The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA’s provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA (...) is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the health care system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry. (shrink)

The author reviews the planned withdrawal of healthcare from the primary public hospital, Grady Memorial Hospital, of Atlanta, Georgia. Prior to passage of the Affordable Care Act of 2010, at least half of the patients had no public or private health insurance and their care was financially supported by State and County funding as well as supplementation from Emory University. New administration in the elected positions of the State and County and at the University reached agreement to (...) decrease care. The University President stated that the Hippocratic Oath was no longer valid for salaried physicians who must follow the direction of their business manager. The author, a tenured Professor, was forcibly transferred to the Veterans Hospital, which also was withholding standard medical care, including life-saving medications. Organizing multiple concerned organizations including members of the King Center, the Carter Center, the Open Door Community Center, Gay Rights, etc., (Grady Coalition) multiple public protests were successful in raising the necessary funds to continue adequate care at Grady and begin an investigation of the Veterans Affairs Hospital. (shrink)

This chapter explores two questions in detail: How should we determine the threshold for costs that individuals are asked to bear through insurance premiums or care-related out-of-pocket costs, including user fees and copayments? and What is an adequate relationship between costs and benefits? This chapter argues that preventing impoverishment is a morally more urgent priority than protecting households against income fluctuations, and that many health insurance plans may not adequately protect individuals from health care costs that threaten to (...) drop their financial status below a decent minimum. A design that places greater emphasis on preventing impoverishment and finances the achievement of that goal by reducing unnecessary subsidies to better-off households would better accord with a sufficientarian approach to health care. -/- . (shrink)

William Smith’s recent article criticises the so-called orthodox approaches to the normative analysis of healthcare resource allocation, associated to the requirement that decision-makers should abide by strictly procedural principles of legitimacy defining a deliberative democratic process. Much of the appeal of Smith’s argument goes down to his awareness of real-world processes and, in particular, to the large gap he identifies between well-led democratic deliberation and the messiness of the process through which the intuitively legitimate Affordable Care Act (ACA) (...) was created. This reply aims to demonstrate that the ACA provides no counterexample to orthodox views, seizing this opportunity to explore the specific space that the procedural principles populating orthodox accounts are meant to regulate. Neither general questions of healthcare justice concerning, for example, universal access nor, relatedly, the activity of elected politicians falls within the natural scope of application of such principles, revealing a much more complex picture of the interactions between justice and legitimacy as well as substantive and procedural considerations than acknowledged by Smith. In the end, orthodox accounts of healthcare resource allocation turn out to provide a precious fund of theoretical resources for the normative study of administrators, which might be useful well beyond bioethics and health policy. (shrink)

The 2010 Patient Protection and Affordable Care Act was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance. Opponents of the mandate argue that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Rather than appeal to the collective good, this Viewpoint argues for a duty to buy health insurance based on the moral duty individuals have to reduce (...) certain burdens they pose on others. When some people have a duty to rescue, others may have a duty to take rescue precautions, in this case, to purchase health insurance to cover acute and emergency care needs. Requiring that individuals meet this obligation is consistent with respect of individual liberty. (shrink)

The only part of the Patient Protection and Affordable Care Act (hereafter, ‘the ACA’) struck down in National Federation of Independent Business (NFIB) et al. v. Sebelius, Secretary of Health and Human Services, et al. was a provision expanding Medicaid. We will argue that this was a mistake; the provision should not have been struck down. We’ll do this by identifying a test that C.J. Roberts used to justify his view that this provision was unconstitutional. We’ll defend that (...) test against some objections raised by J. Ginsburg. We’ll then go on to argue that, properly applied, that test establishes the constitutionality of the Medicaid provision. (shrink)

This paper concerns two topics which, I hope to show, are vitally connected. One is the distinctive importance of appellate adjudication in the legal system of United States. The other is the workings of entangled concepts in the law. That appellate adjudication is important in some sense may seem obvious to everybody (to a few it will seem obvious that appellate adjudication is unimportant). My point will be that via appellate adjudication courts engineer entangled legal concepts, and it is this (...) aspect of appellate adjudication that is both crucial and unique to it, at least in the U.S. legal system. Entangled concepts intertwine description and evaluation; entangled legal concepts facilitate and constrain legal reasoning and legal judgments, in ways that distinguish legal adjudication from pure politics or the implementation of public policy. In the paper itself, I demonstrate more fully what it is for a legal concept to be an entangled one and how entanglement supplies guidance in adjudication. I also broach how entanglement in legal concepts and engineered entanglement have significance for legal pedagogy; appellate adjudication; the respective roles of the judiciary, the legislature, and administrative agencies; the erosion of the distinction between so-called public law and so-called private law; and our understanding of the fact/value distinction. -/- Understanding more specifically the nature of the entanglement at work in appellate adjudication requires much closer scrutiny of appellate opinions than we usually give. I examine carefully the background to MacPherson v. Buick and Justice Benjamin Cardozo’s particular re-engineering of ‘negligence’ and ‘duty,’ entangled concepts belonging to the same legal taxonomy. Via this scrutiny, I demonstrate the flaws in the engineering of some concepts in the buildup to MacPherson, and how these flaws led to those concepts’ collapse and ultimately to Cardozo’s re-engineering of ‘negligence’ and ‘duty.’ I also explain why careful understanding of the engineering of entangled legal concepts can make us appreciate that even the most successful of such concepts have within in them the grounds for their own obsolescence. -/- To show that conceptual engineering of entangled concepts occurs outside the context of state common law, I also examine how the U.S. Supreme Court has engineered ‘commerce’, itself an entangled concept. The recent decision regarding the individual mandate in the Affordable Care Act makes this example particularly timely. This secondary example also clarifies the nature of entanglement and engineering it. -/- This article concerns appellate adjudication in any area of law. I maintain that whether we are dealing with private law or public law, common law or statutory law or Constitutional law, the defining feature of appellate adjudication is its continuous engineering and reengineering of entangled legal concepts. The merger of fact and value in these concepts explains both the fertility of appellate adjudication and the constraints judges work with when they work with legal concepts that entangle fact and value. (shrink)

Lawyers and judges cannot adequately address the nature of text, meaning, or interpretation without reference to the insights provided by linguists and philosophers of language. Exploring some of those insights, this article focuses upon what linguists and philosophers of language call “pragmatics.” Pragmatics examines the relations between words and users rather than the relations of words to words (syntax) or the relations of words to the world (semantics). In other words, pragmatics studies how language users actually use and interpret words (...) and other signs in communication. -/- Pragmatics recognizes that speaker meaning can differ from (and even contradict) linguistic meaning, including the literal meaning of text. In its proper context, for example, “Bob is indeed a good lawyer” can ironically mean just the opposite. Pragmatics also recognizes that relevant text is not a thing-in-itself that is simply given. Good lawyers look at such things as purpose and cohesion when determining relevant text. They do not simply take their opponent’s (or even their client’s) assertions of relevance. -/- Pragmatics also provides lawyers with a number of specific concepts and tools which are helpful in determining speaker meaning. For user convenience, this article attempts to set out in one place a number of such concepts and tools. These include: (1) types of cohesion that help determine relevant text, (2) types of context that help determine meaning, (3) pragmatic principles of construction such as principles of relevance and politeness, and (4) important pragmatic notions or devices such as anaphora, cataphora, ellipsis, deixis, presupposition, unstated premises, entailment, and implementives. -/- Finally, as a recurring example (among others) of pragmatics in action, this article examines from multiple perspectives textual issues raised in King v. Burwell, 576 U.S. __ (2015). -/- Keywords: Pragmatics, Semiotics, Interpretation, Textualism, Plain Meaning, King v. Burwell, Affordable Care Act, Text, Meaning, Speaker Meaning, Implicature. (shrink)

With insights from philosophy of language and semiotics, this article addresses judicial choices and semantic errors involved in United States v. Stevens, 130 S.Ct. 1577 (2010) (refusing to read “killing” and “wounding” to include cruelty and thus striking down a federal statute outlawing videos of animal cruelty), and Snyder v. Phelps, 131 S.Ct. 1207 (2011) (finding a First Amendment right to picket military funerals and verbally attack parents of dead soldiers as part of purportedly-public expression). -/- This article maintains that (...) a better understanding of semiotics (the theory of signs) exposes the flaws in both decisions and bolsters the arguments of the lone dissenter in both cases, Justice Alito. Such a better understanding of semiotics involves grasping (a) how expression involves signs, (b) how signs work in general, and (c) the differences between three basic kinds of signs (indexes, icons and symbols). This article maintains that the expression involved in Stevens and in Phelps was a type of indexical or quasi-indexical expression that, for reasons similar to those involved in child pornography cases, should have no First Amendment protection. -/- This article also notes shifting interpretive positions in the Court that cry out for reform. Although Chief Justice Roberts uses a textualist approach in his majority opinion striking down the animal cruelty statute in Stevens, his majority opinion in National Federation of Independent Business v. Sebelius, 132 S.Ct. 2566 (2012), has no trouble finding a “penalty” a “tax,” upholding the Affordable Care Act, and chastising the dissent for voting to strike down a statute simply because “. . . Congress used the wrong labels.” Id. at 2597. -/- This article attempts to expose such gamesmanship in “textualism” and attempts to lay out a better semiotic path for the Court. It calls for more forthright judicial decision-making in constitutional and statutory interpretation; calls for rejecting mechanical notions of law that conceal judicial choice involved in constitutional and statutory interpretation; and calls for rejecting claims that dictionaries can settle constitutional or statutory interpretation issues without reference to constitutional and statutory goals. -/- Keywords: interpretation, construction, meaning, plain meaning, originalism, original intent, canon, semiotics, signs, signals, symbol, icon, index, signifier, signified, ordinary meaning, freedom of speech, freedom of expression, animal cruelty, first amendment, statutes. (shrink)

The intersection between virtue and care ethics is underexplored in contemporary moral philosophy. This thesis approaches care ethics from a neo-Aristotelian virtue ethical perspective, comparing the two frameworks and drawing on recent work on care to develop a theory thereof. It is split into seven substantive chapters serving three major argumentative purposes, namely the establishment of significant intertheoretical agreement, the compilation and analysis of extant and new distinctions between the two theories, and the synthesis of care (...) ethical insights with neo-Aristotelianism to generate a virtue ethical theory of care. In the first two chapters, I outline virtue ethics and care ethics, and argue for considerable agreement over central premises. Chapter 2 summarises the foundational commitments of care ethics, focusing particularly on their relational ontology and its links to the other ethical claims care ethicists universally ascribe to, namely particularism, partialism, the moral salience of emotions, and the rejection of hard public/private distinctions. Chapter 3 lays out the central concepts in neo-Aristotelian virtue ethics, including eudaimonism, virtue, and character traits, and drawing a number of comparisons between virtue and care ethics specifically with regard to relational ontology and the meta-ethical commitments it underpins. In addition to doing the necessary expository work for the remainder of the thesis, Chapters 2 and 3 also argue that care ethics and virtue ethics have much more in common than is typically acknowledged – the first major contribution of this thesis to the literature. Chapters 2 and 3 to provide at least a prima facie justification for pursuit of the questions I confront in the remainder of the thesis. In Chapter 4, I ask what differentiates these two ethical theories. I survey some of the differences which philosophers in either camp have identified and offer some of my own. I suggest that several of those differences either rest on misunderstandings of one ethic or the other, or that in erecting a divide between virtue and care ethics they also disunify ethics of care. I do, however, identify two differences which seem defensible. Specifically, they are that virtue ethics seems to lack an account of care, which I define minimally as a response or responsiveness to need, and that virtue and care ethics organise their meta-ethical and normative concepts differently. This chapter thus presents a second contribution to the literature: a study of the differences between virtue ethics and care ethics. It also serves to set the trajectory for the remaining chapters, where I respond to the claim that virtue ethics lack an account of care. I spend the remainder of the thesis constructing what I take to be a satisfying foundation for a virtue ethical theory of care. In Chapter 5, I offer three initially viable means of incorporating care into virtue ethics, all of which treat care as a virtue. These are the analogical approach, according to which care is analogous to an existing virtue; the additive approach, according to which care is a novel virtue; and the bundling approach, according to which care is a bundle of virtues. I also offer and evaluate reasons to reject the claim that care is a virtue, concluding that the claim is indeed a viable one so long as the concept of care is sufficiently thick, and I contend that analogical approaches, and particularly analogies with charity, outperform the others. Chapter 5 therefore serves two ends. First, it proffers a novel meta-analysis of concepts of care as a virtue, and thus makes a third contribution to the literature. In doing so, it makes an inroad into the second: the development of a neo-Aristotelian theory of care. Chapter 6 continues this project. I attempt to show how care can be construed as an act-type and a practice. I argue in this chapter that practices are a subcategory of actions, and that care qualifies as an Anscombean act-type which aims at the meeting of needs relating to the care-recipient’s flourishing. I go on to consider the implications of this account for ethics which deploy care as a moral concept, maintaining that it not only offers a better account of consequences than theories of care which include success criteria, but also that it affords us interesting insights into the distinction between ‘caring about’ and ‘caring for’ which allow us to make sense of certain tenets of neo-Aristotelianism. This represents a contribution to both discourses, since neither care nor virtue ethicists working at the intersection of their respective normative theories have delved very deeply into the philosophy of action. Chapter 7 discusses caring relations, suggesting that a virtue ethical theory of caring relations can lean on the work care ethicists have done, and adding some necessary refinements, such as a distinction between ideal and non-ideal caring relations, and a theory of caring relations as reasons for action. This final chapter also draws these three concepts of care together by arguing that virtuous caregivers who are invested in the flourishing of those for whom they care are also sensitive to the relations those care-recipients bear to their institutional environment. I argue that because they are caring participants in caring relations, virtuous agents are characteristically motivated by states of need and dependency to engage in certain sorts of conventionally political practices. In other words, the virtue or virtues of caring characteristically manifest in certain sorts of political or social practices, relating specifically to those areas of moral life. This allows us to build upon recent work in feminist virtue ethics of the sort offered by Tessman and Friedman. I also offer a novel analysis of migration, suggesting that the account of care presenting here is analytically useful both when it comes to historical cases of migration such as the underground railroads and escapes from Nazi-occupied Europe, but also for contemporary issues such as the migrations occurring in the Southern United States and in much of Europe. I thus conclude not only that virtue ethicists ought to incorporate care into their normative framework, and that the theory of care presented here is a coherent one, but that this leads us naturally into applied topics such as virtue politics. I conclude the thesis by considering some its implications and by identifying some further avenues for research. (shrink)

This dissertation aimed to examine the consequence of health-induced poverty and two policy responses to address this issue among older adults in the United States and China. Specifically, Paper I investigates whether public transfers crowded out private transfers among rural and urban Chinese older families and if this dynamic would change when health care expenses were high. Paper II examines the effect of New Rural Cooperative Medical Insurance, a national health insurance program for rural residents in China, on changing (...) the incidence of health-induced poverty among middle-aged and older beneficiaries. Paper III tests the effects of closing the Medicare Part D donut hole (coverage gap) through the Affordable Care Act (ACA) on changing prescription drug cost-induced poverty. Overall, the findings obtained from these three papers provide empirical evidence that health-induced poverty is prevalent among older adults in both China and the United States and the current public transfers and health policies are either ineffective or insufficient to reduce health-induced poverty as intended. (shrink)

Autonomous and automatic weapons would be fire and forget: you activate them, and they decide who, when and how to kill; or they kill at a later time a target you’ve selected earlier. Some argue that this sort of killing is always wrong. If killing is to be done, it should be done only under direct human control. (E.g., Mary Ellen O’Connell, Peter Asaro, Christof Heyns.) I argue that there are surprisingly many kinds of situation where this is false and (...) where the use of Automated Weapons Systems would in fact be morally required. These include cases where a) once one has activated a weapon expected then to behave lethally, it would be appropriate to let it continue because this is part of a plan whose goodness one was best positioned to evaluate before activating the weapon; b) one expects better long-term consequences from allowing it to continue; c) allowing it to continue would express a decision you made to be resolute, a decision that could not have advantaged you had it not been true that you would carry through with it; d) the weapon is mechanically not recallable, so that, to not allow it to carry through, you would have had to refrain from activating it in the first place, something you expected would have disastrous consequences; e) you must deputize necessary killings to autonomous machines in order to protect yourself from guilt you shouldn’t have to bear; f) it would be morally better for the burden of responsibility for the killing to be shared among several agents, and the agents deputizing killing to machines can do this, especially where it’s not predictable which machine will be successful; g) a killing would be morally better done with elements of randomness and lack of deliberation, and a (relatively stupid) machine could do this where a person could not; h) the machine would be acting as a Doomsday Device, so that it could not have had its hoped for deterrent effect had you not ensured that you would be unable to recall it if enemy action activated it; i) letting it carry through is a necessary part of its own learning process, and you expect that this learning will have salutary effects later on; j) human intervention in the machine’s operation would disastrously impair its precision, or its speed and efficiency; k) using non-automated methods would require human resources you just don’t have in a task that nevertheless must be done (e.g., using land-mines to protect remote installations); l) the weapon has such horrible and indiscriminate power that it is doubtful whether it could be actually used in ways compatible with International Humanitarian Law and the Laws of War, which require that weapons be used only in ways respecting distinctness, necessity and proportionality, but its threat of use could respect these principles in affording deterrence provided human error cannot lead to their accidental deployment, this requiring that they be controlled by carefully designed autonomous and automatic systems. I then consider objections based on conceptions of human dignity and find that very often dignity too is best served by autonomous machine killing. Examples include saving your village by activating a robot to kill invading enemies who would inflict great indignity on your village, using a suicide robot to save yourself from a less dignified death at enemy hands, using a robotic drone to kill someone otherwise not accessible in order to restore dignity to someone this person killed and to his family, and using a robot to kill someone who needs killing, but the killing of whom by a human executioner would soil the executioner’s dignity. I conclude that what matters in rightful killing isn’t necessarily that it be under the direct control of a human, but that it be under the control of morality; and that could sometimes require use of an autonomous or automated device. (This paper was formerly called "Fire and Forget: A Defense of the Use of Autonomous Weapons in War" on Philpapers; the current title is the title of the published version.). (shrink)

In this book I show that science suffers from a damaging but rarely noticed methodological disease, which I call rationalistic neurosis. It is not just the natural sciences which suffer from this condition. The contagion has spread to the social sciences, to philosophy, to the humanities more generally, and to education. The whole academic enterprise, indeed, suffers from versions of the disease. It has extraordinarily damaging long-term consequences. For it has the effect of preventing us from developing traditions and institutions (...) of learning rationally devoted to helping us learn how to make progress towards a wiser, more civilized world. On our fragile earth, overcrowded, fraught with injustice, inequality and conflict, menaced by unprecedented and terrifying technological and industrial means for change and destruction, we urgently need to acquire a little more wisdom and civilization if we are to avoid repeating horrors of the kind suffered by so many during the 20th century (and already suffered by many in the first few years of the 21st century). We can ill afford to have in our hands instruments of learning botched and bungled from the standpoint of helping us learn how to live more wisely. It may seem scarcely credible that something as important as our institutions of learning can suffer from wholesale, structural defects. Why has this not been noticed before? Why have not armies of scientists and scholars appreciated the point and, long ago, put the matter right? The answer will emerge as my argument unfolds. I will show that one of the most damaging features of rationalistic neurosis is that it has built-in methodological and institutional mechanisms which effectively conceal that anything is wrong. But there is also an immediately obvious reason: specialization, and the resulting fragmentation of academia, has resulted in a situation in which hardly anyone takes responsibility for the overall ideals, the overall aims and methods, of academic inquiry. Academics, these days, are specialists, furiously trying to keep abreast of developments in their own specialist fields. They have no time, and no inducement, to lift their eyes from their particular disciplines, and look at the whole endeavour. Science has long been under attack, at least since the Romantic movement. Blake objected to “Single vision & Newton’s sleep” and declared that “Art is the Tree of Life... Science is the Tree of Death”. Keats lamented that science will “clip an Angel’s wings” and “unweave a rainbow”. Whereas the Enlightenment had valued science and reason as tools for the liberation of humanity, Romanticism found science and reason oppressive and destructive, and instead valued art, imagination, inspiration, individual genius, emotional and motivational honesty rather than careful attention to objective fact. Much subsequent opposition to science stems from, or echoes, the Romantic opposition of Blake, Wordsworth, Keats and many others. There is the movement Isaiah Berlin has described as the “Counter-Enlightenment” (Berlin, 1979, ch. 1). There is existentialism, with its denunciation of the tyranny of reason, its passionate affirmation of the value and centrality of irrationality in human life, from Dostoevsky, Kierkegaard and Nietzsche to Heidegger and Sartre (see, for example, Barrett, 1962). There is the attack on Enlightenment ideals concerning science and reason undertaken by the Frankfurt school, by postmodernists and others, from Horkheimer and Adorno to Lyotard, Foucault, Habermas, Derrida, MacIntyre and Rorty (see Gascardi, 1999). The soul-destroying consequences of valuing science and reason too highly is a persistent theme in literature: it is to be found in the works of writers such as D.H. Lawrence, Doris Lessing, Max Frisch, Y. Zamyatin. There is persistent opposition to modern science and technology, and to scientific rationality, often associated with the Romantic wing of the green movement, and given expression in such popular books as Marcuse’s One Dimensional Man, Roszak’s Where the Wasteland Ends, Berman’s The Reenchantment of the World and Appleyard’s Understanding the Present. There is the feminist critique of science and conceptions of science: see, for example, Fox Keller (1984) and Harding (1986). And there are the corrosive implications of the so-called “strong programme” in the sociology of knowledge, and of the work of social constructivist historians of science, which depict scientific knowledge as a belief system alongside many other such conflicting systems, having no more right to claim to constitute knowledge of the truth than these rivals, the scientific view of the world being no more than an elaborate myth, a social construct (see Barnes and Bloor, 1981; Bloor, 1991; Barnes, Bloor and Henry, 1996; Shapin and Schaffer, 1985; Shapin, 1994; Pickering, 1984; Latour, 1987). This latter literature has provoked a counter-attack by scientists, historians and philosophers of science seeking to defend science and traditional conceptions of scientific rationality: see Gross and Levitt (1994), Gross, Levitt and Lewis (1996), and Koertge (1998). This debate between critics and defenders of science came abruptly to public attention with the publication of Alan Sokal’s brilliant hoax article ‘Transgressing the boundaries’ in a special issue of the cultural studies journal Social Text in 1996 entitled Science Wars: see Sokal and Bricmont (1998). What does this book have to contribute, given the above avalanche of criticism of science? The criticisms of science developed in this book are diametrically opposed to the above, in so far as the above criticisms oppose scientific rationality, seek to diminish or restrict its influence, or hold that it is unattainable. My central point is that we suffer, not from too much scientific rationality, but from not enough. What is generally taken to constitute scientific rationality is actually nothing of the kind. It is rationalistic neurosis, a characteristic, influential and damaging kind of irrationality masquerading as rationality. Science is damaged by being trapped within a widely upheld but severely defective philosophy of science; free science from this defective philosophy, provide it with a more intellectually rigorous philosophy, and it will flourish in both intellectual and humanitarian terms. And more generally, as we shall see, academic inquiry as a whole is damaged by being trapped within an intellectually defective philosophy of inquiry; free it from this defective philosophy, from its rationalistic neurosis, and it will flourish in intellectual and human terms. It is not reason that is damaging, but defective pretensions to reason — rationalistic neurosis —masquerading as reason. Thus what I seek to do here is the exact opposite of what all those who oppose science and scientific rationality do. I shall argue that Reason, the authentic article, arrived at by generalizing the progress-achieving methods of science, can have profoundly liberating and enriching consequences for all worthwhile, problematic aspects of life, and thus deserves to enter into every aspect of life. The bare bones of the argument of this book can be stated quite simply like this. Science cannot proceed without making the substantial metaphysical assumption that the universe is physically comprehensible (to some extent at least). But this conflicts with the orthodox view that in science everything is assessed impartially with respect to evidence, nothing being permanently assumed independently of evidence. So the metaphysical assumption of comprehensibility is repressed. Science pretends that no such assumption is made. But this damages science. For the assumption is substantial, influential and highly problematic. It needs to be made explicit within science so that it can be critically scrutinized, so that alternatives can be developed and considered. Pretending the assumption is not being made undermines the intellectual rigour of science, its intellectual value and success. And it does not stop there. For science also makes value assumptions. Quite properly, science is concerned to discover that which is of value. New factual knowledge devoid of all value (whether intellectual or practical) does not contribute to science. But the orthodox view of science holds that values have no place within science. As in the case of metaphysics, here too, science pretends that values have no role to play within the intellectual domain of science. And this damages science. For values are, if anything, even more influential and problematic than metaphysics (in influencing the direction of research). Here too, values need to be made explicit within science so that they can be scrutinized, so that alternatives can be developed and assessed. Pretending that values play no role within the intellectual domain damages science; both the intellectual and the practical aspects of science are adversely affected. Science fails to pursue those avenues of research that lie in the best interests of humanity. And it goes further. Science is pursued in a social, cultural, economic and political context. It is a part of various social, economic and political projects which seek to achieve diverse human objectives. But the idea that science is an integral part of humanitarian or political enterprises with political ends clashes, once again, with the official view of science that the aim of science is to improve factual knowledge. The political objectives of science are repressed. And, once again, this damages science. For, of course, the political objectives of science, like all our political objectives, are profoundly problematic. These need to be made explicit so that they can be scrutinized, so that alternatives can be developed and considered. The pretence that science does not have this political dimension once again undermines the intellectual rigour of science, and its human value. It lays science open to becoming a part of economic, corporate and political enterprises that are not in the best interests of humanity. The upshot of the line of argument just indicated is that we need to bring about a revolution in the aims and methods of science, and of academic inquiry more generally. Natural science needs to change; its relationship with the rest of academic inquiry, with social inquiry and the humanities, needs to change; and most importantly and dramatically, academic inquiry as a whole needs to change. The basic task of the academic enterprise needs to become to help humanity learn how to tackle its problems of living in more cooperatively rational ways than at present. We need to put the intellectual tasks of articulating our problems of living, and proposing and critically assessing possible solutions, possible and actual actions, at the heart of academic inquiry. The basic task needs to be to help humanity learn a bit more wisdom – wisdom being the capacity to realize what is of value in life, for oneself and others, wisdom including knowledge and technological know-how, but much else besides. Natural science, despite its flaws, has massively increased our knowledge and technological know-how. This in turn has led to a massive and sometimes terrifying increase in our power to act. Often this unprecedented power to act is used for human good, as in medicine or agriculture. But it is also used to cause harm, whether unintentionally (initially at least) as when industrialization and modern agriculture lead to global warming, destruction of natural habitats and rapid extinction of species, or intentionally, as when the technology of war is used by governments and terrorists to maim and kill. Before the advent of modern science, when we lacked the means to do too much damage to ourselves and the planet, lack of wisdom did not matter too much. Now, with our unprecedented powers to act, bequeathed to us by science, lack of wisdom has become a menace. This is the crisis behind all the other current global crises: science without wisdom. In these circumstances, to continue to pursue knowledge and technological know-how dissociated from a more fundamental quest for wisdom can only deepen the crisis. As a matter of urgency, we need to free science and academia of their neuroses; we need to bring about a revolution in the academic enterprise so that the basic aim becomes to promote wisdom by intellectual and educational means. At present science and the humanities betray both reason and humanity. The argument of this book, which I have just summarized, begins with a discussion of the philosophical and methodological problems that beset theoretical physics. At once, many of those who are concerned about moral, political and environmental issues that plague our world today, will feel impatient. What have the methodological problems of theoretical physics to do with third world poverty, war and the threat of war, pollution, extinction of species, the menace of conventional, chemical, biological and nuclear armaments? I can only plead with such a reader: patience. The root cause of the sickness of our times does indeed lie, I claim, with a methodological sickness of natural science or, even more specifically, of physical science. What makes the modern world so utterly different from all previous ages is our possession of modern science and technology. This is the instrument that has changed the conditions of human life almost beyond all recognition, and put unprecedented, and sometimes terrifying, powers into our hands. One should not dismiss out of hand the suggestion that a part of our problem may lie with this instrument, this engine, of rapid change. We see, here, too, the way in which intellectual specialization, referred to above, has effectively concealed from view the nature and extent of the problem that confronts us. The argument that I shall develop in what follows begins with physics, with problems concerning the aims and methods of physics. But it then leaps to social science, to philosophy, to the humanities, to education, to psychotherapy, and to politics: in the end there is scarcely an aspect of modern life that is not touched and, potentially, affected by the argument. How many academic experts are prepared to follow, to take seriously, an argument that ranges so recklessly across such a wide range of academic disciplines? How many non-academic non-experts? But just this is what the argument and message of this book requires. I hope that the reader will endure with patience the somewhat esoteric discussion concerning the aims and methods of physics pursued in chapter one. This may not seem to have anything much to do with the urgent problems of our times, but it does. This is in part how the intellectual disaster I seek to expose in this book conceals itself from view: it buries itself in the obscure, recondite field of the philosophy of physics. Those who devote their lives to the philosophy of physics are, by and large, too myopic to see how their specialized field of study has anything to do with the great and dreadful humanitarian problems and disasters of our age; and those who are above all concerned with these humanitarian disasters have no time at all for abstruse issues concerning the aims and methods of physics. And so the connection is never made. As it happens, the methodological neurosis of physics, with which we begin in chapter one, is actually a quite simple matter to grasp. It does not require any real knowledge of physics to understand. Indeed, physicists and philosophers of physics are much more likely to find the argument difficult to follow than are non-experts. We non-scientists can stand back and see the whole wood; scientists, trained to think in terms of the current orthodox conception of science, trapped in the thickets of research, will find this much harder to do. In an attempt to take this peculiar circumstance into account, I have arranged the exposition as follows. In chapter one I give a simple exposition of the case for declaring natural science to suffer from what I call "rationalistic neurosis"; this avoids all technicalities, and goes straight to the heart of the matter. In the appendix I tackle a host of more technical objections that may be made to the elementary argument of chapter one. So, those experts in the fields of the philosophy of physics and philosophy of science who find the argument of chapter one naïve and unconvincing, should consult the appendix before tossing the book away in disgust. I write in the hope that there will be a few who will not dismiss out of hand the suggestion that the question of how we are to go about learning how to live in wiser and more civilized ways might have something to learn from scientific learning, and will take the trouble to pursue the line of argument traced out in this book. I write in the hope that these few will grasp just how desperate our situation is, how urgent the need to change the status quo, and will do everything in their power to alert others to the need to heal the methodological sickness from which our institutions and traditions of learning at present suffer. To begin with, we need a campaigning organization, modelled perhaps on "Friends of the Earth", which might be called something like "Friends of Wisdom". (shrink)

Affordances are action-possibilities, ways of relating to and acting on things in our world. They help us understand how these things mean what they do and how we have bodily access to our world more generally. But what happens when this access is ruptured or impeded? I consider this question in the context of psychopathology and reports that describe this experience. I argue that thinking about the bodily consequences of losing access to everyday affordances can help us better understand these (...) reports. An affordance-based approach to psychopathology can illuminate some of the causes, as well as the experiential character and consequences, of affective disorders and diminished spatial agency in self-world disturbances. It also highlights some under-explored ethical and political dimensions of these issues that need further attention. (shrink)

Affordances are action-possibilities, ways of relating to and acting on our world. A theory of affordances helps us understand how we have bodily access to our world and what it means to enjoy such access. But what happens to bodies when this access is somehow ruptured or impeded? This question is relevant to psychopathology. People with psychiatric disorders often describe feeling as though they’ve lost access to affordances that others take for granted. Focusing on schizophrenia, depression, and autistic spectrum disorder, (...) I argue that thinking about the bodily consequences of losing access to everyday affordances can help us better understand these reports. An affordance-based approach to psychopathology can illuminate some of the causes, as well as the experiential character and content, of affective disorders in psychopathology. It can also draw our attention to some under-explored ethical and political dimensions of these issues needing further consideration. (shrink)

I defend a model of the musically extended mind. I consider how acts of “musicking” grant access to novel emotional experiences otherwise inaccessible. First, I discuss the idea of “musical affordances” and specify both what musical affordances are and how they invite different forms of entrainment. Next, I argue that musical affordances – via soliciting different forms of entrainment – enhance the functionality of various endogenous, emotiongranting regulative processes, drawing novel experiences out of us with an expanded complexity and phenomenal (...) character. I argue that music therefore ought to be thought of as part of the vehicle needed to realize these emotional experiences. I appeal to different sources of empirical work to develop this idea. (shrink)

Human behavior is an underlying cause for many of the ecological crises faced in the 21st century, and there is no escaping from the fact that widespread behavior change is necessary for socio-ecological systems to take a sustainable turn. Whilst making people and communities behave sustainably is a fundamental objective for environmental policy, behavior change interventions and policies are often implemented from a very limited non-systemic perspective. Environmental policy-makers and psychologists alike often reduce cognition ‘to the brain,’ focusing only to (...) a minor extent on how everyday environments systemically afford pro-environmental behavior. Symptomatic of this are the widely prevalent attitude–action, value–action or knowledge–action gaps, understood in this paper as the gulfs lying between sustainable thinking and behavior due to lack of affordances. I suggest that by adopting a theory of affordances as a guiding heuristic, environmental policy-makers are better equipped to promote policies that translate sustainable thinking into sustainable behavior, often self-reinforcingly, and have better conceptual tools to nudge our socio–ecological system toward a sustainable turn. Affordance theory, which studies the relations between abilities to perceive and act and environmental features, is shown to provide a systemic framework for analyzing environmental policies and the ecology of human behavior. This facilitates the location and activation of leverage points for systemic policy interventions, which can help socio–ecological systems to learn to adapt to more sustainable habits. Affordance theory is presented to be applicable and pertinent to technically all nested levels of socio–ecological systems from the studies of sustainable objects and households to sustainable urban environments, making it an immensely versatile conceptual policy tool. Finally, affordance theory is also discussed from a participatory perspective. Increasing the fit between local thinking and external behavior possibilities entails a deep understanding of tacit and explicit attitudes, values, knowledge as well as physical and social environments, best gained via inclusive and polycentric policy approaches. (shrink)

This article connects value-sensitive design to Gibson’s affordance theory: the view that we perceive in terms of the ease or difficulty with which we can negotiate space. Gibson’s ideas offer a nonsubjectivist way of grasping culturally relative values, out of which we develop a concept of political affordances, here understood as openings or closures for social action, often implicit. Political affordances are equally about environments and capacities to act in them. Capacities and hence the severity of affordances vary with age, (...) health, social status and more. This suggests settings are selectively permeable, or what postphenomenologists call multistable. Multistable settings are such that a single physical location shows up differently – as welcoming or hostile – depending on how individuals can act on it. In egregious cases, authoritarian governments redesign politically imbued spaces to psychologically cordon both them and the ideologies they represent. Selective permeability is also orchestrated according to business interests, which is symptomatic of commercial imperatives increasingly dictating what counts as moral and political goods. (shrink)

There are important structural similarities in the way that animals and humans engage in unreflective activities, including unreflective social interactions in the case of higher animals. Firstly, it is a form of unreflective embodied intelligence that is ‘motivated’ by the situation. Secondly, both humans and non-human animals are responsive to ‘affordances’ (Gibson 1979); to possibilities for action offered by an environment. Thirdly, both humans and animals are selectively responsive to one affordance rather than another. Social affordances are a subcategory of (...) affordances, namely possibilities for social interaction offered by an environment: a friend’s sad face invites comforting behavior, a person waiting for a coffee machine can afford a conversation, and an extended hand affords a handshake. I will review recent insights in the nature of the bodily intentionality characteristic of unreflective action. Such ‘motor intentionality’ can be characterized as “our direct bodily inclination to act in a situated, environmental context” (Kelly 2005, p. 106). Standard interpretations of bodily intentionality see grasping an object as the paradigmatic example of motor intentionality. I will discuss the implications of another, novel perspective that emphasizes the importance of unreflective switches from one activity to another (Rietveld 2004) and understands bodily intentionality in terms of adequate responsiveness to a field of relevant affordances. In the final section I will discuss some implications for cognitive neuroscientists who use empirical findings related to the ‘mirror neuron system’ as a starting point for a theory of motor intentionality and social cognition. (shrink)

Methodological problems often arise when a special case is confused with the general principle. So you will find affordances only for ‚artifacts’ if you restrict the analysis to ‚artifacts’. The general principle, however, is an ‚invitation character’, which triggers an action. Consequently, an action-theoretical approach known as ‚pragmatic turn’ in cognitive science is recommended. According to this approach, the human being is not a passive-receptive being but actively produces those action effects that open up the world to us. This ‚ideomotor (...) approach’ focuses on the so-called ‚epistemic actions’, which guide our perception as conscious and unconscious cognitions. Due to ‚embodied cognition’ the own body is assigned an indispensable role. The action theoretical approach of ‚enactive cognition’ enables that every form can be consistently processualized. Thus, each ‚Gestalt’ is understood as the process result of interlocking cognitions of ‚forward modelling’ and ‚inverse modelling’. As can be shown, these cognitions are fed by previous experiences of real interaction, which later changes into a mental trial treatment, which is highly automated and can therefore take place unconsciously. It is now central that every object may have such affordances that call for instrumental or epistemic action. In the simplest case, it is the body and the facial expressions of our counterpart that can be understood as a question and provoke an answer/reaction. Thus, emotion is not only to be understood as expression/output according to the scheme ‚input-processing-output’, but acts itself as a provocative act/input. Consequently, artifacts are neither necessary nor sufficient conditions for affordances. Rather, they exist in all areas of cognition—from Enactive Cognition to Social Cognition. (shrink)

The concept of affordances is rapidly gaining traction in the philosophy of mind and cognitive sciences. Affordances are opportunities for action provided by the environment. An important open question is whether affordances can be used to explain mental action such as attention, counting, and imagination. In this paper, we critically discuss McClelland’s (‘The Mental Affordance Hypothesis’, 2020, Mind, 129(514), pp. 401–427) mental affordance hypothesis. While we agree that the affordance concept can be fruitfully employed to explain mental action, we argue (...) that McClelland’s mental affordance hypothesis contain remnants of a Cartesian understanding of the mind. By discussing the theoretical framework of the affordance competition hypothesis, we sketch an alternative research program based on the principles of embodied cognition that evades the Cartesian worries. We show how paradigmatic mental acts, such as imagination, counting, and arithmetic, are dependent on sensorimotor interaction with an affording environment. Rather than make a clear distinction between bodily and mental action, the mental affordances highlight the embodied nature of our mental action. We think that in developing our alternative research program on mental affordances, we can maintain many of the excellent insights of McClelland’s account without reintroducing the very distinctions that affordances were supposed to overcome. (shrink)

Contrary to the popular assumption that linguistically mediated social practices constitute the normativity of action (Kiverstein and Rietveld, 2015; Rietveld, 2008a,b; Rietveld and Kiverstein, 2014), I argue that it is affective care for oneself and others that primarily constitutes this kind of normativity. I argue for my claim in two steps. First, using the method of cases I demonstrate that care accounts for the normativity of action, whereas social practices do not. Second, I show that a social practice (...) account of the normativity of action has unwillingly authoritarian consequences in the sense that humans act only normatively if they follow social rules. I suggest that these authoritarian consequences are the result of an uncritical phenomenology of action and the fuzzy use of “normative”. Accounting for the normativity of action with care entails a realistic picture of the struggle between what one cares for and often repressive social rules. (shrink)

-/- Caring for loved ones with dementia can sometimes necessitate a loose relationship with the truth. Some might view such deception as categorically immoral, and a violation of our general truth-telling obligations. I argue that this view is mistaken. This is because truth-telling obligations may be limited by the particular relationships in which they feature. Specifically, within caregiving relationships, we are often permitted (and sometimes obligated) to deceive the people with whom we share them. Our standing to deceive follows from (...) certain features of caregiving relationships. Specifically, they are relationships that involve obligations to promote a person's interests and values (and not simply their autonomy), that often permit us to assume the hypothetical consent of the person with whom we share them, and in which we are often entitled to act out of self-interest. Once we appreciate these features, we will be able to recognize that the truth-telling norms governing our relationships with loved ones with dementia do not represent a radical departure from our general truth-telling obligations, but are instead consistent with truth-telling norms that feature in other caregiving relationships. In addition, we will be able to understand why we may feel conflicted about lying to loved ones with dementia, even when lying is permissible. (shrink)

The concept of acting intentionally is an important nexus where ‘theory of mind’ and moral judgment meet. Preschool children’s judgments of intentional action show a valence-driven asymmetry. Children say that a foreseen but disavowed side-effect is brought about 'on purpose' when the side-effect itself is morally bad but not when it is morally good. This is the first demonstration in preschoolers that moral judgment influences judgments of ‘on-purpose’ (as opposed to purpose influencing moral judgment). Judgments of intentional action are usually (...) assumed to be purely factual. That these judgments are sometimes partly normative — even in preschoolers — challenges current understanding. Young children’s judgments regarding foreseen side-effects depend upon whether the children process the idea that the character does not care about the side-effect. As soon as preschoolers effectively process the ‘theory of mind’ concept, NOT CARE THAT P, children show the side-effect effect.idea.. (shrink)

How do we care well for a human being: ourselves or another? Non-Kantian scholars rarely identify the philosophy of Kant as a particularly useful resource with which to understand the full complexity of human care. Kant’s philosophy is often taken to presuppose that a philosophical analysis of good human life needs to attend only to how autonomous, rational agents—sprung up like mushrooms out of nowhere, without a childhood, never sick, always independent—ought to act respectfully, and how they can (...) be forced to interact rightfully. Questions involving aspects of human life captured by what Eva Kittay aptly phrased “the fact of dependency” (1999) —such as our vulnerable, fragile, and embodied social natures, asymmetrical care relations, and deep systemic injustices—are therefore commonly thought to be beyond the grasp of Kant and of Kantian philosophy. Against this historically prominent understanding of Kant’s practical philosophy, below I engage and draw upon recent Kant scholarship which shows both the inadequacy of such rationalist readings and the fruitfulness of using Kant’s practical philosophy to enhance our understanding of human care relations. After situating my approach in the existing, relevant secondary literature on Kant’s human agent, I explore key features of Kant’s accounts of human nature and the highest good. I pay special attention to his proposal that our human nature comprises reflective and unreflective aspects and patterns that we (ought to) strive to develop, transform, and integrate in wise ways through our faculty of desire. In addition, I emphasize the dangers that our ineradicable propensity to do bad things (evil) poses for our projects of self- and other- care. I proceed by outlining how Kant’s account of moral (ethical and legal) responsibility for self and others is developed through his theories of freedom, that is, through his theory of virtue (virtuous internal freedom with its account of perfect and imperfect duties) and his theory of right (rightful external freedom with its account of innate, private, and public right). On the conception I am advancing, we are pretty messy, fragile, and vulnerable beings whose projects of caring are difficult, ongoing, and complex. On the one hand, we (should) strive to care for ourselves (by striving to manage and heal badly functioning parts and by developing, transforming, and integrating immature or distinct parts of ourselves into good wholes) and for others (assisting them in their projects of management and healing and of developing, transforming, and integrating themselves into good wholes) in ways that are both respectful and attentive to the particular people we are—people with lives of our own to live—and the kinds of relationships we share. On the other hand, we should, and can, be forced to interact rightfully, meaning interaction consistent with one another’s basic (innate, private, and public) rights and, hence, contribute to reform projects that improve our inherited, imperfect legal-political systems with regard to care relations. Bringing Kant’s philosophy into dialogue with care theorists, I conclude, advances the insights of both traditions by showing one way to arrive at a multifaceted, yet unified account of human care relations where our embodied, social as well as our rational natures are given due consideration. (shrink)

Various data from communication that does not occur face-to-face are taken to be problematic for Kaplan’s account of indexical expressions, as is the case with the so-called answering machine paradox. One fix, developed by Sidelle (1991) and Briciu (2018), is the remote utterance view: recording artifacts are means by which speakers perform utterances at a distance, just as by means of other artifacts agents performs other types of actions at a distance. This view has faced an important objection, namely that (...) remote utterances lead to Moorean paradoxes. In this paper, I defend the remote utterance view against this objection and further develop the view. I argue that worries about Moorean paradoxes can easily be dispelled if we take into consideration the artifactual nature of recording devices, their materiality, and the communicative affordances they bring about. In the first section, we’ll present the answering machine paradox and give a brief overview of the remote utterance view. The second section presents the objection against the view, while the third gives a detailed rejoinder to the objection. Answering this objection is important also because it allows us to explore some underdeveloped aspects of the remote utterance view. First, I will discuss how the theorist calibrates her model with the data she seeks to explain and predict. Secondly, I will argue that speech acts performed via recording devices have different felicity conditions than their oral counterparts. I conclude with a short discussion of some semantic and pragmatic consequences of the view. (shrink)

When philosophers consider factors compromising autonomy in consent, they often focus solely on the consent-giver’s agential capacities, overlooking the impact of the consent-receiver’s conduct on the consensual character of the activity. In this paper, I argue that valid consent requires justified trust in the consent-receiver to act only within the scope of consent. I call this the Trust Condition (TC), drawing on Katherine Hawley’s commitment account of trust. TC constitutes a belief that the consent-receiver is capable and willing to act (...) as we expect from them. If such trust is not warranted, I argue, consent lacks the appropriate normative grounds. After establishing TC, I explore its application in the sexual arena, asserting that due to the non-contractual dimensions of sexual activity — such as the dynamic nature of sexual desires and the absence of external factors effectively binding sexual partners to the terms of consent—trust is warranted in sexual consent by means of care. I define care as a special sensitivity and attention toward the partner’s will and discuss how this approach leads to safer intimate relationships in practice. (shrink)

This paper applies speech-act theory to craft a new response to Pyrrhonian skepticism and diagnose its appeal. Carefully distinguishing between different levels of language-use and noting their interrelations can help us identify a subtle mistake in a key Pyrrhonian argument.

In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and the (...) other pillars of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework. (shrink)

The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person.1 It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture.2-7 Yet medical participation (...) in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001.8-11 Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees. -/- The 2016 release of previously classified portions of guideline from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers. (shrink)

Dance, as a mode of physical interaction, offers opportunities to care and be cared for, but this does not mean that dancers will, in fact, care. There may be no moral motivation underlying a lift, dip or intricate sequence of coordinated action. Choreographic scores may (knowingly or not) encourage merely perfunctory movements that are a poor simulacrum to care. Moreover, the caring that is expressed through dance need not transfer to other walks of life. I am not (...) alone in knowing spectacularly talented dancers whose behaviour off the dance floor is far from ethical – from the arrogant and petty to the flagrant abuse that plagues institutions of art and culture. This article considers how dance can illuminate both the acts and sentiments of care, conveying particular ethical orientations that trouble straightforward, absolute moral reasoning. The article frames an enquiry into the relation between ethics and aesthetics of care, drawn from feminist epistemologists Joan Tronto, Maurice Hamington, and Nel Noddings, as well as my own performance research on partnering. I frame a zone between technique and competence, foregrounding care in dance as both a technical and ethical issue. I will consider the necessary conditions by which dancing together can manifest care, rather than suggest blanketly that it always does or even that it should. To make this argument, I will describe and analyse Considered Care, a duet I created in the autumn of 2021 in collaboration with Boston Ballet. This performance research project provided the material from which to consider the concept of need, a condition of care in a dancing situation. I will conclude by considering the relationship between needs and trust in conceptualizing care within partnering. (shrink)

Many pragmatist and non-representational approaches to cognition, such as the enactivist, have focused on the relations between actions, affectivity, and habits from an intersubjective perspective. For those adopting such approaches, all these aspects are inextricably connected; however, many questions remain open regarding the dynamics by which they unfold and shape each other over time. This paper addresses a specific topic that has not received much attention: the impact on future behavior of not fulfilling possibilities for social interaction even though their (...) fulfillment is desirable within a given context. Inspired by Gibson’s theory of affordances and Dewey’s account of habits, these situations will be characterized as events where an agent does not act upon an inviting affordance for social interaction due to a conflict which he or she experiences between given concerns, needs, and social norms. This conflict leads to a sense of unfulfillment that may eventually bring about a crisis and revision of habits. Through specific examples, this work presents the potential impact of the connection between affordances, habits, and affectivity on everyday situations. It therefore represents an exploration of the common ground between pragmatism and enactivism and an attempt to contribute to a process-based approach to social interaction. (shrink)

To Stiegler’s notion of pansable (curable), one might also need to add that penser (to think) relates to the Latin penso, the frequentative of pendo, to hang, suspend. The pansable (that which can be healed) is as much the pensable (that which can be thought) and the suspensible (that which can be hung). Stiegler’s final act revealed that which was always already there: an unhealed pharmacological shadow that preceded him. While he entered philosophy with the argument of technics as the (...) impensé (unthought) of continental philosophy, he concluded in a final acting out, an impansable (uncurable) that ended his life. He, who believed that life is about cultivating rêveries and protentions capable of promise. Protention means both a capacity to invent and an ability to project oneself into the future through the practice of imagination and desire. He, who pondered about the retentions we have and the various forms of memory they take, and how to make them become the true modes of being-in-the-world. I know now that his fatal transgression is as much an accident as a departure, an emotional ceasefire and a bifurcative ending. Somehow, he found a way to remain faithful to the originary beginning of his thinking in act. (shrink)

Care ethicists have long insisted that Kantian moral theory fails to capture the partiality that ought to be present in our personal relationships. In her most recent book, Virginia Held claims that, unlike impartial moral theories, care ethics guides us in how we should act toward friends and family. Because these actions are performed out of care, they have moral value for a care ethicist. The same actions, Held claims, would not have moral worth for a (...) Kantian because of the requirement of impartiality. Although Kantian moral theory is an impartial theory, I argue that the categorical imperative in the Formulation of Humanity as an End and the duty of respect require that we give special treatment to friends and family because of their relationships with us. Therefore, this treatment does have moral value for a Kantian. (shrink)

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within healthcare (...) organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations. (shrink)

There are prominent resemblances between issues addressed by Simone de Beauvoir in her early essay on moral philosophy, Pyrrhus and Cineas (1944), and issues attracting the attention of contemporary feminist ethicists, especially those concerned with the ethics of care. They include a focus on relationships, interaction, and mutual dependency. Both emphasize concrete ethical challenges rooted in everyday life, such as those affecting parents and children. Both are critical of the level of abstraction and insensitivity to the situation of the (...) moral agent in utilitarianism and Kantian ethics. And both condemn the “moral point of view,” i.e. the assumption that it is possible to speak with a universal voice on behalf of humanity. These resemblances are explored in this article. (shrink)

Laplacean Determinism (his so-called demon argument) is the thesis that every event that transpires in a closed universe is a physical event caused (i.e., determined) in full by some earlier event in accord with laws that govern their behavior. On this view, it is possible, in principle, to make perfect predictions of the state of the universe at any time Tn on the basis of complete knowledge of the state of the universe at time T1. Thus, if identity theory, epiphenomenalism (...) or any other instantiation of Laplacean Determinism is correct, mental events such as free will, intention and other forms of mental agency are tricks of the mind, misleading us into believing our volitional concerns have traction in a world ruled entirely by physical circumstance. Not surprisingly, advocates of free will and related acts of human volition have engaged in spirited debate with adherents to Laplacean orthodoxy, the results of which have been far from conclusive. Rather than join these deliberations, I wholly embrace the demon argument and then ask “what are the consequences of this allegiance?” As I hope to show, acceptance of this argument commits one to a belief in the existence of human precognition. This, I suggest, is a consequence that does not fit comfortably within a contemporary scientific worldview. (shrink)

When someone does something for a reason, what are the reasons for which she does what she does? What is her ‘motivating reason’, as it is sometimes put? The simple answer is: it depends on what is meant by ‘motivating reason’. Non-Psychologists hold that motivating reasons are what the agent believes. I have shown that given that we understand ‘motivating reasons’ as what I term 'grounds', this is quite correct, as what we believe is what plays the role of a (...) ground. However, we have to be careful not to confuse the role of a ground and the role of an explanans. For the conflation of those two roles can occlude the truth in Non-Psychologism. What the Non-Psychologist about Grounds should say is that what plays the role of an explanans, when someone acts on a ground, is a motivation-fact. She should also say that there are two kinds of motivation-facts: those that include normative reasons and those that do not. (shrink)

Research on future-oriented mental time travel (FMTT) is highly active yet somewhat unruly. I believe this is due, in large part, to the complexity of both the tasks used to test FMTT and the concepts involved. Extraordinary care is a necessity when grappling with such complex and perplexing metaphysical constructs as self and time and their co-instantiation in memory. In this review, I first discuss the relation between future mental time travel and types of memory (episodic and semantic). I (...) then examine the nature of both the types of self-knowledge assumed to be projected into the future and the types of temporalities that constitute projective temporal experience. Finally, I argue that a person lacking episodic memory should nonetheless be able to imagine a personal future by virtue of (a) the fact that semantic, as well as episodic, memory can be self-referential, (b) autonoetic awareness is not a prerequisite for FMTT, and (c) semantic memory does, in fact, enable certain forms of personally-oriented FMTT. (shrink)

Palliative care seeks to provide holistic care to improve the quality of life for the sick, especially as they approach the end of their lives. Addressing the spiritual dimension of the human person is useful because it provides answers to the meaning of life. Spiritual care has been shown to be of great benefit to patients. Therefore, this paper explores the importance of the spiritual dimension in palliative care; highlight the act of listening as a key (...) part of spiritual care, showing that physician burnout is the main obstacle to improving listening as an appropriate service that is both comforting and healing. -/- Los cuidados paliativos buscan ofrecer una atención holística para brindar una mejor calidad de vida a los enfermos, especialmente cuando se aproximan al fin de su existencia. Profundizar en la dimensión espiritual de la persona humana resulta útil puesto que ofrece respuestas al sentido de la vida. Se ha constatado que la atención espiritual aporta grandes beneficios para el paciente. Es por eso que en este trabajo hemos querido profundizar en la importancia de la dimensión espiritual en los cuidados paliativos; se destaca la actitud de la escucha como pieza clave de dicha atención espiritual, lo que evidencia que el burnout de los médicos es el principal obstáculo para potenciar la escucha como una adecuada disposición que resulte consoladora y sanadora. (shrink)

English-speaking research on morally right decisions in a healthcare context over the past three decades has been dominated by two major perspectives, namely, the Four Principles, of which the principle of respect for autonomy has been most salient, and the ethic of care, often presented as a rival to not only a focus on autonomy but also a reliance on principles more generally. In my contribution, I present a novel ethic applicable to bioethics, particularly as it concerns human procreation, (...) that I argue is a promising alternative to these two approaches. According to this new moral theory, an act is right just insofar as it treats people’s capacity to commune with respect, where communing is a matter of identifying with others and exhibiting solidarity with them. This ethic is inspired by relational ideals of communion and harmony from the African philosophical tradition, but is shown to be attractive to a broad, indeed global, audience, with regard to its implications for the morality of reproduction. (shrink)

This chapter offers a plea for the media to reframe its coverage of campus controversies from free expression to academic freedom. These freedoms are entwined, but distinct. Freedom of expression is extended to all persons with no expectation of quality control, apart from legal prohibitions against defamation, threats, etc. By contrast, academic freedom is a cluster of freedoms afforded to scholarly personnel for a particular purpose – namely, the pursuit of universities’ academic mission to seek truth and advance understanding in (...) the service of society. An academic freedom framing better reflects the distinctive social purpose around which universities are organized, as well as universities’ duty of care to employees and students. While universities have a legal and moral duty of care to all employees and students, the unjust, exclusionary past and present of higher education arguably makes that duty particularly acute in the case of equity-deserving (e.g., racialized, Indigenous, disabled or 2SLGBTQ+) people. Finally, academic freedom framing for campus media stories is less monolithic than free expression framing, allowing for a more nuanced understanding of campus controversies while keeping universities accountable to the public they serve. In this chapter, I survey three very different campus controversies at a single Canadian university, and the media response each received. I show how an academic freedom frame for those stories would have produced better reportage while reducing opportunities for bad actors to manipulate both universities and the media. At the end of the day, the real crisis at universities isn’t the cancellation of ill-judged events that were never a part of the academic mission; it is the ongoing erosion of academic freedom. (shrink)

This article draws upon the work of Timothy Morton and Slavoj Žižek in order to critically examine how mountain bike trail builders orientated themselves within nature relations. Beginning with a discussion of the key ontological differences between Morton’s object-oriented ontology and Žižek’s blend of Hegelian-Lacanianism, we explore how Morton’s dark ecology and Žižek’s account of the radical contingency of nature, can offer parallel paths to achieving an ecological awareness that neither idealises nor mythologises nature, but instead, acknowledges its strange and (...) contingent form. Empirically, we support this theoretical approach in interviews with twenty mountain bike trail builders. These interviews depicted an approach to trail building that was ambivalently formed in/with the contingency of nature. In doing so, the trail builders acted with a sense of temporal awareness that accepted the radical openness of nature, presenting a ‘symbolic framework’ that was amiable to nature’s ambivalent, strange and contingent form. In conclusion, we argue that we should not lose sight of the ambivalences and strange surprises that emanate from our collective and unpredictable attempts to symbolize nature and that such knowledge can coincide with Morton’s ‘dark ecology’ – an ecological awareness that remains radically open to our ecological existence. (shrink)

This paper examines Heidegger’s position on a foundational distinction for Kantian and post-Kantian philosophy: that between acting ‘in the light of’ a norm and acting ‘merely in accordance with it’. In section 1, I introduce the distinction and highlight several relevant similarities between Kant and Heidegger on ontology and the first-person perspective. In section 2, I press the Kantian position further, focusing on the role of inferential commitments in perception: this provides a foil against which Heidegger’s account can be In (...) section 3, I contrast this Kantian approach with Crowell’s highly sophisticated reading of Heidegger on care: I argue that, subject to certain conditions on how we view explanation, the two approaches are compatible and indeed mutually supporting. I close in section 4 by addressing an importantly distinct dimension of normativity, that marked by critique, broadly construed. I argue that we ultimately need to locate Heidegger in a context that. (shrink)

Given the wide the range of legally available options for end-of-life care in recent decades: from aggressive, even experimental, treatment to active euthanasia, our ethical analysis struggles to keep pace with technology and law. In this essay I show that the principle of double effect (PDE) remains, and will continue to be, a useful tool for ethical analysis of end-of-life care. According to PDE, an agent may ethically perform an act that s/he foresees will have a significant bad (...) effect (e.g., death) in addition to a good effect (e.g., pain relief) only if s/he does not intend the bad effect, the act is not bad for reasons other than its causing the bad effect, and there is a proportionately serious reason to act. Following a brief explanation of PDE and preliminary considerations in favor of counting death as a bad effect, I analyze several end-of-life options in terms of the principle. I begin with those that enjoy significant consensus among proponents of PDE: active euthanasia, “passive euthanasia,” and palliative care. Then I consider the less-straightforward cases of drug provision, refusing food and water, and terminal sedation, arguing that participation in such actions is justifiable via PDE only under very limited conditions. (shrink)

The standard argument for longtermism assumes that we should care as much about far future people as about our contemporaries. I challenge this assumption. I first consider existing interpretations of ‘temporal discounting’, and argue that such discounting seems either unwarranted or insufficient to block the argument. I then offer two alternative reasons to care less about far future people: caring as much about them as about our contemporaries would make our lives less authentic and less meaningful. If I’m (...) right, this undermines at least the strongest versions of longtermism. Plausibly, we should do much more for the far future than we’re currently doing. Still, we often ought to act for contemporaries’ sakes, even if longtermist actions would expectably do more good. (shrink)

Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.

Adoption may be defined as ‘the legal process through which the state establishes a parental relationship, with all its attendant rights and duties, between a child and a (set of) parent(s) where there exists no previous procreative relationship’ . In adoptions from care, state intervention effectively converts an established, or nascent, adult– child relationship into ‘family’ in the legal sense. From the state’s perspective, adoption thus entails the transfer of parental responsibilities for a child in public care to (...) a private family unit, enabling the state to permanently delegate its duties towards a child to this new unit. This seemingly straightforward legal act raises deeper philosophical questions relating to such state ‘family creation’, particularly when the child’s perspective is taken. Such a child- centric approach normatively regards children as equal moral beings, who ought to be included in actions concerning them, regardless of their capacity to form and express an opinion. Accordingly, adoption from care can be described as a moral decision, aimed at doing what is in the child’s best interests. The purpose of this chapter is to explore a suspicion of a lack of child- centrism in adoption from care practice, and to illustrate how adopted children’s rights are inferior to those of their non- adopted peers. This will shed light on a practice currently lacking transparency and accountability and will increase our understanding of how we fail to treat children as equal moral individuals in decision- making that severely impacts children’s lives. (shrink)

Despite negative effects on their health and social lives, many informal carers of people living with dementia claim to be acting in accordance with a moral obligation. Indeed, feelings of failure and shame are commonly reported by those who later give up their caring responsibilities, suggesting a widespread belief that professional dementia care, whether delivered in the person's own home or in an institutional setting, ought always to be a last resort. In this paper, however, I suggest that this (...) common intuition gets things the wrong way around. Adopting a relational egalitarian framework, I argue that the most serious injustices engendered by present‐day dementia care services are contingent on broader societal structures—they can thus be ameliorated relatively easily (if resource intensively) by changing those structures. Informal dementia care, on the other hand, carries similar risks of injustice and is much more resistant to structural reform. While there may be moral obligations to provide informal dementia care in present‐day societies, then, they arise because of the deficiencies of professional care, not the virtues of its informal counterpart. Though we may be far from achieving just care arrangements in most of our societies, we must never lose sight of the fact that, when we engage in morally permitted informal dementia care, we are exercising our last resort. (shrink)

As evidence of the unintended consequences of industrial farm animal production continues to mount, it is becoming increasingly clear that, far from being a trivial matter of personal preference, eating is an activity that has deep moral and spiritual significance. Surprising as it may sound, the simple question of what to eat can prompt Christians daily to live out their spiritual vision of Shalom for all creatures--to bear witness to the marginalization of the poor, the exploitation of the oppressed, the (...) suffering of the innocent, and the degradation of the natural world, and to participate in the reconciliation of these ills through intentional acts of love, justice, mercy, and good stewardship. The aim of this work is to understand the cultivation of more intentional "compassionate eating" habits as a form of engaged Christian discipleship that responds to a wide array of practical, moral, and spiritual problems affecting all aspects of creation--human, animal, and environmental. The guiding suggestion is that compassionate eating is a spiritual discipline that offers a symbolically significant and practically effective way to live in faithful anticipation of the "peaceable kingdom" described in Judeo-Christian creation and redemption narratives. (shrink)