Resumen Ésta es la primera traducción al español de las guías “Atención después de la investigación: un marco para los comités de ética de investigación del National Health Service (NHS) (borrador versión 8.0)”. El documento afirma que existe una fuerte obligación moral de garantizar que los participantes enfermos de un estudio clínico hagan una transición después del estudio hacia una atención de la salud apropiada. Con “atención de la salud apropiada” se hace referencia al acceso para los participantes a la (...) atención de la salud, proporcionada principalmente por el National Health Service (en adelante NHS), el sistema de salud del Reino Unido, y/o a la intervención en estudio, también llamada producto o tratamiento en investigación. Las guías “Atención después de la investigación” están dirigidas principalmente a los miembros de los 79 comités de ética de investigación del NHS y a quienes presentan sus estudios de investigación ante estos comités. Se trata de un documento borrador muy avanzado, trabajado en numerosas reuniones, durante más de 3 años, que ha sido discutido por participantes de estudios y miembros de la comunidad, miembros y presidentes de comités de ética de investigación del Reino Unido, especialistas internacionales en ética de la investigación, representantes de la industria y otras partes interesadas. La redacción de las guías es producto de la colaboración de Neema Sofaer y Penney Lewis, ambas investigadoras del King’s College London, en el Centre of Medical Law and Ethics del Dickson Poon School of Law, y Hugh Davies, Asesor en Ética de la Investigación de la Health Research Authority (HRA) del NHS. El traductor del presente documento, Ignacio Mastroleo, participó del workshop en la Fundación Brocher (Ginebra, Suiza, diciembre de 2011) donde se revisó el borrador versión 7.0 y contribuyó en la revisión del borrador de la versión 8.0 durante el 2012. -/- Abstract This is the first Spanish translation of the guidelines “Care after research: a framework for NHS RECs (8th draft)”. The document states that there is a strong moral obligation to ensure that participants in a clinical study who are ill transition after the study to appropriate healthcare. The terms "appropriate healthcare" refer to participants’ access to health care, mainly provided by the National Health Service (NHS), the health system in the UK, and/or to the intervention study also named investigational treatment or product. The guides "Care after research" are mainly directed to members of the 79 NHS committees of research ethics (RECs) and to those who submit their research to these committees. This is a very advanced draft document, worked in several meetings, for more than three years, that has been discussed with study participants and community members, members and chairs of RECs in the UK, international specialists in research ethics, industry representatives and other stakeholders. The drafting of the guidelines is the result of the collaboration of Neema Sofaer and Penney Lewis, both researchers at King's College London, at the Centre of Medical Law and Ethics of Dickson Poon School of Law, and Hugh Davies, Research Ethics Advisor of the Health Research Authority (HRA) of the NHS. The translator of this document, Ignacio Mastroleo, attended the workshop at the Brocher Foundation (Geneva, Switzerland, December 2011) where draft version 7.0 was revised and contributed in the revision of draft version 8.0 during 2012. (shrink)

Care after research is for participants after they have finished the study. Often it is NHS-provided healthcare for the medical condition that the study addresses. Sometimes it includes the study intervention, whether funded and supplied by the study sponsor, NHS or other party. The NHS has the primary responsibility for care after research. However, researchers are responsible at least for explaining and justifying what will happen to participants once they have finished. RECs are responsible for considering the arrangements. There are (...) ethical and practical issues, in particular when participants may wish to continue on the study intervention after the study. There are also various guidelines and legislation. This document presents a framework of questions to help NHS RECs and their applicants. Information on this document’s development is here. (shrink)

This article considers attempts to include the issues of ageing and ill health in a Rawlsian framework. It first considers Norman Daniels’ Prudential Lifespan Account, which reduces intergenerational questions to issues of intrapersonal prudence from behind a Rawslian veil of ignorance. This approach faces several problems of idealisation, including those raised by Hugh Lazenby, because it must assume that everyone will live to the same age, undermining its status as a prudential calculation. I then assess Lazenby's account, which applies (...) Rawls’ general theory of justice more directly to healthcare. Lazenby suggests that we should apply Rawls’ difference principle – which claims that any inequalities in social goods must benefit the worst off – to conclude that we should significantly prioritise treatment of young patients. I argue first that the existence of young terminally ill patients undermines a number of Rawlsian arguments for the difference principle. I then argue that the structure of ageing undermines the Rawlsian decision mechanism of the ‘veil of ignorance’ on which Lazenby relies. I conclude that age and terminal illness present significant problems for any comprehensive Rawlsian account of justice. (shrink)

Corcoran’s 27 entries in the 1999 second edition of Robert Audi’s Cambridge Dictionary of Philosophy [Cambridge: Cambridge UP]. -/- ancestral, axiomatic method, borderline case, categoricity, Church (Alonzo), conditional, convention T, converse (outer and inner), corresponding conditional, degenerate case, domain, De Morgan, ellipsis, laws of thought, limiting case, logical form, logical subject, material adequacy, mathematical analysis, omega, proof by recursion, recursive function theory, scheme, scope, Tarski (Alfred), tautology, universe of discourse. -/- The entire work is available online free at more than (...) one website. Paste the whole URL. http://archive.org/stream/RobertiAudi_The.Cambridge.Dictionary.of.Philosophy/Robert.Audi_The.Cambrid ge.Dictionary.of.Philosophy -/- The 2015 third edition will be available soon. Before you think of buying it read some reviews on Amazon and read reviews of its competition: For example, my review of the 2008 Oxford Companion to Philosophy, History and Philosophy of Logic,29:3,291-292. URL: http://dx.doi.org/10.1080/01445340701300429 -/- Some of the entries have already been found to be flawed. For example, Tarski’s expression ‘materially adequate’ was misinterpreted in at least one article and it was misused in another where ‘materially correct’ should have been used. The discussion provides an opportunity to bring more flaws to light. -/- Acknowledgements: Each of these entries was presented at meetings of The Buffalo Logic Dictionary Project sponsored by The Buffalo Logic Colloquium. The members of the colloquium read drafts before the meetings and were generous with corrections, objections, and suggestions. Usually one 90-minute meeting was devoted to one entry although in some cases, for example, “axiomatic method”, took more than one meeting. Moreover, about half of the entries are rewrites of similarly named entries in the 1995 first edition. Besides the help received from people in Buffalo, help from elsewhere was received by email. We gratefully acknowledge the following: José Miguel Sagüillo, John Zeis, Stewart Shapiro, Davis Plache, Joseph Ernst, Richard Hull, Concha Martinez, Laura Arcila, James Gasser, Barry Smith, Randall Dipert, Stanley Ziewacz, Gerald Rising, Leonard Jacuzzo, George Boger, William Demopolous, David Hitchcock, John Dawson, Daniel Halpern, William Lawvere, John Kearns, Ky Herreid, Nicolas Goodman, William Parry, Charles Lambros, Harvey Friedman, George Weaver, Hughes Leblanc, James Munz, Herbert Bohnert, Robert Tragesser, David Levin, Sriram Nambiar, and others. -/- . (shrink)

The elimination of gatekeepers for scientific publication has been represented as a means to promote the core moral values of open science, including democratic decision-making and inclusiveness. I argue that this framing ignores the reality that gatekeeping is a way of structuring prestige hierarchies, and that without gatekeeping, some other structuring would be needed: the flattening of prestige hierarchies is not possible given scientists’ need to navigate information overload. I consider two potential restructurings of prestige hierarchies, one based on citation (...) count and the other on search algorithm rank. These are shown to simply reintroduce status biases and hierarchies in ways that either do not further the open science ideals of democracy and inclusiveness, or else involve some de facto gatekeeping. Gatekeeper elimination should not be thought of as an intrinsic part of the open science movement. In fact, insofar as gatekeeping is guided by professional ideals of impartiality and diligence, it can be thought of as an ally of open science values. (shrink)

This is an opinionated guide to the literature on epistemic dilemmas. It discusses seven kinds of situations where epistemic dilemmas appear to arise; dilemmic, dilemmish, and non-dilemmic takes on them; and objections to dilemmic views along with dilemmist’s replies to them.

Epistemologists often appeal to the idea that a normative theory must provide useful, usable, guidance to argue for one normative epistemology over another. I argue that this is a mistake. Guidance considerations have no role to play in theory choice in epistemology. I show how this has implications for debates about the possibility and scope of epistemic dilemmas, the legitimacy of idealisation in Bayesian epistemology, uniqueness versus permissivism, sharp versus mushy credences, and internalism versus externalism.

Philosophers often claim that humility is a dependent virtue: a virtue that depends on another virtue for its value. I consider three views about this relation: Specific Dependence, Unspecific Dependence, and Fittingness. I argue that, since humility cannot uniquely depend on another virtue, and since this uniqueness is desirable, we should reject Specific and Unspecific Dependence. I defend a Fittingness view, according to which the humble person possesses some objectively good quality fitting for humility. I show beyond Slote’s original characterization (...) of the dependence relation that, even if humility’s value depends on having objectively good qualities, humility itself can be one such quality. So, humility can depend on itself. I call this view Bootstrapped Fittingness. (shrink)

Epistemologists spend a great deal of time thinking about how we should respond to our evidence. They spend far less time thinking about the ways that evidence can be acquired in the first place. This is an oversight. Some ways of acquiring evidence are better than others. Many normative epistemologies struggle to accommodate this fact. In this article I develop one that can and does. I identify a phenomenon – epistemic feedback loops – in which evidence acquisition has gone awry, (...) with the result that even beliefs based on the evidence are irrational. Examples include evidence acquired under the influence of confirmation bias and evidence acquired under the influence of cognitively penetrated experiences caused by implicit bias. I then develop a theoretical framework which enables us to understand why beliefs that are the outputs of epistemic feedback loops are irrational. Finally, I argue that many popular approaches to epistemic normativity may need to be abandoned on the grounds that they cannot comfortably explain feedback loops. The scope of this last claim is broad: it includes almost all contemporary theories of justified/rational belief and of the epistemology of cognitive penetration. (shrink)

This article argues that there can be epistemic dilemmas: situations in which one faces conflicting epistemic requirements with the result that whatever one does, one is doomed to do wrong from the epistemic point of view. Accepting this view, I argue, may enable us to solve several epistemological puzzles.

People have sought ways to improve their physical and mental capabilities for thousands of years. For those of us who believe that human enhancement technologies include clothes, tools and weapons, the politics of enhancement started in prehistory. The norms of pre-industrial societies that only certain castes or genders could touch specific tools or wear certain clothes were preliminary politics of enhancement. Prosthetic limbs are thousands of years old, and by the 15th century, there were multiple experiments with vaccination around the (...) world. Although it would be appropriate to write a history of the various forms of empowerment that have taken place since the dawn of civilisation, this volume – that now we can present to the lectors – will be on the debates about human enhancement that began in the early 20th century, once modern medicine had begun to suggest actual technologies for human augmentation. Before examining the relationship between human enhancement and biopolitics (the subject of our work), it is helpful to say a few words about the series in which this volume appears, a series that bears the same title as this first text and which opens with contributions from the best scientific experts on the subject. (shrink)

As the principle of natural selection is generalized to explain (adaptive) patterns of human behavior, it becomes less clear what the selective environment empirically refers to. While the environment and individual are relatively separable in the non-human biological context, they are highly entangled in the context of moral, social, and institutional evolution. This chapter brings attention to the problem of generalizing the selective environment, and argues that it is ontologically disunified and definable only through its explanatory function. What unifies the (...) selective environment is that it explains adaptation in a non-agential way, by screening off various forms of agency, whether divine, organismic, or human. This explanatory function of the selective environment helps avoid some sources of confusion when the theory of natural selection is applied to humanities and social sciences. (shrink)

The success of precision medicine depends on obtaining large amounts of information about at-risk populations. However, getting consent is often difficult. Why? In this commentary I point to the differentials in social status involved. These differentials are inevitable once personal information is surrendered, but are particularly intense when the studied populations are socioeconomically or socioculturally disadvantaged and/or ethnically stigmatized groups. I suggest how the deep distrust of the latter groups can be partially justified as a lack of confidence that their (...) core values or interests will sufficiently be taken into account. Hence, the ethical challenge here lies not in avoiding status differentials, but in dealing with them appropriately. Scientists should not assume trust from others but adopt a norm of “demonstrating trustworthiness”. (shrink)

In the past decade, policy-makers in science have been concerned with harmonizing research integrity standards across Europe. These standards are encapsulated in the European Code of Conduct for Research Integrity. Yet, almost every European country today has its own national-level code of conduct for research integrity. In this study we document in detail how national-level codes diverge on almost all aspects concerning research integrity – except for what constitutes egregious misconduct. Besides allowing for potentially unfair responses to joint misconduct by (...) international collaborations, we argue that the divergences raise questions about the envisaged self-regulatory function of the codes of conduct. (shrink)

Environmental heterogeneity is invoked as a key explanatory factor in the adaptive evolution of a surprisingly wide range of phenomena. This article aims to analyze this explanatory scheme of categorizing traits or properties as adaptations to environmental heterogeneity. First it is suggested that this scheme can be understood as a reaction to how heterogeneity adaptations were discounted or ignored in the modern synthesis. Then a positive account is proposed, distinguishing between two broad categories of adaptation to environmental heterogeneity: properties selected (...) for by well-defined patterns of environmental heterogeneity, and properties that help organisms exploit novel patterns of environmental heterogeneity. (shrink)

Some of the most significant policy responses to cases of fraudulent and questionable conduct by scientists have been to strengthen professionalism among scientists, whether by codes of conduct, integrity boards, or mandatory research integrity training programs. Yet there has been little systematic discussion about what professionalism in scientific research should mean. In this paper I draw on the sociology of the professions and on data comparing codes of conduct in science to those in the professions, in order to examine what (...) precisely the model of professionalism implies for scientific research. I argue that professionalism, more than any other single organizational logic, is appropriate for scientific research, and that codes of conduct for scientists should strengthen statements concerning scientific autonomy and competence, as well as the scientific service ideal. (shrink)

I express some reservations about Hart and Hill's attempt to show that certain Scriptural passages show that God sometimes intends that sins occur, though I express sympathy for the view that God sometimes intends that sins occur.

To varying degrees, many of us think we are “self-made.” Some explicitly state—while others imply—that our accomplishments resulted (almost) entirely from our intelligence, ingenuity, and hard work There is qualified truth in this supposition, even although it is commonly overstated. Others think they are pawns in the chess game of life. However, although some have less control than those more privileged, few are devoid of control. This tandem of judgments is akin to our propensity to make asymmetrical judgments about our (...) actions (and those we like) relative to judgments of those we dislike. We often blame our failures on something other than our ill-advised choices, limited abilities, or lack of persistence. If we receive a poor grade, do not land a desired job or coveted promotion, or are spurned by a potential lover, we often blame another, bad luck, or unfortunate circumstances. We scrounge for ways to excuse or mitigate our responsibility when things turn out badly, while taking credit when actions turn out well. We do not do same for negative traits or actions of those we dislike. The phenomenon I discuss in this paper, however, is more pervasive than blame-deflection or inappropriate pride. Even some who think the notion of the “self-made person” borders on a straw person, also think that we have considerable direct control of our lives. We do not. Although we are not leaves tossed by winds of circumstance, we are shaped by complex causal chains largely beyond our control. After seeing this broadly and in detail, we understand the limits on control and why it is not direct By understanding that and how we are shaped by cultures, governments, businesses, and others, we can isolate levers that help us maximize control we do have. (shrink)

Distrust in scientific experts can be surprisingly stubborn, persisting despite evidence supporting the experts’ views, demonstrations of their competence, or displays of good will. This stubborn distrust is often viewed as a manifestation of irrationality. By contrast, this article proposes a logic of “status distrust”: low-status individuals are objectively vulnerable to collective decision-making, and can justifiably distrust high-status scientific experts if they are not confident that the experts do not have their best interests at heart. In phenomena of status distrust, (...) social status is thus an indicator of distrust, and this has wider implications for the literatures on trust in science and on expert communication. (shrink)

Despite its public visibility and impact on policy, the activity of expert communication rarely receives more than a passing mention in codes of scientific integrity. This paper makes the case for an ethics of expert communication, introducing a framework where expert communication is represented as an intrinsically ethical activity of a deliberative agent. Ethical expert communication cannot be ensured by complying with various requirements, such as restricting communications to one's area of expertise or disclosing conflicts of interest. Expert communication involves (...) morally laden trade‐offs that must be weighed by a deliberative agent. A basic normative framework is introduced, and concrete provisions are proposed for codes of scientific integrity. (shrink)

Disturbances to one's sense of self, the feeling that one has ‘lost a part of oneself’ or that one ‘no longer feels like oneself,’ are frequently recounted throughout the bereavement literature. Engaging Allan Køster's important contribution to this issue, this article reinforces his suggestion that, by rupturing the existential texture of self-familiarity, bereavement can result in experiences of estrangement that can be meaningfully understood according to the concept of self-alienation. Nevertheless, I suggest that whilst Køster's relational interpretation of alienation as (...) the withdrawal of heteronomy can be applied to the experience of world-collapse in bereavement, what sets bereavement apart from other limit situations is the fact that it involves an intersubjective relation between the living and the dead. In contrast to Køster, therefore, I suggest that the experience of self-alienation that is distinctive to bereavement results from the fact that the bereaved is exposed to, and co-opted by, the absolute alterity of death itself. (shrink)

The dominant view today on evolutionary progress is that it has been thoroughly debunked. Even value-neutral progress concepts are seen to lack important theoretical underpinnings: natural selection provides no rationale for progress, and natural selection need not even be invoked to explain large-scale evolutionary trends. In this paper I challenge this view by analysing how natural selection acts in heterogeneous environments. This not only undermines key debunking arguments, but also provides a selectionist rationale for a pattern of “evolutionary unfolding”, where (...) life radiates across an increased range of exploitation of environmental heterogeneity. (shrink)

Darwin hypothesized that some animals, when selecting sexual partners, possess a genuine “sense of beauty” that cannot be accounted for by the logic of natural selection. This hypothesis has been notoriously controversial. In this chapter I propose that the concept of agency can be useful to operationalize the “sense of beauty”, and can help identify the conditions under which one can infer that animals are acting as (aesthetic) agents. Focusing on a case study of the behavior of the Pavo cristatus, (...) I identify the types of evidence that would allow for the inference of agency through aesthetic choice. (shrink)

Boredom is an affective experience that can involve pervasive feelings of meaninglessness, emptiness, restlessness, frustration, weariness and indifference, as well as the slowing down of time. An increasing focus of research in many disciplines, interest in boredom has been intensified by the recent Covid-19 pandemic, where social distancing measures have induced both a widespread loss of meaning and a significant disturbance of temporal experience. This article explores the philosophical significance of this aversive experience of ‘pandemic boredom.’ Using Heidegger’s work as (...) a unique vantage point, this article draws on survey data collected by researchers in an ongoing project titled ‘Experiences of Social Distancing During the Covid-19 Pandemic’ to give an original phenomenological interpretation of the meaninglessness and monotony of pandemic boredom. On a Heideggerian interpretation, pandemic boredom involves either a situative confrontation with relative meaninglessness that upholds our absorption in the everyday world, or an existential confrontation with absolute meaninglessness that forces us to take up the question of our existence. Arguing that boredom during the pandemic makes this distinction difficult to sustain, I consider some of the ways in which pandemic boredom might be seen to expose and then exceed the distinctive methodological limitations of Heidegger’s philosophical interpretation of boredom. (shrink)

I discuss what Aquinas’ doctrine of divine simplicity is, and what he takes to be its implications. I also discuss the extent to which Aquinas succeeds in motivating and defending those implications.

We propose that measures of information integration can be more straightforwardly interpreted as measures of agency rather than of consciousness. This may be useful to the goals of consciousness research, given how agency and consciousness are “duals” in many (although not all) respects.

Does the content of a physically dangerous job affect the moral permissibility of hiring for that job? To what extent may employers consider costs in choosing workplace safety measures? Drawing on Kantian ethical theory, this article defends two strong ethical standards of workplace safety. First, the content of a hazardous job does indeed affect the moral permissibility of offering it. Unless employees need hazard pay to meet basic needs, it is permissible to offer a dangerous job only if prospective employees (...) have a reason other than hazard pay to choose this job instead of safer alternatives. Second, employers typically cannot justify omitting expensive safety measures by paying employees more, even if employees prefer higher pay to greater safety. Employers offering dangerous jobs must meet these two standards to avoid treating their employees merely as means. (shrink)

I argue that evidentialism should be rejected because it cannot be reconciled with empirical work on bias in cognitive and social psychology.

Biologists explain organisms’ behavior not only as having been programmed by genes and shaped by natural selection, but also as the result of an organism’s agency: the capacity to react to environmental changes in goal-driven ways. The use of such ‘agential explanations’ reopens old questions about how justified it is to ascribe agency to entities like bacteria or plants that obviously lack rationality and even a nervous system. Is organismic agency genuinely ‘real’ or is it just a useful fiction? In (...) this paper we focus on two questions: whether agential explanations are to be interpreted ontically, and whether they can be reduced to non-agential explanations (thereby dispensing with agency). The Kantian approach we identify interprets agential explanations non-ontically, yet holds agency to be indispensable. Attributing agency to organisms is not to be taken literally in the way we attribute physical properties such as mass or acceleration, but nor is it a mere heuristic or predictive tool. Rather, it is an inevitable consequence of our own rational capacity: as long as we are rational agents ourselves, we cannot avoid seeing agency in organisms. (shrink)

Background Professional communities such as the medical community are acutely concerned with negligence: the category of misconduct where a professional does not live up to the standards expected of a professional of similar qualifications. Since science is currently strengthening its structures of self-regulation in parallel to the professions, this raises the question to what extent the scientific community is concerned with negligence, and if not, whether it should be. By means of comparative analysis of medical and scientific codes of conduct, (...) we aim to highlight the role of negligence provisions in codes of conduct for scientists, and to discuss the normative consequences for future codes of conduct. -/- Methods We collected scientific and medical codes of conduct in a selection of OECD countries, and submitted each code of conduct to comparative textual analysis. -/- Results Negligence is invariably listed as an infraction of the norms of integrity in medical codes of conduct, but only rarely so in the scientific codes. When the latter list negligence, they typically do not provide any detail on the meaning of ‘negligence’. -/- Discussion Unlike codes of conduct for professionals, current codes of conduct for scientists are largely silent on the issue of negligence, or explicitly exclude negligence as a type of misconduct. In the few cases where negligence is stipulated to constitute misconduct, no responsibilities are identified that would help prevent negligence. While we caution against unreasonable negligence provisions as well as disproportionate sanctioning systems, we do argue that negligence provisions are crucial for justified trust in the scientific community, and hence that there is a very strong rationale for including negligence provisions in codes of conduct. (shrink)

Enlightenment values are built around the presumption of an independent rational self, citizen, consumer and pursuer of self-interest. Even the authoritarian and communitarian variants of the Enlightenment presumed the existence of autonomous individuals, simply arguing for greater weight to be given to their collective interests. Since Hume, however, radical Enlightenment empiricists have called into question the existence of a discrete, persistent self. Today neuroscientific reductionism has contributed to the rejection of an essentialist model of personal identity. Contemporary transhumanism has yet (...) to grapple with the radical consequences of the erosion of liberal individualism on their projects of individually chosen enhancement and longevity. Most transhumanists still reflect an essentialist idea of personal identity, even as they embrace projects of radical cognitive enhancement that would change every constituent element of consciousness. Transhumanists need to grapple with how their projects and ethics would change if personal identity is an arbitrary, malleable fiction. (shrink)

Codes of ethics currently offer no guidance to scientists acting in capacity of expert. Yet communicating their expertise is one of the most important activities of scientists. Here I argue that expert communication has a specifically ethical dimension, and that experts must face a fundamental trade-off between "actionability" and "transparency" when communicating. Some recommendations for expert communication are suggested.

The dominant view on the ethics of cognitive enhancement (CE) is that CE is beholden to the principle of autonomy. However, this principle does not seem to reflect commonly held ethical judgments about enhancement. Is the principle of autonomy at fault, or should common judgments be adjusted? Here I argue for the first, and show how common judgments can be justified as based on a principle of service.

Social media has invaded our private, professional, and public lives. While corporations continue to portray social media as a celebration of self-expression and freedom, public opinion, by contrast, seems to have decidedly turned against social media. Yet we continue to use it just the same. What is social media, and how should we live with it? Is it the promise of a happier and more interconnected humanity, or a vehicle for toxic self-promotion? In this essay I examine the very structure (...) of social media communications in order to sketch how we should engage with social media. Social media communications are, I argue, a public communication of private content. This allows connections to be made with others in ways that would not otherwise be possible; however, it also submits the private to a status competition, which in turn is linked to mental health challenges. A ‘virtuous’ engagement with social media means being aware of these dynamics, and choosing to subordinate social media to other, more important goods. (shrink)

I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly (...) strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort. (shrink)

Recently, dramatic price increases by several pharmaceutical companies have provoked public outrage. These scandals raise questions both about how pharmaceutical firms should be regulated and about how pharmaceutical executives ethically ought to make pricing decisions when drug prices are largely unregulated. Though there is an extensive literature on the regulatory question, the ethical question has been largely unexplored. This article defends a Kantian approach to the ethics of pharmaceutical pricing in an unregulated market. To the extent possible, pharmaceutical companies must (...) price drugs so that those who genuinely need them can get them without financial ruin. This requirement is an ethical side constraint, like the moral prohibitions on deception and theft, that takes precedence over a business’s interest in maximizing profit. That said, the requirement’s application is sensitive to the need to recoup the costs of research and to produce a return that financially justifies the original investment. It may not be either feasible or desirable for government to attempt to enforce the ethical requirements concerning just pharmaceutical pricing. Either price regulation or subsidy could fulfill government’s obligation to protect patients from being objectionably vulnerable to pricing decisions by private companies. (shrink)

History teems with instances of “man’s inhumanity to man.” Some wrongs are perpetrated by individuals; most ghastly evils were committed by groups or nations. Other horrific evils were established and sustained by legal systems and supported by cultural mores. This demands explanation. I describe and evaluate four common explanations of evil before discussing more mundane and psychologically informed explanations of wrong-doing. Examining these latter forms helps isolate an additional factor which, if acknowledged, empowers us to diagnose, cope with, and prevent (...) many ordinary and serious moral wrongs. In so doing, I do not assert that the explanations of first call are never appropriate. I claim only that their role is smaller than many of us reflexively suppose, and that the role of the later feature I identify is more significant, in part, because it supports and amplifies the more mundane and psychologically informed factors prompting wrong-doing. (shrink)

Melancholia is an attunement of despair and despondency that can involve radical disruptions to temporal experience. In this article, I extrapolate from the existing analyses of melancholic time to examine some of the important existential implications of these temporal disruptions. In particular, I focus on the way in which the desynchronization of melancholic time can complicate the melancholic’s relation to death and, consequently, to the meaning and significance of their life. Drawing on Heidegger’s distinction between death and demise, I argue (...) that melancholic time leaves the melancholic in an impossible state of existing, where they are both unable to live and unable to die. Turning to the role of the physician, I consider the significant role that clinical interventions might have in resynchronizing the melancholic with time and examine these ideas further through a case study on physician-assisted suicide. In so doing, I demonstrate that the desynchronization of melancholic time should indeed be understood as a matter of life and death. (shrink)

Philosophers of science and metascientists alike typically model scientists’ behavior as driven by credit maximization. In this article I argue that this modeling assumption cannot account for how scientists have a default level of trust in each other’s assertions. The normative implication of this is that science policy should not focus solely on incentive reform.

When A utters a declarative sentence in a context to B, typically A can mean a proposition by the sentence, the sentence in context literally expresses a proposition, there are propositions A and B can agree the sentence literally expressed, and B can acquire knowledge from this testimonial exchange. In recent work on linguistic communication, each of these four platitudes has been challenged, and on the same basis: viz. on the ground that exactly which proposition the sentence expressed in context (...) is not discernible given the information provided by the context. I argue that, even if this is true, there will be propositional parts of the proposition expressed by the sentence in context which can be identified and that, consequently, the partial understanding afforded by the existence of such identifiable parts undermines the soundness of the arguments against the platitudes. (shrink)

Introduction: The experience of disconnection is common in first-person accounts of grief. One way in which this feeling of estrangement can manifest is through the splintering apart of the time of the mourner and the time of the world. Supplementing and extending Thomas Fuchs' influential idea of temporal desynchronization, my aim in this article is to give an account of the heterogeneous ways in which grief can disturb time. -/- Method: I organize these manifold experiences of temporal disruption according to (...) a method of "depth analysis": a phenomenological interpretation of temporal desynchronization that tracks the increasing disconnect between the mourner and the world as it manifests in time. In so doing, I draw on a wide range of descriptive first-person responses to the question "Has your experience of time changed in any way?" - included as part of an online questionnaire on the emotional experience of grief conducted recently with colleagues at the University of York. I then stratify these according to a mild, moderate, and profound level of disruption. -/- Results: Before setting out the results of this analysis, I give a background account of Fuchs' interpretation of temporal desynchronization in phenomenological psychopathology more generally and in grief specifically. In my results, I then supplement and extend his interpretation by setting out my phenomenological depth analysis of the increasing disconnect between the time of the mourner and the time of the world, as demonstrated by the questionnaire data. As I argue, such a fine-grained account is an important step in understanding the way time can shape the meaning and significance of different grief experiences. Following this, in my discussion, I demonstrate how a depth approach might be helpful in differentiating between temporal disturbances in a range of affective disorders and give an illustrative comparison of grief and depression. -/- Conclusion: In conclusion, I reflect briefly on what grief might reveal about the depth and complexity of temporal experience itself. In so doing, I consider how the radical disruptions to time in grief might transform the mourner's experience of time irreversibly but in a way that enables a renewed connection to both their deceased loved one and the world from which they have become estranged. (shrink)

I develop a broadly reliabilist theory of non-ideal epistemic rationality and argue that if it is correct we should reject the recently popular idea that the standards of non-ideal epistemic rationality are mere social conventions.

When a loved one dies, it is common for the bereaved to feel profoundly lonely, disconnected from the world with the sense that they no longer belong. In philosophy, this experience of ‘loss and loneliness’ has been interpreted according to both a loss of possibilities and a loss of the past. But it is unclear how these interpretations apply to the distinctive way in which loss and loneliness manifest in old age. Drawing on the phenomenological analyses of old age given (...) by de Beauvoir and Améry, I consider how the diminishment of the capacity for projection and recollection complicate recent interpretations of loss and loneliness, whilst nevertheless reinforcing the conclusion that in old age subjectivity is necessarily impoverished. Developing a critical stance on de Beauvoir and Améry’s underlying conception of subjectivity, I turn to Levinas in considering whether or not there is a way to reimagine subjectivity such that the estrangement and alienation of older adults might be ameliorated rather than exacerbated. Grounded in the passive body-in-itself rather than the self-transcending capacity of the body-for-itself, I suggest it becomes possible to reconceptualise the experience of loss and loneliness in old age; both in terms of what is lost and what needs to be restored if older adults are to be helped to find themselves at home in the world in the midst of, and indeed because of, manifold loss. (shrink)

Experiences of enlightened unity with Nature or with Deity are reported not only in the mystical literature of the past but also in contemporary accounts of the psychedelic adventurer. In Chapter 13, Peter Sjöstedt-Hughes seeks to fathom such reported states within the framework of the metaphysics of Benedict de Spinoza – a metaphysics encompassing monism, pantheism, panpsychism, and the eternal substance: the timelessness of pure Nature, God itself. God is Nature for Spinoza. To achieve this framework, the tenets of Spinozism (...) are explicated with a culmination in the Intellectual Love of God, amor Dei intellectualis, where the finite mind and infinite intellect of Nature unite. Sjöstedt-Hughes then provides a phenomenological account of the unitive states occasioned by certain psychedelic substances, notably the ever-so potent 5-MeO-DMT, comparing these phenomenological elements to the ontological aspects of Spinozism. This comparative analysis will proffer a Spinozan-Psychedelic symbiosis: that certain psychedelic states can be understood through the Spinozan system, and that the Spinozan system can be intuited through certain psychedelic states – a blinding flash of Spinozism that can change one’s relation to oneself and to Nature itself. (shrink)

Patients are generally assumed to have the right to choices about treatment, including the right to refuse treatment, which is constrained by considerations of cost‐effectiveness. Independently, many people support the idea that patients who are responsible for their ill health should incur penalties that non‐responsible patients do not face. Surprisingly, these two areas have not received much joint attention. This paper considers whether restricting the scope of responsibility to pre‐treatment decisions can be justified, or whether a demand to hold people (...) responsible for 'usual suspect' choices such as smoking or failure to exercise commits us to also holding people responsible for their treatment choices. I argue that there is no good reason to support this restriction: those who advocate responsibility for (some) pre‐treatment choices should also advocate responsibility for (some) treatment choices. However, I also note that, as with pre‐treatment choices, patients may sometimes have reason to choose in ways that do not optimize their health. As such, I also consider a process, based on the idea of public reasons, for deciding which treatment choices patients cannot legitimately be held responsible for, along with a method for considering proposed changes to this category. (shrink)

This chapter has two aims. First, I distinguish between two forms of testimonial injustice: identity-based testimonial injustice and content-based testimonial injustice. Second, I utilize this distinction to develop a partial explanation for the persistent lack of diverse practitioners in academic philosophy. Specifically, I argue that both identity-based and content-based testimonial injustice are prevalent in philosophical discourse and that this prevalence introduces barriers to participation for those targeted. As I show, the dual and compounding effects of identity-based and content-based testimonial injustice (...) in philosophy plausibly contribute to a lack of diversity in the social identities of practitioners and the discourses in which practitioners are engaged. (shrink)

The vast literature on negative treatment of outgroups and favoritism toward ingroups provides many local insights but is largely fragmented, lacking an overarching framework that might provide a unified overview and guide conceptual integration. As a result, it remains unclear where different local perspectives conflict, how they may reinforce one another, and where they leave gaps in our knowledge of the phenomena. Our aim is to start constructing a framework to help remedy this situation. We first identify a few key (...) ideas for creating a theoretical roadmap for this complex territory, namely the principles of etiological functionalism and the dual inheritance theory of human evolution. We show how a “molecular” approach to emotions fits into this picture, and use it to illuminate emotions that shape intergroup relations. Finally, we weave the pieces together into the beginnings of a systematic taxonomy of the emotions involved in social interactions, both hostile and friendly. While it is but a start, we have developed the argument in a way that illustrates how the foundational principles of our proposed framework can be extended to accommodate further cases. (shrink)

Implicit contextual factors mean that the boundary between causal and noncausal explanation is not as neat as one might hope: as the phenomenon to be explained is given descriptions with varying degrees of granularity, the nature of the favored explanation alternates between causal and non-causal. While it is not surprising that different descriptions of the same phenomenon should favor different explanations, it is puzzling why re-describing the phenomenon should make any difference for the causal nature of the favored explanation. I (...) argue that this is a problem for the ontic framework of causal and noncausal explanation, and instead propose a pragmatic-modal account of causal and non-causal explanation. This account has the added advantage of dissolving several important disagreements concerning the status of non-causal explanation. (shrink)

Some sharing economy firms have adopted a strategy of “regulatory entrepreneurship,” openly violating regulations with the aim of rendering them dead letters. This article argues that in a democracy, regulatory entrepreneurship is a presumptively unethical business strategy. In all but the most corrupt political environments, businesses that seek to change their regulatory environment should do so through the democratic political process, and they should do so without using illegal business practices to build a political constituency. To show this, the article (...) defends a qualified moral obligation for businesspeople to obey the law even in societies that fall short of ideal democracy and that are rife with economic injustice. Owners and managers of successful businesses have strong moral reasons to obey laws concerning resource allocation. Such laws include not only property law, but also tax laws, environmental regulations, and other laws that regulate businesses in competitive markets. The moral reasons to obey such laws apply even to laws that business leaders think unfair or inefficient, provided that the laws in question have reasonable, good faith defenders. (shrink)

IntroductionAssociative theories of political obligation offer a fresh alternative to approaches such as social contract theory, fair play, and the natural duty of justice. Few suggestions in ethics are more intuitive than the idea that we have special obligations to our family and friends, just in virtue of our relationships with them, and it is reasonable that obligations to political society are also grounded through association.A basic question for associative theories is to explain how associations give rise to obligation, but (...) here there is a common error. Many associative theorists and their critics take this question to be equivalent to the question: what distinguishes associations that are morally acceptable from those that are not? The assumption is that associations which are morally acceptable are those that give rise to obligations. However, this assumption is wrong in two ways. Associations that have some unacceptable features may still give rise to obl .. (shrink)