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Moral Responsibility and Mental Illness: A Case Study

Abstract

Various authors have argued that progress in the neurocognitive and neuropsychiatric sciences might threaten the commonsense understanding of how the mind generates behavior, and, as a consequence, it might also threaten the commonsense ways of attributing moral responsibility, if not the very notion of moral responsibility. In the case of actions that result in undesirable outcomes (e.g., someone being harmed), the commonsense conception—which is reflected in sophisticated ways in the legal conception—tells us that there are circumstances in which the agent is entirely and fully responsible for the bad outcome (and deserves to be punished accordingly) and circumstances in which the agent is not at all responsible for the bad outcome (and thereby the agent does not deserve to be punished).

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1. See Gazzaniga M. The Ethical Brain. Chicago: University of Chicago Press; 2005; Greene J, Cohen J. For the law, neuroscience changes nothing and everything. Philosophical Transactions of the Royal Society, London 2004;B359:1775–85; Levy N. The responsibility of the psychopath revisited. Philosophy, Psychiatry and Psychology 2007;14(2):129–38; Kennett K. Agency and Responsibility. Oxford: Oxford University Press; 2001:chaps. 6 and 7.

2. Mitchell EW. Madness and meta-responsibility: The culpable causation of mental disorder and the insanity defence. Journal of Forensic Psychiatry & Psychology 1999;10(3):597–622.

3. The term diminished responsibility in its technical sense is defined by appropriate legal codes (such as The Homicide Act 1957 in the United Kingdom) and it is generally used when defending someone against a charge of murder. In this paper we use the term reduced responsibility to mean that a person is less than fully responsible for a particular action, where the action does not need to be murder.

4. “Bill” is not the young man's real name, and other details of the case (when not relevant to the philosophical discussion that will follow) have been modified to protect confidentiality.

5. Another important question is this: Should we consider Bill responsible for the relapse of his illness because of his smoking of cannabis and to his noncompliance with medication? We do not have room to address this important issue here.

6. The case is first described in Browning SM, Jones S. Ichthyosis and delusions of lizard invasion. Acta Psychiatrica Scandanavica 1988;78:766–7.

7. Campbell J. What does rationality have to do with psychological causation? Propositional attitudes as mechanisms and as control variables. In: Broome M, Bortolotti L, eds. Psychiatry as Cognitive Neuroscience: Philosophical Perspectives. Oxford: Oxford University Press; 2009:chap. 7.

8. Kennett J, Matthews S. Mental time travel, agency and responsibility. In: Broome MR, Bortolotti L, eds. Psychiatry as Cognitive Neuroscience: Philosophical Perspectives. Oxford: Oxford University Press; 2009:chap. 16.

9. Bourget C, Whitehurst L. Capgras Syndrome: A review of the neurophysiological correlates and presenting clinical features in cases involving physical violence. Canadian Journal of Psychiatry 2004;49:719–25.

10. See also the discussion in Bortolotti L, Broome MR. If you didn't care, you wouldn't notice: Recognition and estrangement in psychopathology. Philosophy Psychiatry and Psychology 2007;14(1):39–42.

11. Appleby L, Shaw J, Amos T. National confidential inquiry into homicides and suicides by mentally ill people in the UK. British Journal of Psychiatry 1997;170(2):101–2.

12. Ritchie J, Dick D, Lingham R. Report of the Inquiry into the Care and Treatment of Christopher Clunis. North East Thames and South East Thames Regional Health Authorities. London: Her Majesty's Stationery Office, 1994.

Lisa Bortolotti acknowledges the financial support of the AHRC Research Leave from January to April 2009 [AH/G002606/1]. The authors would like to thank Dr. Marc Lyall, Consultant Forensic Psychiatrist, for his useful comments.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
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