state.
    Suppose the man under the influence of the drug decided to walk along the path and fell to his death. Would not an autopsy reveal he had taken such and such substance and as a result of its influence an inquest could well declare the man to have met with an accident, or at worst committed suicide, whilst the balance of his mind was disturbed?
    I can’t really see that this is a philosophical question; it seems the solution lies in sheer common sense. Notwithstanding it has led to many interesting and erudite replies so has certainly not been a waste of time.

  48. @Don Bird,
    Perhaps the question is what is confusing. Jeremy has noted above that the bar for properly informed consent is much lower than we often assume, and I agree. Therefore, the question being presented is how low should the bar be for informed decision in a matter of informed consent? The problem supposedly outlines a situation demanding an interpretation of informed consent. However, most of the commentators have presented arguments based on informed decision which is different. This could be because the article suggests informed choice is necessary for informed consent.

    A good start with the quagmire is to take the time to define the words being used to ensure both the writer and the reader share the same meanings. Informed consent is a moral process defining power control and is agreed upon by two agents. Only one agent may have all the information, knowledge and ability – such as a doctor/patient relationship or drunken sex. It does not require both agents to have the same knowledge. Consent is a wonderful idea but seems to be best restricted to personal and professional relationships. Consent has no place in the world of law and politics. A political world allows one agent to act without consent of a second agent, and informed decision seems irrelevant.

    Informed decision is partly, as you say, a matter of right mind.

  49. Re:- Dennis Sceviour November 18

    I am in complete agreement with what you say, in fact I have intended to write something similar here for some time. We seldom ask “what do you mean by”? or say “it all depends on what you mean by” before engaging on a discussion. In the absence of this so many disputes arise the basis of which are a merely verbal disagreements.
    Here is an interesting paper by David Chalmers on Verbal Disputes about 20000 words if you have time to read it. http://consc.net/papers/verbal.pdf

  50. @Don Bird,
    Thank you for the paper by David Chalmers on Verbal Disputes. The case of a verbal dispute from William James Pragmatism (1907) is interesting. I believe the man goes around the squirrel. I was wondering whether you hold the same view?

  51. Re:-Dennis Sceviour November 19
    James stated that it depends on what you mean by ‘going round’. If you mean passing from the North of him to the East, then to the South, then to the West and then to the North of him again then the man does go round the squirrel.
    This is not my personal idea of going round an object. To go round an object one would expect to see all sides of it. Assume the tree is transparent then all the man would see is the ventral aspect of the squirrel.

  52. @Don Bird,
    Your reply has made me re-think the viewpoint. Perhaps, you are correct. The squirrel is the axis of interest, and one must go round the squirrel to see all of it.

  53. Where Do You Set The Bar For Sexual Consent? | Talking Philosophy - pingback on December 16, 2012 at 9:33 pm
  54. I think that those of you who believe that you wuold not be making a fully informed choice in the above scenario believe that there is some kind of “true” self and that only that true self can make a fully informed choice. Thus, a drug that appears to inhibit the amygdala (a part of the brain responsible for a person’s fear response and “gut feelings,” what you guys are calling intuition) would alter your consciousness sufficiently so that you are no longer your “true” self and thus in that state you are unable to make fully informed choices. I don’t agree with that view. (It’s also funny because some people use the existence of subconscious processes, such as the “gut feeling,” to argue that people don’t really have free will because so much of what goes into a person’s choices occurs at the subconscious level so that a person’s choices are really influenced by processes beyond his conscious control, but here some are saying that a person is somehow deprived of free will because one of these subconscious processes has been temporarily inhibited by a drug.)
    I think that so long as a person retains his ability to reason, he can make a fully informed choice even though other neural processes have been altered or inhibited.
    Consider this alternate scenario: You are on the cliff with the person whom you are madly in love with. Normally, you would not walk down this path, and you would not be convinced by/taunted into traversing it by another person (you’re not the type to succumb to peer pressure). But you are in love with this person to the point of complete irrationality, and they ask you to walk on this path with them. You can still articulate all of the reasons why taking such a risk is a stupid idea, and you know that you would normally not agree to do such a thing. However, because you are madly in love with the person, none of those reasons seem to matter–all that matters to you at this point is pleasing/impressing this other person. Are you making a fully informed choice?

    What if someone important to you has just recently died a sudden and tragic death, and you are devastated. You can articulate all the reasons why traversing the path is a bad idea, and you know that before the tragedy you would not have traversed it. However, in you present state of anguish, you no longer care about those reasons. You walk down the path, hoping that the danger will momentarily distract you from your grief. Was that an informed choice?
    I think it’s dangerous to assume that people who are fully capable of rational thought are not able to make fully informed choices simply because they are not their “normal” selves.

  55. I must say, the term “fully informed choice” is missleading for me.

    I the sense that yes, this is a fully informed choice. but what does that mean ? If it means that it is a choice you made with your full capacities of decision making, then -no- it’s not. You would be obviously lacking the capacity to apply conscious knowledge to your behavior.

    This is what is broken here, think of addiction, you have the knowledge that going if you keep going through the addictive path you will risk dying, but you cannot apply this knowledge to your behavior (or struggle to).

    For me, as a psychologist, “knowledge” is just a necessary part of decision making, but it’s not sufficient to make good decision. You have knowledge on one side and the capacity to use it on yourself on the other.

    (This is coming from someone who is in Psychology so I may have a different angle of approach on this)

    And by the way, great work on your websites/experiment, it is incredibly well made and thought provoking !

  56. I go with the view that the involvement of the drug as a one-off (?) intervention puts the scenario into the ‘uninformed consent’ category. An important part of this is the assumption I’m making that after the cliff walk, and after the drug wears off, I will look back on the incident with confusion. ‘Why did I do that?’ etc. It’s not made explicit in your scenario whether we’re aware of the drug injection having happened. That for me is a key feature in our interpretation of the event at the time (‘I know I’ve had a drink’ etc) and also afterwards (‘I only did that because of the booze’ etc) and the post hoc rationalisation.

    There then follows a thought of how far our future behaviour and attitudes will be influenced by this experience. That’s really an important aspect of the scenario (and again not explicit). [Swallerstein Nov 14 touched on this with the ‘introvert’ character points; the idea that one’s character would be jarred by this drug-induced event]. One character might interpret this by feeling ‘it was only the drug, I wouldn’t ever have done it otherwise’ whereas another might feel ‘the drug was a release, a liberation; deep down this is what I wanted to do but never dared’ . So the additional ‘risks’ beyond falling off the cliff are in terms of future consequences for one’s character. This is all part of a more thorough understanding of the ‘risks’ in such behaviours; beyond the obvious risks (‘will I die, will I be injured, will it hurt?’) are the less obvious (‘will this experience perhaps change my whole attitude to life?’).

    It’s much easier when life randomly throws these character-forming experiences our way without our being able to make a conscious decision whether to ‘risk it’. So this brings me full circle …. the syringe fell from the sky – life did throw it at me! So ‘consent’, informed or not, is now irrelevant?! Nice scenario!

  57. The setup suggests there is a choice to be made before the effects of the drug take place. If fear normally dominates other considerations, there would be no real choice as the traverse option would be ruled out. So I assume in this scenario that fear is more a consideration which is usually given high value…in which case the absence of fear would change the consideration (and so consent). I would imagine a more important issue from the point of view of the original question, is not whether or not there is fear present, but what are the risks beyond the eliciting of fear (which the drug later takes care of). If the actual risks are minimal (i.e. the path is wide enough to pass without developing new gymnastic skills) then the choice without the drug, would be to consider shall I alarm myself but safely traverse the path, or shall I turn back and avoid alarming myself. If the usual choice is to avoid alarming yourself, then the drug would remove the ability to use ‘alarm minimising’ as a way of making choices. However if the path was not wide enough, this evaluation would not be impeded by the absence of fear as the calculation is not about fear, so the decision would not be impeded by the drug but by the examination of the external risk rather than the alarm (or its absence) at the examination.

  58. Laura Creighton

    Trying to decide, objectively, whether the drug deprived the person of their subjective autonomy is going to always produce odd results. Because it depends on the person. There are people who will tell you that the drug ‘made them another person’ and who are very upset about this. They will ask you to please never inject any more drugs into them without their consent, which they won’t be giving. They believe that the drug robbed them of some measure of their autonomy.

    There are other people who will, when the drug wears off, immediately ask you for the perscription. They want to take the drug _all the time_. They’ve been troubled all their lives by paralysing, irrational fears. And they think that their own fears are robbing them of a significant measure of their own autonomy. They don’t think that the drug has robbed them, but instead given them their own autonomy back.

    You may not be out of the woods yet, though. I can introduce you to some schitzophreniacs who, when they are taking their medication, always want to take their medication, but who, if for some reason miss taking it will immediately want to never take medication again. Which one of these two states represents your real patient? This is a real world problem, and not just a thought exercise.

  59. I’d say that even if the actor was given all relevant information, he was deprived of an essential aspect of his ability to understand it. See Thor Magnus Tangeraas’ post. I was going to quote Damasio, but he beat me to it. So no, I would not say this is informed consent.
    This is a ceteris paribus position: I’m implicitly excluding abnormal cases such as a schizophrenic actor. But even then, if medication induced such a person to walk down a mortally dangerous path, I’d say there was something wrong with the meds.

  60. Drug-induced consent is not informed consent. I know this from personal experience, having grown up in the 60’s 🙂

  61. You say it is a narrow path with a drop off. You didn’t say if I was capable of navigating it. I could think, I am capable of going on this path; the drug has removed the feeling of fear and now I can make an informed decision. I still have all of my decision making facilities and all of the information. i should be able to judge what is good for me. But, another question that emerges is how do we rely on feelings as a part of being rational? Since I spend most of my life making decisions without all of the needed information, I should be able to make this one. Are my fears essential to the decision making process? Without knowing the full impact of the drug, I can’t determine if I am missing something critical. The safe way is; I fall back on the facts as best as I can understand them and take the action I would have normally taken. This is where habit, conditioning and training come in.

  62. I do not feel that my choice after being non-consensually injected with this drug would truly be an informed consent. Although it is clear that the drug would not be impacting my intellect, it would be impacting my emotions which do have a role in the decision making process.
    Personally, I recognize that in many situations I am already willing to take greater risks than I intellectually believe is in my best interests. If a drug is going to take away any of the emotional resistance to a risk, I would not consent to take such a drug before making a decision involving my safety.

    This situation is only informed consent if I agree to take the drug knowing it’s impact on my emotions in order to allow myself to make a freer decision. It is NOT informed consent if the needle falls on me.

  63. The person who is drugged so that he no longer thinks the same as before is not quite himself. I use “think” instead of “feel” here because I want to differentiate between our perceptions of the world and our thoughts about them, pain being part of the former while our “feelings about danger” are actually part of the latter. If our thoughts are suppressed in any way, then we ourselves have lost control over our bodies, which now act based on purely biological mechanisms. Therefore it is not we who make any choice in such a state. Also, I do not believe that such a scenario is possible exactly as described, because in this view no one will be able to (if he is later undrugged) claim that he was completely sober, fully understanding the danger, and yet no longer having his previous thoughts about avoiding the danger. It means that any observations we make of “him” are not really him, if we agree that “he” is not “himself”. So it is not uninformed choice, since it is in fact not even the person’s choice.

    That said, I also want to say that if the person had willingly made prior choices that he knows is likely to predispose him to such dangers, then he is already partially responsible for any dangers he faces even if he was not fully in control of his body at the time he is in danger. For a clear example, a deep sea diver chooses to put his life at risk, and is responsible for himself should a jellyfish sting him and cause him hallucinations halfway through a dive and thus making him drown by doing something dangerous. This aspect of the issue also has to be dealt with in any answer, as our choices are hardly independent and we are well aware of that.

  64. Any drug that alters the senses and how a person feel, especially to the extent that it interfers with their perception of danger would obviously mean that the person would no longer be in full awareness. Any decision made under the power of a drug (especially if it has nulifying effects) would mean that the person would not have full decision-making processes and would not be able to make an informed choice.

  65. Before answering this question I would need to understand whether the drug has left a motivating force such that I am not simply acting purely at random.

    Assuming that I have been bereft partially, but not wholly, of my normal priorities, fears, and inclinations, in a very real way I have been crippled. Later on, I might feel a distance from the “me” that had made the choice.

    At the same time, I do not believe that humans have complete consistency of character. In a way, a “drug from the sky” is altering the choice-making identity at any given time.

    This is not simply a matter of the effects of substances. Instead, it’s both a natural healthy occurrence, it may occur through disease, or it could even occur through treatment.

    So, you could conceive of the “drug from the sky” test as showing that that our understanding of what constitutes our choice-making identity is flexible–or at least mine is.

    A “drug from the sky,” I would resent.

    Other things could produce a similar effect, but because of their natural or internal nature, my moral judgment might be different.

    And there is the problem of treatment–whether returning someone to a “normalized” choice-making identity is moral.

  66. i would feel being deprived of something central to the decision-making process

  67. I wonder if I am the only one considering another point.

    I will illustrate it with two examples.

    1) Imagine that I have an extremely acute acrophobia. I would get physical pain even at a glance at (or even the thought of) that cliff. So despite being perfectly capable physically of navigating that passage, I would likely not try it even if my life will be otherwise in moderate danger. Now, that drug has removed this crippling fear. I don’t see any changes in informed part. And as for free will… Which of these conditions would you call more and which less free-willed?

    And 2) Not really cliff-related… A person has a crippling mental disorder. Bipolar, severe depression, whatever. They are put on drugs which compensate for that. Are their decisions under influence are more or less informed and/or free-willed?

    In context of the interactive scenarios, if they were too depressed to even consider sexual relationship, but are pretty ok while on antidepressants. Would it be considered not quite consensual (and using them in Kantian view)?

    (PS: both examples 1 and 2 are non-fictional)

  68. The question is whether under these circumstances any choice you make is fully informed and/or genuine?

    Under these circumstances any choice is fully informed since your reasoning ability was not impaired, only the emotional part of your brain was deactivated.

    If I was forced to make a choice under these circumstances I would not feel deprived of something central to the decision-making process, as long as I had an intact faculty of reason.

    Emotions are important for those (the majority of mankind and the other animals of this world) who don’t rationalize their actions since it can keep people out of trouble; however emotion is a double edged sword because they also get people into trouble too.

  69. If a needle came down out of the sky and injected me with such a drug as described, I might consider that as proof and change my belief system. I would however, even if I did start believing in the needle, question its motives and wonder if it had my best interests in mind. Just because it came from above, doesn’t mean its helpful. It could have started out below and looped up into the sky and then come down.
    What I’m getting at is that the question posed makes me see that any information or force of any kind that comes from outside myself, keeps me from being autonomous or isolated and whether or not that gives me an advantage or disadvantage is not clear.
    I’ve forgotten the question. I had one philosophy class and that was over 40 years ago so I guess I’d better leave this type of stuff to sharper minds. But since I typed this, I think I’ll post it, I mean, do I have a choice?

  70. Humans are not actually rational, and emotions are a substantial part of our decision making processes. So in some sense the drug impairs our decision-making. However, emotion is also “that which causes us to take action” so to suppress emotion – completely – would leave us in some sense inert – able to cogitate but not to act.

    So in the scenario the relevant question seems to me to be how much is our emotional response suppressed? If only enough to suppress feelings we want to suppress, as @M-ree pointed out above, then I would not say our consent has been impaired – rather that which prevented us from acting as we would given an ability to control our own emotional responses has been removed and our consent can be freely given or not. But it is also clear there can be “too much of a good thing” and we reach the point where we are not suppressing our over-reaction (which may be desirable), but our ability to naturally evaluate the situation (which depends on our emotions correctly priming our brain to think in particular ways).

    So I guess like most psychologists I’d have to say (on the matter of informed consent) “it depends…”

  71. When you state emotion is also “that which causes us to take action” the action can be action or the refrain from action, correct?

  72. Well, the action of refraining perhaps (frozen in terror comes to mind), but that’s different from not caring and therefore doing nothing (sitting down and waiting for death I guess ;-). That is, the state where emotions are completely suppressed would be lassitude.

  73. So there must be three states in the mind?

    (1) When emotion causes and action externally
    (2) when emotion prevents action externally
    (3) when there is no emotion and the mind is in a state of lassitude.

    Perhaps someone should define what emotion is so we have a clear idea of it.

    Recall Artistotle’s method of definition using the four causes.

    First would everyone agree that the class (genus?) that emotion belongs in is the class of Thoughts.

    And the four causes helping to define Emotion are its Material, Formal, Efficient and Final cause.

    So using a chair as an example we would say the Material cause is wood, the Formal Cause is its physical shape, the Efficient Cause is its creator, the carpenter and the Final cause is what it is used for, sitting on.

    Now with emotion what are everyone’s thoughts on defining it using the Aristotelian method?

    Isn’t this the first thing someone like Socrates would do: define the term.

  74. I expect there is going to be a least a little struggling since this points to the difference between knowledge by acquaintance and knowledge by description, no?

  75. It’s arguable whether lack of emotion will result in inaction or in purely pragmatic (or programmatic) behavior — after all, we have systems capable of limited cognitive operation already, and they don’t stay still.

    So even absent emotion, a person could recognize their needs on a purely rational basis and act on that.

  76. But for more than anyone ever wanted to think about emotions 👿 see http://plato.stanford.edu/entries/emotion/

  77. Note that the limbic system is responsible for both emotion and attention (among other things), so complete suppression of emotion would also presumably mean a lack of attention making rational thought difficult. I would conjecture behavior would be similar to that expressed in victims of prefrontal lobotomy (which also induces extreme lassitude).

  78. Even not considering other options (like suppression of only specific chemicals/receptors, or, if we get it fetched further, transmission of consciousness to a platform incapable of emotion only), the initial problem formulation (“magic syringe from the sky”) certainly allows us to abstract from specific biologic mechanisms. It also touches on the robots/drones ethics — things capable of reasoning but not emotions.

  79. I wonder if any of us would bother to put comments here if emotion was removed from us.

    What is the material cause of emotion?

    Is it not the chemical firing of a large number of neurons.

    And the formal cause of emotion is

  80. Strictly speaking, the drug ended the existence of the mind that was a priori /me/.

    In other words, it killed me and replaced me with someone with different values.

    I don’t believe that continuity of memory is sufficient for continuity of identity.

  81. Thanks for the stimulating thought experiment. Maybe a bit late but here’s my personal take on it.

    BTW apologies that I am responding solely to the initial questions (no offense to all previous commentators intended):

    The question or rather questions were
    1) “…whether under these circumstances any choice you make is a fully informed choice?”
    2) would I feel that I was “…being deprived of something central to the decision-making process?”

    My answer to question one would be “no”, the key-word being ‘informed choice’. I have in both cases the same access to information (one could argue about whether emotion is information or not, but the issue is irrelevant in my opinion as I still know what emotion I’d normally feel and why I’m not feeling it, so even the potential ‘warning’ information content of emotion/gut-feeling is still available to me)

    2) my answer to question two is again “no”.

    a) To be clear, my answer is “no” if the “decision-making process” is assumed to be the conscious deliberations that we all, or at least most of us (presumably) normally do when deciding something. And indeed, if that assumption is correct, then it is a true statement that questions 1) and 2) are the same question. (BTW please don’t pounce on the very rough definition, it is just an indicator so we know roughly what we’re talking about. If I could define the ‘decision-making process’ I’d be receiving the Nobel prize instead of posting here, LOL)

    b) However, split brain experiments and a growing body of neuro-scientific evidence suggest that the decision-making process is not the conscious deliberation of the left brain, but that our actions are determined prior to that, and that the left brain provides a ‘story’, a ‘rationalization’ after the fact. Thus patients whose brain stem was split reacted to seeing (with their left eye) something funny by laughing. When asked why they laughed they gave a (plausible) reason for laughing that had however nothing to do with the real cause i.e. was a total fabrication by the left brain. (Interestingly this phenomenon would explain why while many ‘moral’ choices world-wide are the same, the explanations that supposedly inform such choices given by people vary greatly with culture). It would seem that the left brain observes what is going on and gives a running commentary, making up a story as we go, including explaining predetermined behavior as decision-based (in the sense of based on conscious deliberation in the left brain), when in fact only rationalization happens after behavior has been determined. I am choosing my words carefully here, not saying whether a ‘decision’ (free will and all that) has been made or not.
    However if the behavior-determining process is NOT as question 1) (in my view) presumes the conscious deliberation of the brain (roughly: somehow reasons and feelings lead to conscious decision-making that determines behavior) but something else, then questions 1) and 2) are not the same, since informed consent requires consciousness. And if behavior is determined on some subconscious level, then meddling with the limbic system, which controls feelings and ‘wants’, might make a difference to the real behavior-determining process. It is not specified how the drug in the thought experiment is supposed to work i.e. it is only stated that once injected, we are not consciously aware of feeling/caring (I’m being careful here because like with certain pain-killers the feelings might still be there only not rise to consciousness level)…Now one would have to actually know how behavior is really determined i.e. understand fully the causal chain and whether the drug resulting in not (or at least not consciously) feeling really cuts that causal chain and if so at what point. In other words, we would have to know and understand whether and if so what role feelings play in the real process determining actions. But we do not as yet know that (for real, in the real world).
    In fact, it is only the thought experiment, which presumes (asserts) that (once we are drugged with the hypothetical drug) “… these things [I’m paraphrasing: reasons and instinctive reluctance], no longer have any significant motivational force – they have lost the capacity to bind your behaviour. …it doesn’t feel as if it is a big deal…”
    Is this not begging the question? In the thought experiment we are asked to assume that in the absence of (consciousness of) feelings, reasons and instincts cannot (significantly) motivate us/bind behavior. And then we are asked …would you feel that you were being deprived of something central to the decision-making process?” We’ve just been told that without feelings to move us there can be no action, i.e the premise is that they are central to the decision-making process (as regards decisions that actually result in actions), and then we are asked whether (we conclude that) they are central to the decision-making process.
    Despite this flaw (in my view) the question whether feelings are necessary for decisions that actually result in behavior (and are not just bleak ‘I ought to do this and that [but I do not really want to]’) is an interesting one.
    My tentative answer is “yes” and “no”.
    “Yes,” because evidence suggests that most people’s ‘moral’ behavior is determined by gut-feeling and that the cultural explanations (philosophy, religion, or whatever) are not the determining factors but later rationalizations.
    “No,” because we are able to make decisions that are counter-intuitive or go against instinct. Though one could argue that even in these cases there always will be some ‘interest’ (based on feelings/wants like seeking pleasure, avoidance of pain, survival of self or species and compassion necessary for ever growing communities to work together), and that otherwise we would not bother to act.
    Yet on another level there is the worry that feelings might not be part of the real process how action is determined, but a secondary system. Like it seems our thoughts are an overlaid system designed to help us operate, feelings might be a system, which overlays basic instincts, which overlay reflexes, which overlay the systems that control the bodily functions…? Maybe there is nothing but the genetic code and there really is no free will…
    Thanks for this thought experiment.
    PS I came here after taking the test…did anybody find it strange that one question (I think no. 15, not sure) lacked the third option of ‘no moral obligation or superiority of either option’ i.e. you have to decide either to save your child or someone else (I think more than one); whichever you decide, the analysis concludes you adhere to this or that moral theory (e.g. either ‘help your own’ or ‘the greatest good for the greatest number’…

  82. No, this sounds like it would not be fully informed consent.

    The whole point of being informed is that this knowledge will influence the feelings that directs one’s choices. But if this knowledge is prevented from directly affecting one’s feelings, then the person is incapable of making rational choices. A rational choice is one that aligns best with one’s values. If one’s values becomes artificially changed because of a drug, then rational decisions can’t be made, because the values any decisions would be made on are inconsistent with the normal self. It isn’t enough to be cognizant of the situation and the values of the non-drugged self if that information can’t affect one on the emotional level where decision-making actually happens.

  83. My gut reaction is that this is informed consent, but that is base on an assumption that is not discussed here. The first is, whether or not my fear of the cliff is rational or not. In reality, I am scared of heights and as a result, I have avoided activities like sky diving that probably are not nearly as dangerous as they appear and that many others participate in and enjoy. I would be terrified of walking that path, but is that terror saving me from danger or keeping me from enjoyment. I would love a syringe that took away my fear but left me with the ability to understand the actual danger. It seems that this drug would free me of my fear but not from my reason. If it was truly dangerous, just because fear and an understanding of the risks wouldn’t bind my behavior, that doesn’t mean my behavior would recklessness or thrill seeking.

  84. Without having read other comments, I feel this one is sufficiently similar to the friend under the influence scenario.
    Also, I’m thinking about how it came about that I feel unwilling to take the “risky” path.
    I’m aware that I may have had a problematic event in the past and the memory is restricting my action now, by the cliff edge.
    If alcohol is indeed ” in vino veritas” then becoming uninhibited by the handy drug syringe could have put me in a more neutral position regarding the potential for danger.
    If the fear of the danger was restricting my action, then that fear might have made me more likely to fall.
    If with the drug I no longer have that fear then I may well act sufficiently carefully not to fall.
    I think fear of falling makes my ability to act carefully, unlikely.

  85. This is very interesting.
    As i see it, the question can not be answered in this way. In fact, i don’t think the syringe deprives you of information in the sense of the word. It well deprives you of something, but its one of the tools at your disposal to handle and judge information, not the information itself. I understand that this point can be argued, since this tool itself depends on stored information about past events, and by switching it off we loose the ability to compare the present event against our judgemental tool (in this case fear) and further develop it. Simply speaking: if we experience no fear while traversing the path, because it is shut off by the syringe, we temporarily loose the ability to overcome our fear as well (and maybe learn that our fear was unjustified and more of a hindrance than actual protection, or further justify it by almost dying on the way..).

    But in my opinion, you need to be aware that your fear is a judgemental tool (or “information filter” as i call it), to be able to make a “well informed decision” in the first place.
    Given this situation, some people will be reluctant to cross the ridge, while others will crave for it. These two extremes and anything in between is possible and perfectly valid human behavior. If you are reluctant you value your fear highly and act in that favor. If you crave for it you value the effect of adrenaline highly and act accordingly.
    If you see the injection of the syringe not as shutting out something of your own, but as giving you the possibility to experience the situation from someone else’s point of view, is it still a loss of information? I would say quite the opposite actually. It shows you that your fear is not “universal for humans” and gives you an insight about your own personality or what you think it is.
    If you further explore this thought, you can come to a literally vast amount of information about yourself you may not have been aware of before. This is my understanding of “opening the doors of perception”. Just because you are reluctant because of fear, there is no obligation for everyone else to be the same way, which again includes you. There is not necessarily a lack of something (like intuition) just because someone shows no (obvious) fear. Maybe he just prefers the feeling of anxiety or the resulting accomplishment over avoiding it altogether..

    To cut a long story short: you turn off one of your judging tools. Does it become Unconsentual because something is turned off? Or will it become truly informed by showing you that your tool is not necessarily an unchangeable part of your personality?
    You have to add some more assumptions to clarify this i think 😉

  86. Informed, yes. Truly free choice, no. Since the drug has explicitly impaired, or at least altered, the decision making process, such a judgement cannot be held to be entirely mine. In legal terms, I might very well have a defense to my later actions, under the argument that “I was not in my right mind” and also not culpable for being so (versus, for example, self-intoxication).

  87. The information being left out is, “what is the reason, or why is one considering the risk of taking this path?” Is there a pot of gold, a damsel in distress or the rescue of a group of people attained if the path is successfully traversed?

  88. If I’m fully aware of how I would normally feel, I have that information. I’m assuming I’m also aware that I’m high, since I’ve suddenly got a needle sticking out of me. If I know I’m high, I certainly consent, and the rest of my thoughts here are irrelevant. How dangerous is the path? Does it just look scary due to the sudden drop, like driving/walking through mountain roads, or is it a craggly and crumbling ledge that many people have fallen off? Is it the first time I’ve been there? Have I ever in the past tried to traverse the path? If the drug only impacts my sensation of fear, while allowing me the cognitive ability to know I would normally be scared, then the drug detracts nothing from my ability to make any decision.

  89. I use recreational drugs, and I’ve been in very similar situations. I’m always fully aware of how I would normally act, and I’ve acted contrary to that due to the impact of drugs.

    P.S. I fatfingered my email in my first response, so if you’re trying to respond to me, use this one.

  90. I think the scenario is intrinsically flawed.

    The scenario is a moment frozen in time. The parameters are set. It is therefore an artificial situation.

    The issue here is that when you get an answer, to what question was it given.

    Another question is whether philosophy ought to be neutral as such, or come out of a mode of thinking that shapes the way in which the situation is presented.

    You see, when you create an artificial situation, you exclude all other parameters or influences. You cancel out the past and the future. But life is a continuous experience. You cannot know what the future will bring, so walking down a perilous path has an open ending in terms of what could possibly occur. The question of whether or not you have sufficient information based on past experience, past decision making processes or if and to what extent you are compromised as to not to be able to make a decision using past experience is hardly relevant. The scenario attempts to exclude the emotional and information aspects of the decision making proces.

    So how does this scenario come to be? The effort to freeze the continuous flow of experience seems to me a Cartesian folly. What happens is that you cut up the flow of being into a chain of causality with each link separate from another. Basically you do what Descartes heard in a dream he had at Ulm when an angel came to him to say that the conquest of nature was to be achieved through number and measurement.

    So the scenario is the result of the influence of reductionist and isolationist thinking. That means the philosophy is affected by this mode of thinking and so the question asked is not a neutral question but already prone to a preset modality that affects the range of answers given.

    If the question asked is based on isolation and reduction, the answer will be prone those as well. The assumption is that by breaking the flow of the continuum of experience, you can control or capture a quantitative response. Again, a notion heavily grounded in the scientific revolution.

    The question then becomes if and if so, to what extent past experiences stack, per each chained link in the causality of broken up experience, to the start of the scenario. And that flow of being is irreducible and non-linear. So the the idea you can still make use of that information, those experiences is irrelevant.

    Without the syringe there would be no breaking of the flow of being. And so, to express what that means one could use a chain of links metaphor but this time each link is not a bigger stack of past experience but each link represents every other in a holographic fashion.

    The nature of informed consent cannot be found by this situation because the whole scenario is artificial and already skewed towards a mode of thought that directs any given answer to be confined within that mode.

    Is this a search for the base nature of informed consent or one affected by the frame of reference of the scientific revolution?

  91. “…. I’m curious about what people think about the following scenario, which is designed to illuminate one aspect of the phenomenon.”

    No, i don’t think it is intrinsically flawed, if used correctly.
    The question here is not of quantitative nature, thus we don’t ask “how many people would decide this way or the other” to prove (or disprove) a thesis about whether feeling our emotions vs. just knowing of them is crucial for informed consent. In this case you would be correct.

    This artificial scenario is designed merely to describe a specific aspect of our decision making process. To answer the question, you are REQUIRED to add your own context, and give it in a subjective fashion out of your own life and experience. Instead of creating this thought experiment, the author could have asked: “Do you guys think it is crucial for informed consent to actually feel the emotions that take part in the given decision, or does just knowing about them suffice?” But sometimes it’s just easier to use a metaphor to point it out precisely.

    I must agree with you about the frame of reference. I am aware that all research today is heavily grounded in reductionist and isolationist thinking. I am aware that my own thinking and problem solving strategies are grounded on that frame of reference as well. But no matter how long i think about it: imho it’s a valid tool to understand certain causalities (or probabilities), if you don’t make the mistake to exclude the context when trying to make sense of your results.
    Or in other words: if you use an isolationist approach to understand a certain problem, you are required to reverse the isolation afterwards, to get a valid answer.
    Following your logic, it seems impossible to me to ask any single question and get a valid answer, because asking a question is a reductive process in itself. By choosing which question to ask, which words to use and so on, i already apply my own frame of reference to the problem, but does this Make the question irrelevant by default?

  92. No.

    As I read this situation now in my sound mind, the strategy for dealing with the situation is already automated for when the drug kicks in.

    The strategy derived in the sound mind previous to the encounter wouldn’t likely change from the intuitive reactionary response at the time of the encounter because of all strategies are based around motive and incentive.

    If a superior strategy is learned prior to encounter, whether planning on the encounter or not, the incentive and motive changes in light of the new knowledge.

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