Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity (...) criteria in Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal access may (...) compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

Truthmaker monism is the view that the one and only truthmaker is the world. Despite its unpopularity, this view has recently received an admirable defence by Schaffer :307–324, 2010b). Its main defect, I argue, is that it omits partial truthmakers. If we omit partial truthmakers, we lose the intimate connection between a truth and its truthmaker. I further argue that the notion of a minimal truthmaker should be the key notion that plays the role of constraining ontology and that truthmaker (...) monism is not necessary for an appropriate solution to the problem of finding truthmakers for negative truths. I conclude that we should reject truthmaker monism once and for all. (shrink)

Like Husserl, the young Heidegger was preoccupied with the a-priority of phenomenology. He also incorporates hermeneutics into phenomenology, though Husserl was convinced that the a-priority of phenomenology removed all interpretation from its analyses. This paper investigates how the early Heidegger is able to make hermeneutics a general condition of understanding while maintaining, in line with Husserl, that phenomenology is an a-priori science. This paper also provides insight into key debates in the history of phenomenology. I examine two places (...) in which Heidegger departs from Husserl’s phenomenology – the doctrine of categorial intuition and the “as-structure” of understanding – to show that a-priority and hermeneutic understanding come together, ontically, in facticity as the only possible starting point for phenomenology. Ontologically, however, a-priority and hermeneutics come together in the co-affection of Dasein as understanding and being as pre-given. This co-affection is itself dependent on Temporality as “the condition of any possible earlier”. (shrink)

The current study is conducted to examine how investors’ information priorities for investment decision-making influence their fear during the crisis.

Steinberg has recently proposed an argument against Schaffer’s priority monism. The argument assumes the principle of Necessity of Monism, which states that if priority monism is true, then it is necessarily true. In this paper, I argue that Steinberg’s objection can be eluded by giving up Necessity of Monism for an alternative principle, that I call Essentiality of Fundamentality, and that such a principle is to be preferred to Necessity of Monism on other grounds as well.

In both the paper "Revisability and Conceptual Change in 'Two Dogmas of Empiricism'" and in Constructing the World, David Chalmers has argued against W.V.O. Quine's claim that there are no 'analytic' sentences. I argue here that Chalmers's argument does not advance this debate.

Priority Theory is an increasingly popular view in metaphysics. By seeing metaphysical questions as primarily concerned with what explains what, instead of merely what exists, it promises not only an interesting approach to traditional metaphysical issues but also the resolution of some outstanding disputes. In a recent paper, Louis deRosset argues that Priority Theory isn’t up to the task: Priority Theory is committed to there being explanations that violate a formal constraint on any adequate explanation. This paper (...) critically examines deRosset’s challenge to Priority Theory. We argue that deRosset’s challenge ultimately fails: his proposed constraint on explanation is neither well-motivated nor a general constraint. Nonetheless, lurking behind his criticism is a deep problem for prominent ways of developing Priority Theory, a problem which we develop. (shrink)

How should governments balance saving people from very large individual disease burdens (such as an early death) against saving them from middling burdens (such as erectile dysfunction) and minor burdens (such as nail fungus)? This chapter considers this question through an analysis of a priority-setting proposal in the Netherlands, on which avoiding a multitude of middling burdens takes priority over saving one person from early death, but no number of very small burdens can take priority over avoiding (...) one death. It argues that there is some, albeit imperfect, evidence of substantial public support for such a policy. Furthermore, it provides a principled rationale for it in terms of respect for the person who faces the largest burden. (shrink)

Introduction. Taking into account the priorities of the state policy in the field of economic and innovative development of the Perm region, assessment of the regional potential of the digital economy, the strategic importance of economic activities implemented by SMEs for the economy of the region and the country as a whole, the actual impact of the norms on the instruments of development of small and medium-sized enterprises in the Perm region is assessed. The purpose of this study is to (...) improve the regional regulatory platform of tools for the development of small and medium-sized businesses in the Perm region in order to gain the status of an investment-attractive region in the digital economy of the Russian Federation, taking into account the Strategy of the information society in the Russian Federation, which will ultimately contribute to the development of e-business in the Perm region, rehabilitation and competitiveness of the economy of the Perm region in the global market. Methodology. The General methodological basis of the study was the dialectical- materialistic method of cognition of legal reality, which allowed to study the tools of development of small and medium-sized businesses in the Perm region in their development, to consider the problems of tools for the integrated development of small and medium-sized businesses in the Perm region, taking into account the changed socio-economic conditions in inseparable unity with other related tools relevant to the needs of digitalization of society. Such universal scientific methods as analysis and synthesis of doctrinal and normative materials were used in the work. In addition, special legal methods were used: the method of legal modeling, which allows to design possible legal situations using digital tools for the development of small and medium- sized businesses in the Perm region; the method of systematic interpretation used in assessing the actual impact of regional norms on the tools of development of small and medium-sized businesses in the Perm region. Results. The article proposes a new tool for the development of SMEs as a regional electronic platform for the promotion of goods, works and services of SMEs in the Perm region. Attention is paid to the level of digital literacy of SMEs and consumers of their goods, works and services: the conclusion about the lack of digital competence. Conclusion. It is necessary to improve the regional regulatory platform taking into account economic trends: it is important to introduce digital competencies everywhere, including at the professional level in relation to SMEs in the Perm region, in order to increase the business activity of young people and other representatives of the working population. As for the actual introduction of new tools for the development of small and medium-sized businesses in the Perm region, we propose that the regional legislator develop a new electronic information platform at the expense of the regional budget to promote goods, works and services sold by SMEs in the Perm region. We believe that the measures proposed by us to enhance the economic activity of SMEs can be perceived by other regions. (shrink)

ABSTRACTThis essay offers a reconfiguration of the possibility‐space of positions regarding the metaphysics and epistemology associated with historical knowledge. A tradition within analytic philosophy from Danto to Dummett attempts to answer questions about the reality of the past on the basis of two shared assumptions. The first takes individual statements as the relevant unit of semantic and philosophical analysis. The second presumes that variants of realism and antirealism about the past exhaust the metaphysical options . This essay argues that both (...) of these assumptions should be rejected. It develops as an alternative an irrealist account of history, a view based in part on work by Leon Goldstein and Ian Hacking. On an irrealist view, historical claims ought to be treated as subject to the same conditions and caveats that apply to any theory of empirical or scientific knowledge. Irrealism argues for pasts as made and not found. The argument emphasizes the priority of classification over perception in the order of understanding and so verification. Because nothing a priori anchors practices of classification, no sense can be attached to claims that some single structure must or does determine what events take place in human history. Irrealism denies to realism the very intelligibility of any imagined view from nowhere, that is, a determinately configured past subsisting sub specie aeternitatis. A plurality of pasts exists because constituting a past always depends to some degree on socially mediated negotiations of a fit between descriptions and experience. (shrink)

The state of national economies development varies and is characterized by many indicators. Economically developed countries are known as doubtless leaders that are in progress and form political stability, social and economics standards, scientific and technical progress and determine future priorities. It is worth mentioning that the progressive development of national economies in conditions of globalization can take place only in case of the increase of their intellectualization level, through saturation of people`s life, economic relations and production by brain activity, (...) knowledge, creativity, innovation, culture, ethical considering of the historical heritage. The main aim of the research is national economies intellectualization evaluating in globalization conditions. In order to gain this aim, the following tasks were defined: to identify existing indices of the national economies intellectualization level evaluation, develop the authors’ methodological approach to the national economies intellectualization level, determine the areas of measurement results application. While conducting the research, systematic approach, the methods of analysis, synthesis, grouping, abstracting, generalization, imaginary experiment and grounding were used. In the modern world, there are a large number of indicators which characterize differences in intellectual state of the national economy. When comparing the state of national economies intellectualization, the problems arise with different number of countries, duplication of indicators, disproportionate number of the components of indicators, various years of publication, etc. Therefore, to ensure comparability, we choose four general indicators – the index of human development, the global innovation index, the global competitiveness index and the knowledge economy index. Using these indices, we do the research and determine the state of national economies intellectualization in the world economy. According to the calculated results, as of 2013, we have divided 190 national economies by level of intellectualization into five groups: countries with the highest (30 countries), high (30 (countries), low (30 countries), the lowest (35 countries) and the countries with uncertain state of intellectualization (65 countries). The leaders in the state of intellectualization are Switzerland, Sweden, The Netherlands, Finland and the USA. The countries with the highest level of intellectualization serve as an example to all other countries of the world. These countries are characterized by developed market economy; a dominant position in the international economy, which allows actively engaging own and imported resources in the economic turnover; the shift of the center of gravity of economic activity into the services sector and the dominance of service economy; the greatest exhaustion of sources and factors of industrial development; advanced post-industrial development. The economic policy of the first group of countries has a decisive influence on the state and dynamics of the global economy, defining the main directions of its scientific and technological development and structural adjustment. The average index of the national economy intellectualization (AINEI), calculated by the authors, shows the place of each country in the world community as to their intellectual capital. Considering the continued deployment of R&D progress, the growing role of high-tech production and the complexity of social and economic relations, AINEI can serve as a reliable indicator of the macroeconomic environment intellectualization state. Therefore, the following organizations, bodies and individuals can use the comparative results of this study: the international organizations while developing international economic development programs; the state authorities of the countries in foreign and domestic policy forming; companies that create innovative and investment policy; migrants, tourists and persons who perform professional and transit activity for the formation of human potential and capital; scientists and teachers who develop mechanisms of intellectualization. (shrink)

According to the priority view, or prioritarianism, it matters more to benefit people the worse off they are. But how exactly should the priority view be defined? This article argues for a highly general characterization which essentially involves risk, but makes no use of evaluative measurements or the expected utility axioms. A representation theorem is provided, and when further assumptions are added, common accounts of the priority view are recovered. A defense of the key idea behind the (...) priority view, the priority principle, is provided. But it is argued that the priority view fails on both ethical and conceptual grounds. (shrink)

I will defend two claims. First, Schaffer's priority monism is in tension with many research programs in quantum gravity. Second, priority monism can be modified into a view more amenable to this physics. The first claim is grounded in the fact that promising approaches to quantum gravity such as loop quantum gravity or string theory deny the fundamental reality of spacetime. Since fundamental spacetime plays an important role in Schaffer's priority monism by being identified with the fundamental (...) structure, namely the cosmos, the disappearance of spacetime in these views might undermine classical priority monism. My second claim is that priority monism can avoid this issue with two moves: first, in dropping one of its core assumptions, namely that the fundamental structure is spatio-temporal, second, by identifying the connection between the non-spatio-temporal structure and the derivative spatio-temporal structure with mereological composition. (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)

A critique of Strawson's distinction between descriptive and revisionary metaphysics.

Should priority in the allocation of organs be given to those who have previously donated or declared their willingness to do so? This article examines the Israeli priority rule in light of two prominent critiques of priority rules, pertaining to failure to reciprocate and unfairness. The scope and content of these critiques are interpreted from the perspective of equality of opportunity. Because the Israeli priority rule may be reasonably criticized for unfairness and failing to reward certain (...) behaviors, the article develops an adjusted priority rule, which removes and adjust the elements in the Israeli priority rule deemed problematic. However, such a priority rule is complex to the extent that it may fail to increase donation rates and furthermore introduce new concerns of fairness, as the better off may be better able to navigate the complex adjusted priority rule. (shrink)

An exploration of the metaphysics of relation as a unifying motif in modern physics. What happens when Ideal observers begin to observe their own observing?

This paper presents a preliminary analysis of the first participatory budgeting experiment in the United States, in Chicago's 49th Ward. There are two avenues of inquiry: First, does participatory budgeting result in different budgetary priorities than standard practices? Second, do projects meet normative social justice outcomes? It is clear that allowing citizens to determine municipal budget projects results in very different outcomes than standard procedures. Importantly, citizens in the 49th Ward consistently choose projects that the research literature classifies as low (...) priority. The results are mixed, however, when it comes to social justice outcomes. While there is no clear pattern in which projects are located only in affluent sections of the ward, there is evidence of geographic clustering. Select areas are awarded projects like community gardens, dog parks, and playgrounds, while others are limited to street resurfacing, sidewalk repairs, bike racks, and bike lanes. Based on our findings, we offer suggestions for future programmatic changes. (shrink)

A moral requirement R1 is said to be lexically prior to a moral requirement R2 just in case we are morally obliged to uphold R1 at the expense of R2 – no matter how many times R2 must be violated thereby. While lexical priority is a feature of many ethical theories, and arguably a part of common sense morality, attempts to model it within the framework of decision theory have led to a series of problems – a fact which (...) is sometimes spun as a ‘decision theoretic critique’ of lexical priority. In this paper, I develop an enriched decision theoretic framework that is capable of modelling lexical priority while avoiding all extant problems. This will involve introducing several new ingredients into the standard decision theoretic framework, including multidimensional utilities, de minimis risks, and the means to represent two different conceptions of risk. (shrink)

Digitalization processes are global and performed in all spheres of economic activities. The development of the digital economy correlates with the dynamics of educational, scientific and technical, and innovative activities in the country. Higher education particularly affects the development of the digital economy because it is a system training highly qualified personnel, conducting quality research, and generating innovations. The purpose of the article is the identification of promising vectors of higher education system development under the conditions of digitalization of national (...) economy. Section 1 of the article presents the authors’ methodological approach to assessment the impact of educational, research, and innovation components on digital economy development. The implementation of the authors’ approach covers the phased use of methods of statistical, index, cluster and system analysis. The influence of higher education on the structural components of the digital economy (educational, research, innovative ones) is grounded. The result of the study was the identification of main trends in the development of higher education under the conditions of digital economy. The problems of the development of higher education are systematized in the groups: contextual, legal, organizational and economic, financial, logistical problems, and problems of internationalization. Based on the results of the analysis, the authors conclude the necessity of development of a conceptual base for increasing the digital adaptability of the higher education system to new socio-economic conditions. Section 2 of the article describes the concept of the digital adaptability strategy of the higher education system. The concept was developed on the base of structural and functional, systemic and synergetic, and institutional approaches. The proposed concept is based on the idea of deepening the long-term partnership of universities with stakeholders within the Quadruple Helix model. In the conclusion section, the authors highlight the key priorities of the digital adaptability strategy of the higher education system. (shrink)

The fear that business corporations have claimed unwarranted constitutional protections which have entrenched corporate power has produced a broad social movement demanding that constitutional rights be restricted to human beings and corporate personhood be abolished. We develop a critique of these proposals organized around the three salient rationales we identify in the accompanying narrative, which we argue reflect a narrow focus on large business corporations, a misunderstanding of the legal concept of personhood, and a failure to distinguish different kinds of (...) constitutional rights and the reasons for assigning them. Corporate personhood and corporate constitutional rights are not problematic per se once these notions are decoupled from biological, metaphysical, or moral considerations. The real challenge is that we need a principled way of thinking about the priority of human over corporate persons which does not reduce the efficacy of corporate institutions or harm liberal democracies. (shrink)

Philosophical orthodoxy has it that intentional action consists in one’s intention appropriately causing a motion of one’s body, placing the latter as (conceptually and/or metaphysically) prior to the former. Here I argue that this standard schema should be reversed: acting intentionally is at least conceptually prior to intending. The argument is modelled on a Williamsonian argument for the priority of knowledge developed by Jenifer Nagel. She argues that children acquire the concept KNOWS before they acquire BELIEVES, building on this (...) alleged developmental priority of knowledge to establish its conceptual priority. I start by taking a closer look at Nagel’s argument, canvassing extant objections to do both with the empirical adequacy of her claims and their philosophical implications. Doing so allows me in the second part of the paper to draw lessons that inform the construction of a revamped parallel argument for the priority of ACTS INTENTIONALLY. (shrink)

Recently theorists have demonstrated a growing interest in the ethical aspects of resource allocation in international non-governmental humanitarian, development and human rights organizations (INGOs). This article provides an analysis of Thomas Pogge's proposal for how international human rights organizations ought to choose which projects to fund. Pogge's allocation principle states that an INGO should govern its decision making about candidate projects by such rules and procedures as are expected to maximize its long-run cost-effectiveness, defined as the expected aggregate moral value (...) of the projects it undertakes divided by the expected aggregate cost of these projects? I critique Pogge's argument on two fronts: (1) I demonstrate that his view is problematic on his own terms, even if we accept the cost-effectiveness framework he employs. (2) I take issue with his overall approach because it generates results which can undermine the integrity of INGOs. Further, his approach mis-characterizes the nature of INGOs, and this mistake is at the root of his problematic view of INGO priority-setting. Ultimately, I argue for a conception of INGOs in which they are understood as ?organizations of principle?, in the sense that they are independent moral agents and so should be permitted a fairly wide sphere of autonomy within reasonable moral constraints. (shrink)

The combination of panpsychism and priority monism leads to priority cosmopsychism, the view that the consciousness of individual sentient creatures is derivative of an underlying cosmic consciousness. It has been suggested that contemporary priority cosmopsychism parallels central ideas in the Advaita Vedānta tradition. The paper offers a critical evaluation of this claim. It argues that the Advaitic account of consciousness cannot be characterized as an instance of priority cosmopsychism, points out the differences between the two views, (...) and suggests an alternative positioning of the Advaitic canon within the contemporary debate on monism and panpsychism. (shrink)

Rawls offers three arguments for the priority of liberty in Theory, two of which share a common error: the belief that once we have shown the instrumental value of the basic liberties for some essential purpose (e.g., securing self-respect), we have automatically shown the reason for their lexical priority. The third argument, however, does not share this error and can be reconstructed along Kantian lines: beginning with the Kantian conception of autonomy endorsed by Rawls in section 40 of (...) Theory, we can explain our highest-order interest in rationality, justify the lexical priority of all basic liberties, and reinterpret Rawls’ threshold condition for the application of the priority of liberty. Perhaps unsurprisingly, this Kantian reconstruction will not work within the radically different framework of Political Liberalism. (shrink)

Argument that priority monism is best understood as being a contingent thesis.

In this paper, I argue the importance of competition and cooperation cannot be denied as they both are instrumental in making any business transaction. Because two parties always set for themselves different priorities to a business transaction, business has been thought of in terms of competition. But cooperative action is also important, because in the case of cooperative activities the overall total is greater (though the outcomes differ) if we do cooperate than if we do not. Hence humans form cooperative (...) groups to compete for scarce resources. Those business firms, where employees take specialized, interdependent jobs and work together to compete in the free market, produce higher quality products and show greater work efficiency. Hence friendly cooperation is needed to compete more efficiently against other individuals or groups. It is for this reason people should value more in belonging to a group, practicing teamwork, helping others, etc. They should put more value on cooperation than competition though both competition and cooperation are natural to man. (shrink)

A contemporary form of panpsychism says that phenomenality is prevalent because all physical ultimates instantiate phenomenal or protophenomenal properties. According to priority cosmopsychism, an alternative to panpsychism that we propose in this chapter, phenomenality is prevalent because the whole cosmos instantiates phenomenal or protophenomenal properties. It says, moreover, that the consciousness of the cosmos is ontologically prior to the consciousness of ordinary individuals like us. Since priority cosmopsychism is a highly speculative view our aim in this chapter remains (...) modest and limited. Instead of providing a full defense of priority cosmopsychism, we try to show only the theoretical advantage of the view over panpsychism. Tis, however, by no means entails that we develop the view in logical space merely for its own sake. We offer instead a blueprint for a new alternative to panpsychism and explain how such a view avoids some of the most persistent problems for panpsychism while maintaining several of its strengths. (shrink)

Michael Otsuka, Alex Voorhoeve and Marc Fleurbaey have challenged the priority view in favour of a theory based on competing claims. The present paper shows how their argument can be used to recast the priority view. All desert claims in distributive justice are comparative. The stronger a party’s claims to a given benefit, the greater is the value of her receiving it. Ceteris paribus, the worse-off have stronger claims on welfare, and benefits to them matter more. This can (...) account for intuitions that at first appear egalitarian, as the analysis of an example of Larry Temkin’s shows. The priority view, properly understood, is desert-adjusted utilitarianism under the assumption that no other claims pertain. (shrink)

In the Categories, Aristotle intends to ascribe to particular substances ontological priority over all other things, but it is far from obvious what notion of priority would make this plausible. This question is the focus of my paper. I will examine what has been the standard account of his notion of ontological priority— the “modal-existential” account—and the problems it entails, as well as some scholarly alternatives to it. I will defend my own alternative account—the “explan- atory-existential” account—which (...) addresses the problems that arise for other pro- posed accounts, and will make plausible Aristotle’s claim that particular substances have priority over all other things. I will argue that he puts forth this notion of prior- ity in Categories 12, and that it bears a similarity to the notion of grounding as dis- cussed in contemporary metaphysics. (shrink)

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

Epistemic burdens – the nature and extent of our ignorance (that and how) with respect to various courses of action – serve to determine our incentive structures. Courses of action that seem to bear impossibly heavy epistemic burdens are typically not counted as options in an actor’s menu, while courses of action that seem to bear comparatively heavy epistemic burdens are systematically discounted in an actor’s menu relative to options that appear less epistemically burdensome. That ignorance serves to determine what (...) counts as an option means that epistemic considerations are logically prior to moral, prudential, and economic considerations: in order to have moral, prudential, or economic obligations, one must have options, and epistemic burdens serve to determine our options. One cannot have obligations without doing some epistemic work. We defend this claim on introspective grounds. We also consider how epistemic burdens distort surrogate decision-making. The unique epistemology of surrogate cases makes the priority of the epistemic readily apparent. We then argue that anyone who accepts a principle similar to ought implies can is committed to the logical priority of the epistemic. We also consider and reject several possible counterarguments. -/- . (shrink)

In recent work, the interrelated questions of whether there is a fundamental level to reality, whether ontological dependence must have an ultimate ground, and whether the monist thesis should be endorsed that the whole universe is ontologically prior to its parts have been explored with renewed interest. Jonathan Schaffer has provided arguments in favour of 'priority monism' in a series of articles (2003, 2004, 2007a, 2007b, forthcoming). In this paper, these arguments are analysed, and it is claimed that they (...) are not compelling: in particular, the possibility that there is no ultimate level of basic entities that compose everything else is on a par with the possibility of infinite 'upward' complexity. The idea that we must, at any rate, postulate an ontologically fundamental level for methodological reasons ( Cameron 2008 ) is also discussed and found unconvincing: all things considered, there may be good reasons for endorsing 'metaphysical infinitism'. In any event, a higher degree of caution in formulating metaphysical claims than found in the extant literature appears advisable. (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)

Rawls offers three arguments for the priority of liberty in Theory, two of which share a common error: the belief that once we have shown the instrumental value of the basic liberties for some essential purpose (e.g., securing self-respect), we have automatically shown the reason for their lexical priority. The third argument, however, does not share this error and can be reconstructed along Kantian lines: beginning with the Kantian conception of autonomy endorsed by Rawls in section 40 of (...) Theory, we can explain our highest-order interest in rationality, justify the lexical priority of all basic liberties, and reinterpret Rawls’ threshold condition for the application of the priority of liberty. Perhaps unsurprisingly, this Kantian reconstruction will not work within the radically different framework of Political Liberalism. (shrink)

Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws (...) of first-come, first-served allocation; (iv) the relevance of post-episode survival; (v) the difference between age and other factors that affect life-expectancy; and (vi) the need to avoid quality-of-life judgments. In the second part, we lay out some positions on which reasonable people can and do differ. These include (i) conflicts between maximizing benefits and priority to the worst off; (ii) role-based priority; and (iii) whether patients’ existing lifesaving resources should be subject to redistribution. (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)

For many years there has been a debate about the role of the parietal lobe in the generation of behavior. Does it generate movement plans (intention) or choose objects in the environment for further processing? To answer this, we focus on the lateral intraparietal area (LIP), an area that has been shown to play independent roles in target selection for saccades and the generation of visual attention. Based on results from a variety of tasks, we propose that LIP acts as (...) a priority map in which objects are represented by activity proportional to their behavioral priority. We present evidence to show that the priority map combines bottom-up inputs like a rapid visual response with an array of top-down signals like a saccade plan. The spatial location representing the peak of the map is used by the oculomotor system to target saccades and by the visual system to guide visual attention. (shrink)

Schaffer (2010) argues that the internal relatedness of all things, no matter how it is conceived, entails priority monism. He claims that a sufficiently pervasive internal relation among objects implies the priority of the whole, understood as a concrete object. This paper shows that at least in the case of an internal relatedness of all things conceived in terms of physical intentionality - one way to understand dispositions - priority monism not only doesn't follow but also is (...) precluded. We conclude that the internal relatedness of all things is compatible with several different ontologies (including varieties of pluralism) but entails nothing concerning dependence between concrete objects. (shrink)

This article has two goals: a historical and a speculative one. The historical goal is to offer a coherent account of Spinoza’s view on mereological composition. The speculative goal is to show that Spinoza’s substance monism is distinct from versions of monism that are currently defended in metaphysics and that it deserves the attention of contemporary metaphysicians. Regarding the second goal, two versions of monism are currently defended and discussed in contemporary metaphysics: existence monism according to which there actually exists (...) exactly one concrete entity; and priority monism that is famously defended by Jonathan Schaffer and according to which there exists exactly one fundamental concrete being, the cosmos, and several derivative concrete beings that are the parts of the cosmos. In this article, I argue that substance monism is neither an existence nor a priority monism because, while Spinoza’s monist is committed to the existence of a unique fundamental individual—the substance—and to the existence of several derivative individuals—the bodies or modes of extension—, Spinoza denies that the substance is mereologically complex. Regarding the first goal, the paper solves several interpretative puzzles by arguing that Spinoza distinguishes between three kinds of composition and that his talk of composition between the substance and its modes is by his own light not to be interpreted as literally true. (shrink)

Aiming at the allocation of scarce medical resources, Immanuel and other scholars have put forward a set of influential ethical values and guiding principles. It assigns the priority of resource allocation to those whose lives can be saved and maximized, those who can bring the greatest instrumental value, and those who are the worse off. For other members of society, random selection under the same conditions is adopted. Following the Rawlsian "lexical order, lexicographical" rule, this priority arrangement requires (...) that the "utilitarian principle" should be placed before the "equality principle", and the "instrumental difference principle", the "integrity difference principle" and the "fair opportunity principle" in turn acts on specific distribution agents. Although the framework and its priority rules have obvious drawbacks when faced with Medical Resources Squeeze and other dilemmas, with the help of an understanding of its internal structure, it can effectively respond to the four core issues in the allocation of scarce medical resources. (shrink)

Throughout the critical period Kant enigmatically insists that reason is a ‘unity’, thereby suggesting that both our theoretical and practical endeavors are grounded in one and the same rational capacity. How Kant's unity thesis ought to be interpreted and whether it can be substantiated remain sources of controversy in the literature. According to the strong reading of this claim, reason is a ‘unity’ because all our reasoning, including our theoretical reasoning, functions practically. Although several prominent commentators endorse this view, it (...) is widely thought to lack exegetical support. This paper seeks to strengthen the case for this reading by showing how theoretical reason's positive function, as Kant presents it in the Appendix to the Transcendental Dialectic, may be construed as fundamentally practical. I argue that reason's supreme regulative principle ought to be understood as a categorical practical imperative. This interpretation, I suggest, resolves the apparent inconsistencies that blight Kant's account of the principle in the Appendix, while bringing greater overall coherence to his account of theoretical reason's regulative function. (shrink)

The lexical priority of fair equality of opportunity in John Rawls’s justice as fairness, which has been sharply criticized by Larry Alexander and Richard Arneson among others, is left almost entirely undefended in Rawls’s works. I argue here that this priority rule can be successfully defended against its critics despite Rawls’s own doubts about it. Using the few textual clues he provides, I speculatively reconstruct his defense of this rule, showing that it can be grounded on our interest (...) in self-realization through work. This reconstructed defense makes liberal use of concepts already present in A Theory of Justice , including the Aristotelian Principle (which motivates the achievement of increasing virtuosity) and the Humboldtian concept of social union (which provides the context for the development of such virtuosity). I also show that this commitment to self-realization, far from violating the priority of right in Rawls’s theory, stems directly from his underlying commitment to autonomy, which is the very foundation of the moral law in his doctrine of right. The reconstituted defense of this priority rule not only strengthens the case for justice as fairness but also has important and controversial implications for public policy. (shrink)

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

One of the issues that deeply interested the philosophers of late antiquity, the Ancient Greek Commentators, concerns the priority of substances. While questions concerning ontological priority have recently attracted attention in Aristotelian scholarship and contemporary metaphysics, the Commentators’ discussions have not yet received the attention they deserve. My aim is to start to fill in this gap, by focusing on John Philoponus’s account of the priority of substances in his commentary on Aristotle’s "Categories". In particular, I aim (...) to show how Philoponus develops and defends the view that, while particular substances enjoy priority over accidents and concepts (“universals after the many”), they do not enjoy priority over all other things. Rather, a certain type of universal substance (“universals prior to the many”) enjoys priority over particulars. (shrink)

More philosophical effort is spent articulating evolutionary rationales for the development of belief-like capacities than for precursors of desires or preferences. Nobody, though, seriously expects naturally evolved minds to be disinterested epistemologists. We agree that world-representing states won’t pay their way without supporting capacities that prioritise from an organism’s available repertoire of activities in light of stored (and occurrent) information. Some concede that desire-like states would be one way of solving this problem. Taking preferences as my starting point instead of (...) belief-like states, I defend two conclusions. First, psychologically real preference states, which approximately token expected utilities, have a quite general evolutionary rationale. They are a solution to the problem of efficiently allocating capacities with incompatible uses. This argument is a version of the Environmental Complexity Thesis. Second, preferences can plausibly function and naturally evolve without belief-like states, even though the converse claim is incredible. Preferences, that is, can mediate between discriminations of occurrent states (‘internal’ or ‘external’) and the processes selecting activity without mediation by stored indicative representations. By tokening expected utilities of actions conditional on discriminated state, they can increase the rate at which the ‘right thing’ is done at appropriate times, and they can do this without the support of belief-like, world-representing states. Preferences, even incomplete and noisy sets of them, are a fuel for success that will tend to be favoured when environments are complex in ways that matter to an organism, and when the organisms have complex behavioural repertoires with heterogenous returns and costs. (shrink)