Through engagement with key informants and review of ethical theories applicable to refugee policy, this paper examines the ethical and policy considerations that policy-level stakeholders believe should factor into setting the refugee resettlement ceiling. We find that the ceiling traditionally has been influenced by policy goals, underlying values, and practical considerations. These factors map onto several ethical approaches to resettlement. There is significant alignment between U.S. policy interests and ethical obligations toward refugees. We argue that the refugee ceiling should be (...) restored to historical norms, and that there exists a corresponding obligation to counter negative public perceptions about refugees and the costs of resettlement. (shrink)

In this commentary, I critique three aspects of Emily Walsh's proposal to reduce the moral and legal weight of advance directives: (1) the ambiguity of its initial thesis, (2) its views about the ethics and legality of clinical practice, and (3) its interpretation and application of Ronald Dworkin’s account of advance directives and L.A. Paul's view on transformative experience. I also consider what Walsh’s proposal would mean for people facing the prospect of dementia. I conclude that our reasons to (...) honor many advance directives survive the move to a transformative experience framework. (shrink)

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and (...) disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

Current challenges in medical practice, research, and administration demand physicians who are familiar with bioethics, health law, and health economics. Curriculum directors at American Association of Medical Colleges-affiliated medical schools were sent confidential surveys requesting the number of required hours of the above subjects and the years in which they were taught, as well as instructor names. The number of relevant publications since 1990 for each named instructor was assessed by a PubMed search.In sum, teaching in all three subjects combined (...) comprises less than two percent of the total hours in the American medical curriculum, and most instructors have not recently published articles in the fields they teach. This suggests that medical schools should reevaluate their curricula and instructors in bioethics, health law, and health economics. (shrink)

Health policy is only one part of social policy. Although spending administered by the health sector constitutes a sizeable fraction of total state spending in most countries, other sectors such as education and transportation also represent major portions of national budgets. Additionally, though health is one important aspect of economic and social activity, people pursue many other goals in their social and economic lives. Similarly, direct benefits—those that are immediate results of health policy choices—are only a small portion of the (...) overall impact of health policy. This chapter considers what weight health policy should give to its “spill-over effects,” namely non-health and indirect benefits. (shrink)

In this paper I shall defend the idea that there is an abstract and general core meaning of objectivity, and what is seen as a variety of concepts or conceptions of objectivity are in fact criteria of, or means to achieve, objectivity. I shall then discuss the ideal of value-free science and its relation to the objectivity of science; its status can be at best a criterion of, or means for, objectivity. Given this analysis, we can then turn to the (...) problem of inductive risk. Do the value judgements regarding inductive risk really pose a threat to the objectivity of science? I claim that this is not the case because they do not lower the thresholds scientifically postulated for objectivity. I shall conclude the paper with a discussion of under-appreciated influences of values on science, which indeed pose a serious threat to the objectivity of some scientific disciplines. (shrink)

We argue that the ethical case for instituting vaccine benefit programs is justified by 2 widely recognized values: (1) reducing overall harm from COVID-19 and (2) protecting disadvantaged individuals. We then explain why they do not coerce, exploit, wrongfully distort decision-making, corrupt vaccination's moral significance, wrong those who have already been vaccinated, or destroy willingness to become vaccinated. However, their cost impacts and their effects on public perception of vaccines should be evaluated.

In certain cases, people judge that agents bring about ends intentionally but also that they do not bring about the means that brought about those ends intentionally—even though bringing about the ends and means is just as likely. We call this difference in judgments the Kraemer effect. We offer a novel explanation for this effect: a perceived difference in the extent to which agents know how to bring about the means and the ends explains the Kraemer effect. In several experiments, (...) we replicate the Kraemer effect in a variety of non-moral and moral scenarios, and we find support for our new account. This work accords with a burgeoning area of action theory that identifies an important connection between know-how and intentionality. (shrink)

We consider an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? We argue that it is ethical to consider local resource constraints when deciding what interventions to provide. The provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.

Consistent and well-designed frameworks for ethical oversight enable socially valuable research while forestalling harmful or poorly designed studies. I suggest some alterations that might strengthen the valuable checklist Rattani & Hyder propose for the ethical review of health policy and systems research (HPSR), or prompt future work in the area.

Although policymakers and investigators still struggle to quantify and compare the effects of various Covid-related interventions, we are steadily amassing data that could help inform choices. The pandemic’s medical, social, and economic harms have been immense, and they warrant a continuous policy response. All decision makers use some type of mental model to weigh the pros and cons of various policy options. Rigorous economic evaluation formalizes this process. Value judgments will still be required, but economic evaluation can make the decision-making (...) process more systematic, comprehensive, and transparent. (shrink)

Household debt has been widely discussed among social scientists, policy makers, and activists. Many have questioned the levels of debt households are required to take on, and have made various proposals for assisting households in debt. Yet theorists of distributive justice have left household debt underexamined. This article offers a normative examination of the distributive justice issues presented by proposals to relieve household debt or protect households from overindebtedness. I examine two goals at which debt relief proposals aim: remedying disadvantage (...) and stabilizing expectations. I then examine strategies for relieving existing debts such as debt abolition, forgiveness, bankruptcy, and mitigation, as well as strategies that aim to prevent future indebtedness, such as public provision or financing of costly goods and credit or interest rate regulations. (shrink)

When hospitals face surges of patients with COVID-19, fair allocation of scarce medical resources remains a challenge. Scarcity has at times encompassed not only hospital and intensive care unit beds—often reflecting staffing shortages—but also therapies and intensive treatments. Safe, highly effective COVID-19 vaccines have been free and widely available since mid-2021, yet many Americans remain unvaccinated by choice. Should their decision to forgo vaccination be considered when allocating scarce resources? Some have suggested it should, while others disagree. We offer a (...) framework for evaluating when it is ethical and briefly discuss its legality in American law. (shrink)

On the standard interpretation, if a person holds cyclical preferences, the person is prone to acting irrationally. I provide a different interpretation, tying cyclical preferences not to irrationality, but to indecision. According to this alternative understanding – coined the indecision interpretation – top cycles in a person’s preferences can be associated with a difficulty in justifying one’s choice. If an agent’s justificatory impasse persists despite attempts to resolve the cycle, the agent can be deemed undecided. The indecision interpretation is compatible (...) with the standard interpretation of such cycles as instances of irrationality. Yet indecision corresponds to a first-person, non-instrumental perspective on the problem, whereas irrationality usually corresponds to a third-person, instrumental perspective. Due to these differences, interpreting cycles in terms of indecision offers a novel conceptual perspective, pertinent both for explanatory purposes and for the aim of normative theorizing. (shrink)

In this short response to Kerstein and Bognar, we clarify three aspects of the complete lives system, which we propose as a system of allocating scarce medical interventions. We argue that the complete lives system provides meaningful guidance even though it does not provide an algorithm. We also defend the investment modification to the complete lives system, which prioritizes adolescents and older children over younger children; argue that sickest-first allocation remains flawed when scarcity is absolute and ongoing; and argue that (...) Kerstein and Bognar are mistaken to base their allocation principles on differences in personhood. (shrink)

This paper takes a novel approach to the active bioethical debate over whether advance medical directives have moral authority in dementia cases. Many have assumed that advance directives would lack moral authority if dementia truly produced a complete discontinuity in personal identity, such that the predementia individual is a separate individual from the postdementia individual. I argue that even if dementia were to undermine personal identity, the continuity of the body and the predementia individual’s rights over that body can support (...) the moral authority of advance directives. I propose that the predementia individual retains posthumous rights over her body that she acquired through historical embodiment in that body, and further argue that claims grounded in historical embodiment can sometimes override or exclude moral claims grounded in current embodiment. I close by considering how advance directives grounded in historical embodiment might be employed in practice and what they would and would not justify. (shrink)

Most business ethicists maintain that corporate actors are subject to a variety of moral obligations. However, there is a persistent and underappreciated concern that the competitive pressures of the market somehow provide corporate actors with a far-reaching excuse from meeting these obligations. Here, we assess this concern. Blending resources from the history of philosophy and strategic management, we demonstrate the assumptions required for and limits of this excuse. Applying the idea of ‘the state of nature’ from Thomas Hobbes, we suggest (...) that corporate actors would be excused from duties if complying with them threatened their vital interests. We show how this excuse is not available for most individuals within firms; instead, it is an excuse perhaps available to firms themselves, but only given substantive assumptions about corporate personhood. For those willing to make these assumptions, we apply the competitive advantage construct to delimit the scope of this excuse. We suggest that firms are excused from fulfilling an obligation when complying leads to a competitive disadvantage, as this imperils the firm’s vital interests. After revealing why this excuse does not generalize, we conclude by considering when we should reform the market to avoid the legitimacy of this excuse. (shrink)

Technological and societal changes have made downward social and economic mobility a pressing issue in real-world politics. This article argues that a Rawlsian society would not provide any special protection against downward mobility, and would act rightly in declining to provide such protection. Special treatment for the downwardly mobile can be grounded neither in Rawls’s core principles—the basic liberties, fair equality of opportunity, and the difference principle—nor in other aspects of Rawls’s theory. Instead, a Rawlsian society is willing to sacrifice (...) particular individuals’ ambitions and plans for the achievement of justice, and offers those who lose out from justified change no special solicitude over and above the general solicitude extended to all. Rather than guaranteeing the maintenance of any particular individual or group’s economic position, it provides all of its members—the upwardly mobile, the downwardly mobile, and the immobile—a form of security that is at once more generous and more limited: that they will receive the liberties, opportunities, and resources promised by the principles of justice. (shrink)

This article proposes a novel strategy, one that draws on insights from antidiscrimination law, for addressing a persistent challenge in medical ethics and the philosophy of disability: whether health systems can consider quality of life without unjustly discriminating against individuals with disabilities. It argues that rather than uniformly considering or ignoring quality of life, health systems should take a more nuanced approach. Under the article's proposal, health systems should treat cases where quality of life suffers because of disability-focused exclusion or (...) injustice differently from cases where lower quality of life results from laws of nature, resource scarcity, or appropriate tradeoffs. Decisionmakers should ignore quality-of-life losses that result from injustice or exclusion when ignoring them would improve the prospects of individuals with disabilities; in contrast, they should consider quality-of-life losses that are unavoidable or stem from resource scarcity or permissible tradeoffs. On this proposal, while health systems should not amplify existing injustice against individuals with disabilities, they are not required to altogether ignore the potential effects of disability on quality of life. (shrink)

Justin Garson introduces the distinction between two views on Madness we encounter again and again throughout history: Madness as dysfunction, and Madness as strategy. On the latter view, Madness serves some purpose for the person experiencing it, even if it’s simultaneously harmful. The strategy view makes intelligible why Madness often holds a certain allure – even when it’s prima facie terrifying. Moreover, if Madness is a strategy in Garson’s metaphorical sense – if it serves a purpose – it makes sense (...) to use consciously chosen strategies for living with Madness that doesn’t necessarily aim to annihilate or repress it as far as possible. In this paper, we use our own respective stories as case studies. We have both struggled to resist the allure of Madness, and both ended up embracing a kind of Pyrrhonian scepticism about reality instead of clinging to sane reality. (shrink)

The Gamer’s Dilemma is based on the intuitions that in single-player video games fictional acts of murder are seen as morally acceptable whereas fictional acts of sexual assault are seen as morally unacceptable. Recently, it has been suggested that these intuitions may apply across different forms of media as part of a broader Paradox of Fictionally Going Too Far. This study aims to empirically explore this issue by determining whether fictional murder is seen as more morally acceptable than fictional sexual (...) assault across different media types, and whether audio-visuality and the degree of agency afforded by the medium influences these judgments. An experimental survey study was developed where participants responded to imaginary fictional scenarios as part of a 2 (engages with fictional murder or fictional sexual assault) X 2 (in a high or low agency) X 2 (audio-visual or non-audio-visual medium) factorial design. It was found that fictional murder was seen to be more morally acceptable than fictional sexual assault across all media types, providing empirical support for the Paradox of Fictionally Going Too Far. It was also found that the audio-visuality and degree of agency influenced judgments of moral acceptability. (shrink)

The U.S. FDA has issued emergency use authorizations for monoclonal antibodies for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA’s Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (...) with increased infectivity and/or severity emerge, further rationing may be required. We identify relevant ethical principles and priority groups for access to therapies based on an integrated approach to population health and medical factors. Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors. (shrink)

This chapter discusses how justice applies to public health. It begins by outlining three different metrics employed in discussions of justice: resources, capabilities, and welfare. It then discusses different accounts of justice in distribution, reviewing utilitarianism, egalitarianism, prioritarianism, and sufficientarianism, as well as desert-based theories, and applies these distributive approaches to public health examples. Next, it examines the interplay between distributive justice and individual rights, such as religious rights, property rights, and rights against discrimination, by discussing examples such as mandatory (...) treatment and screening. The chapter also examines the nexus between public health and debates concerning whose interests matter to justice (the “scope of justice”), including global justice, intergenerational justice, and environmental justice, as well as debates concerning whether justice applies to individual choices or only to institutional structures (the “site of justice”). The chapter closes with a discussion of strategies, including deliberative and aggregative democracy, for adjudicating disagreements about justice. (shrink)

It is still a live question in epistemology and philosophy of science as to what exactly evidence is. In my view, evidence consists in experiences called “seemings.” This view is a version of the phenomenal conception of evidence, the position that evidence consists in nonfactive mental states with propositional content. This conception is opposed by sense-data theorists, disjunctivists, and those who think evidence consists in physical objects or publicly observable states of affairs—call it the courtroom conception of evidence. Thomas Kelly (...) has recently argued that the phenomenal conception cannot play all the roles evidence plays and is thus inadequate. Having first explained the nature of seemings, in this essay I utilize Kelly’s own understanding of the four major roles of evidence and argue that the phenomenal conception can play each one. Experience is a good candidate for evidence. (shrink)

This chapter examines how social- scientific research on public preferences bears on the ethical question of how those resources should in fact be allocated, and explain how social-scientific researchers might find an understanding of work in ethics useful as they design mechanisms for data collection and analysis. I proceed by first distinguishing the methodologies of social science and ethics. I then provide an overview of different approaches to the ethics of allocating scarce medical interventions, including an approach—the complete lives system—which (...) I have previously defended, and a brief recap of social-scientific research on the allocation of scarce medical resources. Following these overviews, I examine different ways in which public preferences could matter to the ethics of allocation. Last, I suggest some ways in which social scientists could learn from ethics as they conduct research into public preferences regarding the allocation of scarce medical resources. (shrink)

The existence of God is once again the focus of vivid philosophical discussion. From the point of view of analytic theology, however, people often talk past each other when they debate about the putative existence or nonexistence of God. In the worst case, for instance, atheists deny the existence of a God, which no theists ever claimed to exist. In order to avoid confusions like this we need to be clear about the function of the term 'God' in its different (...) contexts of use. In what follows, I distinguish between the functions of 'God' in philosophical contexts on the one hand and in theological contexts on the other in order to provide a schema, which helps to avoid confusion in the debate on the existence or non-existence of God. (shrink)

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

A fundamental question asked in modal logic is whether a given theory is consistent. But consistent with what? A typical way to address this question identifies a choice of background knowledge axioms (say, S4, D, etc.) and then shows the assumptions codified by the theory in question to be consistent with those background axioms. But determining the specific choice and division of background axioms is, at least sometimes, little more than tradition. This paper introduces generic theories for propositional modal logic (...) to address consistency results in a more robust way. As building blocks for background knowledge, generic theories provide a standard for categorical determinations of consistency. We argue that the results and methods of this paper help to elucidate problems in epistemology and enjoy sufficient scope and power to have purchase on problems bearing on modalities in judgement, inference, and decision making. (shrink)

Countermeasures for mpox (formerly known as monkeypox), primarily vaccines, have been in limited supply in many countries during outbreaks. Equitable allocation of scarce resources during public health emergencies is a complex challenge. Identifying the objectives and core values for the allocation of mpox countermeasures, using those values to provide guidance for priority groups and prioritisation tiers, and optimising allocation implementation are important. The fundamental values for the allocation of mpox countermeasures are: preventing death and illness; reducing the association between death (...) or illness and unjust disparities; prioritising those who prevent harm or mitigate disparities; recognising contributions to combating an outbreak; and treating similar individuals similarly. Ethically and equitably marshalling available countermeasures requires articulating these fundamental objectives, identifying priority tiers, and recognising trade-offs between prioritising the people at the highest risk of infection and the people at the highest risk of harm if infected. These five values can provide guidance on preferable priority categories for a more ethically sound response and suggest methods for optimising allocation of countermeasures for mpox and other diseases for which countermeasures are in short supply. Properly marshalling available countermeasures will be crucial for future effective and equitable national responses to outbreaks. (shrink)

-/- This chapter evaluates the ethical issues that using cost-effectiveness considerations to set animal health priorities might present, and its conclusions are cautiously optimistic. While using cost-effectiveness calculations in animal health is not without ethical pitfalls, these calculations offer a pathway toward more rigorous priority-setting efforts that allow money spent on animal well-being to do more good. Although assessing quality of life for animals may be more challenging than in humans, implementing prioritization based on cost-effectiveness is less ethically fraught.

We argue that the universal recommendations against “off-label” pediatric use of approved COVID-19 issued by the FDA, CDC, and AAP are overbroad. Especially for higher-risk children, vaccination can be ethically justified even before FDA authorization or approval – and similar reasoning is relevant for even younger patients. Legal risks can also be managed, although the FDA, CDC, and Department of Health and Human Services (HHS) should move quickly to provide clarity.

From the mid-1960s until the late 1980s, the well-known general philosophies of science of the time were applied to economics. The result was disappointing: none seemed to fit. This paper argues that this is due to a special feature of economics: it possesses ‘orientational paradigms’ in high number. Orientational paradigms are similar to Kuhn’s paradigms in that they are shared across scientific communities, but dissimilar to Kuhn’s paradigms in that they are not generally accepted as valid guidelines for further research. (...) As will be shown by several examples, orientational paradigms provide economics with common points of reference that support its epistemic coherence and make scientific discourse more easily possible across school boundaries. With the help of systematicity theory, a newer general philosophy of science, one can further elucidate the role of orientational paradigms with regard to scientific progress. (shrink)

The article traces the evolution and crystallization of Buber’s philosophy of dialogue. It focuses on his consideration of the epistemological and ontological issues attendant to the principium individuationis, the subject of his doctoral dissertation of 1904. Culminating with the publication of Ich und Du in 1923, this process was punctuated by life experiences that led him to affirm rather than to seek to transcend the principium individuationis as the ontological ground of being manifest in the matrix of everyday life, which (...) we are beckoned to sanctify through I-Thou relations. (shrink)

When life-saving medical resources are scarce and not everyone can be saved, is the only relevant goal saving the most lives? Or can other factors be considered, at least as tiebreakers, such as how early in life the people we don't save will die or how much future life they are likely to lose? This commentary defends a multiprinciple allocation approach that considers objectives in addition to saving more lives, including preventing early death and preventing harm in the form of (...) lost future life. Particularly compared to an arbitrary, coin-flip tiebreaker, this multiprinciple approach more effectively prevents harm, prioritizes the worst-off, mitigates socioeconomic and racial health disparities, and tracks public values regarding allocation under scarcity—and is legally sound. -/- . (shrink)

There is a close systematic relationship between panentheism, as a metaphysical theory about the relation between God and the world, and transhumanism, the ethical demand to use the means of the applied sciences to enhance both human nature and the environment. This relationship between panentheism and transhumanism provides a ‘cosmic’ solution to the problem of evil: on panentheistic premises, the history of the world is the one infinite life of God, and we are part of the one infinite divine being. (...) We ourselves are therefore responsible for the future development of the life of the divine being. We should therefore use the means provided by the natural sciences to develop the history of the world in such a way that the existence of evil shall be overcome and shall no longer be part of the divine being in whom we move and live and have our being. The metaphysics of panentheism leads to the ethics of transhumanism. (shrink)

This article examines a fundamental question of justice in global health. Is it ethically preferable to provide a larger number of people with cheaper treatments that are less effective (or more toxic), or to restrict treatments to a smaller group to provide a more expensive but more effective or less toxic alternative? We argue that choosing to provide less effective or more toxic interventions to a larger number of people is favored by the principles of utility, equality, and priority for (...) those worst-off. Advocates are mistaken to demand that medical care provided in low-income and middle-income countries should be the same as in high-income countries. (shrink)

The assumption that procuring more organs will save more lives has inspired increasingly forceful calls to increase organ procurement. This project, in contrast, directly questions the premise that more organ transplantation means more lives saved. Its argument begins with the fact that resources are limited and medical procedures have opportunity costs. Because many other lifesaving interventions are more cost‐effective than transplantation and compete with transplantation for a limited budget, spending on organ transplantation consumes resources that could have been used to (...) save a greater number of other lives. This argument has not yet been advanced in debates over expanded procurement and could buttress existing concerns about expanded procurement. To support this argument, I review existing empirical data on the cost‐effectiveness of transplantation and compare them to data on interventions for other illnesses. These data should motivate utilitarians and others whose primary goal is maximizing population‐wide health benefits to doubt the merits of expanding organ procurement. I then consider two major objections: one makes the case that transplant candidates have a special claim to medical resources, and the other challenges the use of cost‐effectiveness to set priorities. I argue that there is no reason to conclude that transplant candidates’ medical interests should receive special priority, and that giving some consideration to cost‐effectiveness in priority setting requires neither sweeping changes to overall health priorities nor the adoption of any specific, controversial metric for assessing cost‐effectiveness. Before searching for more organs, we should first ensure the provision of cost‐effective care. (shrink)

In this paper, I shall defend two main claims. First, Friedman’s famous paper “On the methodology of positive economics” (“F53”) cannot be properly understood without taking into account the influence of three authors who are neither cited nor mentioned in the paper: Max Weber, Frank Knight, and Karl Popper. I shall trace both their substantive influence on F53 and the historical route by which this influence took place. Once one has understood these ingredients, especially Weber’s ideal types, many of F53’s (...) astonishing sentences like “the more significant the theory, the more unrealistic the assumptions”, make good sense. Second, I shall claim that the much-discussed question whether Friedman’s essay espouses an instrumentalist or a realist position, is the wrong question to be asked. I shall illustrate that by a comparison with examples from physics in which also unrealistic assumptions are made. Also there, the question whether these assumptions are indicators of instrumentalism or realism is not appropriate. Cleared from these misunderstandings, F53 presents itself as an interesting and reasonable but much less controversial contribution to the methodology of economics. (shrink)

In the United States, the Presidential Commission for the Study of Bioethical Issues has proposed deliberative democracy as an approach for dealing with ethical issues surrounding synthetic biology. Deliberative democracy might similarly help us as we update the regulation of human subjects research. This paper considers how the values that deliberative democratic engagement aims to realize can be realized in a human subjects research context. Deliberative democracy is characterized by an ongoing exchange of ideas between participants, and an effort to (...) justify decisions that bind participants by appeal to reasons that the participants can understand and share. Even when unanimous agreement is not reached, the active participation of everyone along with the requirement that reasons be made accessible enhances the legitimacy of the ultimate outcome. Importantly, deliberative democratic structures avoid strict hierarchies and place participants, as much as possible, in the position of equals. Human subjects research has some features that may make deliberative democratic principles seem initially unappealing. For one, there are asymmetries in knowledge between expert researchers conducting the research and participants in the research process. For another, statistical validity is made easiest by research paradigms that produce standardized, quantitative data, which can be difficult to achieve if research participants are given the power to deliberatively reshape the research design as it progresses. These and other problems have tended to produce a human subjects research process where subjects do not actively participate in shaping research, but rather consent to a predefined set of interventions designed by expert researchers and vetted by Institutional Review Boards (IRBs). In this paper, I suggest some ways in which human subjects research could do more to realize deliberative democratic values, and, in particular, how a revised Common Rule might help to realize these values. First, research participants could be treated not as passive subjects but instead involved in research design, ethical review, and the ongoing conduct and dissemination of research. Such participation might involve, for instance, including people who have served as research subjects on IRBs, or replacing IRB oversight for certain forms of research exempted from IRB oversight under a revised Common Rule with oversight by a body of community members or research subjects. It might also involve having the oversight of research that uses more participatory models be more participatory and less hierarchical in nature. I also raise questions about the exemption of research on public benefit programs from any research-level oversight and from consent requirements. While IRBs are likely not the correct overseers, there may be good reason to view such research with a critical eye, because of its potential for long-range impacts on the lives of participants. By giving research subjects a greater voice in research that aims at fine-tuning public benefit programs on which subjects rely, a deliberative oversight process has the potential to recast research participation as a form of active democratic participation and to address a “democratic deficit” in public health. Numerous proposals regarding health care have called for greater participation by laypeople and a more nonhierarchical approach to setting health priorities. Involving lay research subjects in the conduct of public benefits research and other forms of public health research may help to further these goals. (shrink)

This chapter argues that rather than viewing transparency as a right, we should regard it as a finite resource whose allocation involves tradeoffs. It then argues that those tradeoffs should be resolved by using a multi-principle approach to distributive justice. The relevant principles include maximizing welfare, maximizing autonomy, and giving priority to the worst off. Finally, it examines some of the implications for law of recognizing the tradeoffs presented by transparency proposals.

Darcy's law is a phenomenological relationship for fluid flow rate that finds one of its principle applications in hydrology. Theoretical hydrologists rely upon a multiplicity of conceptual models to carry out approximate derivations of Darcy's law. These derivations provide structural explanations of the law; they require the application of fundamental principles, such as conservation of momentum, to idealized models of the porous media within which the flow occurs. In practice, recognition of the idealized conditions incorporated into models facilitates the empirical (...) clarification of the domain within which the law remains accurate. Structural explanations also contribute to the physical interpretation of phenomenological parameters. (shrink)

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

This paper presents a dilemma for Matthew Kramer’s view, as defended in his _Liberalism with Excellence_. A central aim of that book is to critique existing liberal perfectionist theories, which he labels “edificatory,” and to defend a different such theory, which he calls “aspirational.” Edificatory perfectionism holds that governments ought to promote citizens’ well-being directly by inducing them to live lives that are more wholesome, cultivated, or autonomous. Aspirational perfectionism, meanwhile, holds that governments ought to promote the conditions under which (...) every citizen can be warranted in harboring a strong sense of self-respect, by promoting the occurrence of outstanding achievements within society. We first argue that Kramer’s two central arguments against edificatory perfectionism, which appeal to the value of freedom and to moral integrity, fail to establish the impermissibility of edificatory policies. His critique could be salvaged by holding that the ambit of legitimate government activity is limited to the provision and distribution of primary goods. However, we argue, second, that Kramer’s own aspirational perfectionism also runs afoul of this restriction, because his conception of warranted self-respect is not a primary good. Kramer is thus faced with a choice between upholding his objections to edificatory perfectionism and maintaining the coherence of his aspirational perfectionism. -/- . (shrink)

This essay shows how John Henry Newman reconciled the certitude of faith with a fallibilist epistemology. While Newman holds that many of our beliefs are held with certitude, he does not conceive of all certitude as Cartesian, apodictic certitude. In this way, he walks a middle road between rationalism and fideism.

Alex Rosenberg’s latest book purports to establish that narrative history cannot have any epistemic value. Rosenberg argues not for the replacement of narrative history by something more science-like, but rather the end of histories understood as an account of human doings under a certain description. This review critiques three of his main arguments: 1) narrative history must root its explanations in folk psychology, 2) there are no beliefs nor desires guiding human action, and 3) historical narratives are morally and ethically (...) pernicious. Rosenberg’s book reprises themes about action explanation he first rehearsed 40 years ago, albeit with neuroscience rather than sociobiology now “preempting” explanations that trade on folk psychological notions. Although Rosenberg’s argument strategy has not altered, the review develops a number of reasons as to why his approach now lacks any plausibility as a strategy for explaining histories, much less a successful one. (shrink)

Special divine action is an integral part of the Christian worldview. In fact, the plausibility of the Christian worldview depends on and is grounded in the putative reality, and therefore possibility, of special divine action. Without special divine action, Scripture does not make sense, and without Scripture, Christianity neither. However, the possibility of special divine action is highly contested in almost every field of human enquiry. In what follows, I briefly suggest a minimal definition of special divine action and show (...) its indispensability for the internal plausibility of Christian faith. I then argue against the very possibility of special divine action. I end by way of identifying ways in which Christian theologians can respond to the arguments in order to justify the possibility of special divine action. It turns out that special divine action neither contradicts science nor metaphysics. (shrink)