The arguments advanced in this paper are the following. Firstly, that just as Trevarthen’s three subjective/intersubjective levels, primary, secondary, and tertiary, mapped out different modes of access, so too response is similarly structured, from direct primordial responsiveness, to that informed by shared pragmatic concerns and narrative contexts, to that which demands the distantiation afforded by representation. Secondly, I propose that empathy is an essential mode of intentionality, integral to the primary level of subjectivity/intersubjectivity, which is crucial to our survival as (...) individuals and as a species. Further to this last point, I argue that empathy is not derived on the basis of intersubjectivity, nor does it merely disclose intersubjectivity, rather it is constitutive of intersubjectivity at the primary level. Empathy is a direct, irreducible intentionality separable in thought from the other primary intentional modes of perception, rationality, memory and imagination, but co-arising with these. In regard to the inter-personal level, the concrete relations with others, primary empathy is both the ground for the possibility of the secondary manifestations—pity, sympathy, perspective taking, etc., and motivates them. Thirdly, it is the movement in the core of subjectivity initially generated by shifting attention between the ‘I’ and ‘we’ perspectives and later ‘solidified’ through affect to become shifting identification, which opens up the intersubjective domain. So we can affirm that we are not only born into sociality but our sociality goes to the roots of our being as Husserl, Heidegger and Merleau-Ponty have claimed. (shrink)

The phenomenon of distributed knowledge is well-known in epistemic logic. In this paper, a similar phenomenon in ethics, somewhat neglected so far, is investigated, namely distributed morality. The article explains the nature of distributed morality, as a feature of moral agency, and explores the implications of its occurrence in advanced information societies. In the course of the analysis, the concept of infraethics is introduced, in order to refer to the ensemble of moral enablers, which, although morally neutral per se, can (...) significantly facilitate or hinder both positive and negative moral behaviours. (shrink)

Philosophical theorizing is often, either tacitly or explicitly, guided by intuitions about cases. Theories that accord with our intuitions are generally considered to be prima facie better than those that do not. However, recent empirical work has suggested that philosophically significant intuitions are variable and unstable in a number of ways. This variability of intuitions has led naturalistically inclined philosophers to disparage the practice of relying on intuitions for doing philosophy in general (e.g. Stich & Weinberg 2001) and for doing (...) moral philosophy in particular (Appiah 2008; Doris & Stich 2005; Horowitz 1998; Nadelhoffer & Feltz 2008; Sinnott Armstrong 2008). In this paper, we will draw on naturalistic considerations to offer some solace to philosophers who rely on intuitions. We wouldn’t call this a defense of intuitions, exactly, since we are sympathetic with much of the naturalists’ critique. But we want to introduce into the debate some neglected naturalistic reasons to be optimistic about intuitions, focusing especially on ethical intuitions. (shrink)

Arriving at a moral judgment is not a straightforward or linear process in which ethical theories are simply applied to cases. Instead it is a process in which the formulation of the moral problem, the formulation of possible "solutions", and the ethical judging of these solutions go hand in hand. This messy character of moral problems, however, does not rule out a systematic approach. In this article, we describe a systematic approach to problem solving that does justice to the complex (...) nature of moral problems and ethical judgment: the ethical cycle. Our goal is to provide a structured and disciplined method of addressing moral problems, which helps to guide a sound analysis of these problems. We will illustrate the usefulness of this cycle with an example. Further, we will discuss two general issues in applied ethics in relation to the proposed ethical cycle: the role of ethical theories and the place of individual judgment versus collective deliberation. (shrink)

Suppose that one is at least a minimal realist about a given domain, in that one thinks that that domain contains truths that are not in any interesting sense of our own making. Given such an understanding, what can be said for and against the method of reflective equilibrium as a procedure for investigating the domain? One fact that lends this question some interest is that many philosophers do combine commitments to minimal realism and a reflective equilibrium methodology. Here, for (...) example, is David Lewis on philosophy: Our “intuitions” are simply opinions: our philosophical theories are the same. Some are commonsensical, some are sophisticated; some are particular; some general; some are more firmly held, some less. But they are all opinions, and a reasonable goal for a philosopher is to bring them into equilibrium. Our common task it to find out what equilibria there are that can withstand examination, but it remains for each of us to come to rest at one or another of them… Once the menu of well-worked out theories is before us, philosophy is a matter of opinion. Is that to say that there is no truth to be had? Or that the truth is of our own making, and different ones of us can make it differently? Not at all! If you say flatly that there is no god, and I say that there are countless gods but none of them are our worldmates, then it may be that neither of us is making any mistake of method. We may each be bringing our opinions to equilibrium in the most careful possible way, taking account of all the arguments, distinctions, and counterexamples. But one of us, at least, is making a mistake of fact. Which one is wrong depends on what there is (1983: x-xi). In addition to philosophy in general, the method of reflective equilibrium has also been endorsed as the appropriate procedure for investigating various other subject.. (shrink)

Ethicists differ considerably in their reasons for using empirical data. This paper presents a brief overview of four traditional approaches to the use of empirical data: “the prescriptive applied ethicists,” “the theorists,” “the critical applied ethicists,” and “the particularists.” The main aim of this paper is to introduce a fifth approach of more recent date (i.e. “integrated empirical ethics”) and to offer some methodological directives for research in integrated empirical ethics. All five approaches are presented in a table for heuristic (...) purposes. The table consists of eight columns: “view on distinction descriptive-prescriptive sciences,” “location of moral authority,” “central goal(s),” “types of normativity,” “use of empirical data,” “method,” “interaction empirical data and moral theory,” and “cooperation with descriptive sciences.” Ethicists can use the table in order to identify their own approach. Reflection on these issues prior to starting research in empirical ethics should lead to harmonization of the different scientific disciplines and effective planning of the final research design. Integrated empirical ethics (IEE) refers to studies in which ethicists and descriptive scientists cooperate together continuously and intensively. Both disciplines try to integrate moral theory and empirical data in order to reach a normative conclusion with respect to a specific social practice. IEE is not wholly prescriptive or wholly descriptive since IEE assumes an interdepence between facts and values and between the empirical and the normative. The paper ends with three suggestions for consideration on some of the future challenges of integrated empirical ethics. (shrink)

Starting from the sensuous perception of what is seen, an attempt is made at re-casting a Husserlian theory of constitution of the object of intuition, as one leaves the natural attitude through a transcendental method, by positing several theses so as to avoid the aporias of philosophical binary oppositions such as rationalism and empiri-cism, realism and idealism, logicism and psychologism, subjectivism and objectivism, transcendentalism and ontologism, metaphysics and positivism. Throughout fifty-five theses on constitution, the Husserlian proposal of continuously reforming philosophizing (...) by transcendental reduction is revisited, leaving the latter incomplete as new conversions are required by noetic-noematic correlations between world and consciousness. (shrink)

Various theories have been put forward in an attempt to explain what makes moral judgments justifiable. One of the main theories currently advocated in bioethics is a form of coherentism known as wide reflective equilibrium. In this paper, I argue that wide reflective equilibrium is not a satisfactory approach for justifying moral beliefs and propositions. A long-standing theoretical problem for reflective equilibrium has not been adequately resolved, and, as a result, the main arguments for wide reflective equilibrium are unsuccessful. Moreover, (...) practical problems that arise in using the method of wide reflective equilibrium undermine the idea that it is a viable approach for justifying moral judgments about cases and policies. Given that wide reflective equilibrium is the most prominent version of coherentism, these considerations call into question the coherentist approach to justification in bioethics. (shrink)

In this commentary, I critically discuss the respective views of Gert and Beauchamp–Childress on the nature of so-called common morality and its promise for enriching ethical reflection within the field of bioethics. Although I endorse Beauchamp and Childress’ shift from an emphasis on ethical theory as the source of moral norms to an emphasis on common morality, I question whether rouging up common morality to make it look like some sort of ultimate and universal foundation for morality, untouched by the (...) dialectics of time and reflective equilibrium, was an equally good move. As for Gert’s magisterial conception of common morality, I conclude that certain elements of his system are controversial at best and woefully inadequate at worst. He has a tendency to find in common morality what he himself put there, and his highly restricted conception of duties of assistance strikes this reader as ad hoc, inadequately defended, and unworthy of a project whose goal is to lessen the amount of misery in the world. (shrink)

Services of ethics consultants are nowadays commonly used in such various spheres of life as engineering, public administration, business, law, health care, journalism, and scientific research. It has however been maintained that use of ethics consultants is incompatible with personal autonomy; in moral matters individuals should be allowed to make their own decisions. The problem this criticism refers to can be conceived of as a conflict between the professional autonomy of ethics experts and the autonomy of the persons they serve. (...) This paper addresses this conflict and maintains that when the nature of both ethics consultation and individual autonomy is properly understood, the professional autonomy of ethics experts is compatible with the autonomy of the persons they assist. (shrink)

Interactive technology assessment is a novel approach to evaluating (health) technology, which philosophically draws from the works of Rawls and Habermas. That is, it seeks to organise a practical setting for discursive ethics in order to find a legitimate basis for policy to be pursued when the technology under scrutiny features a moral controversy. Interactive technology assessment involves a cycle of interviews with all stakeholders, who are explicitly asked to respond (anonymously) to the concerns and issues raised by other participants. (...) This cycle is completed repeatedly, so that a process of vicarious learning develops. This process aims at identifying issues agreed and disagreed upon, on the basis of which widely endorsed policy recommendations can be formulated. This chapter involves an interactive technology assessment of paediatric cochlear implantation. The rationale, the design, and the results are explained, as well as the main ethical aspects of the procedure. (shrink)

Arriving at a moral judgment is not a straightforward or linear process in which ethical theories are simply applied to cases. Instead it is a process in which the formulation of the moral problem, the formulation of possible “solutions”, and the ethical judging of these solutions go hand in hand. This messy character of moral problems, however, does not rule out a systematic approach. In this article, we describe a systematic approach to problem solving that does justice to the complex (...) nature of moral problems and ethical judgment: the ethical cycle. Our goal is to provide a structured and disciplined method of addressing moral problems, which helps to guide a sound analysis of these problems. We will illustrate the usefulness of this cycle with an example. Further, we will discuss two general issues in applied ethics in relation to the proposed ethical cycle: the role of ethical theories and the place of individual judgment versus collective deliberation. (shrink)

Consultancy firms inform, advise, implement and mediate in their own interests and in the interests of their clients. We can only guess if their work is also in the interest of the public. There is no critical and systematical assessment of the behavior of consultancy firms. What roles do consultancy firms chose? And what arguments do they use? In the nineties the international consultancy firm Hill & Knowlton took on two assignments that showed a remarkable difference in the required role (...) the firm had to play. In the first role the firm acted as an impartial advocate, in the second role the firm acted as a political agent. An analysis of the argumentation for both roles shows us the familair short-sighted choice for the annual turnover at the cost of internal and external trustworthiness. In this decade consultancy firms will need to develop ethical assessments that meet more professional standards. (shrink)

Some empirical findings seem to show that people value health benefits differently depending on the age of the beneficiary. Health economists and philosophers have offered justifications for these preferences on grounds of both efficiency and equity. In this paper, I examine the most prominent examples of both sorts of justification: the defence of age-weighting in the WHO's global burden of disease studies and the fair innings argument. I argue that neither sort of justification has been worked out in satisfactory form: (...) age should not be taken into account in the framework of the burden of disease measure, and on the most promising formulations of the fair innings argument, it turns out to be merely an indicator of some other factor. I conclude by describing the role of age in theories of justice of healthcare resource allocation. (shrink)

Liberal societies are characterized by respect for a fundamental value pluralism; i.e., respect for individuals’ rights to live by their own conception of the good. Still, the state must make decisions that privilege some values at the cost of others. When public ethics committees give substantial ethical advice on policy related issues, it is therefore important that this advice is well justified. The use of explicit tools for ethical assessment can contribute to justifying advice. In this article, I will discuss (...) one approach to ethical assessment, the ethical matrix method. This method is a variant of intuitionist balancing. Intuitionism is characterized by stressing the existence of several (at least two) fundamental prima facie moral principles, between which there is no given rank order. For some intuitionist approaches, coherentism has been proposed as a model of justification. This article will discuss justification of ethical advice and evaluate the appropriateness of coherentism as a justificatory approach to intuitionist tools. (shrink)

In this paper it is argued that functional role semantics can be saved from criticisms, such as those raised by Putnam and Fodor and Lepore, by indicating which beliefs and inferences are more constitutive in determining mental content. The Scylla is not to use vague expressions; the Charybdis is not to endorse the analytic/synthetic distinction. The core idea is to use reflective equilibrium as a strategy to pinpoint which are the beliefs and the inferences that constitute the content of a (...) mental state. The beliefs and the inferences that are constitutive are those that are in reflective equilibrium in the process of attributing mental states to others. (shrink)

This paper considers the place of children within liberal-democratic society and its related political morality. The genesis of the paper is two considerations which are in tension with one another. First, that there must be some point at which children are divided from adults, with children denied the rights which go along with full membership of the liberal community. The justification for the difference in the statue between these two groups must be rooted in some notion of capacities, since these (...) are the only relevant differences between adults and children. Second, that linking an individual's capacities to her status undermines the central liberal commitment of political equality. This dilemma explains what I term the threshold view, which holds that children become adult citizens upon reaching an age of competence and that above this level differences in abilities cease to matter to an individual's status. While this view has attractions, this paper argues that this view must eventually be rejected because of its inability to deal with the actual process of human development. In its place, the paper proposes a modification to this view which sees the threshold constrained by moral demands and applied indirectly to age groups rather than individuals. These constraints preserve the commitment to equality in a way consistent with a plausible view of children's place in society. (shrink)

While the epistemic significance of disagreement has been a popular topic in epistemology for at least a decade, little attention has been paid to logical disagreement. This monograph is meant as a remedy. The text starts with an extensive literature review of the epistemology of (peer) disagreement and sets the stage for an epistemological study of logical disagreement. The guiding thread for the rest of the work is then three distinct readings of the ambiguous term ‘logical disagreement’. Chapters 1 and (...) 2 focus on the Ad Hoc Reading according to which logical disagreements occur when two subjects take incompatible doxastic attitudes toward a specific proposition in or about logic. Chapter 2 presents a new counterexample to the widely discussed Uniqueness Thesis. Chapters 3 and 4 focus on the Theory Choice Reading of ‘logical disagreement’. According to this interpretation, logical disagreements occur at the level of entire logical theories rather than individual entailment-claims. Chapter 4 concerns a key question from the philosophy of logic, viz., how we have epistemic justification for claims about logical consequence. In Chapters 5 and 6 we turn to the Akrasia Reading. On this reading, logical disagreements occur when there is a mismatch between the deductive strength of one’s background logic and the logical theory one prefers (officially). Chapter 6 introduces logical akrasia by analogy to epistemic akrasia and presents a novel dilemma. Chapter 7 revisits the epistemology of peer disagreement and argues that the epistemic significance of central principles from the literature are at best deflated in the context of logical disagreement. The chapter also develops a simple formal model of deep disagreement in Default Logic, relating this to our general discussion of logical disagreement. The monograph ends in an epilogue with some reflections on the potential epistemic significance of convergence in logical theorizing. (shrink)

Philosophy strives to give us a firmer hold on our concepts. But what about their hold on us? Why place ourselves under the sway of a concept and grant it the authority to shape our thought and conduct? Another conceptualization would carry different implications. What makes one way of thinking better than another? This book develops a framework for concept appraisal. Its guiding idea is that to question the authority of concepts is to ask for reasons of a special kind: (...) reasons for concept use, which tell us which concepts to adopt, adhere to, or abandon, thereby shoring up—or undercutting—the reasons for action and belief that guide our deliberations. Traditionally, reasons for concept use have been sought either in timeless rational foundations or in concepts’ inherent virtues, such as precision and consistency. Against this, the book advances two main claims: that we find reasons for concept use in the conceptual needs we discover when we critically distance ourselves from a concept by viewing it from the autoethnographic stance; and that sometimes, concepts that conflict, or exhibit other vices such as vagueness or superficiality, are just what we need. By considering not what concepts are absolutely best, but what concepts we now need, we can reconcile ourselves to the contingency of our concepts, determine the proper place of efforts to tidy up thought, and adjudicate between competing conceptions of things—even things as contested as liberty or free will. A needs-based approach separates helpful clarification from hobbling tidy-mindedness, and authoritative definition from conceptual gerrymandering. (shrink)

Social innovations are usually understood as new ideas, initiatives, or solutions that make it possible to meet the challenges of societies in fields such as social security, education, employment, culture, health, environment, housing, and economic development. On the one hand, many citizen science activities serve to achieve scientific as well as social and educational goals. Thus, these actions are opening an arena for introducing social innovations. On the other hand, some social innovations are further developed, adapted, or altered after the (...) involvement of scientist-supervised citizens in research and with the use of the citizen science tools and methods such as action research, crowdsourcing, and community-based participatory research. Such approaches are increasingly recognized as crucial for gathering data, addressing community needs, and creating engagement and cooperation between citizens and professional scientists. However, there are also various barriers to both citizen science and social innovation. For example, management, quality and protection of data, funding difficulties, non-recognition of citizens’ contributions, and limited inclusion of innovative research approaches in public policies. In this volume, we open theoretical as well as empirically-based discussion, including examples, practices, and case studies of at least three types of relations between citizen science and social innovation: domination of the citizen science features over social innovation aspects; domination of the social innovation features over the citizen science aspects; and the ways to achieve balance and integration between the social innovation and citizen science features. Each of these relationships highlights factors that influence the development of the main scales of sustainability of innovations in the practice. These innovations are contributing to a new paradigm of learning and sharing knowledge as well as interactions and socio-psychological development of participants. Also, there are factors that influence the development of platforms, ecosystems, and sustainability of innovations such as broad use of the information and communications technologies including robotics and automation; emerging healthcare and health promotion models; advancements in the development and governance of smart, green, inclusive and age-friendly cities and communities; new online learning centers; agri-food, cohousing or mobility platforms; and engagement of citizens into co-creation or co-production of services delivered by public, private, non-governmental organizations as well as non-formal entities. (shrink)

As individuals grow older, they usually require assistance with the daily tasks of self-care. This type of assistance, ancillary care, is essential to maintaining the health of those who need these services. In his prudential lifespan account, Norman Daniels includes access to such services making his account an attractive proposal given the current demographic shift. In this paper, I examine the prudential lifespan account through the lens of old age and I focus on the two concepts on which the lifespan (...) account relies. I show that these two concepts, normal species functioning and opportunity cannot buttress Daniels’s lifespan account; at least it cannot do so for older persons. The tensions that I identify in the prudential lifespan account in relation to aging are instructive for the more recent proposals to include aging in a theory of health and health justice. In addition, my analysis allows me to demonstrate that Daniels’s view of opportunity is irreconcilable to capabilities, the latter being more adaptable to the realities of aging. If capabilities appear more promising, it is nonetheless imperative that the specificities of extended care, such as the need for unpaid caregiving, be taken into consideration. (shrink)

Although collegial relationships are among the most prevalent types of interpersonal relationships in our lives, they have not been the subject of much philosophical study. In this paper, we take the first step in the process of developing an ethics of collegiality by establishing what qualifies two people as colleagues and then by determining what it is that gives value to collegial relationships. We argue that A and B are colleagues if both exhibit sameness regarding at least two of the (...) following three features: the same work content or domain of activity; the same institutional affiliation or common purpose; and/or the same status or level of responsibility. Moreover, we describe how the potential value of collegial relationships is grounded in the relationship goods that two colleagues have reason to generate qua colleagues, namely, collegial solidarity and collegial recognition. Two interesting conclusions that can be drawn from our analysis are that one has to be proficient at one’s work if one is to be considered a good colleague and that we are also more likely to be better colleagues if we regard the work we do as valuable. Finally, we draw special attention to the working conditions that are conducive to the generation of good collegial relationships and suggest some policies to promote them. (shrink)

In recent years, scholars in science and technology studies have examined the advice that experts make for the governance of biomedicine. This STS scholarship, however, has not yet explained how the credibility of ethics expertise in public bioethics is produced from particular conditions and extended to different settings. This article describes how a bioethics commission created the ethical principle of justice and examines how the ethics expertise established public credibility on the justice principle. The findings suggest that the principle of (...) justice was first explored as the diverse concepts of “equality” with reference to the review of fetal research, redefined as “fairness” or “desert” from theoretical viewpoints, and then circulated as a standard framework in local settings. The credibility of ethics expertise, based on the coproduction of material and moral orders, was made possible by reaching common ground among different data, principles, and background theories. (shrink)

In this article, we develop an approach for the moral assessment of research and development networks on the basis of the reflective equilibrium approach proposed by Rawls and Daniels. The reflective equilibrium approach aims at coherence between moral judgments, principles, and background theories. We use this approach because it takes seriously the moral judgments of the actors involved in R & D, whereas it also leaves room for critical reflection about these judgments. It is shown that two norms, namely reflective (...) learning and openness and inclusiveness, which are used in the literature on policy and technological networks, contribute to achieving a justified overlapping consensus. We apply the approach to a case study about the development of an innovative sewage treatment technology and show how in this case the two norms are or could be instrumental in achieving a justified overlapping consensus on relevant moral issues. (shrink)

Human dignity is one of the key concepts of our ethical evaluations, in politics, in biomedicine, as well as in everyday life. In moral philosophy, however, human dignity is a source of intractable trouble. It has a number of characteristic features which apparently do not fit into one coherent ethical concept. Hence, philosophers tend to ignore or circumvent the concept. There is hope for a philosophically attractive conception of human dignity, however, given that one takes three crucial turns. The negative (...) turn: to start the inquiry with violations of human dignity. The inductive turn: to consider the whole range of applications of the concept of human dignity in different areas of ethics. And finally, the historical turn: to take into account the historical bonds between human dignity and traditional conceptions of dignity. Taken together they point in the direction of an understanding of human dignity as universal nobility. (shrink)

Leiter (2016) charges public philosophy with being “neoliberal”. To understand that charge better, I define, in §1, three versions of public philosophy which might be concerned and two pictures of its practice targeted by Leiter. I also compare two deliberative sites wherein those pictures may play out. In §2, I sketch how Leiter’s two paradoxes for “neoliberal” public philosophy lead to a revised public philosophy. §3 questions the paradoxes’ empirical grounding and scope. Lastly, in §4, I assume Leiter’s picture and (...) illustrate how philosophical dialogue, through appeal to personal self-image and “moral perceptions”, may still influence public discourse. I conclude that Leiter both over- and understates his case and that his conclusions require greater scrutiny. (shrink)

This book develops a novel approach to distributive justice by building a theory based on a concept of desert. As a work of applied political theory, it presents a simple but powerful theoretical argument and a detailed proposal to eliminate unmerited inequality, poverty, and economic immobility, speaking to the underlying moral principles of both progressives who already support egalitarian measures and also conservatives who have previously rejected egalitarianism on the grounds of individual freedom, personal responsibility, hard work, or economic efficiency. (...) By using an agnostic, flexible, data-driven approach to isolate luck and ultimately measure desert, this proposal makes equal opportunity initiatives both more accurate and effective as it adapts to a changing economy. It grants to each individual the freedom to genuinely choose their place in the distribution. It provides two policy variations that are perfectly economically efficient, and two others that are conditionally so. It straightforwardly aligns outcomes with widely shared, fundamental moral intuitions. Lastly, it demonstrates much of the above by modeling four policy variations using 40 years of survey data from the Panel Study of Income Dynamics. (shrink)

Bioethics has increasingly become a standard part of medical school education and the training of healthcare professionals more generally. This is a promising development, as it has the potential to help future practitioners become more attentive to moral concerns and, perhaps, better moral reasoners. At the same time, there is growing recognition within bioethics that nonideal theory can play an important role in formulating normative recommendations. In this chapter we discuss what this shift toward nonideal theory means for ethical curricula (...) within healthcare education. In particular, we contend that more attention to the particularities of historical and social context needs to be incorporated into bioethics training. To make this argument, we focus on two examples: teaching units on race and medicine and those that focus on stigma and coercion in mental health. For both, we show how a pedagogical approach in which educators focus on social injustice could influence how practitioners engage in ethics in the clinic. This chapter, then, demonstrates what a commitment to nonideal theory can mean practically when it comes to bioethics education. (shrink)

John Rawls is famous for two things: his attempt to ground morality in rationality and his conception of justice as fairness. He has developed and polished both in conjunction over the course of half a century. Yet the moral principles he advocates have always been more doctrinaire than the corresponding justification model should have ever allowed with design details explicitly promising objectivity. This article goes to the beginning, or to a reasonable proxy for it, in the “Outline of a Decision (...) Procedure for Ethics,” with the aim of exposing and examining the discrepancy where it originates. The goal is not to prey on the earliest version of an initiative later undergoing revision but to identify and investigate the inception of a systematic bias that is retained rather than revised in subsequent iterations. (shrink)

In this paper, I argue that addressing the medical needs of older persons warrants expanding the array of insured services as described by the Canada Health Act to include home care. The growing importance of chronic care supports my call for federally regulated home care services as the nature of disease management has changed significantly in the last decades. In addition, if the values of equity, fairness and solidarity, which are the keystone values of the CHA, are to be upheld (...) within the current social and demographic context, then Canada’s health care system should adapt accordingly. I focus my argument on the services provided to older persons for two main reasons. First, the changing nature of disease management is best seen in this population. If it is to be successfully argued that the transformations in medicine warrant an expansion of insured services covered by the CHA, it will be best illustrated by looking at the needs of older persons. Second, with the demographic shift looming large in the policy agenda, an exploration of this issue is not only crucial but timely. (shrink)

Many agents have failed to comply with their responsibilities to take the action needed to avoid dangerous anthropogenic climate change. This pervasive noncompliance raises two questions of nonideal political theory. First, it raises the question of what agents should do when others do not discharge their climate responsibilities. (the Responsibility Question) In this paper I put forward four principles that we need to employ to answer the Responsibility Question (Sections II-V). I then illustrate my account, by outlining four kinds of (...) action that should be undertaken (Section VI). Pervasive noncompliance also raises a second question: Given the lack of progress in combating climate change, should existing governance structures be maintained or changed (and if they should be changed, in what ways)? (the Governance Question). The paper briefly outlines a methodology for addressing this question and outlines what a nonideal response to the existing institutional structures would be (Section VII). It does so with reference to the Paris Agreement, and in particular the creation of a "global stocktake" (Article 14, Paris Agreement) and the "facilitative dialogue" (paragraph 20 of the ‘Adoption of the Paris Agreement’). The aim, then, is to set out an account of a nonideal theory of climate justice. (shrink)

In recent years, neuroscience has been a particularly prolific discipline stimulating many innovative treatment approaches in medicine. However, when it comes to the brain, new techniques of intervention do not always meet with a positive public response, in spite of promising therapeutic benefits. The reason for this caution clearly is the brain’s special importance as “organ of the mind”. As such it is widely held to be the origin of mankind’s unique position among living beings. Likewise, on the level of (...) the individual human being, the brain is considered the material substrate of those traits that in combination render each person unique. In view of this preeminent significance of the brain, it is understandable that, in general, interventions into the brain are considered a delicate issue and that new techniques of intervention are scrutinised with particular care. However, in doing so it is important not to go to the opposite extreme and shy away from promising new therapeutic approaches for debilitating disorders of the brain. With respect to the new techniques of brain intervention a broad interdisciplinary perspective is required to discern irrational fear from justified concern. Hence, the Europäische Akademie established a project group consisting, on the one hand, of experts from different fields of medicine who have got first-hand experience of applying the techniques at issue and, on the other hand, of philosophers and a legal expert. The task of this team was to review the state of the art with respect to each single technique of intervening in the brain, to indicate future developments, and to address the ethical and legal issues common to all of them. The project’s outcome is the book at hand. (shrink)

Insights from social science are increasingly used in the field of applied ethics. However, recent insights have shown that the empirical branch of business ethics lacks thorough theoretical grounding. This article discusses the use of the Rawlsian methods of wide reflective equilibrium and overlapping consensus in the field of applied ethics. Instead of focussing on one single comprehensive ethical doctrine to provide adequate guidance for resolving moral dilemmas, these Rawlsian methods seek to find a balance between considered judgments and intuitions (...) concerning particular cases on the one hand and general principles and theories on the other. In business ethics this approach is promissing because it enables decision-making in a pluralist context with different stakeholders who often endorse different or even conflicting cultural and moral frameworks without giving priority to any of them. Moreover, the method is well founded in political theory. A taxonomy of different kinds of applications is developed, and classified according to the purpose, the content, and the type of justification. On the basis of this taxonomy an inventory of 12 recent applications is made. In terms of the purpose and content of the method the applications are rather diverse. Two conceptual obstacles for applying Rawlsian methods are identified, viz. inclusiveness and the communitarian objection that people have to become detached from their personal life. It is found that methodological questions, such as the question how to retrieve the relevant empirical data, are scarcely addressed in the literature. To advance the use of empirical approaches in general, and that of Rawlsian approaches in particular, it is important not only to use empirical data but to use methodological insights from social sciences in order to further advance the field of empirical ethics. It is recommended that stakeholders be given a more active role in the assessment and justification of these methods. (shrink)

A Moorean fact, in the words of the late David Lewis, is ‘one of those things that we know better than we know the premises of any philosophical argument to the contrary’. Lewis opens his seminal paper ‘Elusive Knowledge’ with the following declaration.

How are we to appraise new technological developments that may bring revolutionary social changes? Currently this is often done by trying to predict or anticipate social consequences and to use these as a basis for moral and regulatory appraisal. Such an approach can, however, not deal with the uncertainties and unknowns that are inherent in social changes induced by technological development. An alternative approach is proposed that conceives of the introduction of new technologies into society as a social experiment. An (...) ethical framework for the acceptability of such experiments is developed based on the bioethical principles for experiments with human subjects: non-maleficence, beneficence, respect for autonomy, and justice. This provides a handle for the moral and regulatory assessment of new technologies and their impact on society. (shrink)

This paper is about the moral status of those human beings with profound intellectual disabilities (PIDs). We hold the common sense view that they have equal status to ‘normal’ human beings, and a higher status than any non-human animal. We start with an admission, however: we don’t know how to give a fully satisfying theoretical account of the grounds of moral status that explains this view. And in fact, not only do we not know how to give such an account, (...) but the most satisfying account of moral status that we know (which we call ‘the standard account’) entails that our view is false. It entails that those with PIDs have a lower status than ordinary human beings and an equal status to non-human animals. Now, in this paper, we do absolutely nothing to try to show where the standard account goes wrong, and we do absolutely nothing to resolve the difficulties we see in developing an alternative account that supports our view. Indeed, we do not give any argument against the standard account or in favour of our own view. Instead, we raise the following question: in order to be justified in continuing to hold our view, are we obliged to give such an account? Our answer will be that we are not. (shrink)

The anti-counterfeiting trade agreement was originally meant to harmonise and enforce intellectual property rights provisions in existing trade agreements within a wider group of countries. This was commendable in itself, so ACTA’s failure was all the more disappointing. In this article, I wish to contribute to the post-ACTA debate by proposing a specific analysis of the ethical reasons why ACTA failed, and what we can learn from them. I argue that five kinds of objections—namely, secret negotiations, lack of consultation, vagueness (...) of formulation, negotiations outside any international body, and the creation of a new governing body outside already existing forums—had only indirect ethical implications. This takes nothing away from their seriousness but it does make them less compelling, because agreements should be evaluated, ethically, for what they are, rather than for the alleged reasons why they are being proposed. I then argue that ACTA would have caused three ethical problems: an excessive and misplaced kind of responsibility, a radical decrease in freedom of expression, and a severe reduction in information privacy. I conclude by indicating three lessons that can help us in shaping a potential ACTA 2.0. First, we should acknowledge the increasingly vital importance of the framework of implicit expectations, attitudes, and practices that can facilitate and promote morally good decisions and actions. ACTA failed to perceive that it would have undermined the very framework that it was supposed to foster, namely one promoting some of the best and most successful aspects of our information society. Second, we should realise that, in advanced information societies, any regulation affecting how people deal with information is now bound to influence the whole ‘onlife’ habitat within which they live. So enforcing IPR becomes an environmental problem. Third, since legal documents, such as ACTA, emerge from within the infosphere that they affect, we should apply to the process itself, which one day may lead to a post-ACTA treaty, the very framework and ethical values that we would like to see promoted by it. (shrink)

In contemporary debates about justice, political philosophers take themselves to be engaged with a subject that’s narrower than the whole of morality. Many contemporary liberals, notably John Rawls, understand this narrowness in terms of context specificity. On their view, justice is the part of morality that applies to the context of a society’s institutions, but only has indirect application to the context of citizens’ personal lives. In contrast, many value pluralists, notably G.A. Cohen, understand justice’s narrowness in terms of singularity (...) against a plural background. On their view, justice is one fundamental value amongst a plurality of fundamental values. The purpose of my thesis is to establish that the pluralist conception of justice’s narrowness is theoretically significant and true. To establish its theoretical significance, I argue that proper attention to the ways in which different understandings of narrowness inform the work of contemporary egalitarians explains a considerable amount of disagreement between them concerning the content and scope of distributive justice. On the one hand, I’ll argue that if we understand justice’s narrowness in the manner Cohen and other pluralists do, i.e., understand a conception of justice to be a conception of a particular fundamental value, then both luck-egalitarianism and the claim that justice extends to the personal context are compelling. On the other hand, I’ll argue that if we understand justice’s narrowness in a contextual manner, i.e., understand justice to comprise one or more all-things-considered principles adopted for the institutional context, then both luck-egalitarianism and the claim that justice extends to the personal context prove implausible. To establish the truth of the pluralist conception of narrowness, I argue first, that the contextual understanding is only plausible if fairness should be understood procedurally instead of substantively; and second, that substantive fairness cannot be eliminated, as specifying the content of procedural fairness requires a substantive criterion. The upshot is that justice’s narrowness is best understood in terms of singularity against a plural background, rather than in terms of context specificity. (shrink)

In his recent book, The Dimensions of Consequentialism, Martin Peterson puts forward a new version of consequentialism that he dubs ‘multidimensional consequentialism’. The defining thesis of the new theory is that there are irreducible moral aspects that jointly determine the deontic status of an act. In defending his particular version of multidimensional consequentialism, Peterson advocates the thesis—he calls it DEGREE—that if two or more moral aspects clash, the act under consideration is right to some non-extreme degree. This goes against the (...) orthodoxy according to which—Peterson calls this RESOLUTION—each act is always either entirely right or entirely wrong. The argument against RESOLUTION appeals to the existence of so-called deontic leaps: the idea is that endorsing RESOLUTION would not give each relevant moral aspect its due in the final analysis. Our paper argues that, contrary to Peterson, all moral aspects remain visible in what can properly be called the final analysis of a moral theory that involves RESOLUTION, moral aspects do not have to remain visible in judgements of all-things-considered rightness or wrongness, respectively, introduction of what Peterson calls verdictive reasons does not change the overall picture in favour of DEGREE. We conclude that multi-dimensional consequentialists should accept RESOLUTION rather than DEGREE. (shrink)

This study is a contribution to the bioethical debate about new and possibly emerging reproductive technologies. Its point of departure is the intuition, which many people seem to share, that using such technologies to select non-disease traits – like sex and emotional stability - in yet unborn children is morally problematic, at least more so than using the technologies to avoid giving birth to children with severe genetic diseases, or attempting to shape the non-disease traits of already existing children by (...) environmental means, like education. The study employs philosophical analysis for the purpose of making this intuition intelligible and judging whether it is justified. Different ways in which the moral problems posed by reproductive technologies are often framed in bioethical debates are criticised as inadequate for this task. In particular, it is argued that the intuition cannot fully be made sense of in terms of harm to the children that such technologies help create. The study attempts to elaborate an alternative to that broadly consequentialist approach, by drawing on Martin Heidegger’s philosophy of technology, Hans Jonas’s ethics, and Aristotle’s practical philosophy, as it has been received and developed in the hermeneutical tradition. It is suggested that reproductive choices, unlike decisions for already born children, are characterised by a peculiar one-sidedness: the future child appears to the parents as something wholly theirs to decide about, not as a concrete other with whom they must interact in a responsive and attuned way. This is problematic because it means that such choices cannot call upon the particularised moral understanding only gained in interpersonal encounters. In particular, it makes them easily shaped by various tendencies, to which parents are always susceptible, to relate to children in instrumentalising ways, and at risk of reinforcing such tendencies. However, this does not mean that all uses of reproductive technologies are equally troubling. When selecting against severe disease the parents can rely on a widely shared illness experience to escape the dangers that one-sidedness involves. It is concluded that the intuition under discussion, thus explicated and in some ways qualified, makes sense morally. (shrink)

In A Theory of Justice (1971), John Rawls introduces the concept of “reflective equilibrium.” Although there are innumerable references to and discussions of this concept in the literature, there is, to the present author's knowledge, no discussion of the most important question: Why reflective equilibrium? In particular, the question arises: Is the method of reflective equilibrium applicable to the choice of this method itself? Rawls's drawing of parallels between Kant's moral theory and his own suggests that his concept of “reflective (...) equilibrium” is on a par with Kant's concept of “transcendental deduction.” Treating these two approaches to justification as paradigmatic, I consider their respective merits in meeting the reflexive challenge, i.e., in offering a justification for choice of mode of justification. In the first part of this enquiry (Eng 2014a), I raised the issue of the reflexivity of justification and questioned whether the reflexive challenge can be met within the framework of A Theory of Justice. In the second part (Eng 2014b), I outlined a Kantian approach that represents a paradigmatic alternative to Rawls. In this third and final part, I shall argue that Rawls's reflective equilibrium cannot justify the choice of itself and that in the broader perspective thus necessitated, we cannot escape the metaphysical issues integral to the Kantian approach. (shrink)

This paper is concerned with the practical importance of different forms of paternalism for educational theory and practice. Contrary to the traditional treatment of paternalism as a sometimes necessary and rather messy aspect of educational practices, I demonstrate that paternalism is to be regarded as an “indigenous concept” of educational theory and as the ‘indigenous model of justification’ that underlies the structure of educational practices. Based on an analysis of the intricate nexus between autonomy-oriented forms of paternalism and educational forms (...) of autonomy-based perfectionism I furthermore argue that a perfectionistically structured conception of autonomy provides a more adequate evaluative framework for justifying autonomy as an educational aim than alternative educational regimes of autonomy can deliver. Finally, I discuss some major theoretical problems of bridging the gap between general ethical principles and their application in practical fields. (shrink)

To be able to understand the history of bioethics, it is necessary to provide an overview of the mainstreams in philosophy which influenced them. That way one can clarify the theoretical origins of several ways of thought in bioethics as well as pinpoint certain problems within the field of bioethics. This paper will give a brief overview of moral theories in the history of philosophy and the way the have influenced ethical thought on biotechnology.

In A Theory of Justice (1971), John Rawls introduces the concept of “reflective equilibrium.” Although there are innumerable references to and discussions of this concept in the literature, there is, to the present author's knowledge, no discussion of the most important question: Why reflective equilibrium? In particular, the question arises: Is the method of reflective equilibrium applicable to the choice of this method itself? Rawls's drawing of parallels between Kant's moral theory and his own suggests that his concept of “reflective (...) equilibrium” is on a par with Kant's concept of “transcendental deduction.” Treating these two approaches to justification as paradigmatic, I consider their respective merits in meeting the reflexive challenge, i.e., in offering a justification for choice of mode of justification. My enquiry into this topic comprises three parts. In this first part, I raise the issue of the reflexivity of justification and question whether the reflexive challenge can be met within the framework of A Theory of Justice. (shrink)

Ordinary Language Philosophy has largely fallen out of favour, and with it the belief in the primary importance of analyses of ordinary language for philosophical purposes. Still, in their various endeavours, philosophers not only from analytic but also from other backgrounds refer to the use and meaning of terms of interest in ordinary parlance. In doing so, they most commonly appeal to their own linguistic intuitions. Often, the appeal to individual intuitions is supplemented by reference to dictionaries. In recent times, (...) Internet search engine queries for expressions of interest have become quite popular. Apparently, philosophers attempt to surpass the limits of their own linguistic intuitions by appealing to experts or to factual uses of language. I argue that this attempt is commendable but that its execution is wanting. Instead of appealing to dictionaries or Internet queries, philosophers should employ computer-based linguistic corpora in order to confirm or falsify hypotheses about the factual use of language. This approach also has some advantages over methods employed by experimental philosophers. If the importance of ordinary language is stressed, the use of linguistic corpora is hardly avoidable. (shrink)

Mucopolysaccharidosis type I (MPS I) is a rare lysosomal storage disorder treated with bone marrow transplantation or enzyme replacement therapy with laronidase, a high-cost orphan drug. Laronidase was approved by the US Food and Drug Administration and the European Medicines Agency in 2003 and by the Brazilian National Health Surveillance Agency in 2005. Many Brazilian MPS I patients have been receiving laronidase despite the absence of a governmental policy regulating access to the drug. Epidemiological and treatment data concerning MPS I (...) are scarce. This study aims to present a demographic profile of Brazilian patients with MPS I, describe the routes of access to laronidase in Brazil, and discuss associated ethical issues relating to public funding of orphan drugs. (shrink)

Empirical studies on people's moral attitudes regarding ethically challenging topics contribute greatly to research in medical ethics. However, it is not always clear in which ways this research adds to medical ethics as a normative discipline. In this article, we aim to provide a systematic account of the different ways in which attitudinal research can be used for normative reflection. In the first part, we discuss whether ethical judgements can be based on empirical work alone and we develop a sceptical (...) position regarding this point, taking into account theoretical, methodological and pragmatic considerations. As empirical data should not be taken as a direct source for normative justification, we then delineate different ways in which attitudes research can be combined with theoretical accounts of normative justification in the second part of the article. Firstly, the combination of attitudes research with normative-ethical theories is analysed with respect to three different aspects: The extent of empirical data which is needed, the question of which kind of data is required and the ways in which the empirical data are processed within the framework of an ethical theory. Secondly, two further functions of attitudes research are displayed which lie outside the traditional focus of ethical theories: the exploratory function of detecting and characterising new ethical problems, and the field of ‘moral pragmatics’. The article concludes with a methodological outlook and suggestions for the concrete practice of attitudinal research in medical ethics. (shrink)