We discuss the role of prior authorization (PA) in supporting patient-centered care (PCC) by directing health system resources and thus the ability to better meet the needs of individual patients. We begin with an account of PCC as a standard that should be aimed for in patient care. In order to achieve widespread PCC, appropriate resource management is essential in a healthcare system. This brings us to PA, and we present an idealized view of PA in order to argue (...) how at its best, it can contribute to the provision of PCC. PA is a means of cost saving and as such it has mixed success. The example of the US demonstrates how implementation of PA has increased health inequalities whereas best practice has the potential to reduce them. In contrast, systems of universal coverage, like those in Europe, may use the cost savings of PA to better address individuals' care and PCC. The conclusion we offer therefore is an optimistic one, pointing towards areas of supportive overlap between PCC and PA where usually the incongruities are most evident. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of Molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of Molnupiravir through the large-scale PANORAMIC randomised control trial. By analysing the ways in which the authorisation and clinical use of Molnupiravir complicate standard approaches to clinical equipoise, standard of care, and participant consent in the PANORAMIC randomised control trial we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

An underexamined insight of W. E. B. Du Bois’s John Brown is that John Brown worked for much of his life to cultivate democratic relationships with the Black Americans with and for whom he worked. Brown did so through practicing deference and deliberation, and by seeking authorization. However, Brown’s commitment to these practices faltered at a crucial moment in decision making: when he raided Harpers Ferry absent widespread support. Examining this aspect of John Brown brings into relief an overlooked (...) tragic choice Brown made: To act in accordance with his own substantive vision of what justice required, Brown eschewed democratic ideals and practices that grounded the distinctive relations of equality he had cultivated with the Black communities with and for whom he worked. (shrink)

This paper addresses the always online behavior of the data owner in proxy re- encryption schemes for re-encryption keys issuing. We extend and adapt multi-authority ciphertext policy attribute based encryption techniques to type-based proxy re-encryption to build our solution. As a result, user authentication and user authorization are moved to the cloud server which does not require further interaction with the data owner, data owner and data users identities are hidden from the cloud server, and re-encryption keys are only (...) issued to legitimate users. An in depth analysis shows that our scheme is secure, flexible and efficient for mobile cloud computing. (shrink)

The topic of alienation has fallen out of fashion in social and political philosophy. It used to be salient, especially in socialist thought and in debates about labor practices in capitalism. Although the lack of identification of people with their working lives—their alienation as workers—remains practically important, normative engagement with it has been set back by at least four objections. They concern the problems of essentialist views, a mishandling of the distinction between the good and the right, the danger of (...) paternalistic impositions, and the significance of democratic authorization. This paper recasts the critique of alienation in a way that vindicates its importance for social and political philosophy and rebuts these objections. First, it provides an analytic framework to understand alienation—distinguishing its various conceptual, explanatory, and normative dimensions. Second, it accounts for the normative aspect of the critique of alienation by articulating it in terms of prudential and moral ideas of positive freedom regarding human flourishing and solidaristic empowerment. Finally, the normative account is developed further, and sharpened to respond to the four objections, through the introduction of the Dignitarian Approach—the view that we have reason to organize social life in such a way that we respond appropriately to the valuable features of individual human beings that give rise to their dignity. (shrink)

In this essay, I discuss why consent is invalidated by duress that involves attaching penalties to someone's refusal to give consent. At the heart of my explanation is the Complaint Principle. This principle specifies that consent is defeasibly invalid when the consent results from someone conditionally imposing a penalty on the consent‐giver's refusal to give the consent, such that the consent‐giver has a legitimate complaint against this imposition focused on how it is affects their incentives for consenting. The Complaint Principle (...) says that this consent is defeasibly invalid to make room for the Authorization Principle, which allows sincere authorizations to constitute valid consent, even when these are issued by an agent acting under duress. The Authorization Principle has application only in cases of third‐party duress because when the consent‐receiver is the source of the duress, the consent‐giver is not sincerely authorizing the action. (shrink)

In this article I discuss a particular aspect of the Dutch reception of the ideas of René Descartes, namely the use of his Traité de l’homme by Henricus Regius. I analyze the use that Regius made of the theory of the movement of muscles, passions, hunger, and more generally of the neurophysiology expounded by Descartes in his book (not printed until 1662–1664). In my analysis, I reconstruct the internal evolution of Regius’s neurophysiology, I illustrate its sources beyond Descartes (i.e., Jean (...) Fernel and Santorio Santorio), and I show that he was certainly acquainted with some of its contents as early as 1641 (when he used it with the mediation of Descartes), before relying on it—as variously discussed in secondary literature—in his Fundamenta physices (1646), when he appropriated from it without Descartes’s authorization. (shrink)

Critical thinking involves deliberate application of tests and standards to beliefs per se and to methods used to arrive at beliefs. Pedagogical license is authorization accorded to teachers permitting them to use otherwise illicit means in order to achieve pedagogical goals. Pedagogical license is thus analogous to poetic license or, more generally, to artistic license. Pedagogical license will be found to be pervasive in college teaching. This presentation suggests that critical thinking courses emphasize two topics: first, the nature and (...) usefulness of critical thinking; second, the nature and pervasiveness of pedagogical license. Awareness of pedagogical license alerts the student to the need for critical thinking. Indoctrination is done to students; education is done by students. (shrink)

A number of bioethicists have been critical of the power of the family to “veto” a patient’s decision to posthumously donate her organs within opt-in systems of organ procurement. One major objection directed at the family veto is that when families veto the decision of their deceased family member, they do something wrong by violating or failing to respect the autonomy of that deceased family member. The goal of this paper is to make progress on answering this objection. I do (...) this in two stages. First, I argue that the most plausible interpretation of what happens when a person registers as an organ donor in an opt-in system is that she gives her consent to the state to posthumously remove her organs for transplantation purposes. Call this the Authorization Account. Second, given the Authorization Account, I argue by analogy that when families veto an individual’s decision to donate and the individual’s organs are not in the end removed, neither the doctors nor the family violate the individual’s autonomy in any morally objectionable sense. Call this the Nonremoval Thesis. I argue that since the Nonremoval Thesis is true, we do not violate or fail to respect the autonomy of registered donors when we fail to remove their organs because their family has objected. (shrink)

CRITICAL THINKING AND PEDAGOGICAL LICENSE https://www.academia.edu/9273154/CRITICAL_THINKING_AND_PEDAGOGICAL_LICENSE JOHN CORCORAN.1999. Critical thinking and pedagogical license. Manuscrito XXII, 109–116. Persian translation by Hassan Masoud. Please post your suggestions for corrections and alternative translations. -/- Critical thinking involves deliberate application of tests and standards to beliefs per se and to methods used to arrive at beliefs. Pedagogical license is authorization accorded to teachers permitting them to use otherwise illicit means in order to achieve pedagogical goals. Pedagogical license is thus analogous to poetic license (...) or, more generally, to artistic license. Pedagogical license will be found to be pervasive in college teaching. This presentation suggests that critical thinking courses emphasize two topics: first, the nature and usefulness of critical thinking; second, the nature and pervasiveness of pedagogical license. Awareness of pedagogical license alerts the student to the need for critical thinking. (shrink)

The current ethical and regulatory framework for research is often charged with burdening investigators and impeding socially valuable research. To address these concerns, a growing number of research ethicists argue that informed consent should be adapted to the risks of research participation. This would require less rigorous consent standards in low-risk research than in high-risk research. However, the current discussion is restricted to cases of research in which the risks of research participation are outweighed by the potential clinical benefits for (...) the individual research participant. Furthermore, current proposals do not address the worry that risk-adapted informed consent may result in enrolling participants into research without their autonomous authorization. In this paper, we show how the standard view of informed consent – consent as autonomous authorization – can be adapted to risk even when the research does not have a favourable risk-benefit profile for the participant. Our argument has two important implications: first, it implies that current and proposed consent standards are not adequately calibrated to risk and, second, that consent standards also need to be adapted to factors other than risk. (shrink)

ABSTRACTPeople smugglers help transport migrants across international borders without authorization and in return for compensation. Many people object to people smuggling and believe that the smuggling of migrants is an evil trade. In this paper, I offer a qualified defense of people smuggling. In particular, I argue that people smuggling that assists refugees in escaping threats to their rights can be morally justified. I then rebut the objections that people smugglers exploit migrants, have defective motivations, and wrongly violate the (...) law. My conclusion is that people smuggling is sometimes a permissible way of helping refugees to evade unjust immigration restrictions and compelling states to bear their fair share of the global refugee population. (shrink)

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

The pelvic exam is used to assess the health of female reproductive organs and so involves digital penetration by a physician. However, it is common practice for medical students to acquire experience in administering pelvic exams by performing them on unconscious patients without prior authorization. In this article, we argue that such unauthorized pelvic exams (UPEs) are sexual assault. Our argument is simple: in any other circumstance, unauthorized digital penetration amounts to sexual assault. Since there are no morally significant (...) differences between UPEs and other instances of digital penetration, UPEs are sexual assault. So, insofar as one is against sexual assault, one should be against UPEs. (shrink)

Legal norms are an invention. This paper advances a proposal about what kind of invention they are. The proposal is that legal norms derive from rules which specify role functions in a legal system. Legal rules attach to agents in virtue of their status within the system in which the rules operate. The point of legal rules or a legal system is to solve to large scale coordination problems, specifically the problem of organizing social and economic life among a group (...) of people and their successors, though not every legal rule pertains to a coordination problem. The framework for thinking about legal norms that I describe is a framework for thinking about institutions and policies more generally. The idea is to show that legal norms are a species of institutional norm. There are two central ideas. The first is the idea of a role in an institution. The second is the idea of proxy agency. Proxy agency involves one agent or group acting under the authorization of another agent or group (perhaps subsuming it) in a way that makes the actions of the proxy count as actions (under a description) of the individual or group for which it is a proxy. We get the characteristic structure of a legal system by conceiving of an institutional group, itself conceived of as a set of interlocking roles realized in individuals, as having one or more roles for proxy agents who are authorized by the group to make policy for the group. The set of rules governing the basic constitution of the group and spelling out the powers of the policy proxies determine fundamental norms for the group with specific role responsibilities attaching to particular positions in institutional arrangements. The policies determine further norms whose force derives from the fundamental norms. We must then say some further things to distinguish institutions and policies which we wish to designate as legal. (shrink)

Traditional Yorùbá culture admits the hegemonic locus that humans rank above all else on the planet. The outlook received decisive ratification several millennia ago in one of the Odùs of their Ifá Corpus. Specifically, in Odù Ògúndá Otura, one of the numerous chapters of the Ifá Corpus, Ọ̀rúnmìlà, the founder and primordial deity of Ifá discloses his authorization, the use of non-human animals for sacrifice and other human ends interminably. In this study, we engage the Ifá chapter that upholds (...) this outlook. We riposte that the age long supercilious perspective among the Yorùbá that humans rank higher and over non-human animals, as documented in the said Odù is no longer tenable on biological and moral-legal grounds. If the biological and moral-legal thrusts are not invalid, what framework is plausible when the interest(s) of non-human animals clash with the interest(s) of Ifá tradition and Yorùbá culture? On what basis will it be appropriate to jettison the interest(s) of the one for the interest(s) of the other? In the light of these posers, we employ Kai Horsthemke’s ethical individualism as the suitable groundwork that considers the interest of animals recommended for sacrifice in Ifá obeisance. (shrink)

In analytic political philosophy, it is common to view state-sponsored injustice as the work of a corporate agent. But as I argue, structural injustice theory provides grounds for reassessing the agential approach, producing new insights into state-sponsored injustice. Using the case of eugenic sterilization in the United States, this article proposes a structurally-sensitive conception of state-sponsored injustice with six components: authorization, protection, systemization, execution, enablement, and norm- and belief-influence. Iris Marion Young’s models of responsibility for agential and structural injustice, (...) and the place of state-sponsored injustice with respect to these models, are also discussed. (shrink)

The wishes of registered organ donors are regularly set aside when family members object to donation. This genuine overruling of the wishes of the deceased raises difficult ethical questions. A successful argument for providing the family with a veto must (a) provide reason to disregard the wishes of the dead, and (b) establish why the family should be allowed to decide. One branch of justification seeks to reconcile the family veto with important ideas about respecting property rights, preserving autonomy, and (...) preventing harm. These arguments are ultimately unsuccessful. Another branch of arguments is consequentialist, pointing out the negative consequences of removing the veto. Whether construed as concerning family distress or as a potential drop in the organs available, these arguments are unsuccessful; the first fails to recognize the tremendous distress associated with waiting for an organ, while the second has little supporting evidence. A final section considers and rejects whether combining some of the arguments just examined could justify the family veto. We should thus remove the family veto in organ donation. (shrink)

Note that this paper is 35 pages, and had been replaced in many places w/ a draft w/o authorization. -/- The academy, broadly construed to include faculty, administrators at all levels, and editors, referees, and publishers of academic work, is beset by more ills bespeaking of a fundamental lack of integrity than can possibly be enumerated in a single monograph; nevertheless, as the need is urgent, and everyone seems to prefer either silence or piecemeal treatments, myself heretofore included, five (...) ills are enumerated herein, then traced to seven deadly sins that beset the entire enterprise—although not in its entirety, of course—and some surprisingly simple, commonsensical, and practicable solutions are advanced. (shrink)

Attention has turned from Hobbes the systematic thinker to his inconsistencies, as the essays in the Hobbes symposium published in the recent volume of Political Theory suggest. Deborah Baumgold, in “The Difficulties of Hobbes Interpretation,” shifted the focus to “the history of the book,” and Hobbes’s method of serial composition and peripatetic insertion, as a major source of his inconsistency. Accepting Baumgold’s method, the author argues that the manner of composition does not necessarily determine content and that fundamental paradoxes in (...) Hobbes’s work have a different provenance, for which there are also contextual answers. Hobbes was a courtier’s client, but one committed early to a materialist ontology and epistemology, and these commitments shackled him in treating the immediate political questions with which he was required to deal, leading to systemic paradoxes in his treatment of natural law, liberty, authorization, and consent. (shrink)

This article brings an account of reasonable expectations to bear on the question of when unauthorized immigrants have a right to be regularized—that is, to be formally guaranteed freedom from the threat of deportation. Contrary to the current literature, which implicitly relies on a flawed understanding of reasonable expectations, this article argues that only those unauthorized immigrants who have both been tacitly permitted by the state despite lacking formal authorization and have remained long enough to develop deep social roots (...) in the state have a right to regularization. (shrink)

The copy provided on ths site is a late draft. It provides a philosophical argument for the view that by and large it is morally wrong to buy shares in a company that is behaving badly unless you (if necessary acting together with others) are able and willing to prevent the misbehaviour. A key lemma in my argument concerns a chain of authorisation from the shareholders to the company's board to the CEO -- one in virtue of which shareholders are (...) ultimately responsible for major patterns of wrongdoing by the company. (shrink)

TB human challenge studies could accelerate TB vaccine development by reducing uncertainty in early-stage vaccine testing, selecting promising vaccine candidates for large-scale field trials, and identifying an immune correlate of protection. However, ethical concerns regarding the exposure of trial participants and bystanders to significant risk have been a limiting factor for TB human challenge models. We analyze the expected social value and risks of different types of TB human challenge models, and conclude that given the massive public health burden of (...) TB, challenge models with even scant probabilities of expediting TB vaccine authorization have enormous expected humanitarian value, saving between 33,000 and 1,375,000 lives over the next ten years. We argue that attenuated M.tb challenge trials can be conducted ethically, and discuss the benefits and drawbacks of conducting virulent M.tb challenge trials. (shrink)

Thomas Hobbes’ theory of punishment plays a constitutive role in the Leviathan’s theory of state sovereignty. Despite this, Hobbes’ justification for punishment is widely found to be discrepant, weak, inconsistent, and contradictory. Two dominant tendencies in the scholarship attempt to stabilize the Leviathan’s justification for the state’s right to punish by either identifying it with the sovereign’s right to war or by elaborating a theory of authorization within the state. In contrast, by tracing the deployments of the metaphor that (...) Hobbes utilizes to evoke the state’s right to punish in the Leviathan (i.e. that of the nerves of the Leviathan) this paper finds that these two accounts can be made to be consistent with each other — thereby destabilizing the grounds upon which the theory of punishment can be founded. (shrink)

Anna Stilz claims that citizens of democratic states bear “task responsibility” to repair unjust harms done by their states. I will argue that the only situation in which Stilz’s argument for such “task responsibility” is not redundant, given her own premises, is a situation where the state leaves it up to the citizens whether to indemnify others for the harms done by the state. I will also show that Stilz’s “authorization view” rests on an unwarranted and implausible assumption (which (...) I call “the authorization principle”) about authorization and political obligation, and that this problem cannot be remedied by limiting the account to democratic states. I will then briefly turn to Pasternak’s account of citizen responsibility for state action and argue that it suffers from two deficiencies: first, she equates group membership with collective action, and second, she does not provide any explanation as to why citizens should incur liability for the acts of their state under the four conditions she highlights. I conclude that neither Stilz nor Pasternak succeed in showing that at least citizens of democratic states are liable (barring very special circumstances) for the acts of their states. (shrink)

La théorie démocratique contemporaine entretient une relation ambivalente avec les élections. Alors que les points de vue agrégatifs et minimalistes les considèrent comme une institution centrale de la démocratie représentative , les conceptions plus riches de la démocratie n’ont pas nécessairement de penchant pour elles. Les théories délibératives ont tendance à négliger les élections pour se concentrer sur la délibération publique, c’est-à-dire sur le processus continu de formation de l’opinion et d’échange de raisons qui se produit entre les élections . (...) Les théories participatives ont également tendance à les écarter en faveur d’une vision moins agonistique et plus coopérative de l’action politique . Par conséquent, peu d’attention normative a été accordée dans la littérature récente à ce moment très distinctif de la vie démocratique, à quelques notables exceptions près . Une conséquence naturelle est que la plupart des théoriciens font appel à des expériences délibératives telles que les jurys de citoyens et les mini-publics comme réponse efficace aux préoccupations démocratiques actuelles . Le tirage au sort peut ainsi être présenté comme une alternative préférable à l’élection, car il garantit une représentation descriptive, évite la capture de l’État par des élites puissantes et promet des résultats substantiellement meilleurs. Alors que de nombreux théoriciens s’intéressent aux moyens de compléter les institutions électorales par des organes délibératifs non électoraux , certains chercheurs se débarrasseraient volontiers des élections . Le moment est-il venu de les abandonner ? Cet article se concentre sur une affirmation spécifique que beaucoup de partisans du tirage au sort ont avancée, à savoir que celui-ci serait plus égalitaire que les élections, et vise à la rejeter. D’autres chercheurs ont déjà critiqué le tirage au sort pour diverses raisons. Landa et Pevnick , ainsi qu’Umbers objectent qu’il ne permet pas d’obtenir les améliorations instrumentales du gouvernement promises par ses promoteurs ; Ceva et Ottonelli , ainsi que Lafont nient que les critiques lotocratiques des élections reflètent une compréhension adéquate de l’autorité démocratique en tant que forme d’autonomie collective ; et Umbers soutient également que la lotocratie est en contradiction avec les principes de justice distributive et d’égalité sociale . En complément à ces critiques récentes, nous soutenons que la vision de l’égalité politique qui sous-tend le tirage au sort est problématique et peu convaincante. (shrink)

In this article I describe and defend an account of social freedom grounded in intersubjective recognition. I term this the ‘normative authorisation’ account. It holds that a person enjoys social freedom if she is recognised as a discursive equal able to engage in justificatory dialogue with other social agents about the appropriateness of her reasons for action. I contrast this with Axel Honneth’s theory of social freedom, which I term the ‘self-realisation’ account. According to this view, the affirmative recognition of (...) others is necessary for obtaining a positive relation-to-self and hence freedom. I identify several problems with this account, which challenge the connection Honneth draws between social recognition and freedom. I show how the normative authorisation account avoids these problems and captures some basic features of our everyday, normative interactions. Finally, I suggest that the account fits well with recent work on epistemic injustice. Specifically, it shows that securing the social conditions of freedom requires ensuring epistemically-just social relations. Thus, the normative authorisation account is an explanatorily powerful, inclusive theory of social freedom that fits well with wider accounts of justice and freedom. Thus, it represents the most promising way of understanding social freedom in terms of interpersonal recognition. (shrink)

This article develops a civic republican approach to medical ethics. It outlines civic republican concerns about the domination that arises from subjection to an arbitrary power of interference, while suggesting republican remedies to such domination in healthcare. These include proposals for greater review, challenge and pre-authorisation of medical power. It extends this analysis by providing a civic republican account of assistive arbitrary power, showing how it can create similar problems within both formal and informal relationships of care, and offering strategies (...) for tackling it. Two important objections to civic republican medical ethics—that it overvalues independence and political participation in healthcare—are also considered and rebutted. (shrink)

This article draws upon the civic republican tradition to offer new conceptual resources for the normative assessment of mental capacity law. The republican conception of liberty as non-domination is used to identify ways in which such laws generate arbitrary power that can underpin relationships of servility and insecurity. It also shows how non-domination provides a basis for critiquing legal tests of decision-making that rely upon ‘diagnostic’ rather than ‘functional’ criteria. In response, two main civic republican strategies are recommended for securing (...) freedom in the context of the legal regulation of psychological disability: self-authorisation techniques and participatory shaping of power. The result is a series of proposals for the reform of decisional capacity law, including a transition towards purely functional assessment of decisional capacity, surer legal footing for advanced care planning, and greater control over the design and administration of decision-making capacity laws by those with psychological disabilities. (shrink)

An analysis of the issues of the Journal of the History of Philosophy shows that the journal has effectively recorded the changing image of Hobbes over the course of the 20th century, shifting from a strictly political perspective and a marked focus on the internal coherence of Hobbesian thought (with particular reference to the moral/political nexus and the examination of the “naturalistic fallacy”), to an increasing emphasis on the theme of theology and civil religion. Three examples are examined in this (...) article: the theme of moral obligation as the foundation of political obligation as discussed in the 1970s issues of the Journal of the History of Philosophy, the centrality of the contract and the concept of authorisation brought into focus in the 1980s, and the theme of Hobbes’ religious sincerity or atheism at the centre of discussion in the 1990s. (shrink)