Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource (...) allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics. (shrink)

The widespread conviction that we are living in a post-truth era rests on two claims: that a large number of people believe things that are clearly false, and that their believing these things reflects a lack of respect for truth. In reality, however, fewer people believe clearly false things than surveys or social media suggest. In particular, relatively few people believe things that are widely held to be bizarre. Moreover, accepting false beliefs does not reflect a lack of respect for (...) truth. Almost everyone’s beliefs are explained by rationally warranted trust in some sources rather than others. This allows us to explain why people have false beliefs. (shrink)

The COVID-19 pandemic has been accompanied by an “infodemic” of misinformation and conspiracy theory. This article points to three explanatory factors: the challenge of forming accurate beliefs when overwhelmed with information, an implausibly individualistic conception of epistemic virtue, and an adversarial information environment that suborns epistemic dependence. Normally we cope with the problems of informational excess by relying on other people, including sociotechnical systems that mediate testimony and evidence. But when we attempt to engage in epistemic “superheroics” - withholding trust (...) from others and trying to figure it all out for ourselves – these can malfunction in ways that make us vulnerable to forming irrational beliefs. Some epistemic systems are prone to coalescing audiences around false conspiracy theories. This analysis affords a new perspective on philosophical efforts to understand conspiracy theories and other epistemic projects prone to collective irrationality. (shrink)

A considerable literature has emerged around the idea of using ‘personal responsibility’ as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as ‘responsibilisation’. This discussion focuses most prominently, but not exclusively, on ‘luck egalitarianism’, the view that deviations from equality are justified only by suitably free choices. A superficially separate issue in distributive justice concerns the two–way relationship (...) between health and other social goods: deficits in health typically undermine one's abilities to secure advantage in other areas, which in turn often have further negative effects on health. This paper outlines the degree to which this latter relationship between health and other social goods exacerbates an existing problem for proponents of responsibilisation (the ‘harshness objection’) in ways that standard responses to this objection cannot address. Placing significant conditions on healthcare access because of a person's prior responsibility risks trapping them in, or worsening, negative cycles where poor health and associated lack of opportunity reinforce one another, making further poor yet ultimately responsible choices more likely. It ends by considering three possible solutions to this problem. (shrink)

There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth might seem to enable us (...) to overcome—fairness of burdens and reliance on self-reporting—I note that these problems would only really be solved by unacceptably comprehensive forms of personal health surveillance which applies to all of us at all times. A more plausible model is to use personal health surveillance as a last resort for patients who would otherwise independently qualify for responsibility-based penalties. However, I note that there are still a number of ethical and practical problems that such a policy would need to overcome. The prospects of mHealth enabling a fair, genuinely cost-saving policy of patient responsibility are slim. (shrink)

No-platforming—the refusal to allow those who espouse views seen as inflammatory the opportunity to speak in certain forums—is very controversial. Proponents typically cite the possibility of harms to disadvantaged groups and, sometimes, epistemically paternalistic considerations. Opponents invoke the value of free speech and respect for intellectual autonomy in favor of more open speech, arguing that the harms that might arise from bad speech are best addressed by rebuttal, not silencing. In this article, I argue that there is a powerful consideration (...) in favor of no-platforming some speakers: allowing them a platform generates genuine higher-order evidence in favor of their claims. When that higher-order evidence would be misleading, we may reasonably believe it should not be generated. (shrink)

Much of what we know we know through testimony, and knowing on the basis of testimony requires some degree of trust in speakers. Trust is therefore very valuable. But in trusting, we expose ourselves to risks of harm and betrayal. It is therefore important to trust well. In this paper, I discuss two recent cases of the betrayal of trust in (broadly) academic contexts: one involving hoax submissions to journals, the other faking an identity on social media. I consider whether (...) these betrayals suggest that we ought to be less trusting in contexts like these. I argue that we should not: the acquisition of knowledge is dependent on trust, and we cannot intentionally reduce the extent to which we trust in these kinds of contexts without risking destroying it utterly. Instead, we must trust in our epistemic networks and the way they work to filter out deception. (shrink)

Various scientists and philosophers have heavily criticized what they see as problematic forms of ‘nutritional reductionism’ or ‘nutritionism’ whereby studying food–health interactions at the level of isolated food components produces largely misguided science and misleading interpretations. However, the exact target of these diverse criticisms remains elusive, and its implications are overstated, which may hinder scientific understanding. To better identify the types of flaws supposedly hindering reductionist research, we disentangle three types of reductionist claims to better determine what the debate is (...) about and to propose ways to move it forward. We then present a qualified defence of the reductionist programme that hinges on the ability to identify nutritional causes that make a difference, which we illustrate through central examples in the history of nutrition. This defence is taken further by using insights from the philosophy of mechanisms to analyse how the field of nutritional ecology offers a synthetic framework to explain, generate, and test predictions about nutrient–organism interactions, which is premised on the biological mechanisms of nutrient-specific appetite regulation. The result, which we call ‘synthetic reductionism’, avoids many, though perhaps not all, of the challenges raised by anti-reductionists, and also highlights the potential of reductionism to identify nutritional difference makers. (shrink)

In the world of Austrian neonatal intensive care units, the role of ethics is recognized only partially. The normatively tense cases that are at the backdrop of this essay concern the situations around the limit of viability, which is the point in the development of an extremely preterm infant at which there are chances of extra-uterine survival. This essay first outlines the key explicit ethical challenges that are mainly concerned with notions of uncertainty and best interest. Then, it attempts to (...) elucidate the less explicit ethical challenges related to the notion of nudging in the neonatal practice and argue that the role of ethics needs to be recognized more—with the focus on the role of virtue ethics—in order to improve the practice of neonatal medicine. (shrink)

This paper argues that there exists a collective epistemic state of ‘Broad Medical Uncertainty’ regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about (...) the benefit/harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a ‘Corrective Response’. We then consider some objections to this position, including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing. (shrink)