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Hi Natalia, interesting post. I wonder if Strawson would disagree with anything you suggest here--or rather whether he'd be happy to have us try to develop more fine-grained accounts of when agents should be exempt or excused. He never actually uses any variations of the words 'exempt' or 'excuse' in his 1962 essay (did Watson introduce them?), but he does say, "I must deal here in crude dichotomies and ignore the ever-interesting and ever-illuminating varieties of cases." I read him as presenting the objective and participant stances as two ends of a spectrum, and we struggle to find the right place to land on that spectrum when we interact with people who display various degrees and types of excusing or exempting conditions, including people with mental illnesses and indeed children. Perhaps his talk of the "hopeless schizophrenic," the "systematically perverted," and the "warped or deranged" was aimed to lead us to consider the far end of the spectrum to help us see what he meant by the objective stance, cases where "you cannot reason with him [at all!]"

Having said all this, I do think Strawson just gestured us in the right direction, but his own distinctions between what we now call excuses and exemptions are problematic (or at least incomplete). He just wanted us to get out of our metaphysical conniptions and get back on track to talk of "the moral sentiments" and the reactive attitudes and moral practices that "express our nature." (These complexities are nicely illustrated in the case you link to of the man behind the yellow door, especially the attitudes and actions of the man's parents and ex-wife.)

I don't find it at all obvious that competence for medical decision making should be linked to philosophical accounts of responsibility. What's that connection supposed to be?

Also: in the medical context competency assessments are standardly relativized to a particular treatment context. That is, rather than being across the board competent-or-not assessments of a patient, such assessments are of a patient for purposes of a particular issue or proposed treatment. So of course for various assessments confirmed kleptomania wouldn't preclude a patient from being judged competent (though perhaps for some it would). Am I misunderstanding something?

Hi Eddy! Yes, I think Watson introduced the excuse/exemption language, but I figured that at Flickers I better start from the source! Even if we agree to run over the excuse exemption distinction though, I wonder how much of the responsible agency=competence line we should take as the right direction. The devil is in the details, of course, but do you have any initial thoughts?

No, Fritz, I think your confusion is right on track… I think the story is supposed to go like this: take the extreme case of someone experiencing florid psychosis who appears to be a danger to themselves and others. What is it about this person that makes it ‘obvious’ (if it is at all obvious) that violating the autonomy principle, by for example, administering medication or restricting freedoms, is justified? There are some commonplace responses that sound distinctly Strawsonian, like ‘He isn’t himself’ or ‘that’s his disease talking’, which call rationality or reasons-responsiveness into question in similar ways as those responses which are supposed to absolve agents of responsibility. One might think, then, that what these justifications are latching onto is the idea that what makes one competent to make medical decisions are the same characteristics or capabilities which enable agency. If that’s right, then trying to find out how different psychological conditions impair agency will be important for determining competence.
That being said, if there are systematic differences between folk and philosophical ideas about competency, and clinical ideas, I’d love to hear more!

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