Discrimination is an important real-life issue that affects many individuals and groups. It is also a fruitful field of study that intersects several disciplines and methods. This Special Section brings together papers on discrimination and prioritization in healthcare from leading scholars in bioethics and closely related fields.

With the limited initial availability of COVID-19 vaccines in the first months of 2021, decision-makers had to determine the order in which different groups were prioritized. Our aim was to find out what normative approaches to the allocation of scarce preventive resources were embedded in the national COVID-19 vaccination schedules. We systematically reviewed and compared prioritization regulations in 27 members of the European Union, the United Kingdom, and Israel. We differentiated between two types of priority categories: groups that have (...) increased infection fatality rate (IFR) compared to the average for the general population and groups chosen because their members experience increased risk of being infected (ROI). Our findings show a clear trend: all researched schedules prioritized criteria referring to IFR (being over 65 years old and coexisting health conditions) over the ROI criteria (eg occupation and housing conditions). This is surprising since, in the context of treatment, it is common and justifiable to adopt different allocation principles (eg introducing a saving more life-year approach or prioritizing younger patients). We discuss how utilitarian, prioritarian, and egalitarian principles can be applied to interpret normative differences between the allocation of curative and preventive interventions. (shrink)

I argue that many of the priority rankings that have been proposed by effective altruists seem to be in tension with apparently reasonable assumptions about the rational pursuit of our aims in the face of uncertainty. The particular issue on which I focus arises from recognition of the overwhelming importance and inscrutability of the indirect effects of our actions, conjoined with the plausibility of a permissive decision principle governing cases of deep uncertainty, known as the maximality rule. I conclude that (...) we lack a compelling decision theory that is consistent with a long-termist perspective and does not downplay the depth of our uncertainty while supporting orthodox effective altruist conclusions about cause prioritization. GPI Working Paper No. 2-2019. (shrink)

Effective altruism sounds so innocuous—who could possibly be opposed to doing good more effectively? Yet it has inspired significant backlash in recent years. This paper addresses some common misconceptions and argues that the core “beneficentric” ideas of effective altruism are both excellent and widely neglected. Reasonable people may disagree on details of implementation, but all should share the basic goals or values underlying effective altruism.

Is it appropriate to honor artists who have created great works but who have also acted immorally? In this article, after arguing that honoring involves identifying a person as someone we ought to admire, we present three moral reasons against honoring immoral artists. First, we argue that honoring can serve to condone their behavior, through the mediums of emotional prioritization and exemplar identification. Second, we argue that honoring immoral artists can generate undue epistemic credibility for the artists, which can (...) lead to an indirect form of testimonial injustice for the artists’ victims. Third, we argue, building on the first two reasons, that honoring immoral artists can also serve to silence their victims. We end by considering how we might respond to these reasons. (shrink)

Some philosophers and segments of the public think age is relevant to healthcare priority-setting. One argument for this is based in equity: “Old” patients have had either more of a relevant good than “young” patients or enough of that good and so have weaker claims to treatment. This article first notes that some discussions of age-based priority that focus in this way on old and young patients exhibit an ambiguity between two claims: that patients classified as old should have a (...) low priority, and that patients classified as young should have high priority. The author next argues, drawing on a problem raised by Christine Overall, that equity cannot justify giving “old” patients low priority, since there is wide variety in the total lifetime experiences of older people, partly influenced by gender, race, class, and disability injustice. Finally, the author suggests that there might be a limited role for age-based prioritization in the context of infant and childhood death, since those who die in childhood are always and uncontroversially among the worst-off. (shrink)

Centred on 'Foams', the third volume of his Spheres trilogy, this article questions the privilege granted by Peter Sloterdijk to motifs of inclusion and exclusion, contending that whilst his prioritization of dwelling as a central aspect of human existence provides a promising counterpoint to the dislocative and isolative effects of post-industrial capitalism, it is compromised by its dependence upon an anti-cosmopolitan outlook that views cultural distantiation as a natural and preferable state of human affairs, and valorizes a purported ontological (...) security attained through defensive postures with respect to perceived foreigners or externalities. Sloterdijk’s conceptualization of culture as a kind of immune system, it is argued, although posited as a rebuke to models of essentialism and ethno-nationalism, provides ontological support to the xenophobic critiques of immigration that are today finding increasing currency. (shrink)

States cannot legitimately enforce their borders against migrants if dominant conceptions of sovereignty inform enforcement because these conceptions undermine sufficient respect for migrants’ basic human rights. Instead, such conceptions lead states to assert total control over outsiders’ potential cross-border movements to support their in-group’s self-rule. Thus, although legitimacy requires states to prioritize universal respect for basic human rights, sovereign states today generally fail to do so when it comes to border enforcement. I contend that this enforcement could only be rendered (...) legitimate if it was predicated on more desirable conceptions of sovereignty that supported the universal prioritization of basic human rights. Specifically, desirable conceptions would not establish and require absolute state sovereignty over borders as a necessary precondition for true popular self-governance. (shrink)

Psychiatrist Stuart Grassian has proposed the term “SHU syndrome” to name the cluster of cognitive, perceptual and affective symptoms that commonly arise for inmates held in the Special Housing Units (SHU) of supermax prisons. In this paper, I analyze the harm of solitary confinement from a phenomenological perspective by drawing on Husserl’s account of the essential relation between consciousness, the experience of an alter ego and the sense of a real, Objective world. While Husserl’s prioritization of transcendental subjectivity over (...) transcendental intersubjectivity underestimates the degree to which first-person consciousness is constitutively intertwined with the embodied consciousness of others, Husserl’s phenomenology nevertheless provides a fruitful starting-point for a philosophical engagement with the psychiatric research on solitary confinement. (shrink)

Nyansa nye sika na w'akyekyere asie. One critical factor that has contributed to the spread of the virus COVID-19 and resulting illnesses and deaths is both the conceptual and the ethical confusion between the prioritization of individual rights over social duties. The adherence to the belief in the priority of rights over duties has motivated some individuals to refrain from social distancing and, as a result, has placed themselves and other individuals at serious risk to health and life. My (...) argument is that the ethical enjoinder of social duty possesses priority over the ethical value of individual rights especially in times of global crisis. I demonstrate this point by arguing that the concept of individual right is derivative from the concept of social duty and through the argument that the concept of social duty is more efficacious in addressing global threats to human life than is the concept of individual rights. What is needed is an in-depth revision of the moral ordering of rights and duties and a vision of the human being as inherently other directed with duties toward others. I shall examine two specific ethical systems, that of Confucian and African, Akan moral philosophy that exemplify such a revision of the moral order. (shrink)

Non-communicable diseases now account for the majority of the global burden of disease and an international campaign has emerged to raise their priority on the post-2015 development agenda. We argue, to the contrary, that there remain strong reasons to prioritize maternal and child health. Policy-makers ought to assign highest priority to the health conditions that afflict the worst off. In virtue of how little healthy life they have had, children who die young are among the globally worst off. Moreover, many (...) interventions to deal with the conditions that cause mortality in the young are low-cost and provide great benefits to their recipients. Consistent with the original Millennium Development Goals, the international community should continue to prioritize reductions in communicable diseases, neonatal conditions, and maternal health despite the shifts in the global burden of disease. (shrink)

Abstract - This paper primarily harps on the issue whether the admission of universals (Especially as discussed in this paper resemblance and supervenience) would impose any extra burden on the ontology. In this connection I would like to make a special mention of the fact that metaphysical issues dealt in Philosophy are quite relevant in medical ethics and management speculations or even in marketing. In this paper both the relation of Supervenience and that of Resemblance is dealt which undoubtedly helps (...) in the understanding of properties, the structure or orientation of any programming or theory. So the present paper may be a sure help in prioritization of issues in case of management study or in the removal of any disharmony generated in patients after treatment of an ailment. Keeping this in mind I have tried to analyze the almost known fact that providing an account of sameness of type is the compulsory task for any theory of Universals since unless the question of sameness of type is answered and a philosophical superstructure is unfolded the question of making or arriving at an ontology which is not unduly burdened can at all be addressed. I started with the Realist and the Nominalist. In order to arrive at this position I had first discussed about the positions of the different types of Nominalism. I have also tried to show how realism and the different forms of nominalism have made an attempt to explain the compulsory task of giving an account of sameness of type. I have seriously dealt with a very crucial point of considering resemblance as a relation and supervenience as a relation. Here one thing is stressed on namely that both supervenience and resemblance if and when considered as a dyadic universal which binds two relatas, it works as a property of a pair ( relatas). So it can very well be thought of as gaining a separate status over and above the pair that it unites. The whole discussion on a non-cumbersome ontology thus gains its strength at this point when such extra burden is ruled out by both supervenience and resemblance nominalism theory. I have made an attempt also to show that a burden less ontology can also be achieved if further questions on the issue of similarity being subjective or objective or simply as innate be addressed. (shrink)

La pandemia de la COVID-19 ha levantado sospechas de edadismo y gerontofobia en diversas prácticas de racionamiento sanitario. La edad es un criterio de triaje controvertido. En este artículo se esclarece la relevancia ética de la edad dentro de los sistemas de triaje, analizando particularmente su rol dentro de los principios de equidad y de eficiencia. La equidad requiere dar más oportunidades a aquellos que han cumplido menos ciclos vitales. La eficiencia tiene en cuenta la edad de manera subrepticia al (...) tratar de maximizar los beneficios a corto plazo (salvar vidas) y a largo plazo (salvar años de vida). Finalmente, la edad no debe ser la última ratio de las decisiones de triaje, aunque es una variable a tener en cuenta debido a su presencia implícita en principios fundamentales de priorización. The COVID-19 pandemic has raised suspicions of ageism and gerontophobia in various health rationing practices. Age is a controversial triage criterion. This article clarifies the ethical relevance of age within triage systems, particularly its role within the principles of fairness and efficiency. Fairness requires giving more opportunities to those who have completed fewer life cycles. Efficiency takes age into account surreptitiously when trying to maximize short-term (saving lives) and long-term (saving years of life) benefits. Finally, age should not be the final rationale in triage decisions, although it is a variable to be taken into account because of its implicit presence in fundamental principles of prioritization. (shrink)

Rorty regards himself as furthering the project of the Enlightenment by separating Enlightenment liberalism from Enlightenment rationalism. To do so, he rejects the very need for explicit metaphysical theorizing. Yet his commitments to naturalism, nominalism, and the irreducibility of the normative come from the metaphysics of Wilfrid Sellars. Rorty's debt to Sellars is concealed by his use of Davidsonian arguments against the scheme/content distinction and the nonsemantic concept of truth. The Davidsonian arguments are used for Deweyan ends: to advance secularization (...) and anti-authoritarianism. However, Rorty's conflation of theology and metaphysics conceals the possibility of post-theological metaphysics. The key distinction lies between “metaphysics” and “Metaphysics.” The former provisionally models the relations between different vocabularies; the latter continues theology by other means. Sellars shows how to do metaphysics without Metaphysics. This approach complements Rorty's prioritization of cultural politics over ontology and his vision of Enlightenment liberalism without Enlightenment rationalism. (shrink)

Mill thinks our attitudes should be held in a way that’s active and ‘alive’. He believes attitudes that lack these qualities—those held dogmatically, or in unreflective conformity—are inimical to our well-being. This claim then serves as a premiss in his argument for overarching principles of liberty. He argues that attitudinal vitality, in the relevant sense, relies upon people experiencing attitudinal conflict, and that this necessitates a prioritization of personal liberties. I argue that, pace Mill, contestation isn’t required for attitudinal (...) vitality. I describe one species of attitudinal vitality that isn’t reliant upon conflict. (shrink)

This article considers the contemporary effective altruism (EA) movement from a classical Indian Buddhist perspective. Following barebones introductions to EA and to Buddhism (sections one and two, respectively), section three argues that core EA efforts, such as those to improve global health, end factory farming, and safeguard the long-term future of humanity, are futile on the Buddhist worldview. For regardless of the short-term welfare improvements that effective altruists impart, Buddhism teaches that all unenlightened beings will simply be reborn upon their (...) deaths back into the round of rebirth (samsāra), which is held to be undesirable due to the preponderance of duhkha (unsatisfactoriness, dis-ease, suffering) over well-being that characterizes unenlightened existence. This is the samsāric futility problem. Although Buddhists and effective altruists disagree about what ultimately helps sentient beings, section four suggests that Buddhist-EA dialogue nonetheless generates mutually-instructive insights. Buddhists – including contemporaries, such as those involved in Socially Engaged Buddhism – might take from EA a greater focus on explicit prioritization research, which seeks knowledge of how to do the most good we can, given our finite resources. EA, for its part, has at least two lessons to learn. First, effective altruists have tended to assume that the competing accounts of welfare converge in their practical implications. The Buddhist conception of the pinnacle of welfare as a state free from duhkha and, correspondingly, the Buddhist account of the path that leads to this state weigh against this assumption. Second, contrasting Buddhist with effective altruist priorities shows that descriptive matters of cosmology, ontology, and metaphysics can have decisive practical implications. If EA wants to give a comprehensive answer to its guiding question – “how can we do the most good?” – it must argue for, rather than merely assume, the truth of secular naturalism. (shrink)

Companies committed to corporate social responsibility should ensure that their managers possess the appropriate competencies to effectively manage the CSR adaptation process. The literature provides insights into the individual competencies these managers need but fails to prioritize them and adequately contextualize them in a manner that makes them meaningful in practice. In this study, we contextualized the competencies within the different job roles CSR managers have in the CSR adaptation process. We interviewed 28 CSR managers, followed by a survey to (...) explore the relative importance of the competencies within each job role. Based on our analysis, we identified six distinct managerial roles, including strategic, coordinating, and stimulating roles. Next, we identified per role key individual CSR-related competencies as prioritized by the respondents. Our results show that the context, as indicated in this study by CSR managers’ job roles, indeed influenced the importance of particular CSR-related competencies, because each role seems to require a different combination and prioritization of these competencies. Moreover, the results suggest that the relative importance of these competencies within each role may be driven by business logic rather than an idealistic logic. The results are presented as a competence profile which can serve as a reflection tool and as a frame of reference to further develop the competence profile for CSR managers. (shrink)

Amartya Sen argues that sectarian discord and violence are fueled by confusion about the nature of identity, including the pervasive tendency to see ourselves as members of singular social groups standing in opposition to other groups (e.g. Democrat vs. Republican, Muslim vs. Christian, etc.). Sen defends an alternative model of identity, according to which we all inevitably belong to a plurality of discrete identity groups (including ethnicities, classes, genders, races, religions, careers, hobbies, etc.) and are obligated to choose, in any (...) given context, which among our multiple affiliations to prioritize. While Sen’s model of discrete identity prioritization is a clear advance over single-factor accounts, it overlooks significant lessons about identity from over 150 years of scholarship by feminists of color. In ignoring the experiences of women of color, Sen’s model falsely assumes that identities are in-principle separable for the purposes of practical deliberation; and, in obligating individuals to make such identity-based “reasoned choices,” Sen’s model forces those with multiply marginalized identities to choose from a set of externally defined identity options, none of which sufficiently captures their experiences. (shrink)

Not the publicly asserted reasons (humanitarianism and self-defense) but cooptation of oil reserves was the objective behind the US invasion of Iraq in 2003. This underlying motive utterly fails to satisfy just war jus ad bellum conditions. This prioritization of petroleum is well documented and is consistent with decades old US policy towards the Middle East, especially as codified by Anthony Cordesman in 1998 and US DoD's Strategic Assessment 1999 and then adopted by Bush II. This fraudulent use of (...) military force raises a question as to how motives for war can be accurately identified prior to falsely justified belligerence. Some positive signs are noted herein as to political philosophers' better use of Rawls's reflective equilibrium. (shrink)

Companies committed to corporate social responsibility (CSR) should ensure that their managers possess the appropriate competencies to effectively manage the CSR adaptation process. The literature provides insights into the individual competencies these managers need but fails to prioritize them and adequately contextualize them in a manner that makes them meaningful in practice. In this study, we contextualized the competencies within the different job roles CSR managers have in the CSR adaptation process. We interviewed 28 CSR managers, followed by a survey (...) to explore the relative importance of the competencies within each job role. Based on our analysis, we identified six distinct managerial roles, including strategic, coordinating, and stimulating roles. Next, we identified per role key individual CSR-related competencies as prioritized by the respondents. Our results show that the context, as indicated in this study by CSR managers’ job roles, indeed influenced the importance of particular CSR-related competencies, because each role seems to require a different combination and prioritization of these competencies. Moreover, the results suggest that the relative importance of these competencies within each role may be driven by business logic rather than an idealistic logic. The results are presented as a competence profile which can serve as a reflection tool and as a frame of reference to further develop the competence profile for CSR managers. (shrink)

Feelings of belonging are integral in people’s choice of what career to pursue. Women and men are disproportionately represented across careers, starting with academic training. The present research focuses on two fields that are similar in their history and subject matter but feature inverse gender gaps—psychology (more women than men) and philosophy (more men than women)—to investigate how theorized explanations for academic gender gaps contribute to feelings of belonging. Specifically, we simultaneously model the relative contribution of theoretically relevant individual differences (...) (empathizing, systematizing, and intellectual combativeness) as well as life goals (prioritization of family, money, and status) to feelings of belonging and majoring in psychology or philosophy. We find that men report higher intellectual combativeness than women, and intellectual combativeness predicts feelings of belonging and majoring in philosophy over psychology. Although systematizing and empathizing are predictive of belonging and, in turn, majoring in psychology and philosophy, respectively, when other factors are taken into account, women and men do not differ in empathizing and systematizing. Women, more than men, report prioritizing having a family, wealth, and status in choosing a career, and these directly or indirectly feed into feelings of belonging and majoring in psychology, in contrast to prior theory. Together, these findings suggest that students’ perceptions of their own combativeness and the extent to which they desire money and status play essential roles in women’s feeling they belong in psychology and men’s feeling they belong in philosophy. (shrink)

For Hegel, personhood is developed primarily through the possession, ownership, and exchange of property. Property is crucial for individuals to experience freedom as persons and for the existence of Sittlichkeit, or ethical life within a community. The free exchange of property serves to develop individual personalities by mediating our intersubjectivity between one another, whereby we share another’s subjective experience of the object by recognizing their will in it and respecting their ownership of it. This free exchange is grounded the abstract (...) right to property which is defined by the liberal institution of private property. Like all legal/juridical rights, the abstract property right and its related institution are productions of the state, which can also claim priority over them. This prioritization reveals the dialectic inherent in the both the conception and exercise of the right, in which the private right to property at the level of civil society confronts the public right of the state, resulting in both the preservation and uplifting of the right, and, at the same time, its cancellation or annihilation. (shrink)

Progressive stacking is a strategy for prioritizing in-class contributions that allows marginalized students to speak before non-marginalized students. I argue that this strategy is both pedagogically and ethically defensible. Pedagogically, it provides benefits to all students (e.g., expanded in-class discourse) while providing special benefits (e.g., increased self-efficacy) to marginalized students, helping to address historic educational inequalities. Ethically, I argue that neither marginalized nor non-marginalized students are wronged by such a policy. First, I present a strategy for self-disclosure that reduces the (...) risk of inadvertent, unwanted disclosure while respecting marginalized student autonomy in a manner analogous to accommodations provided under the Americans with Disabilities Act. Second, I argue that non-marginalized students are not wronged because such students are not silenced during discussion and because non-marginalized students benefit from the prioritization of marginalized voices. (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.

This essay attempts to explain the traditional and contemporary philosophical neglect of disability by arguing that the philosophical prioritization of rationality leads to a distinctly philosophical conception of disability as a negative category of non-normative embodiment. I argue that the privilege given to rationality as distinctive of what it means to be both a human subject and a moral agent informs supposedly rational norms of human embodiment. Non-normative types of embodiment in turn can only be understood in contradistinction to (...) these rationalized norms, which are predicated on the elimination of certain features and types of embodiment deemed inimical to reason. To establish this thesis, I focus on Platonic philosophy and the Republic as Platonic conceptions of reason and normative types of embodiment have a historical and conceptual influence on contemporary assumptions concerning rational human nature, medicine, mental health, vice, disease, and impairment. (shrink)

Ethical considerations play a key role in the proposed frameworks for COVID-19 vaccine allocation. Based on a set of ethical principles, these frameworks make recommendations on those who should be prioritized for vaccination. WHO Strategic Advisory Group of Experts of Immunization (SAGE)1, the National Academy of Medicine (NAM)2, and the Johns Hopkins Center for Health Security (JHCHS)3 have issued frameworks for allocation and prioritization of COVID-19 vaccination. None of these frameworks have made any recommendations as to the prioritization (...) of those who have not yet been infected with SARS-CoV-2 (non-infected group) over those who have been infected previously (infected group). Does this imply that giving priority to the non-infected group is not justified from the ethical perspective of these frameworks? In the following, we review the ethical foundations of these frameworks and show that prioritization of the non-infected group is not only consistent with, but also implied by, these ethical foundations. (shrink)

Caritas in Veritate leaves us with a question, Does Benedict XVI see politics as a practice or as an institution? How one answers this question has tremendous implications for how one should address the inequalities of contemporary society and the increasing globalization of the world. Alasdair MacIntyre, for instance, would consider politics to be primarily a practice with a good internal to its activities. This good consists in rational deliberation with others about the common good. If one considers politics an (...) institution, however, as seems to be the case with Jacques Maritain, then one pays less attention to the common good and more attention to the mechanics of the political institution. The difference in understanding goes a long way toward how one conceives of, determines, and achieves the common good, a central task for Catholic social teaching. It also prefigures whether and how one can justify self-sacrifice for the common good, demanded of police officers and soldiers, for instance, as well as whether and how one prioritizes the practices of a given political community. Caritas in Veritate (CIV) brings to the forefront issues of self-sacrifice and prioritization of practices at the global level. This paper shall address the position Benedict XVI lays out on globalization with reference to a global politics through the lens of the common good and the distinction between practice and institution. (shrink)

Climate change increasingly impacts the resilience of ecosystems and agricultural production. On the one hand, changing weather patterns negatively affect crop yields and thus global food security. Indeed, we live in an age where more than one billion people are going hungry, and this number is expected to rise as climate-induced change continues to displace communities and thus separate them from their means of food production (Internal Displacement Monitoring Centre 2015). In this context, if one accepts a humancentric ethic, then (...) the focus would be on addressing impacts to agricultural production, and thus food security (Borlaug 1997; Navin 2012). On the other hand, ecological resilience is also being impacted by climate change, as species go extinct or migrate due to fluctuating temperatures and shifting weather patterns. This reduction of resilience negatively impacts ecosystem services and the ability of the natural world to support life (Palmer and Larson 2014; Urban 2015). From an environmental holist perspective, then, one could argue that the ethical path would be to focus on reducing negative impacts to species and/or local ecosystems rather than increasing crop yields. Thus, there appears to be a tension between the prioritization of crop yields and the mitigation of ecosystem impacts. While this tension is well established in the agricultural literature (Kirschenmann 2010; Noll 2018), climatezas lochange exacerbates the situation, as agricultural lands are stressed and climate-induced migrations increase already high demands for foodstuffs, thus bringing the conflict to the forefront (Macdonald et al. 2015; Food and Agriculture Organization of the United Nations 2017a). (shrink)

This paper draws on Friedrich Nietzsche’s work to defend the (admittedly non-Nietzschean) conclusion that a non-liberal egalitarian society is superior in two ways: first, as a moral ideal, it does not rest on questionable claims about essential human equality and, second, such a society would provide the optimal psychological and political conditions for individual wellbeing, social stability, and cultural achievement. I first explain Nietzsche’s distinction between forms of egalitarianism: noble and slavish. The slavish form promotes equality, defined negatively as the (...) elimination of privilege. It is non-liberal in its prioritization of equality over the interests of the advantaged. Nietzsche rejects both slavish egalitarianism and liberalism for the same reasons: they questionably assume the equal value of all persons, and they harm cultural achievement, sacrificing the potential of those who are most valuable to cultural development to the interests of the majority. Noble egalitarianism, in contrast, exemplifies Nietzsche’s conception of justice as ‘equality among equals’. It demands that individuals of equal worth or power (such as members of an artistic or political elite) treat each other as what they, in fact, are: equals. It avoids asserting essential equality, demanding instead—against both slavish and liberal forms—respect on the basis of shared superiority. And it escapes the charge of harm to cultural development, commanding respect only where equality already exists. Although Nietzsche quickly assumes that ‘noble egalitarianism’ requires the rejection of all forms of universal egalitarianism, concluding that we should ‘never make equal what is unequal’, in fact it only entails the rejection of slavish methods: equalization through harm to the advantaged. However, non-liberal forms of egalitarianism can be ‘noble’, promoting equality without harm to the advantaged—through, for example, unequal distribution of resources, the equalization of economic opportunities, and economic regulation to prevent the creation of substantial wealth disparities. If egalitarianism can ‘make equal’ without slavish methods, then Nietzsche’s demand for ‘equality for equals’ applies to the newly equal, too. More importantly, his moral psychology of power—the view that our source of happiness and incentive to self-development is the feeling of power in relation to equal resistance or ‘opponents who are our equals’ —supports the superiority of a nobly-achieved, non-liberal egalitarian society. For achieved, practical equality of wealth and opportunity would optimize conditions for the feeling of power: a balance of equal, oppositional powers serving as mutual limitation and resistance. Such a society is superior in three ways. First, it maximizes social happiness by promoting and maintaining the feeling of power in all. Liberal and aristocratic societies, in contrast, allow radical inequalities that not only diminish the power of the disadvantaged, but diminish the opportunities of the advantaged to encounter equal resistance, thus undermining the happiness of all. Second, it promotes social stability by preserving a balance of powers that prevents domination and exploitation, in contrast to the inevitable class conflicts of aristocratic and liberal societies. Finally, it promotes cultural achievement, since the feeling of power in relation to proportional resistance is the psychological incentive for self-development and cultural achievement. (shrink)

Self-conflict is a feature of most women’s lives, particularly as we struggle to balance the demands of work and family. Theories of autonomy that rest on a notion of a coherent self treat self-conflict as incompatible with autonomy; therefore, women who suffer self-conflict fail to act autonomously. Though autonomy and self-conflict can be accommodated by conceiving of autonomy as a matter of degree relative to a context of choice, this result sanctions a political system that forces the prioritization of (...) one context over another. Yet choices in one context often compromise choices in another context, creating a situation where acting autonomously simultaneously diminishes autonomy. Given that autonomous choice justifies political liberalism, it is unjust that choices are set against one another in this way. Consequently, the burden on liberal governments to address the structural sources of self-conflict is far greater than is often supposed. (shrink)

The focus of the research is to develop recommendations of smart specialization (SS) for Ukrainian policymakers using European approaches. The authors revealed that the main SS projects are presented in such sectors as agri-food, industrial modernization and energy. More than 12 EU countries were the plot for conducted analysis of SS, as a result of which the level of activity of each country was determined. The creation of consortiums, including SMEs, associations, universities and other participants, disclosed the successful way of (...) SS realization. The structure of SME’s innovative potential in Ukraine was identified underlining their main characteristic features like types of innovations and innovative activity, differentiation according to enterprise size, their regional distribution. The authors explored lack of innovations on regional and national level and significant territorial disparities, which could be eliminated through policy implementation of regional SS. The existing legislative norms for possibility of SS implementation in Ukraine were analyzed due to correspondence with the EU ones. The analysis provides the opportunity to consider them only as general framework documents without any action plans and sectoral prioritization at all. The weak points of these law documents are emphasized. As a result of research, the authors developed recommendations presented by direct action plan for Ukrainian policymakers, which include such activities as underlining key priorities (especially ICT applicability in every SS project) and their correspondence with the EU ones; eliminating regional imbalances by focusing on innovation development and reorientation of some regions according to SS priorities; respecting regional existing capacities; providing organizational mechanism for cooperation of stakeholders and financial mechanism for SS support through the EU structural funds. (shrink)

Rationale, aims, and objectives: One of the sectors challenged by the COVID-19 pandemic is medical research. COVID-19 originates from a novel coronavirus (SARSCoV- 2) and the scientific community is faced with the daunting task of creating a novel model for this pandemic or, in other words, creating novel science. This paper is the first part of a series of two papers that explore the intricate relationship between the different challenges that have hindered biomedical research and the generation of scientific knowledge (...) during the COVID-19 pandemic. Methods: During the early stages of the pandemic, research conducted on hydroxychloroquine (HCQ) was chaotic and sparked several heated debates with respect to the scientific methods used and the quality of knowledge generated. Research on HCQ is used as a case study in both papers. The authors explored biomedical databases, peer-reviewed journals, pre-print servers, and media articles to identify relevant literature on HCQ and COVID-19, and examined philosophical perspectives on medical research in the context of this pandemic and previous global health challenges. Results: This paper demonstrates that a lack of prioritization among research questions and therapeutics was responsible for the duplication of clinical trials and the dispersion of precious resources. Study designs, aimed at minimising biases and increasing objectivity, were, instead, the subject of fruitless oppositions. The duplication of research works, combined with poor-quality research, has greatly contributed to slowing down the creation of novel scientific knowledge. Conclusions: The COVID-19 pandemic presented challenges in terms of (1) finding and prioritising relevant research questions and (2) choosing study designs that are appropriate for a time of emergency. (shrink)

Rationale, aims and objectives: The COVID-19 pandemic has impacted every facet of society, including medical research. This paper is the second part of a series of articles that explore the intricate relationship between the different challenges that have hindered biomedical research and the generation of novel scientific knowledge during the COVID-19 pandemic. In the first part of this series, we demonstrated that, in the context of COVID-19, the scientific community has been faced with numerous challenges with respect to (1) finding (...) and prioritizing relevant research questions and (2) choosing study designs that are appropriate for a time of emergency. Methods: During the early stages of the pandemic, research conducted on hydroxychloroquine (HCQ) sparked several heated debates with respect to the scientific methods used and the quality of knowledge generated. Research on HCQ is used as a case study in both papers. The authors explored biomedical databases, peerreviewed journals, pre-print servers and media articles to identify relevant literature on HCQ and COVID-19, and examined philosophical perspectives on medical research in the context of this pandemic and previous global health challenges. Results: This second paper demonstrates that a lack of research prioritization and methodological rigour resulted in the generation of fleeting and inconsistent evidence that complicated the development of public health guidelines. The reporting of scientific findings to the scientific community and general public highlighted the difficulty of finding a balance between accuracy and speed. Conclusions: The COVID-19 pandemic presented challenges in terms of (3) evaluating evidence for the purpose of making evidence-based decisions and (4) sharing scientific findings with the rest of the scientific community. This second paper demonstrates that the four challenges outlined in the first and second papers have often compounded each other and have contributed to slowing down the creation of novel scientific knowledge during the COVID-19 pandemic. (shrink)

As in other branches of social sciences, many studies on altruism have been conducted in the field of psychology. Altruism, which is at the intersection point of social psychology, positive psychology and the psychology of religion, is based on the prioritization of the other rather than oneself. Providing a roadmap for social relations, religions glorifies altruistic behavior. For this reason, it has been accepted that there is a natural relationship between altruism and religious attachment. In this article, the relationship (...) between altruism and religious attitude is examined through university students from different departments. The study, which involves 334 undergraduate students, uses The Altruism Scale developed by Ümmet, Ekşi and Otrar (2013) and the Religious Attitude Scale developed by Ok (2011). As a result of the research, it is determined that there is a positive significant correlation (r =, 360, p <, 001) between the level of religiousness and altruism. When comparing the departments, the lowest level of altruism is found to be psychology (3.76), and the highest level to be theology (4.08). The field of health (3.98) and social and humanities (3.93) follow theology, respectively. According to the LSD test results, the differences between psychology and theology, health and social and humanities are significant. When analyzed in terms of sub-dimensions, a significant difference is found between the departments in "participation in voluntary activities", "financial assistance", "assistance in traumatic situations" and "assistance based on physical strength". There is no such difference in the other three sub-dimensions. While the highest score in the sub-dimension of "help in traumatic situations" belongs to the field of social sciences and humanities, the highest score in all other sub-dimensions belongs to the field of theology. (shrink)

Suppose you want to do as much good as possible. What should you do? According to members of the effective altruism movement—which has produced much of the thinking on this issue and counts several moral philosophers as its key protagonists—we should prioritise among the world’s problems by assessing their scale, solvability, and neglectedness. Once we’ve done this, the three top priorities, not necessarily in this order, are (1) aiding the world’s poorest people by providing life-saving medical treatments or alleviating poverty (...) itself, (2) preventing global catastrophic risks, such as those posed by nuclear war or rogue artificial intelligence, and (3) ending factory farming. These claims are both plausible and striking. If correct, they should prompt a stark revision of how we approach our altruistic activities. However, the project of determining how to do the most good—as opposed to say, whether we should do the most good—has only recently, within the last ten years, become the subject of serious academic attention. Many key claims have not yet been carefully scrutinised. This is a cause for concern: are effective altruists doing good badly? In this thesis, I critique and develop some of the latest claims about how individuals can do the most good. I do this in three areas: the value of saving lives (preventing premature deaths), how best to improve lives (making people happier during their lives), and cause prioritisation methodology (frameworks for determining which problems are the highest priorities). In each case, I raise novel theoretical considerations that, when incorporated, change the analysis. Roughly speaking, my main conclusions are (1) saving lives is not as straightforwardly good we tend to suppose, may not be good at all, and is not clearly a priority; (2) happiness can be measured through self-reports and, based on the self-reported evidence, treating mental health stands out as an overlooked problem that may be an even more cost-effective way to improve lives than alleviating poverty; (3) the cause prioritisation methodology proposed by effective altruists needs to be moderately reconceptualised and, when it is, it turns out it is not as illuminating a tool as we might have thought and hoped. (shrink)

I argue that excessive reliance on the notion of “the badness of death” tends to lead theorists astray when thinking about healthcare prioritisation. I survey two examples: the confusion surrounding the “time-relative interests account” of the badness of death, and a confusion in the recent literature on cost-benefit analyses for family planning interventions. In both cases, the confusions in question would have been avoided if (instead of attempting to theorise in terms of the badness of death) theorists had forced themselves (...) first to write down an appropriate value function, and then focused on the question of how to maximize value. (shrink)

Although a safe, effective, and licensed coronavirus vaccine does not yet exist, there is already controversy over how it ought to be allocated. Justice is clearly at stake, but it is unclear what justice requires in the international distribution of a scarce vaccine during a pandemic. Many are condemning ‘vaccine nationalism’ as an obstacle to equitable global distribution. We argue that limited national partiality in allocating vaccines will be a component of justice rather than an obstacle to it. For there (...) are role-based and community-embedded responsibilities to take care of one’s own, which constitute legitimate moral reasons for some identity-related prioritisation. Furthermore, a good form of vaccine nationalism prioritises one’s own without denying or ignoring duties derived from a principle of equal worth, according to which all persons, regardless of citizenship or identity, equally deserve vaccine-induced protection from COVID-19. Rather than dismissing nationalism as a tragic obstacle, it is necessary to acknowledge that a limited form of it is valuable and expresses moral commitments. Only then can one understand our world of competing obligations, a world where cosmopolitan duties of benevolence sometimes conflict with special obligations of community membership. Once these competing obligations are recognised as such, we can begin the work of designing sound ethical frameworks for achieving justice in the global distribution of a coronavirus vaccine and developing practical strategies for avoiding, mitigating or resolving conflicts of duty. (shrink)

BackgroundViral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines.Main textIn this article, we critically evaluate the most common ethical (...) arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation.ConclusionsWe argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs. (shrink)

This article applies the tools of experimental philosophy to the ongoing debate about both the theoretical viability and the practical import of partially aggregative moral theories in distributive ethics. We conduct a series of three experiments (N=383): First, we document the widespread occurrence of the intuitions that motivate this position. Our study then moves beyond establishing the existence of partially aggregative intuitions in two dimensions: First, we extend experimental work in such a way as to ascertain which amongst existing versions (...) of partial aggregation (localised vs. global) chimes more fully with moral common sense. Specifically, we document how, in tie-breaking cases, ‘irrelevant goods’ judgments (Kamm) are just as robust as the original aggregative/non-aggregative pair of judgments that constitute partial aggregation. Second, by pairing laypeople’s moral judgments in standard cases with their intuitions about the limits of permissible self-prioritisation, we investigate whether one prominent explanation of why irrelevant claims may not be aggregated (Voorhoeve’s ‘personal prerogative’ argument) can be said to underpin people’s intuitions about the (ir)relevance relation of claims in conflict cases. We close with a discussion of our findings’ practical and theoretical import and highlight avenues for future research. (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 paper makes two claims. Firstly, it shows that thinking the truth of any particular concept (such as politics) is founded upon an instrumental logic that betrays the truth of a situation. Truth cannot be thought ‘of something’, for this would fall back into a theory of correspondence. Instead, truth is a function of thought. In order to make this move to a functional concept of truth, I outline Dewey’s criticism, and two important repercussions, of dogmatically instrumental philosophy. I then (...) show how Badiou’s philosophy is indeed guilty of instrumentalisation, but emphasise that his prioritisation of truth is nevertheless important to maintain. The second claim this paper makes is that the criticism of Deleuze’s conception of truth as circular is misplaced, as it is founded on the assumption that Deleuze conceptualises the truth of objects. Instead, I show that, for Deleuze, truth is not a property of an object but of its production. To reach this conclusion, I develop what I call Dewey’s account of pragmatic instrumentalisation (as opposed to the dogmatic instrumentalisation he criticises) into Deleuze’s conceptualisation of truth as the process of making sense of our precarious world. I conclude by making some provisional remarks that Deleuze’s pragmatic account of truth paves the way for an ethics that is not founded on truths it cannot explain (i.e. God or mathematics), but as an ongoing, subversive practice. (shrink)

The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and minimising harms, mitigating unfair (...) disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children. (shrink)

It is widely accepted that a liberal state has a general duty to protect its people from undue health risks. However, the unprecedented emergent measures against the COVID-19 pandemic taken by governments worldwide give rise to questions regarding the extent to which this duty may be used to justify suspending a vaccine rollout on marginal safety grounds. -/- In this chapter, I use the case of vaccination to argue that while a liberal state has a general duty to protect its (...) people’s health, there is a limit to the measures this duty can be used to justify. First, I argue that since every available option involves different risks and benefits, the incommensurability of the involved risks and benefits forbids the prioritisation of a particular vaccine. Second, I argue that given epistemic limitations and uncertainty, policies that favour certain vaccines are not only epistemically ill-founded but also morally unacceptable. I conclude that in a highly uncertain situation such as the unfolding pandemic, the duty a liberal state ought to uphold is to properly communicate the knowns and unknowns to the general public and help people decide which option to choose for themselves. I call this duty the duty to facilitate risk-taking. (shrink)

A number of philosophers have argued that if you care about how much goodness your actions generate, or how good the state-of-affairs you actions bring about are, then your attention should be directed towards the very far future. But many don’t care about how much goodness their actions generate, nor do they care about things like “states-of-affairs”. Amongst a multitude of things, many people care about how their actions impact individuals. And they also care about the sorts of justifications they (...) are able to offer for those actions. One moral theory which captures this moral viewpoint is contractualism. In this chapter, I argue that contractualism is, in large part, incompatible with longtermism – the view that, in many contexts, we ought to do that which will most improve the prospects of future people. I then discuss what advice, if any at all, contractualism can offer to the longtermist. (shrink)

In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an important (...) higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre‐existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID‐19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives. (shrink)

The COVID-19 pandemic has been the scene of several epistemic battles at the science-society interface, creating deadlocks that have been hard to overcome. To cut through the paralysing elements of these discussions, we present an analysis of three epistemic battles, concerning empirical evidence, expertise, and model projections. Our analysis singles out a crucial factor that drives unhelpful disputes like these: the contested prioritisation of specific types of scientific knowledge, which are considered adequate for policy only if they meet predetermined standards. (...) To move beyond these deadlocks, we introduce the conceptual tools of epistemic pluralism and contextualism, which give concrete indications in the three controversies we discuss and show us the way forward in debates on science-based policy. (shrink)

Cohen’s hostility to Rawls’ justification of the Difference Principle by social facts spawned Cohen’s general thesis that ultimate principles of justice and morality are fact-insensitive, but explain how any fact-sensitive principle is grounded in facts. The problem with this thesis, however, is that when facts F ground principle P, reformulating this relation as the "fact-insensitive" conditional “If F, then P” is trivial and thus explanatorily impotent. Explanatory, hence justificatory, force derives either from subsumption under more general principles, or precisely exhibiting (...) value in light of relevant (actual or hypothetical) facts. In examples where no subsumption occurs, actual facts trivially become hypothetical facts in "fact-insensitive" conditionals, an empty formalism. Indeed, Rawls’ grounding of principles of justice in “conditions of life” can easily be reformulated as a conditional principle “sensitive” only to hypothetical such conditions, and thus formally fact-insensitive in Cohen's sense, for all Cohen’s ire against Rawls’s grounding.Moreover, any plausible “ultimate fact-insensitive principle” must be intricately qualified, which tacit ceteris paribus clauses mask. Each qualification implies prioritisation of one principle over another in conceivable circumstances, and wherever the now qualified principle is given scope, that too implies prioritisation over competing principles in typical circumstances. Any principle is thus sensitive to conceivable circumstances of application, as recognised by more sophisticated intuitionisms. Non-trivial ultimate principles – luck egalitarianism, act utilitarianism, etc. - require defense, which inevitably involves showing how they best interpret and respond to facts about human needs, goals, and capacities in predictable circumstances. Finally, the substantive debate between Rawls and Cohen about which facts are relevant to the DP is only obscured by the doctrine of fact-insensitivity. (shrink)

The COVID-19 pandemic has been overwhelming public health-care systems around the world. With demand exceeding the availability of medical resources in several regions, hospitals have been forced to invoke triage. To ensure that this difficult task proceeds in a fair and organised manner, governments scrambled experts to draft triage guidelines under enormous time pressure. Although there are similarities between the documents, they vary considerably in how much weight their respective authors place on the different criteria that they propose. Since most (...) of the recommendations do not come with ethical justifications, analysing them requires that one traces back these criteria to their underlying theories of distributive justice. In the literature, COVID-19 triage has been portrayed as a value conflict solely between utilitarian and egalitarian elements. While these two accounts are indeed the main antipodes, I shall show that in fact all four classic theories of distributive justice are involved: utilitarianism, egalitarianism, libertarianism, and communitarianism. Detecting these in the documents and classifying the suggested criteria accordingly enables one to understand the balancing between the different approaches to distributive justice—which is crucial for both managing the current pandemic and in preparation for the next global health crisis. (shrink)

Eco-Rational Education proposes an educational response to climate change, environmental degradation, and desctructive human relations to ecology through the delivery of critical land-responsive environmental education. -/- The book argues that education is a powerful vehicle for both social change and cultural reproduction. It proposes that the prioritisation and integration of environmental education across the curriculum is essential to the development of ecologically rational citizens capable of responding to the environmental crisis and an increasingly changing world. Using philosophical analysis, particularly environmental (...) philosophy, pragmatism, and ecofeminism, the book develops an understanding of contemporary issues in education, especially inquiry-based learning as pedagogy, diversifying knowledge, environmental and epistemic justice, climate change education, and citizenship education. -/- Eco-Rational Education will be of interest to researchers and post-graduate students of social and political philosophy, educational philosophy, as well as environmental philosophy, ethics, and teacher education. (shrink)

How should we think of the preferences of citizens? Whereas self-optimal policy is relatively straightforward to produce, socially optimal policy often requires a more detailed examination. In this paper, we identify an issue that has received far too little attention in welfarist modelling of public policy, which we name the "hidden assumptions" problem. Hidden assumptions can be deceptive because they are not expressed explicitly and the social planner (e.g. a policy maker, a regulator, a legislator) may not give them the (...) critical attention they need. We argue that ethical expertise has a direct role to play in public discourse because it is hard to adopt a position on major issues like public health policy or healthcare prioritisation without making contentious assumptions about population ethics. We then postulate that ethicists are best situated to critically evaluate these hidden assumptions, and can therefore play a vital role in public policy debates. (shrink)