Luck egalitarianism is often taken to task for its alleged harsh implications. For example, it may seem to imply a policy of nonassistance toward uninsured reckless drivers who suffer injuries. Luck egalitarians respond to such objections partly by pointing to a number of factors pertaining to the cases being debated, which suggests that their stance is less inattentive to the plight of the victims than it might seem at first. However, the strategy leaves some cases in which the attribution of (...) individual responsibility is appropriate . One such case is oral health or significant aspects of this. It is appropriate, the paper argues, to hold people responsible for a number of factors that affect their oral health. A luck egalitarian approach inspired by John Roemer can assess whether people have acted responsibly by comparing their choices to those of their peers. A luck egalitarian approach to oral health would recommend prioritizing scarce resources in a responsibility-weighted queuing system and include copayment and general taxation among its measures of financing. (shrink)

A belief that the government does have broad authority to protect and improve health, coupled with an understanding that collective action is often necessary to address public health challenges effectively, is central to the public health mindset. But many are questioning whether this vision of a strong government role is applicable to non-communicable disease threats and the social determinants of health. Arguments about public health paternalism are playing a role in political opposition to new law and policy interventions and in (...) legal challenges aimed at striking down existing public health laws. This article explores the forces behind the cultural and political resonance of concerns about public health paternalism, “personal responsibility,” and the “nanny state” and attempts to outlines a potential path forward from here. (shrink)

The concept of autonomy as self-sovereignty is developed in this essay through an examination of the thought of American transcendentalist philosophers Emerson and Thoreau. It is conceived as the quality of living in accordance with one’s inner nature or genius. This conception is grounded in a transcendentalist moral anthropology that values independence, self-reliance, spirituality, and the capacity to find beauty in the world. Though still exerting considerable popular and academic influence, both the concept of autonomy as self-sovereignty and the underlying (...) anthropology diverge in important ways from counterparts that are prominent in contemporary bioethics. Autonomy as self-sovereignty calls into question the manifold ways that patients (and citizens) are brought to heel by institutional (and political) values they do not themselves affirm. It also emphasizes the inevitable deep plurality of moral visions of health and appropriate healthcare, rejecting tendencies (strong in mainstream bioethics) to regard “health” as a univocal concept or healthcare as a basic need, to attempt to conform “reasonable” clinical decision-making to a single model, and to appoint government as a guarantor of access to healthcare or a regulator of healthcare standards. Autonomy as self-sovereignty, like its competitors, can justify itself only in question-begging terms. Still, bioethics might do well to recognize it within the mix of moral visions. (shrink)

Several attempts have been made to apply the choice-sensitive theory of distributive justice, luck egalitarianism, in the context of health and healthcare. This article presents a framework for this discussion by highlighting different normative decisions to be made in such an application, some of the objections to which luck egalitarians must provide answers and some of the practical implications associated with applying such an approach in the real world. It is argued that luck egalitarians should address distributions of health rather (...) than healthcare, endorse an integrationist theory that combines health concerns with general distributive concerns and be pluralist in their approach. It further suggests that choice-sensitive policies need not be the result of applying luck egalitarianism in this context. (shrink)

Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the ‘bad behaviour’ of individuals suffering lifestyle-related disease, and policies aimed at encouraging ‘responsibilisation’ in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and psychological mechanisms of health behaviour (...) could undermine some commonly held and tacit assumptions about the moral responsibility of agents for the sorts of lifestyles they adopt. I use Philip Petit's conception of freedom as ‘fitness to be held responsible’ to consider the significance of some of this evidence for assessing the moral responsibility of agents. I propose that, in some cases, factors outside the agent's control may influence behaviour in such a way as to undermine her freedom along the three dimensions described by Pettit: freedom of action; a sense of identification with one's actions; and whether one's social position renders one vulnerable to pressure from more powerful others. (shrink)

The U.S. scientific community has long led the world in research on such areas as public health, environmental science, and issues affecting quality of life. These scientists have produced landmark studies on the dangers of DDT, tobacco smoke, acid rain, and global warming. But at the same time, a small yet potent subset of this community leads the world in vehement denial of these dangers. -/- Merchants of Doubt tells the story of how a loose-knit group of high-level scientists and (...) scientific advisers, with deep connections in politics and industry, ran effective campaigns to mislead the public and deny well-established scientific knowledge over four decades. Remarkably, the same individuals surface repeatedly-some of the same figures who have claimed that the science of global warming is "not settled" denied the truth of studies linking smoking to lung cancer, coal smoke to acid rain, and CFCs to the ozone hole. "Doubt is our product," wrote one tobacco executive. These "experts" supplied it. -/- Naomi Oreskes and Erik M. Conway, historians of science, roll back the rug on this dark corner of the American scientific community, showing how ideology and corporate interests, aided by a too-compliant media, have skewed public understanding of some of the most pressing issues of our era. (shrink)

Responsible public policy making in a technological society must rely on complex scientific reasoning. Given that ordinary citizens cannot directly assess such reasoning, does this call the democratic legitimacy of technical public policies in question? It does not, provided citizens can make reliable second-order assessments of the consensus of trustworthy scientific experts. I develop criteria for lay assessment of scientific testimony and demonstrate, in the case of claims about anthropogenic global warming, that applying such criteria is easy for anyone of (...) ordinary education with access to the Web. However, surveys show a gap between the scientific consensus and public opinion on global warming in the U.S. I explore some causes of this gap and argue that democratic reforms of our culture of political discourse may be able to address it. (shrink)

The legal basis of informed consent in Texas may on first examination suggest an unqualified affirmation of persons as the source of authority over themselves. This view of individuals in the practice of informed consent tends to present persons outside of any social context in general and outside of their families in particular. The actual functioning of law and medical practice in Texas, however, is far more complex. This study begins with a brief overview of the roots of Texas law (...) and public policy regarding informed consent. This surface account is then contrasted with examples drawn from the actual functioning of Texas law: Texas legislation regarding out-of-hospital do-not-resuscitate (DNR) orders. As a default approach to medical decision-making when patients lose decisional capacity and have failed to appoint a formal proxy or establish their wishes, this law establishes a defeasible presumption in favor of what the law characterizes as “qualified relatives” who can function as decision-makers for those terminal family members who lose decisional capacity. The study shows how, in the face of a general affirmation of the autonomy of individuals as if they were morally and socially isolated agents, space is nevertheless made for families to choose on behalf of their own members. The result is a multi-tier public morality, one affirming individuals as morally authoritative and the other recognizing the decisional standing of families. (shrink)

Mainstream epistemology is a highly theoretical and abstract enterprise. Traditional epistemologists rarely present their deliberations as critical to the practical problems of life, unless one supposes—as Hume, for example, did not—that skeptical worries should trouble us in our everyday affairs. But some issues in epistemology are both theoretically interesting and practically quite pressing. That holds of the problem to be discussed here: how laypersons should evaluate the testimony of experts and decide which of two or more rival experts is most (...) credible. It is of practical importance because in a complex, highly specialized world people are constantly confronted with situations in which, as comparative novices, they must turn to putative experts for intellectual guidance or assistance. It is of theoretical interest because the appropriate epistemic considerations are far from transparent; and it is not clear how far the problems lead to insurmountable skeptical quandaries. This paper does not argue for flat-out skepticism in this domain; nor, on the other hand, does it purport to resolve all pressures in the direction of skepticism. It is an exploratory paper, which tries to identify problems and examine some possible solutions, not to establish those solutions definitively. (shrink)

There is a robust scientific consensus concerning climate change and evolution. But many people reject these expert views, in favour of beliefs that are strongly at variance with the evidence. It is tempting to try to explain these beliefs by reference to ignorance or irrationality, but those who reject the expert view seem often to be no worse informed or any less rational than the majority of those who accept it. It is also tempting to try to explain these beliefs (...) by reference to epistemic overconfidence. However, this kind of overconfidence is apparently ubiquitous, so by itself it cannot explain the difference between those who accept and those who reject expert views. Instead, I will suggest that the difference is in important part explained by differential patterns of epistemic deference, and these patterns, in turn, are explained by the cues that we use to filter testimony. We rely on cues of benevolence and competence to distinguish reliable from unreliable testifiers, but when debates become deeply politicized, asserting a claim may itself constitute signalling lack of reliability. (shrink)

Why do irrational beliefs adopt the trappings of science, to become what is known as “pseudoscience”? Here, we develop and extend an epidemiological framework to map the factors that explain the form and the popularity of irrational beliefs in scientific garb. These factors include the exploitation of epistemic vigilance, the misunderstanding of the authority of science, the use of the honorific title of “science” as an explicit argument for belief, and the phenomenon of epistemic negligence. We conclude by integrating the (...) various factors in an epidemiological framework and thus provide a comprehensive cultural evolutionary account of science mimicry. (shrink)

Why do irrational beliefs adopt the trappings of science, to become what is known as “pseudoscience”? Here, we develop and extend an epidemiological framework to map the factors that explain the form and the popularity of irrational beliefs in scientific garb. These factors include the exploitation of epistemic vigilance, the misunderstanding of the authority of science, the use of the honorific title of “science” as an explicit argument for belief, and the phenomenon of epistemic negligence. We conclude by integrating the (...) various factors in an epidemiological framework and thus provide a comprehensive cultural evolutionary account of science mimicry. (shrink)

Philosophers have long agreed that moral responsibility might not only have a freedom condition, but also an epistemic condition. Moral responsibility and knowledge interact, but the question is exactly how. Ignorance might constitute an excuse, but the question is exactly when. Surprisingly enough, the epistemic condition has only recently attracted the attention of scholars, and it is high time for a full volume on the topic. The chapters in this volume address the following central questions. Does the epistemic condition require (...) akrasia? Why does blameless ignorance excuse? Does moral ignorance sustained by one’s culture excuse? Does the epistemic condition involve knowledge of the wrongness or wrongmaking features of one’s action? Is the epistemic condition an independent condition, or is it derivative from one’s quality of will or intentions? Is the epistemic condition sensitive to degrees of difficulty? Are there different kinds of moral responsibility and thus multiple epistemic conditions? Is the epistemic condition revisionary? What is the basic structure of the epistemic condition? (shrink)

Alvin Goldman has criticized the idea that, when evaluating the opinions of experts who disagree, a novice should “go by the numbers”. Although Goldman is right that this is often a bad idea, his argument involves an appeal to a principle, which I call the non-independence principle, which is not in general true. Goldman's formal argument for this principle depends on an illegitimate assumption, and the examples he uses to make it seem intuitively plausible are not convincing. The failure of (...) this principle has significant implications, not only for the issue Goldman is directly addressing, but also for the epistemology of rumors, and for our understanding of the value of epistemic independence. I conclude by using the economics literature on information cascades to highlight an important truth which Goldman's principle gestures toward, and by mounting a qualified defense of the practice of going by the numbers. (shrink)

In recent years, ‘nudge’ theory has gained increasing attention for the design of population-wide health interventions. The concept of nudge puts a label on efficacious influences that preserve freedom of choice without engaging the influencees’ deliberative capacities. Given disagreements over what it takes genuinely to preserve freedom of choice, the question is whether health influences relying on automatic cognitive processes may preserve freedom of choice in a sufficiently robust sense to be serviceable for the moral evaluation of actions and policies. (...) In this article, I offer an argument to this effect, explicating preservation of freedom of choice in terms of choice-set preservation and noncontrol. I also briefly explore the healthcare contexts in which nudges may have priority over more controlling influences. (shrink)

Alvin Goldman has criticized the idea that, when evaluating the opinions of experts who disagree, a novice should “go by the numbers”. Although Goldman is right that this is often a bad idea, his argument involves an appeal to a principle, which I call the non-independence principle, which is not in general true. Goldman's formal argument for this principle depends on an illegitimate assumption, and the examples he uses to make it seem intuitively plausible are not convincing. The failure of (...) this principle has significant implications, not only for the issue Goldman is directly addressing, but also for the epistemology of rumors, and for our understanding of the value of epistemic independence. I conclude by using the economics literature on information cascades to highlight an important truth which Goldman's principle gestures toward, and by mounting a qualified defense of the practice of going by the numbers. (shrink)

In June 2012, New York City Mayor Michael Bloomberg announced his plans for a ban on the sale of sugary beverages in containers larger than 16 ounces. Shortly thereafter, the Center for Consumer Freedom took out a full-page ad in the New York Times featuring Bloomberg photo-shopped into a matronly dress with the tag line “New Yorkers need a Mayor, not a Nanny.” On television, the CATO Institute's Michael Cannon declared, “This is the most ridiculous sort of nanny state-ism; [i]t’s (...) none of the mayor's business how much soda people are drinking.” And in newspapers around the country, editorial pages featured headlines such as “Gulp! Yet Another Intrusion of the Nanny State.” Just like that, the public debate about this measure became focused on government overreach, while the public health problem of obesity faded into the background. (shrink)

We propose a model of motivated skepticism that helps explain when and why citizens are biased information processors. Two experimental studies explore how citizens evaluate arguments about affirmative action and gun control, finding strong evidence of a prior attitude effect such that attitudinally congruent arguments are evaluated as stronger than attitudinally incongruent arguments. When reading pro and con arguments, participants (Ps) counterargue the contrary arguments and uncritically accept supporting arguments, evidence of a disconfirmation bias. We also find a confirmation bias—the (...) seeking out of confirmatory evidence—when Ps are free to self-select the source of the arguments they read. Both the confirmation and disconfirmation biases lead to attitude polarization—the strengthening of t2 over t1 attitudes—especially among those with the strongest priors and highest levels of political sophistication. We conclude with a discussion of the normative implications of these findings for rational behavior in a democracy. (shrink)

We propose a model of motivated skepticism that helps explain when and why citizens are biased information processors. Two experimental studies explore how citizens evaluate arguments about affirmative action and gun control, finding strong evidence of a prior attitude effect such that attitudinally congruent arguments are evaluated as stronger than attitudinally incongruent arguments. When reading pro and con arguments, participants (Ps) counterargue the contrary arguments and uncritically accept supporting arguments, evidence of a disconfirmation bias. We also find a confirmation bias—the (...) seeking out of confirmatory evidence—when Ps are free to self-select the source of the arguments they read. Both the confirmation and disconfirmation biases lead to attitude polarization—the strengthening of t2 over t1 attitudes—especially among those with the strongest priors and highest levels of political sophistication. We conclude with a discussion of the normative implications of these findings for rational behavior in a democracy. (shrink)

This book develops and defends a theory of responsible belief. The author argues that we lack control over our beliefs, but that we can nonetheless influence them. It is because we have intellectual obligations to influence our beliefs that we are responsible for them.

_Any assistance an author receives with writing a scientific article that is not acknowledged in the article is described as ghost-writing. Articles ghost-written by medical writers engaged by pharmaceutical companies who have a vested interest in the content have caused concern after scandals revealed misleading content in some articles. A key criterion of authorship in medical journals is final approval of the article submitted for publication. Authors are responsible for the content of their articles and for acknowledging any assistance they (...) receive. Action taken by some journals and medical writer associations to encourage acknowledgement is an uphill task in the light of disinterest from the pharmaceutical industry and ignorance or similar lack of interest by those who agree to be named authors. However, acknowledgment alone is not sufficient to resolve medical ghost-writing; issues of how the acknowledgement is formulated, permission to acknowledge and access to raw data also need to be tackled._. (shrink)