This paper considers the responsibilities of the FDA with regard to disseminating information about the benefits and harms of e-cigarettes. Tobacco harm reduction advocates claim that the FDA has been overcautious and has violated ethical obligations by failing to clearly communicate to the public that e-cigarettes are far less harmful than cigarettes. We argue, by contrast, that the FDA’s obligations in this arena are more complex than they may appear at first blush. Though the FDA is accountable for informing the (...) public about the health risks and benefits of products it regulates, it also has other roles that inform when and how it should disseminate information. In addition to being a knowledge purveyor, it is also a knowledge producer, an advisor to the public, and a practical agent shaping the material conditions in which people make health-related choices. In our view, those other roles call for caution in the way the FDA interprets and communicates the available evidence. (shrink)

D’après Heidegger, chaque époque/épochè est caractérisé par un certain mode de révélation des étants, qui est à la fois une dissimulation d’une façon de l’Être. Ce mode particulier paraît ne venir de nulle part en ce qu’il se base sur un certain oubli. Dana S. Belu le met en scène pour son livre en faisant valoir la tendance de Heidegger « to treat the history of being (Seinsgeschichte) as a noncausal succession of universal principles of intelligibility that presupposes the (...) forgetting (Seinsvergessenheit) of the clearing (die Lichtung) as their source » (p. 15). L’oubli de notre époque est marqué par une divulgation technologique dans le mode de l’arraisonnement (Gestell) où les étants se révèlent comme partie du fonds (Bestand) d’être calculés, manipulés, exploités, et mis en réserve pour un usage ultérieur. La phénoménologie féministe de l’A. essaie de faire sens à la gestation, la maternité et la procréation médicalement assistée (PMA) qui font aux femmes faire partie de ce fonds et ouvre, parmi les paramètres du Gestell, la porte à une ère « sans mère ». (shrink)

A deeply personal reckoning with family, mental illness, and suicide, Dana Trusso captures the meaning of Nietzsche's armor fati--to love one's fate--through her surreal imagery and longing to heal intergenerational wounds. Lines are drawn from Lars von Trier's Melancholia, Sonic Youth's Experimental Jet Set, Trash and No Star, and lines she read from her aunt's journals as a child. -/- The photo is a sculpture of an earth goddess by Jean-Philippe Richard located in the botanical gardens of Èze, France. (...) Nearby is Le Chemin de Nietzsche, a steep hike from the seaside to mountainous ruins that is said to have inspired Thus Spoke Zarathustra. (shrink)

Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help make (...) treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (shrink)

Hannah Arendt's rich and varied political thought is more influential today than ever before, due in part to the collapse of communism and the need for ideas that move beyond the old ideologies of the Cold War. As Dana Villa shows, however, Arendt's thought is often poorly understood, both because of its complexity and because her fame has made it easy for critics to write about what she is reputed to have said rather than what she actually wrote. Villa (...) sets out to change that here, explaining clearly, carefully, and forcefully Arendt's major contributions to our understanding of politics, modernity, and the nature of political evil in our century.Villa begins by focusing on some of the most controversial aspects of Arendt's political thought. He shows that Arendt's famous idea of the banality of evil--inspired by the trial of Adolf Eichmann--does not, as some have maintained, lessen the guilt of war criminals by suggesting that they are mere cogs in a bureaucratic machine. He examines what she meant when she wrote that terror was the essence of totalitarianism, explaining that she believed Nazi and Soviet terror served above all to reinforce the totalitarian idea that humans are expendable units, subordinate to the all-determining laws of Nature or History. Villa clarifies the personal and philosophical relationship between Arendt and Heidegger, showing how her work drew on his thought while providing a firm repudiation of Heidegger's political idiocy under the Nazis. Less controversially, but as importantly, Villa also engages with Arendt's ideas about the relationship between political thought and political action. He explores her views about the roles of theatricality, philosophical reflection, and public-spiritedness in political life. And he explores what relationship, if any, Arendt saw between totalitarianism and the "great tradition" of Western political thought. Throughout, Villa shows how Arendt's ideas illuminate contemporary debates about the nature of modernity and democracy and how they deepen our understanding of philosophers ranging from Socrates and Plato to Habermas and Leo Strauss.Direct, lucid, and powerfully argued, this is a much-needed analysis of the central ideas of one of the most influential political theorists of the twentieth century. (shrink)

We often find ourselves in situations where it is up to us to make decisions on behalf of others. How can we determine whether such decisions are morally justified, especially if those decisions may change who it is these others end up becoming? In this paper, I will evaluate one plausible kind of justification that may tempt us: we may want to justify our decision by appealing to the likelihood that the other person will be glad we made that specific (...) choice down the line. Although it is tempting, I ultimately argue that we should reject this sort of appeal as a plausible justification for the moral permissibility of our vicarious decisions. This is because the decisions that we make on behalf of another may affect the interests and values that that person will hold in the future. As I will show, this complicates the justificatory relationship between present decisions and future attitudes, since the latter can depend on the former. This is not to say that the predicted future attitudes of others can play no significant role in justifying our decisions on others’ behalf. Rather, appealing to the future attitudes in our moral justifications may play an important role in our practical thinking but only when we consider the future attitudes of all relevant possible futures. (shrink)

Benardete paradoxes involve infinite collections of Grim Reapers, assassins, demons, deafening peals, or even sentences. These paradoxes have recently been used in arguments for finitist metaphysical theses such as temporal finitism, causal finitism, and discrete views of time. Here we develop a new finite Benardete-like paradox. We then use this paradox to defend a companions in guilt argument that challenges recent applications of patchwork principles on behalf of the aforementioned finitist arguments. Finally, we develop another problem for those applications by (...) examining the notion of exact duplication. (shrink)

When people are making certain medical decisions – especially potentially transformative ones – the specter of regret may color their choices. In this paper, I ask: can predicting that we will regret a decision in the future serve any justificatory role in our present decision-making? And if so, what role? While there are many pitfalls to such reasoning, I ultimately conclude that considering future retrospective emotions like regret in our decisionmaking can be both rational and authentic. Rather than indicating that (...) one is about to make a mistake or that there is some underlying value that one already cares about but is overlooking, the prediction that one will regret a decision in the future makes one confront how her present values and priorities may change as a result of her choice in ways she cannot presently anticipate. (shrink)

Heron Heart is a poem born out of reflecting on the nature of existence during long stretches of isolation, where the boundary of what is and is not a living being was challenged—the nonhuman more alive than the human. It evokes the absurdity of the banal out of the confusion and beauty of sensory experience, with hints of nostalgia for a mythological world that never existed but is ever-present.

In The Second Sex, Simone de Beauvoir diagnoses “woman” as the “lost sex,” torn between her individual autonomy and her “feminine destiny.” Becoming a “real woman” in patriarchal societies demands that women lose their authentic, autonomous selves to become the “inessential Other” for Man. To better understand this diagnosis and how women might refind themselves, I rehabilitate the influence of Søren Kierkegaard and his concept of repetition as what must be lost to be found again in Beauvoir’s account of freedom (...) and, specifically, the liberation of women. Beauvoir offers a dual account of repetition, that of mundane repetition and sacrificial repetition, bringing them to bear both on her diagnosis of women’s oppression and her theorization of our liberation. Sacrificial repetition becomes a temporality for freedom—one must be able to repeat or retake their autonomy continuously toward an open future. For this to happen concretely, Beauvoir insists that we must sacrifice the (racist, classist) patriarchal ideals of the “real woman” and “real man” as we retake our autonomy and reconfigure the meaning of sex difference anew. (shrink)

Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood (...) as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

Democratizing the syllabus has been discussed in the fields of sociology and political science but rarely in philosophy. In this paper I will draw upon my experience of teaching Philosophy of Love in an online modality to examine the impact on motivation when students fill in the gaps presented in a democratic syllabus.

In this paper, I endorse the idea that age is a defensible criterion for eligibility to vote, where age is itself a proxy for having a broad set of cognitive and motivational capacities. Given the current (and defeasible) state of developmental research, I suggest that the age of 16 is a good proxy for such capacities. In defending this thesis, I consider alternative and narrower capacity conditions while drawing on insights from a parallel debate about capacities and age requirements in (...) the criminal law. I also argue that the expansive capacity condition I adopt satisfies a number of powerful and complementary rationales for voting eligibility, and conclude by addressing challenging arguments that, on the one hand, capacity should not underlie voting eligibility in the first place, and, on the other, that capacity should do so directly and not via any sort of proxy, including age. (shrink)

Abstract: Each affective state has distinct motor-expressions, sensory perceptions, autonomic, and cognitive patterns. Panksepp (1998) proposed seven neural affective systems of which the SEEKING system, a generalized approach-seeking system, motivates organisms to pursue resources needed for survival. When an organism is presented with a novel stimulus, the dopamine (DA) in the nucleus accumbens septi (NAS) is released. The DA circuit outlines the generalized mesolimbic dopamine-centered SEEKING system and is especially responsive when there is an element of unpredictability in forthcoming rewards. (...) We propose that when the outcome of this interaction is unexpected or unanticipated then Panksepp’s “cognitive or expectancy reset” mechanism involving the cognitive dissonance would yield the subjective emotion of surprise. In order to appropriately react to the environment’s stimuli one needs fundamental processes that would enable one to distinguish between what is novel and what has been already experienced, as well as the different degrees of novelty. Novel events are those whose essential features of the representation (visceral and perceptual) are altered and being discrepant provoke more sustained attention. Novelty arises from salient and arousing events and the organism experiences surprise, as coming out of a habitual state. In this framework, we shall look at established theories of emotions and propose a different approach to their taxonomy. (shrink)

Many people view disabilities as misfortunes, call this the standard view. In this paper, I examine one criticism that has been launched against the Standard View. Rather than determine in advance whether having a disability is good or bad for a person, some critics argue that the Standard View is reflective of and brings about inappropriate emotional responses toward people with disabilities and their circumstances. For instance, philosophers have recently argued that in holding the standard view, we become prone to (...) a destructive kind of unwarranted pity or that the view leads us to hold certain untenable or inappropriate hopes for our children and for our society. I think this sort of challenge to the Standard View has a lot of appeal, but I worry that if it is not properly articulated, the approach is vulnerable to what has been known as “The Wrong Kind of Reason” problem. The paper highlights and addresses this worry. (shrink)

This essay explores a conception of responsibility at work in moral and criminal responsibility. Our conception draws on work in the compatibilist tradition that focuses on the choices of agents who are reasons-responsive and work in criminal jurisprudence that understands responsibility in terms of the choices of agents who have capacities for practical reason and whose situation affords them the fair opportunity to avoid wrongdoing. Our conception brings together the dimensions of normative competence and situational control, and we factor normative (...) competence into cognitive and volitional capacities, which we treat as equally important to normative competence and responsibility. Normative competence and situational control can and should be understood as expressing a common concern that blame and punishment presuppose that the agent had a fair opportunity to avoid wrongdoing. This fair opportunity is the umbrella concept in our understanding of responsibility, one that explains it distinctive architecture. (shrink)

The aesthetics of body and dress are in a continuous flux. The body, being the locus where fashion challenges the traditional norms, escapes from the narrow boundaries of the conventionally beautiful; the disgusting soma, in the realm of Negative Aesthetics, takes its place. In this paper, I attempt to define what is disgusting fashion and how can contribute to the deliberation of the body from the restricting margins of the aesthetically beautiful. The distorted imagery of the feminine soma is the (...) center of the analysis of the non-beautiful as an aesthetically pleasing phenomenon. Different examples of repulsive clothing are analyzed from a philosophical point of view, in order to understand the relation between the negative emotional responses towards disgusting fashion and its aesthetic value. -/- . (shrink)

Socrates engages his audience in Phaedrus with speeches that include revised or newly composed myths that express his theory of philosophical eros. The aim of the speeches is to generate a love for truth that spills over into dialogue. Speeches are a starting point for dialogue, just like physical attraction is the beginning of love. In the case of Phaedrus, the beginning of philosophy is portrayed using playful and rhetorically rich speeches that serve as "love potions" awakening the novice's soul, (...) and ultimately leading Phaedrus to higher rungs on the ladder of love through the palinode, a medicinal speech. It is thinking about speeches, not the speeches themselves, which moves Socrates' student Phaedrus from the love of speeches to the love of Beauty itself. This is a stark contrast to the purpose of speechmaking for the sophist. The sophist seeks to enchant the soul, while the philosopher seeks to charm the soul into loving wisdom through stimulating discussions. Socrates also uses role reversals in the lover-beloved relationship to model the soul's ascent, contrasting the traditional roles with the way the lover and beloved are presented in Socrates' speeches. The novice must actively recollect Beauty itself in order to ascend, rather than passively listening to speeches that provide an image of beauty. Socrates' interlocutors must move themselves up the ladder of love from their own philosophical eros; wisdom is not attained by merely being pushed all the way up the ladder of love. (shrink)

Starting from the notion of the Ideal Feminine, this paper discusses the representation of trauma and the portrayal of women as open wounds in the designs of Alexander McQueen and John Galliano. Particularly, I explore how the McQueen’s Deadly Woman and Galliano’s Doll question the boundaries between mortality, sexuality and decay. By examining the relationship between fear, desire and disgust in the aesthetic representation of the wounded fashioned body, I argue that in their works disgust functions as an empowering emotion, (...) contributing to the perception of the aversive fashioned body as a feministic act. (shrink)

Abstract: This research paper presents a novel approach to predict audit risks using a neural network model. The dataset used for this study was obtained from Kaggle and comprises 774 samples with 18 features, including Sector_score, PARA_A, SCORE_A, PARA_B, SCORE_B, TOTAL, numbers, marks, Money_Value, District, Loss, Loss_SCORE, History, History_score, score, and Risk. The proposed neural network architecture consists of three layers, including one input layer, one hidden layer, and one output layer. The neural network model was trained and validated, achieving (...) an impressive accuracy of 100% and an average error of 0.000015, indicating its robust predictive capability. Moreover, we conducted feature importance analysis to identify the most influential features for predicting audit risk. The key features found to be critical for classifying fraudulent activities in audit risk prediction are Sector_score, PARA_A, SCORE_A, PARA_B, SCORE_B, TOTAL, numbers, marks, Money_Value, District, Loss, Loss_SCORE, History, and History_score. This research contributes to the field of audit risk prediction by demonstrating the effectiveness of a neural network-based approach and highlighting the importance of specific features in detecting fraudulent activities. The findings have significant implications for auditors and organizations seeking to enhance their audit risk assessment processes, ultimately leading to improved financial transparency and fraud detection. (shrink)

Le but de ce texte est de mettre en évidence les équi­valences entre la façon dont le concept de conatus résout, dans l'Éthique, le problème de l'unité modale complexe. en rendant consis­tant le concept de chose singulière en tant que celle-ci doit être consi­dérée comme un légitime sujet d'attribution d'états, et la façon dont ce même concept dessine le rapport cognitif de l'esprit avec lui-même, rapport par lequel l'esprit se saisit comme sujet de ses états et qui ca­ractérise la notion (...) moderne de subjectivité. Ainsi, en éclairant cet as­pect du concept spinoziste de chose singulière. on comprendra aussi, de façon indirecte, l'une des conditions par lesquelles les choses peuvent, dans la doctrine spinoziste, devenir des objets ou des signes pour la connaissance humaine. (shrink)

Question: Do clinicians providing abortion practicing in states that restrict abortion experience more moral distress than those practicing in states that protect abortion? -/- Findings: In this national, purposive survey study of 310 clinicians providing abortion, moral distress was elevated among all clinicians, with those practicing in restrictive states reporting higher levels of moral distress compared with those practicing in protective states. -/- Meaning: The findings suggest that structural changes addressing bans on necessary health care, such as federal protection for (...) abortion, are needed at institutional, state, and federal policy levels to address clinician moral distress. (shrink)

Commentary on Walsh, E. 2020. Cognitive transformation, dementia, and the moral weight of advance directives. The American Journal of Bioethics. 20(8): 54–64.

Darwinism, especially in the form of the Modern Synthesis, has become one of the most influential theories in the worldwide scientific community. However, due to its often dogmatic interpretation, it is more and more orthodoxical. An increasing number of scientists have come to criticise Darwinism and go beyond it with a systemic approach and an expanded vision of the evolutionary process. As a matter of fact, the discovery of natural genetic engineering mechanisms shows that living cells are able to rewrite (...) their own genetic material at the genomic level, thus leading to evolutionary innovations. This teleological standpoint triggers a paradigm shift that could turn out to be a genuine scientific revolution. (shrink)

The question I want to explore is whether experience supports an antireductionist ontology of time, that is, whether we should take it to support an ontology that includes a primitive, monadic property of nowness responsible for the special feel of events in the present, and a relation of passage that events instantiate in virtue of literally passing from the future, to the present, and then into the past.

It seems natural to choose whether to have a child by reflecting on what it would be like to actually have a child. I argue that this natural approach fails. If you choose to become a parent, and your choice is based on projections about what you think it would be like for you to have a child, your choice is not rational. If you choose to remain childless, and your choice is based upon projections about what you think it (...) would be like for you to have a child, your choice is not rational. This suggests we should reject our ordinary conception of how to make this life-changing decision, and raises general questions about how to rationally approach important life choices. (shrink)

This discussion revises and extends Jonny Anomaly's ‘public goods’ account of public health ethics in light of recent criticism from Richard Dees. Public goods are goods that are both non-rival and non-excludable. What is significant about such goods is that they are not always provided efficiently by the market. Indeed, the state can sometimes realize efficiency gains either by supplying such goods directly or by compelling private purchase. But public goods are not the only goods that the market may fail (...) to provide efficiently. This point to a way of broadening the public goods account of public health to accommodate Dees' counterexamples, without abandoning its distinctive appeal. On the market failures approach to public health ethics, the role of public health is to correct public health-related market failures of all kinds, so far as possible. The underlying moral commitment is to economic efficiency in the sense of Pareto: if we can re-allocate resources in the economy so as to raise the welfare of some without lowering the welfare of any other, we ought to do so. (shrink)

The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

Philosophers of experiment have acknowledged that experiments are often more than mere hypothesis-tests, once thought to be an experiment's exclusive calling. Drawing on examples from contemporary biology, I make an additional amendment to our understanding of experiment by examining the way that `wide' instrumentation can, for reasons of efficiency, lead scientists away from traditional hypothesis-directed methods of experimentation and towards exploratory methods.

Hate speech, understood broadly, is any form of expression intended to arouse hatred or contempt toward members of a particular social group. When university administrators have reason to believe that a planned speaking event on campus may feature hate speech (at least in the eyes of some), how should they respond? In this paper I address this question as it arises for Canadian universities. I argue that, where the regulation of campus speech is concerned, the right course of action for (...) university administrators is nearly always to do absolutely nothing. They will have reason to become actively involved only in order to ensure that a speaking event proceeds safely, or when it threatens to disrupt the functioning of the university, or when it is itself threatened with disruption by protesting groups. In those instances the justification for intervention will be to protect and facilitate speech, not to shut it down. (shrink)

Is the virtue of the good citizen the same as the virtue of the good man? Aristotle addresses this in Politics 3.4. His answer is twofold. On the one hand, (the account for Difference) they are not the same both because what the citizen’s virtue is depends on the constitution, on what preserves it, and on the role the citizen plays in it, and because the good citizens in the best constitution cannot all be good men, whereas the good man’s (...) virtue is uniform. On the other hand, (the account for Identity) the two virtues are identical in the good men in the best constitution, in which all are good citizens, each possessing the ability for ruling and for being ruled. This nuanced answer can be seen as Aristotle’s synthesis of a Periclean view (contribution to state blots out personal wrongs) and a Socratic view (no good citizen is without justice). Its nuances reflect the extent to which Aristotle’s conceptions of good citizenship and the best constitution accommodate deviations of what is probable from the human ideal set out in his ethical writings. In the present chapter, I will first address three puzzles regarding the nuances of Aristotle’s answer. Second, I will consider one question about its implication: Does Aristotle’s account for Difference turn out to entail something ultra-Periclean: that no one can simultaneously be a good man and a good citizen in any constitution other than the best? I shall argue the negative. (shrink)

Je cherche à explorer comment l'expérience de la temporalité est multiforme et fortement perturbée à l'époque de la pandémie Covid-19 et des politiques de confinement, générant une expérience d'hétérochronie, qui remet en question notre rapport à la vie.

The tripartite account of propositional, fallibilist knowledge that p as justified true belief can become adequate only if it can solve the Gettier Problem. However, the latter can be solved only if the problem of a successful coordination of the resources (at least truth and justification) necessary and sufficient to deliver propositional, fallibilist knowledge that p can be solved. In this paper, the coordination problem is proved to be insolvable by showing that it is equivalent to the ''''coordinated attack'''' problem, (...) which is demonstrably insolvable in epistemic logic. It follows that the tripartite account is not merely inadequate as it stands, as proved by Gettier-type counterexamples, but demonstrably irreparable in principle, so that efforts to improve it can never succeed. (shrink)

Philosophical discussions of species have focused on multicellular, sexual animals and have often neglected to consider unicellular organisms like bacteria. This article begins to fill this gap by considering what species concepts, if any, apply neatly to the bacterial world. First, I argue that the biological species concept cannot be applied to bacteria because of the variable rates of genetic transfer between populations, depending in part on which gene type is prioritized. Second, I present a critique of phylogenetic bacterial species, (...) arguing that phylogenetic bacterial classification requires a questionable metaphysical commitment to the existence of essential genes. I conclude by considering how microbiologists have dealt with these biological complexities by using more pragmatic and not exclusively evolutionary accounts of species. I argue that this pragmatism is not borne of laziness but rather of the substantial conceptual problems in classifying bacteria based on any evolutionary standard. (shrink)

Citizens in wealthy liberal democracies are typically expected to see to basic needs like food, clothing, and shelter out of their own income, and those without the means to do so usually receive assistance in the form of cash transfers. Things are different with health care. Most liberal societies provide their citizens with health care or health care insurance in kind, either directly from the state or through private insurance companies that are regulated like public utilities. Except perhaps for small (...) co-pays or deductibles, citizens are not expected to see to their health needs out-of-pocket, at least for some basic level of care. Instead, when a citizen gets sick, the state or her insurance company foots the... (shrink)

In a recent issue of Philosophy East and West Douglas Berger defends a new reading of Mūlamadhyamakakārikā XXIV : 18, arguing that most contemporary translators mistranslate the important term prajñaptir upādāya, misreading it as a compound indicating "dependent designation" or something of the sort, instead of taking it simply to mean "this notion, once acquired." He attributes this alleged error, pervasive in modern scholarship, to Candrakīrti, who, Berger correctly notes, argues for the interpretation he rejects.Berger's analysis, and the reading of (...) the text he suggests is grounded on that analysis, is insightful and fascinating, and certainly generates an understanding of Nāgārjuna's enterprise that is welcome .. (shrink)

I defend a one category ontology: an ontology that denies that we need more than one fundamental category to support the ontological structure of the world. Categorical fundamentality is understood in terms of the metaphysically prior, as that in which everything else in the world consists. One category ontologies are deeply appealing, because their ontological simplicity gives them an unmatched elegance and spareness. I’m a fan of a one category ontology that collapses the distinction between particular and property, replacing it (...) with a single fundamental category of intrinsic characters or qualities. We may describe the qualities as qualitative charactersor as modes, perhaps on the model of Aristotelian qualitative (nonsubstantial) kinds, and I will use the term “properties” interchangeably with “qualities”. The qualities are repeatable and reasonably sparse, although, as I discuss in section 2.6, there are empirical reasons that may suggest, depending on one’s preferred fundamental physical theory, that they include irreducibly intensive qualities. There are no uninstantiated qualities. I also assume that the fundamental qualitative natures are intrinsic, although physics may ultimately suggest that some of them are extrinsic. On my view, matter, concrete objects, abstract objects, and perhaps even spacetime are constructed from mereological fusions of qualities, so the world is simply a vast mixture of qualities, including polyadic properties (i.e., relations). This means that everything there is, including concrete objects like persons or stars, is a quality, a qualitative fusion, or a portion of the extended qualitative fusion that is the worldwhole. I call my view mereological bundle theory. (shrink)

According to a recent challenge to Kratzer's canonical contextualist semantics for deontic modal expressions, no contextualist view can make sense of cases in which such a modal must be information-sensitive in some way. Here I show how Kratzer's semantics is compatible with readings of the targeted sentences that fit with the data. I then outline a general account of how contexts select parameter values for modal expressions and show, in terms of that account, how the needed, contextualist-friendly readings might plausibly (...) get selected in the challenge cases. (shrink)

Galileo’s Error is a superlative work of public philosophy, particularly as a way of introducing modern academic panpsychism to a broader audience. In this commentary, I reflect on an issue that is prominent, though often with different background concerns, in both academic and popular discourse: what it means to be ‘scientific’ or ‘unscientific’. Panpsychism is not itself a scientific hypothesis, but neither is it (as critics sometimes claim) in conflict with science. Indeed, Goff argues, and I agree, that panpsychism is (...) an eminently scientific worldview, in the sense of a way of viewing reality that accords with and embraces what science reveals. But what exactly it means to ‘accord with and embrace’ science is disputed; this paper tries to untangle some of the threads. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

The genetic modification of pigs as a source of transplantable organs is one of several possible solutions to the chronic organ shortage. This paper describes existing ethical tensions in xenotransplantation (XTx) that argue against pursuing it. Recommendations for lifelong infectious disease surveillance and notification of close contacts of recipients are in tension with the rights of human research subjects. Parental/guardian consent for pediatric xenograft recipients is in tension with a child’s right to an open future. Individual consent to transplant is (...) in tension with public health threats that include zoonotic diseases. XTx amplifies concerns about justice in organ transplantation and could exacerbate existing inequities. The prevention of infectious disease in source animals is in tension with the best practices of animal care and animal welfare, requiring isolation, ethologically inappropriate housing, and invasive reproductive procedures that would severely impact the well-being of intelligent social creatures like pigs. (shrink)

Much of the discussion of the role of emerging technologies associated with AI, machine learning, digital simulacra, and relevant ethical considerations such as those discussed in the target article, take a relatively narrow and episodic view of a person’s healthcare needs. There is much speculation about diagnostic, treatment, and predictive applications but relatively little consideration of how such technologies might be used to address a person’s lived experience of illness and ongoing care needs. This is likely due to the greater (...) weight or priority given to acute care needs and the role of medical treatment in care provision, but it may also reflect the limitations of current technologies and our limited vision of their potential application. Such limitations are not surprising given that we are still grappling with the complexities and nuances of achieving the ethical and humanistic ideals of care, namely, care that addresses the hermeneutical, relational, contextual, temporal, and agential dimensions of a person’s health and wellbeing. (shrink)

In this paper, I distinguish two conceptions of solidarity, which I call solidarity as beneficence and solidarity as mutual advantage. I argue that only the latter is capable of providing a complete foundation for national universal health care programs. On the mutual advantage account, the rationale for universal insurance is parallel to the rationale for a labor union’s “closed shop” policy. In both cases, mandatory participation is necessary in order to stop individuals free-riding on an ongoing system of mutually advantageous (...) cooperation. (shrink)