India, despite being the world's largest vaccine manufacturer is now struggling with various unprecedented social, legal, moral issues with the ongoing Covid-19 vaccination program for 1.3 billion people, the largest democracy in the world. With three major vaccines including Covishield, homemade vaccine Covaxin, and Russia's Sputnik V, India is still facing acute scarcity of vaccines and raw material supply. This is not only unfortunate but also reveals the ethically-triggered facts about the imbalanced healthcare system between public and private sectors, (...) ineffective inequitable healthcare policies, unaccountable data reports that raise mistrust and confusion, and a deeper concern about global unfair distribution. In this paper, I have briefly discussed some unparalleled ethical issues raised from the vaccination program of India. (shrink)

In this paper I discuss justice in the distribution of resources, both within states and across different states. On one influential view, it is always unjust for one person to have less than another through no fault of her own. State borders, on this account, have no importance in determining which distributions are just. I show that an alternative approach is needed. I argue that distributions of wealth are only unjust in so far as they issue from (...) class='Hi'>unfair treatment. It follows that not all inequalities in the distribution of goods are unjust. I use these results to explain how state borders do play a role in determining which inequalities are unjust, since some of these inequalities issue from unfair treatment of citizens by the state. (shrink)

The article examines the role of ethnic favoritism in maldistribution of national resources in Kenya and discusses two broad proposals for attacking such corruption. Evidence drawn from research in Kenya disproves the view of Chabal and Daloz, who argue that Africans prefer to distribute goods according to ethnic ties, and shows that frustration with the lack of alternatives to such a system, rather than enthusiasm for it, drives cooperation with corrupt maldistribution. One solution to the problem is to decentralize government (...) so that resources are retained locally. A second solution is to attack the culture of appropriation and push for a fair evaluation of needs and the equitable distribution of national resources to where they are needed most. Drawing on the ideas of Hannah Arendt, the article proposes a modified federalism where government is small enough to enlist the help and support of locals but powerful enough to provide funds to impoverished sectors of the country. (shrink)

Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to pluralism about justice, where theorizing (...) about just principles demands paying attention to the role particular goods play in our lives. This means that different approaches to the temporal subject—as well as other relevant issues—may be appropriate for different goods, including different goods within healthcare. In particular, the paper discusses two central goods targeted by healthcare: life-saving and pain relief. The view is offered as complementary to, rather than competitive with, lifetime approaches. As such, the paper finishes by considering how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives. (shrink)

The increasing application of artificial intelligence (AI) to healthcare raises both hope and ethical concerns. Some advanced machine learning methods provide accurate clinical predictions at the expense of a significant lack of explainability. Alex John London has defended that accuracy is a more important value than explainability in AI medicine. In this article, we locate the trade-off between accurate performance and explainable algorithms in the context of distributive justice. We acknowledge that accuracy is cardinal from outcome-oriented justice because it (...) helps to maximize patients’ benefits and optimizes limited resources. However, we claim that the opaqueness of the algorithmic black box and its absence of explainability threatens core commitments of procedural fairness such as accountability, avoidance of bias, and transparency. To illustrate this, we discuss liver transplantation as a case of critical medical resources in which the lack of explainability in AI-based allocation algorithms is procedurally unfair. Finally, we provide a number of ethical recommendations for when considering the use of unexplainable algorithms in the distribution of health-related resources. (shrink)

Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but (...) the theoretical conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness. (shrink)

This paper explores the implications of extended and distributed cognition theory for our notions of personal identity. On an extended and distributed approach to cognition, external information is under certain conditions constitutive of memory. On a narrative approach to personal identity, autobiographical memory is constitutive of our diachronic self. In this paper, I bring these two approaches together and argue that external information can be constitutive of one’s autobiographical memory and thus also of one’s diachronic self. To develop this claim, (...) I draw on recent empirical work in human-computer interaction, looking at lifelogging technologies in both healthcare and everyday contexts. I argue that personal identity can neither be reduced to psychological structures instantiated by the brain nor by biological structures instantiated by the organism, but should be seen as an environmentally-distributed and relational construct. In other words, the complex web of cognitive relations we develop and maintain with other people and technological artifacts partly determines our self. This view has conceptual, methodological, and normative implications: we should broaden our concepts of the self as to include social and artifactual structures, focus on external memory systems in the (empirical) study of personal identity, and not interfere with people’s distributed minds and selves. (shrink)

Gini coefficients, which measure gross inequalities rather than their unfair components, are often used as proxy measures of absolute or relative distributive injustice in Western societies. This presupposes that the fair inequalities in these societies are small and stable enough to be ignored. This article presents a model for a series of ideal, perfectly just societies, where comfortable lives are equally available to everyone, and calculates the Gini coefficients for each. According to this model, inequalities produced by age and (...) other demographic factors, together with reasonable choices under equal opportunity, can raise the Gini coefficients for perfectly just societies to levels at least as high as those of any current Western country, and can as easily account for differences in Gini coefficients between such societies or within one such society over time. If Gini coefficients at these levels are possible for ideal societies without distributive injustice, then they should not be used as proxy measures of distributive injustice in real societies. (shrink)

To believe that every single scientist ought to be individually engaged in ethical thinking in order for science to be responsible at a collective level may be too demanding, if not plainly unrealistic. In fact, ethical labor is typically distributed across different kinds of scientists within the scientific community. Based on the empirical data collected within the Horizon 2020 ‘RRI-Practice’ project, we propose a classification of the members of the scientific community depending on their engagement in this collective (...) activity. Our classification offers, on the one hand, a model of how the ethical aspects of science are taken into consideration by scientists and, on the other, some indications on how to institutionalize ethics in science. (shrink)

Moral luck occurs when factors beyond an agent’s control affect her blameworthiness. Several scholars deny the existence of moral luck by distinguishing judging blameworthy from blame-related practices. Luck does not affect an agent’s blameworthiness because morality is conceptually fair, but it can affect the appropriate degree of blame for that agent. While separatism resolves the paradox of moral luck, we aim to show it that it needs amendment, because it is unfair to treat two equally blameworthy people unequally. We (...) argue that separatists should conceive fairness as a pro tanto reason for blame. By locating fairness as a ground for blame within a wider axiology of blame, separatism could resolve the challenge of blaming fairly. In such an axiology, reasonable and fair blame diverge. (shrink)

The purpose of this article is to highlight the clientelistic strategies and informal practices that the ruling political parties in Albania use during the elections to ensure an unfair advantage in their favour over the opposition challengers. One of the main characteristics of the political developments of the transition period in Albania since 1991 has been the flourishing of informal practices and clientelist networks of political parties within state structures, which has produced an extreme politicization of these institutions. (...) These strategies that in general terms we label as “clientelistic” and that have been used to a large extent by the incumbent political parties have had a direct negative impact on the conduct of free and fair elections in Albania by distorting their main goal: to reflect the will of the people. This is because such clientelist strategies, together with the informal practices/mechanisms that accompany them, have influenced the creation of an unlevelled playing field, and have produced a hyperincumbency advantage in the electoral contests between political parties in Albania. The case of the recent elections held in Albania on 25 April 2021 will be the empirical case of this study, in which are evidenced the electoral containment strategies and practices that the ruling political party used to provide an unfair advantage in its favour and to secure its grip on power. (shrink)

The general introduction, which is replicated across all four volumes, aims to orientate readers unfamiliar with this area of research. It provides an overview of the different approaches within distributed cognition and discussion of the value of a distributed cognitive approach to the humanities.

The paper tries to examine the effects of economic crisis on philosophical considerations of distributive justice. It tackles the problem of a radical increase in scarcity as a condition of justice. Instead of assuming a relatively fixed (“moderate”) level of scarcity as a background against which justice in distribution obtains, the paper examines what happens when this level risks falling below and how does that change our views of distributive justice. It takes upon the recent events in the United (...) States to construe a specific philosophical model and ask how crisis distribution, where that favors wealthier actors, can be justified. By analyzing the crisis distribution principle, it ultimately aims to suggest that moderate scarcity should not be seen as a mere condition, but an important and vital object of justice. As such it falls within, not beyond legitimate obligations of democratic governance. (shrink)

In several papers, I have argued for a theory of distributive justice and considered its implications. This theory includes a principle of responsibility that was endorsed by others within an account of defensive force (self-defense and defense of others). Whitley Kaufman criticizes this account which he refers to as the "distributive justice theory of self-defense" (DJ theory). In this paper, I respond to this criticism. I argue that Kaufman presents the theory inaccurately, that his standard of evaluation of the (...) theory is inadequate and that his claim that the theory should be rejected is unconvincing. (shrink)

Despite the prominence of thresholds in theories of distributive justice, there is no general account of what sort of role is played by the idea of a threshold within such theories. This has allowed an ongoing lack of clarity and misunderstanding around views that employ thresholds. In this article, I develop an account of the concept of thresholds in distributive justice. I argue that this concept contains three elements, which threshold views deploy when ranking possible distributions. These elements are (...) (i) the level of the threshold, (ii) what constitutes the value of the threshold, and (iii) how benefits above and below the threshold must be allocated. I highlight three contributions that this particular account of thresholds makes: it clarifies the nature of the shift that occurs at the threshold; it resolves a common misunderstanding about headcount principles; and it shows how the arbitrariness objection can be met. (shrink)

Equal Justice explores the role of the idea of equality in liberal theories of justice. The title indicates the book’s two-part thesis: first, I claim that justice is the central moral category in the socio-political domain; second, I argue for a specific conceptual and normative connection between the ideas of justice and equality. This pertains to the age-old question concerning the normative significance of equality in a theory of justice. The book develops an independent, systematic, and comprehensive theory of equality (...) and egalitarianism. The principal question is about the importance of equality in a theory of justice. More precisely, we should pose questions in four contracting circles: 1. Is justice the supreme value guiding our setup of the basic structure of society, or are there other, equally important values, such as recognition, care, communal belonging? 2. If justice is the highest guiding principle, which competing ideals—especially equality and freedom—ought to have precedence in a policy oriented toward justice? What status does the ideal of equality have in that framework? 3. If equality is a basic ideal of just policy, how should it be practically realized? What sort of equality (equal opportunity, equality of welfare, resource equality) should be demanded? 4. What patterned distribution of which specific goods does the ideal of equality demand? Which principles of distribution can be justified according to our justice ideal? To conclude and summarize: 5. What is the essential core of an egalitarian theory of justice, as opposed to an inegalitarian theory? These five questions structure the work’s order of argumentation. Part A elaborates the conceptual foundations and basic moral principles of justice and equality. Chapter I sets out to install justice as the central moral category in the socio-political domain. At the beginning of the first chapter, the conceptual foundations of justice are clarified. While not eliminating the classical distinctions between different forms of justice, I argue that the distributive paradigm is of primary importance. The primacy of justice in the socio-political domain is developed out of a confrontation with alternative positions, those which maintain either that justice generally, or distributive justice in particular, are subsidiary virtues. At the end of Chapter I, the first of the questions mentioned above is answered in a way that establishes justice as the guiding normative concept for the foundation and evaluation of any social order. To clarify the role of equality in a theory of justice, Chapter II separates the idea of equality into four different principles. They are organized in a way that begins with the most general and uncontroversial principle of equality, and progresses towards increasingly detailed and contested principles. There are two theses that articulate and defend the significance of equality for justice: First there is a conceptual connection between justice and equality, in that principles of formal and proportional equality are necessary in order to explicate the concept of justice. These two principles establish an unbreakable bond between justice and equality. Justice can only be explained—or so I argue—by reference to these and other (normative) principles of equality. The second thesis posits a normative relationship between justice and equality, which is disclosed by three substantive principles of equality: moral equality, the presumption of equality, and the principle of responsibility. I argue that the normative core of an egalitarian theory of justice is expressed by the latter two principles, which are themselves based on the first principle, that of moral equality. When we view one another as persons, what form of equality or equal treatment is normatively demanded? I argue that the answer to this question is given by the procedural principle of the presumption of equality: regardless of their apparent differences, all persons deserve strictly equal treatment, unless certain kinds of differences have whatever particular relevance would justify, on generally acceptable grounds, unequal treatment or unequal distribution. The justification of the presumption of equality is central to this work and has considerable importance. If the presumption principle’s validity can be justified by enlisting the principle of general justification, then the primacy of equality, and the essential argument for an egalitarian theory of justice, is established. This would likewise provide a procedure for the construction of a material theory of justice. The second question is answered thereby at the end of Chapter II: Equality should have primacy over competing ideals within a justice-oriented policy. The presumption of equality establishes this primacy and, at the same time, offers an appropriate metric and guideline for the construction of a material theory of distributive justice. The presumption of equality in Part B offers an elegant procedure for the development of a theory of distributive justice. Chapter III clearly sets out the necessary prerequisites that a theory of distribution must satisfy in order to determine a liberal-egalitarian distributional framework. We need to specify in which situation the distribution takes place; which goods are and are not to be distributed; in which respect the presumptive equality is to be produced; and by and to whom, and for what period, the relevant goods are to be distributed. The distribution is based on resources understood as general-purpose means. It is necessary to divide goods into different categories, since the justification for unequal treatment in one domain will not carry over into another. This makes presumptive equality necessarily complex. To that end, four spheres of justice are distinguished: (1) the political sphere, which involves allocating rights through the distribution of civil liberties; (2) the democratic sphere, in which political power and the rights of political participation are regulated; (3) the economic sphere, in which income and property are distributed; (4) the social sphere, in which social positions and opportunities are distributed. This framework of distributive justice answers the third of our guiding questions, about the nature of equality, in terms of equality of resources. Chapters IV and V set out the egalitarian distributive criteria for each sphere. I argue that the generally accepted, fundamental rights of classical liberalism are more effectively reconstructed by reference to the equal resource distribution presumptively required in those spheres. Chapter IV shows that when it comes to the first two spheres, those involving basic rights and freedoms and entitlement political participation, there can be no justified exceptions to the equal distribution of the relevant goods. That section argues, contrary to what we commonly find in theories of freedom or popular sovereignty, that the value of freedom and self-determination as the political basis of autonomy is best realized through the presumption of equal distribution. Chapter V deals with the other two spheres, those of economic goods and social positions, and argues for justified exceptions to equal distribution. In the economic sphere we find one principal reason favouring unequal distribution of resources, and three restrictions and compensations limiting that inequality. The basic exception to equal economic distribution arises from the unequal consequences of personal responsibility. From a suitably egalitarian standpoint, the principle of responsibility is the normative principle that determines which reasons justify economic inequality. Here the basic idea is that unequal shares of social goods are fair if they result from the choices and deliberate actions of the relevant parties. That individuals have to bear the costs of their own choices is a condition of autonomy. However, benefits or disadvantages arising from arbitrary and unmerited differences in social circumstances or natural endowments is unfair. The unequal consequences of independent decision-making and action must therefore be limited by compensating first for preferences, secondly for disadvantages, and thirdly by redistributing wealth in aid of the worse-off. I situations of emergency, compensating for disadvantages has priority over all other claims, owing to the urgency of the situation. Social inequalities go beyond the permissible limit if it is possible to improve the long-term social or economic situation of the worse-off by redistributing wealth to them. These exceptions lead to a complex system of free economic action within a framework of compensatory tax and transfer mechanisms. Finally, in the social sphere, the distribution of social positions, offices and opportunities must be structured to ensure that equally talented and motivated citizens have roughly equal chances of obtaining those offices or positions, irrespective of their economic or social class backgrounds. This compromise is permissible for reasons of freedom and prudence, and it makes a certain measure of inequality acceptable. The fourth of our guiding questions is answered accordingly. There are five principles of justice for the basic structure of society, and five legal principles that govern the special distribution of goods in the respective spheres—all are ranked according to their most defensible grounds of priority, ensuring that everyone is accorded equal justice. Chapter VI recapitulates the initial question of equality’s value. The conception of equal justice developed in this work postulates five principles of equality and five principles of law; these constitute an egalitarian framework because they support and promote social justice. Equality has value with respect to them, but is not given any independent, intrinsic value. That is why I call the account developed here a form of constitutive egalitarianism: justice is realized through the realization of equality, itself accomplished by applying the five postulates of equality and five distributive principles of law. This is an egalitarianism on two levels. The first level is involves the claim that morality or justice is conceptually connected with equality. The second level gives equality a substantial weight in what is conceptually validated at the first level, namely the presumption of equality, and constructs an appropriate interpretation and conception of distributive justice through principles of distribution for the individual spheres. The weight and importance of equality is shown by the distributive criteria applied to those spheres. This answers our final guiding question about the nature of an egalitarian theory. (shrink)

Collaborative remembering, in which two or more individuals cooperate to remember together, is an ordinary occurrence. Ordinary though it may be, it challenges traditional understandings of remembering as a cognitive process unfolding within a single subject, as well as traditional understandings of memory knowledge as a justified memory belief held within the mind of a single subject. Collaborative memory has come to be a major area of research in psychology, but it has so far not been investigated in (...) epistemology. In this chapter, we attempt an initial exploration of the epistemological implications of collaborative memory research, taking as our starting point the “extended knowledge” debate which has resulted from the recent encounter between extracranialist theories of cognition and externalist theories of knowledge (Carter et al., 2014; Carter et al., forthcoming). Various forms of socially and technologically augmented memory have played important roles in the extended knowledge debate, but the debate has so far not taken collaborative memory, in particular, into account. We will argue that collaborative memory supports a novel externalist theory of knowledge: distributed reliabilism. Distributed reliabilism departs in two important respects from both traditional reliabilism (Goldman, 2012) and updated theories such as extended (Goldberg, 2010) and social reliabilism (Goldman, 2014). First, it acknowledges that belief-forming processes may extend extracranially to include processing performed both by other subjects and by technological artifacts. Second, it acknowledges that distributed sociotechnical systems themselves may be knowing subjects. Overall, then, the main aim of the chapter is to draw out the philosophical implications of psychological research on collaborative memory. But our argument will also suggest that it may be useful to broaden the standard conception of collaborative memory to include not only the sorts of direct interactions among subjects that have been the focus of psychological research so far but also a range of more indirect, technology-supported and -mediated interactions, and it thus has implications for psychology as well. (shrink)

Chronic fatigue syndrome or myalgic encephalomyelitis remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker’s concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of (...) treatments. Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by health professionals, and many patients vocally oppose the effectiveness, and the conceptualization, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice. We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the marginalization of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. (shrink)

Lippert-Rasmussen and Petersen discuss my ‘Moral case for legal age change’ in their article ‘Age change, official age and fairness in health’. They argue that in important healthcare settings (such as distributing vital organs for dying patients), the state should treat people on the basis of their chronological age because chronological age is a better proxy for what matters from the point of view of justice than adjusted official age. While adjusted legal age should not be used in deciding (...) who gets scarce vital organs, I remind the readers that using chronological age as a proxy is problematic as well. Using age as a proxy could give wrong results and it is better, if possible, for states to use the vital information directly than use age as a proxy. (shrink)

Rare diseases pose a particular priority setting problem. The UK gives rare diseases special priority in healthcare priority setting. Effectively, the National Health Service is willing to pay much more to gain a quality-adjusted life-year related to a very rare disease than one related to a more common condition. But should rare diseases receive priority in the allocation of scarce healthcare resources? This article develops and evaluates four arguments in favour of such a priority. These pertain to public (...) values, luck egalitarian distributive justice the epistemic difficulties of obtaining knowledge about rare diseases and the incentives created by a higher willingness to pay. The first is at odds with our knowledge regarding popular opinion. The three other arguments may provide a reason to fund rare diseases generously. However, they are either overinclusive because they would also justify funding for many non-rare diseases or underinclusive in the sense of justifying priority for only some rare diseases. The arguments thus fail to provide a justification that tracks rareness as such. There are no data in this work. (shrink)

This chapter explores properties that bind individuals, knowledge, and communities, together. Section ‎‎1 introduces Hardwig’s argument from trust in others’ testimonies as entailing that trust is the glue ‎that binds individuals into communities. Section 2 asks “what grounds trust?” by exploring assessment ‎of collaborators’ explanatory responsiveness, formal indicators such as affiliation and credibility, ‎appreciation of peers’ tacit knowledge, game-theoretical considerations, and the role moral character ‎of peers, social biases, and social values play in grounding trust. Section 3 deals with establishing (...) ‎reliability standards for formation and breaching of trust. Different epistemic considerations and their ‎underpinning of inductive risks are examined through various communication routes within a ‎discipline, between disciplines, and to the public. Section 4 examines whether a collective entity can ‎be trusted over and above trust that is given to its individual members. Section 5 deals with the roles ‎technological artifacts play in distributed research and collective knowledge. It presents the common ‎view in which genuine trust cannot, in principle, be accorded to artifacts, so as an opposite view. We ‎show that what counts as a genuine object of trust is relevant to debates about the boundaries of ‎collective agency and as a criterion for extended cognitive systems.‎. (shrink)

Health policy changes in Nepal displayed struggles against a poor political, geographical, and economic setting; Millennium Development Goal #4 demanded improved infant and child mortality, as well as adequate measles vaccine coverage by the year 2015. Research in this report presents progress and direction of child health care policy across more than a decade of time in attempts of attaining MDG #4 and general child health care advancements. Subsequent observations and suggestions were delineated and offered. Progress since the 1990’s up (...) to 2012 was analyzed by review of serial national survey and report data. Trends and variations between regions were mostly analyzed amongst various child health care determinants. Results indicated many improved factors; Nepal will likely achieve MDG regarding child under-5 mortality, but may not achieve measles vaccine coverage or infant mortality goals. Furthermore, severe regional disparities were evident within Nepal, particularly in the Mid and Far-Western regions. A call for integrated community-based primary health care (CB-PHC) for infants and children became an ultimate ideal. A comprehensive, multidisciplinary, and community based primary care delivery service would address many of the deficits identified as well as reach rural and remote areas that still suffered. Risk and data-based resource allocation promise improved utilization, but also demands more frequent and better data reporting. Coordinated, multi-sector health policy initiatives have been underway; this demonstrated a strong direction in improving child health care from urban to every village. (shrink)

Artificial intelligence systems have been widely applied to various contexts, including high-stake decision processes in healthcare, banking, and judicial systems. Some developed AI models fail to offer a fair output for specific minority groups, sparking comprehensive discussions about AI fairness. We argue that the development of AI systems is marked by a central paradox: the less participation one stakeholder has within the AI system’s life cycle, the more influence they have over the way the system will function. This (...) means that the impact on the fairness of the system is in the hands of those who are less impacted by it. However, most of the existing works ignore how different aspects of AI fairness are dynamically and adaptively affected by different stages of AI system development. To this end, we present a use case to discuss fairness in the development of corporate wellness programs using smart wearables and AI algorithms to analyze data. The four key stakeholders throughout this type of AI system development process are presented. These stakeholders are called service designer, algorithm designer, system deployer, and end-user. We identify three core aspects of AI fairness, namely, contextual fairness, model fairness, and device fairness. We propose a relative contribution of the four stakeholders to the three aspects of fairness. Furthermore, we propose the boundaries and interactions between the four roles, from which we make our conclusion about the possible unfairness in such an AI developing process. (shrink)

This chapter discusses cryptocurrency, distributed ledger technology and blockchain tokens within the context of technological innovation, the history of money and accounting practices, and their multiple functionalities beyond those of standard currencies. This discussion is motivated by the design of cryptocurrencies for specific community needs, and to reflect anti-rival, positive sum value.

While psychologists and political scientists have long investigated issues of interest to philosophers, the development of political experimental philosophy has remained limited. This slow progress is surprising, given that political philosophers commonly acknowledge the relevance of empirical data for normative theorizing. In this chapter, we illustrate the importance of empirical data by outlining recent developments in three domains related to theories of justice, where empirical results reinforce or endanger popular philosophical theories. Our first showcase concerns the boundaries of the concept (...) of fairness. While both libertarian thinkers and social egalitarians have united in rejecting the concept of natural injustice, we show that people do consider that unpreventable natural inequalities can be described as unfair. Second, we take the example of impartiality devices, such as the veil of ignorance or the idea of an impartial spectator, to show that such devices are efficient at shifting people’s intuitions in a more impartial manner. Third, we review empirical data on fairness intuitions to show that people conform to a pluralist theory of justice, valuing desert, needs-satisfaction, and equality at the same time. However, distribution according to desert enjoys a privileged position: people mostly care for the satisfaction of basic needs of deserving recipients, and people are willing to tolerate large inequalities in meritocratic contexts. The centrality of desert leads to dilemmas for mainstream egalitarian theorists, as theories that do not recognize the value of desert could fail to find support or legitimacy within the population. (shrink)

There are numerous ways in which “the particular”—particular individuals, particular ideologies, values, beliefs, and perspectives—are sometimes overlooked, ignored, or even driven out of the healthcare profession. In many such cases, this is bad for patients, practitioners, and the profession. Hence, we should seek to find a place for the particular in health care. Specific topics that I examine in this essay include distribution of health care based on the particular needs of patients, the importance of protecting physicians’ right (...) to conscientious objection, the value in tolerating a plurality of moral and medical perspectives within the field, and more. Ultimately, as the imagery in the essay’s title suggests, I argue that if one cares about the “well-being” of the medical profession, then one should seek to avoid destroying the many diverse and particular entities that constitute it. (shrink)

Previously proposed strategies for tackling hermeneutical injustices take for granted the interests people have in certain things about them being intelligible to them and/or to others, and seek to enable them to satisfy these interests. Strategies of this sort I call interests-as-given strategies. I propose that some hermeneutical injustices can instead be tackled by doing away with certain of these interests, and so with the possibility of their unfair non-satisfaction. Strategies of this sort I call interests-in-question strategies. As a (...) case study in when such an interests-in-question strategy ought to be pursued, I look at how to tackle hermeneutical injustices arising in the context of gender-affirming healthcare as provided to adults by the National Health Service in the UK. I argue that considerations of trust, privacy, and respect all support pursuing such a strategy. One way to do so, I suggest, would be by replacing the existing gatekeeping model with an informed consent model for the provision of gender-affirming healthcare. Considerations of hermeneutical justice can hence be added to the already-impressive case for undertaking this shift. (shrink)

This paper introduces a new, expanded range of relevant cognitive psychological research on collaborative recall and social memory to the philosophical debate on extended and distributed cognition. We start by examining the case for extended cognition based on the complementarity of inner and outer resources, by which neural, bodily, social, and environmental resources with disparate but complementary properties are integrated into hybrid cognitive systems, transforming or augmenting the nature of remembering or decision-making. Adams and Aizawa, noting this distinctive complementarity argument, (...) say that they agree with it completely: but they describe it as “a non-revolutionary approach” which leaves “the cognitive psychology of memory as the study of processes that take place, essentially without exception, within nervous systems.” In response, we carve out, on distinct conceptual and empirical grounds, a rich middle ground between internalist forms of cognitivism and radical anti-cognitivism. Drawing both on extended cognition literature and on Sterelny’s account of the “scaffolded mind” (this issue), we develop a multidimensional framework for understanding varying relations between agents and external resources, both technological and social. On this basis we argue that, independent of any more “revolutionary” metaphysical claims about the partial constitution of cognitive processes by external resources, a thesis of scaffolded or distributed cognition can substantially influence or transform explanatory practice in cognitive science. Critics also cite various empirical results as evidence against the idea that remembering can extend beyond skull and skin. We respond with a more principled, representative survey of the scientific psychology of memory, focussing in particular on robust recent empirical traditions for the study of collaborative recall and transactive social memory. We describe our own empirical research on socially distributed remembering, aimed at identifying conditions for mnemonic emergence in collaborative groups. Philosophical debates about extended, embedded, and distributed cognition can thus make richer, mutually beneficial contact with independently motivated research programs in the cognitive psychology of memory. (shrink)

Introduction: The Kenyan government has put a spirited reform to ensure all Kenyans get universal healthcare. This has led to restructuring of several entities among them the health insurance industry. This is geared at alleviating the burden of catastrophic expenditure on health from the poor Kenyans. However, insurance uptake remains at less than a quarter of the population with many Kenyans still paying for healthcare out-of-pocket. These out-of-pocket payers often don’t afford the ever-increasing cost of healthcare in (...) Kenya. This study looked at how doctors deal with patients given their modality of payment. Methodology: This was an online based survey that was distributed to Kenyan doctors via email by Kenya Medical Association. The survey sought information from the respondents on how they dealt with patients given their modality of payment. In addition, respondents were asked to provide an example of a case they had dealt with that touched on each payment modality. Results: Respondents gave their experiences where insurance had influenced their clinical decisions. Codes developed from the prose were; “inability to pay”, “harmful to the patient”, “changed the prescription” among others Health insurance played a crucial role whenever respondents made decisions. Top on the list of things that the majority indicated would be considered is insurance status and/or their ability of patients to pay for the services. Conclusion: Respondents are stuck in a limbo; striving to give the best care to patients but limited by the patients’ inability to pay. In explaining their experiences, respondents explain a situation where they intend to offer the best, but patients cannot afford. This especially so for those without health insurance who end up either not getting services or at the very best, get inferior services. (shrink)

I analyse the impact of search engines on our cognitive and epistemic practices. For that purpose, I describe the processes of assessment of documents on the Web as relying on distributed cognition. Search engines together with Web users, are distributed assessment systems whose task is to enable efficient allocation of cognitive resources of those who use search engines. Specifying the cognitive function of search engines within these distributed assessment systems allows interpreting anew the changes that have been caused by (...) search engine technologies. I describe search engines as implementing reputation systems and point out the similarities with other reputation systems. I thus call attention to the continuity in the distributed cognitive processes that determine the allocation of cognitive resources for information gathering from others. (shrink)

How can a business institution function as an ethical institution within a wider system if the context of the wider system is inherently unethical? If the primary goal of an institution, no matter how ethical it sets out to be, is to function successfully within a market system, how can it reconcile making a profit and keeping its ethical goals intact? While it has been argued that some ethical businesses do exist, e.g., Johnson and Johnson, the argument I (...) would like to put forth is that no matter how ethical a business institution is, or how ethical its goals are, its capacity to act in an ethical manner is restricted by the wider system in which it must operate, the market system. Unless there is a fundamental change in the notion of the market system itself, the capacity for individual businesses to act in an ethical manner will always be restricted. My argument is divided into two parts. The first part is to show the inherent bias towards unethical outcomes that is inherent in the market system. The second part is to suggest how to reorient the general economic framework in order to make ethical institutions more possible. The question then becomes, how to define economic behavior in terms other than competition for profit. (shrink)

Memory is studied at a bewildering number of levels, with a vast array of methods, and in a daunting range of disciplines and subdisciplines. Is there any sense in which these various memory theorists – from neurobiologists to narrative psychologists, from the computational to the cross-cultural – are studying the same phenomena? In this exploratory position paper, I sketch the bare outline of a positive framework for understanding current work on constructive remembering, both within the various cognitive sciences, and (...) across gulfs between the cognitive and the social sciences. I pinpoint some lines of psychological theory and research which offer promising and compatible ways of thinking about individual memory and shared or social memory simultaneously. These are obviously ambitious projects, and this paper seeks more to elicit help with forging these connections than to present firm results. The aim is to draw out some consequences of empirical work on social memory and in developmental psychology. (shrink)

In this paper, we aim to show that the framework of embedded, distributed, or extended cognition offers new perspectives on social cognition by applying it to one specific domain: the psychology of memory. In making our case, first we specify some key social dimensions of cognitive distribution and some basic distinctions between memory cases, and then describe stronger and weaker versions of distributed remembering in the general distributed cognition framework. Next, we examine studies of social influences on memory in (...) cognitive psychology, and identify the valuable concepts and methods to be extended and embedded in our framework; we focus in particular on three related paradigms: transactive memory, collaborative recall, and social contagion. Finally, we sketch our own early studies of individual and group memory developed within our framework of distributed cognition, on social contagion of autobiographical memories, collaborative flashbulb memories, and memories of high school at a high school reunion. We see two reciprocal benefits of this conceptual and empirical framework to social memory phenomena: that ideas about distributed cognition can be honed against and tested with the help of sophisticated methods in the social cognitive psychology of memory; and conversely, that a range of social memory phenomena that are as yet poorly understood can be approached afresh with theoretically motivated extensions of existing empirical paradigms. (shrink)

The objective of the paper is to explore the issue that despite the absence of adequate formal and systematic ways for the poor and disadvantaged people to get access to health benefit like in a rich liberal society, there are active social customs, feelings and individual and collective responsibilities among the people that help the disadvantaged and poor people to have access to the minimum health care facility in both liberal and non-liberal poor countries. In order to explain the importance (...) and functional contribution of the social norms in this respect, some examples will be illustrated from Bangladesh which is a poor liberal country. There will be two sections of the paper. In the first section, it will be exhibited how the naturally and socially disadvantaged people in a liberal society get benefit following Rawls‟ theory of distributive justice. In the second section, it will be showed that in a poor country where there are less resources of the government to provide enough services to the poor and disadvantaged people, the communal feelings and the informal social institutions play a vital role that helps the disadvantaged and poor people to get access to the health benefit. The traditional social norms impose indirect sanction on its people to come forward to help the worse off people of the country. It is depicted that Rawlsian theory of distribution does not work properly in these countries, rather the communitarian feelings is more welcomed for the benefit of the overall welfare of the society and this will be shown in the conclusion of the paper. (shrink)

Luck egalitarianism provides a reason to object to conditionality in health incentive programmes in some cases when conditionality undermines political values such as solidarity or inclusiveness. This is the case with incentive programmes that aim to restrict access to essential healthcare services. Such programmes undermine solidarity. Yet, most people's lives are objectively worse, in one respect, in non-solidary societies, because solidarity contributes both instrumentally and directly to individuals' well-being. Because solidarity is non-excludable, undermining it will deprive both the prudent (...) and the imprudent citizens of its goods. Thereby, undermining solidarity can make prudent citizens worse off than they would have otherwise been, out of no fault or choice of their own, but rather as a result of somebody else's imprudent choice. This goes against the spirit of luck egalitarianism. Therefore (luck egalitarian) justice can require us to save the imprudent and avoid conditionality in access to essential healthcare services. (shrink)

Several attempts have been made to apply the choice-sensitive theory of distributive justice, luck egalitarianism, in the context of health and healthcare. This article presents a framework for this discussion by highlighting different normative decisions to be made in such an application, some of the objections to which luck egalitarians must provide answers and some of the practical implications associated with applying such an approach in the real world. It is argued that luck egalitarians should address distributions of health (...) rather than healthcare, endorse an integrationist theory that combines health concerns with general distributive concerns and be pluralist in their approach. It further suggests that choice-sensitive policies need not be the result of applying luck egalitarianism in this context. (shrink)

Most people are completely oblivious to the danger that their medical data undergoes as soon as it goes out into the burgeoning world of big data. Medical data is financially valuable, and your sensitive data may be shared or sold by doctors, hospitals, clinical laboratories, and pharmacies—without your knowledge or consent. Medical data can also be found in your browsing history, the smartphone applications you use, data from wearables, your shopping list, and more. At best, data about your health might (...) end up in the hands of researchers on whose good will we depend to avoid abuses of power.2 Most likely, it will end up with data brokers who might sell it to a future employer, or an insurance company, or the government. At worst, your medical data may end up in the hands of criminals eager to commit extortion or identity theft. In addition to data harms related to exposure and discrimination, the collection of sensitive data by powerful corporations risks the creation of data monopolies that can dominate and condition access to health care. -/- This chapter aims to explore the challenge that big data brings to medical privacy. Section I offers a brief overview of the role of privacy in medical settings. I define privacy as having one’s personal information and one’s personal sensorial space (what I call autotopos) unaccessed. Section II discusses how the challenge of big data differs from other risks to medical privacy. Section III is about what can be done to minimise those risks. I argue that the most effective way of protecting people from suffering unfair medical consequences is by having a public universal healthcare system in which coverage is not influenced by personal data (e.g., genetic predisposition, exercise habits, eating habits, etc.). (shrink)

Distributive justice deals with allocations of goods and bads within a group. Different principles and results of distributions are seen as possible ideals. Often those normative approaches are solely framed verbally, which complicates the application to different concrete distribution situations that are supposed to be evaluated in regard to justice. One possibility in order to frame this precisely and to allow for a fine-grained evaluation of justice lies in formal modelling of these ideals by metrics. Choosing a metric (...) that is supposed to map a certain ideal has to be justified. Such justification might be given by demanding specific substantiated axioms, which have to be met by a metric. This paper introduces such axioms for metrics of distributive justice shown by the example of needs-based justice. Furthermore, some exemplary metrics of needs-based justice and a three dimensional method for visualisation of non-comparative justice axioms or evaluations are presented. Therewith, a base worth discussing for the evaluation and modelling of metrics of distributive justice is given. (shrink)

In what follows, I appeal to Charles Babbage’s discussion of the division of mental labor to provide evidence that—at least with respect to the social acquisition, storage, retrieval, and transmission of knowledge—epistemologists have, for a broad range of phenomena of crucial importance to actual knowers in their epistemic practices in everyday life, failed adequately to appreciate the significance of socially distributed cognition. If the discussion here is successful, I will have demonstrated that a particular presumption widely held within the (...) contemporary discussion of the epistemology of testimony—a presumption that I will term the personalist requirement—fails to account for those very practices of knowers that I detail here. I will then conclude by suggesting that an alternate account of testimonial warrant, one that has heretofore been underappreciated, ought to be given more serious consideration—in particular because it is well suited to account for those actual practices of knowers that the personalist requirement leaves unrecognized. (shrink)

The paper discusses the possibility that the benefits of pharmacogenomics will not be distributed equally and will create orphan populations. I argue that since these inequalities are not substantially different from those produced by ‘traditional’ drugs and are not generated with the intention to discriminate, their production needs not be unethical. Still, the final result is going against deep-seated moral feelings and intuitions, as well as broadly accepted principles of just distribution of health outcomes and healthcare. I thus (...) propose two provisos that would prevent the most offensive outcomes and moderate the scope of the produced inequalities. The first proviso rejects pharmacogenomics innovations that worsen existing group inequalities and aggravate the disadvantage of communities with a history of discrimination. The second proviso requires that there is a strategy in place to even out as much as possible the distribution of benefits in the future and that a system of compensations is in place for pharmacogenomic orphans. Given that only one moral problem generated by pharmacogenomics has been tackled, the list of provisos might be expanded when other issues are considered. (shrink)

The need for innovative development of healthcare institutions is determined by the necessity to increase the efficiency of organizational processes based on the formation of new models of cooperation, which will make it possible to get access to new technologies and knowledge. The goal of the study is to determine the parameters of the impact of innovative open cooperation strategy and the strategy of innovative closed cooperation of healthcare institutions on the effectiveness of their organizational structure in the (...) context of dissemination and the use of knowledge. Simulation modeling was applied to generate the most effective organizational management structure in the context of innovative cooperation and knowledge exchange within the organizational processes “Inside-out” and “Inside-in”. It is substantiated that the strategies of innovative cooperation “Open Innovation/Closed Innovation” have a significant impact on the organizational structure of management of healthcare institutions in terms of the “degree of centralization” (Dci), “degree of mediation” (Dii), and “degree of centralization of powers” (Dpi). The values of the selected criteria range from 25,52% to 61,50% in the case of Dii, and from 34,53% to 52,63% in the case of Dci, which indicates a higher efficiency of organizational knowledge exchange processes in healthcare institutions, which adhere to the Open Innovation strategy of innovative cooperation. Therefore, there are significant differences in the effectiveness of the management’s organizational structure depending on the degree of openness of innovative cooperation of healthcare institutions. The strategy of innovative openness allows increasing the number and quality of connections in the context of knowledge exchange between the subjects (actors, agents) of the organizational structure (in a broad sense, considering internal and external levels of externality) of healthcare institutions, regardless of the distance between them and the level of similarity. (shrink)

Eli Feiring has developed a concept of forward-looking responsibility in healthcare. On this account, what matters morally in the allocation of scarce healthcare resources is not people's past behaviours but rather their commitment to take on lifestyles that will increase the benefit acquired from received treatment. According to Feiring, this is to be preferred over the backward-looking concept of responsibility often associated with luck egalitarianism. The article critically scrutinises Feiring's position. It begins by spelling out the wider implications (...) of Feiring's view. Against this background, it shows that (i) Feiring's distinction between backward-looking and forward-looking responsibility is incompatible with the Scanlonian notion of responsibility she apparently endorses; (ii) her favoured forward-looking notion of responsibility is subject to the objections levelled against the luck egalitarian view (whatever the strength of such objections). (shrink)

Human memory in the wild often involves multiple forms of remembering at once, as habitual, affective, personal, factual, shared, and institutional memories operate at once within and across individuals and small groups. The interdisciplinary study of the ways in which history animates dynamical systems at many different timescales requires a multidimensional framework in which to analyse a broad range of social memory phenomena. Certain features of personal memory - its development, its constructive nature, and its role in temporally extended (...) agency - make it apt for various forms of integration into larger socio-cognitive systems. Drawing on ideas from psychology, distributed cognition, and social theory, this paper aims to make conceptual space for a naturalistic ontology of collective memory. (shrink)

Substantially increased wealth inequality across the developed world has prompted many philosophers, economists and legal theorists to support comprehensive taxes on all forms of wealth. Proposals include levying taxes on the basis of total wealth, or alternatively the change in the value of capital holdings measured from year-to-year. This contrasts with most existing policies that tax capital assets at the point they are transferred from one beneficiary to another through sale or gifts. Are these tax reforms likely to meet their (...) aims of greater economic and political equality? We argue that these policies are likely to fail because, following neoclassical economic theory, they are based on a conception of capital as possessing given values in what amounts to a static equilibrium. This mischaracterizes the dynamic and subjective character of market economies and the contested value of real instantiations of capital goods. This makes them very difficult, often impossible, to value apart from at the point of voluntary transfer or profit realization. This means most taxes levied on a mark-to-market basis will be arbitrary and unfair. We propose alternative policies based on an income realization approach to taxation that are more likely to curb excessive wealth holdings. This includes introducing international treaties that prohibit preferential tax treatment for individual companies and specific sectors, and broadening the income tax base to include the imputed rent of personal housing wealth. (shrink)

We present a vignette study conducted with a quota sample of the German population (n = 400). Subjects had to redistribute a good between two hypothetical persons who contributed equally to the available amount but differed in quantity needed and the reason for their neediness. On a within-subjects level, we tested for the effects of need, accountability, and resource availability on their third-party distribution decisions. Between subjects, we further varied the kinds of needs: The persons either needed the (...) good as a means to survive, to live a decent life, to participate in society, or to be autonomous. Despite equal productivity, the mean share allocated to the needier person was significantly higher than an equal share. However, this share turned out significantly smaller when the needier person was accountable for needing more than the other. Nonetheless, even if accountable, the needier person still got a share larger than their contribution would suggest. When there was a surplus of resources, the needier person got an even higher share than when resources were scarce. (shrink)

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

Introduction: Universal health coverage (UHC) was introduced in Iran in 2014. The aim of this study was to evaluate the usage rate of health services by human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients after UHC implementation. Material and methods: In 2018, in a cross-sectional study, we evaluated the outpatients’ needs (within its previous month) and inpatients’ needs (within its previous 6 months) of HIV/AIDS patients in Isfahan province (the center of Iran). Concurrently, we estimated the essential health (...) care services that HIV/AIDS patients have to receive regularly, including vaccination for hepatitis B, measurement of CD4, tuberculosis (TB) assessments and TB treatment, anti-retroviral therapy, examination of viral load, treatment approach, and drug side effects counseling. Two checklists were used for assessing the utilization of health services and essential health cares for HIV/AIDS patients, validated by the Ministry of Health and Medical Education of Iran. Data were analyzed by χ2 test, Pearson’s correlation coefficient, and Spearman’s correlation test. Results: Two hundred and thirteen HIV/AIDS patients completed the questionnaires. The mean age of participants was 41.14 ± 9.23. The outpatient service utilization rate was 31.94% in the previous month and the rate of hospitalization was 126 per 1,000 HIV/AIDS patients in the previous 6 months. The majority of HIV/AIDS patients received essential health services more often than the national standard goals estimation. Conclusions: After UHC implementation, the utilization rate of outpatients and inpatients services in HIV/AIDS patients was more than similar indices in the general population. In addition, HIV/AIDS patients received essential health services adequately. (shrink)

The concept of causation is essential for understanding relationships among various phenomena, yet its fundamental nature and the criteria for establishing it continue to be debated. This paper presents a new theory of causation through a quasi-axiomatic approach. The core of this framework is Probability Distribution Determinism (PDD), which updates traditional determinism by representing states of affairs as probability distributions, with the if-then function serving as its foundational definition. Based on PDD, by merely using appropriate naming strategies, it is (...) possible to derive systems in which the structural characteristics of relationships among things closely resemble those in the real world, such as having various forms of nested hierarchies. Additionally, there are two related yet distinctly different contexts about relationships in PDD: one emphasizes the potential influence of conditions on outcomes in the general sense, while the other focuses on attributing responsibility for the state changes in specific scenarios. The formula for determining the relationship in the general sense is established as S(Y |S1(X), Ψ) ̸≡ S(Y |S2(X), Ψ). Subsequently, within the PDD framework, the paper clarifies the legitimate use of a series of concepts related to causation in those two contexts, thus encompassing the entire detailed connotation of the concept of causation. The comparison with other theories of causation and the analysis of case applications demonstrate that the new theory applies not only to situations where other theories are competent but also to situations where they are not. This suggests that, although certain aspects within the new framework may require further analysis, it provides a highly promising direction for a deeper understanding of causation. (shrink)

This article examines where Kant stands on the question of the redistribution of wealth and income both nationally and globally. Kant is rightly seen as a radical reformer of the world order from a political standpoint seeking a republican, federative worldwide system; can he also be seen as wanting to bring about an equally dramatic shift from an economic perspective? To answer this question we have first of all to address the question of whether he is an egalitarian or an (...) inegalitarian at the national level. Certainly there are certain social and material inequalities within a civil society Kant is prepared to accept and there are some he is not. This would imply that he would affirm certain inequalities at an international level and that there are others upon which he would recommend action. Thus the question arises as to whether or not it is appropriate for Kantians to regard the current enormous inequalities in wealth and income between individuals living in different parts of the globe as scandalous and in need of change. The paper throughout relates the problem of distributive justice within the state to the problem of distributive justice amongst states, arguing that this approach is warranted by Kant's own method. Particular attention is paid to how Kant's own approach to political philosophy may be deployed to underpin a change to a distinctive type of international distributive justice. (shrink)