What is the role of lay deliberation – if any – in health-care rationing, and administration more generally? Two potential answers are suggested by recent debates on the subject. The one, which I will call the technocratic answer, suggests that there is no distinctive role for lay participation once ordinary democratic politics have set the goals and priorities which reform should implement. Determining how best to achieve those ends, and then actually achieving them, this view suggests, is a matter (...) for experts, armed with the best evidence available to them, both of the subject area involved, and of management and administrative excellence. -/- By contrast, the second, deliberative, view holds that lay deliberation has an important role in the administration and execution of government policy, both because these latter inevitably have a political element which needs to reflect democratic norms and values, and because lay people are, themselves, a source of information, even of wisdom, that experts will want to use in fulfilling their professional responsibilities. Recent debates on the value of lay participation in healthcare provision can illuminate the strengths and weaknesses of both approaches, as can the experience of NICE. So, I will start by examining two articles by Albert Weale, which attempt to clarify the role that lay deliberation should have in healthcare, before turning to the dilemmas for both the technocratic and deliberative views which emerge from the experience of NICE. (shrink)

The present paper is an attempt at examining the value configuration and the socio-demographical profiles of the local political elites in four countries of East-Central Europe: Romania, the Czech Republic, Bulgaria, and Poland. The treatment is a comparative one, predominantly descriptive and exploratory, and employs, as a research method, the case-study, being a quite circumscribed endeavor. The cases focus on the members of the Municipal/Local Council in four towns similar in terms of demography and developmental strategies (i.e. small-to-medium sized (...) communities of around 35,000 inhabitants, with economies largely based on food industry and commercial activities): Tecuci (Galați county, Romania), Česká Lípa (Liberec region, Czech Republic), Targovishte (Targovishte province, Bulgaria), and Oleśnica (Lower Silesia province, Poland). Hypothesizing that the local elites of the former Sovietized Erurope tend to differ in outlook, priorities, and value attainment, as compared to their Western counterparts, the paper considers the former’s attitudes and perspectives in regard to seven values: a series of values customarily connected with the concept of ‘democracy’ (i.e. citizen participation, political conflict, gradual change, economic equality), state intervention in economy, decentralization and increased local autonomy, cultural-geographical self-identification. The study uses, as well, five models of value attainment in what concerns the ‘ideal portrait’ of the local councilor (Putnam 1976): ethical, pragmatic, technocratic, political, and gender. According to the results of a study applying a standard written questionnaire among the local councilors of the three communities in the period December 2010-February 2013, the paper distinguishes among three corresponding types of local elites: (1) ‘predominantly elitistic,’ (2) ‘democratic elitist,’ and (3) ‘predominantly democratic,’ following two types of explanation accounting for the differences among the four cases: the legacy of the defunct regime and the degree of administrative decentralization. (shrink)

This paper argues that societal duties of health promotion are underwritten (at least in large part) by a principle of beneficence. Further, this principle generates duties of justice that correlate with rights, not merely “imperfect” duties of charity or generosity. To support this argument, I draw on a useful distinction from bioethics and on a somewhat neglected approach to social obligation from political philosophy. The distinction is that between general and specific beneficence; and the approach from political philosophy has (...) at times been called equality of concern. After clarifying the distinction and setting out the basis of the equality of concern view, I argue that the result is a justice-based principle of “specific” beneficence that should be reflected in a society’s health policy. I then draw on this account to criticize, refine, and extend some prominent health care policy proposals from the bioethics literature. (shrink)

When are inequalities in political power undemocratic, and why? While some writers condemn any inequalities in political power as a deviation from the ideal of democracy, this view is vulnerable to the simple objection that representative democracies concentrate political power in the hands of elected officials rather than distributing it equally among citizens, but they are no less democratic for it. Building on recent literature that interprets democracy as part of a broader vision of social equality, I argue that concentrations (...) of political power are incompatible with democracy, and with a commitment to social equality more generally, when they consist in some having greater arbitrary power to influence decisions according to their idiosyncratic preferences. A novel account of the relationship between power and social status clarifies the role of social equality in the justification of democracy, including a representative democracy in which public officials have more political power than ordinary citizens. (shrink)

Citizens in wealthy liberal democracies are typically expected to see to basic needs like food, clothing, and shelter out of their own income, and those without the means to do so usually receive assistance in the form of cash transfers. Things are different with health care. Most liberal societies provide their citizens with health care or health care insurance in kind, either directly from the state or through private insurance companies that are regulated like public utilities. Except (...) perhaps for small co-pays or deductibles, citizens are not expected to see to their health needs out-of-pocket, at least for some basic level of care. Instead, when a citizen gets sick, the state or her insurance company foots the... (shrink)

Imagine you are the CEO of a hospital [. . .]. Decisions are constantly being made in your organization about how to spend the organization's money. The amount of money available to spend is never adequate to pay for everything you wish you could spend it on, therefore you must set spending priorities. There are two questions you need to be able to answer . . . How should we set priorities in this organization? How do we know when we (...) are doing it well? When people seek to achieve good public policy, the result will tend to be good public policy. In a collective choice process, public‐spirited individual participants produce good public policy by deliberating—talking with each other, listening to each other's arguments, and being willing to learn and change their minds based on such dialogue. –Steven Kelman (1992: 181) Public policy scholars agree that those persons (or agencies) vested with the authority to establish health care priorities should elicit public input before making rationing decisions. The two most common approaches are (i) consultation and (ii) deliberation. Though deliberation has obvious advantages over consultation, it falters in the face of the objection that ordinary citizens lack the cognitive resources for the extended, rigorous inquiry required of them in undertaking the priority‐setting task. To overcome this objection, I propose that deliberative forums for health care rationing should be designed so that they imitate the natural pattern of human experience. The experience of deliberation should encompass both prolonged periods of less‐demanding cognitive activity, in which citizens passively receive information, and briefer periods of more‐demanding cognitive activity, in which they engage in active problem‐solving. In arguing for this thesis, I rely on two theoretical sources and one practical case study, in the following order: (i) John Dewey's metaphysics of experience, (ii) cognitive science research on schemas and frames, and (iii) the Health Care Council in São Paulo, Brazil. (shrink)

The underreporting of suspected adverse drug reactions hinders pharmacovigilance. Solutions to underreporting are oftentimes directed at clinicians and health care professionals. However, given the recent rise of public inclusion in medical science, solutions may soon begin more actively involving patients. I aim to offer an evaluative framework for future possible proposals that would engage patients with the aim of mitigating underreporting. The framework may also have value in evaluating current reporting practices. The offered framework is composed of three criteria (...) that are bioethical, social-epistemic, and pragmatic: (i) patients should not be exposed to undue harms, e.g., nocebo effects; (ii) data should be collected, analyzed, and communicated prioritizing pharmacovigilance’s aims, i.e., free from industry bias; and (iii) proposals should account for existing and foreseeable pragmatic constraints like clinician ‘buy in’ and existing reporting infrastructure. Proposals to engage patients in pharmacovigilance that fulfil or address these criteria are preferable to those that do not. (shrink)

In this paper, I distinguish two conceptions of solidarity, which I call solidarity as beneficence and solidarity as mutual advantage. I argue that only the latter is capable of providing a complete foundation for national universal health care programs. On the mutual advantage account, the rationale for universal insurance is parallel to the rationale for a labor union’s “closed shop” policy. In both cases, mandatory participation is necessary in order to stop individuals free-riding on an ongoing system of mutually (...) advantageous cooperation. (shrink)

The study aimed to identify the sharing of information and its impact on the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. The study adopted the descriptive analytical approach. The number is 2150 employees, and the questionnaire was distributed to a stratified random sample of 330 employees, and 302 questionnaires were retrieved, with a rate of 91.5%. One of the most important results of the study was that there is a statistically significant effect (...) at the level (α≤0.05) of information sharing for the performance of the medical staff in the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. The axis of participation in information came with a relative weight (69.6%) and a high degree. The level of health care quality was high with a relative weight of (69.0%). One of the most important recommendations of the study was the need to pay attention to measuring patients' satisfaction levels, and to set up a box for complaints and suggestions for patients, and what are their suggestions and point of view for the service provided to them. (shrink)

Patient and public involvement is widely thought to be important in the improvement of health care delivery and in health equity. Purpose: The article examines the role of experiential knowledge in service co-production in order to develop opiate substitution treatment services (OST) for high-risk opioid users. Method: Drawing on social representations theory and the concept of social identity, we explore how experts’ by experience and registered nurses’ understandings of OST contain discourses about the social representations, identity, and citizenship (...) of the participants and the effects these may have on developing or hindering inclusive and bottom-up forms of patient and public involvement. Results: The meeting sessions that potentially offer room for creativity and problem-solving fail to provide any new propositions for fixing the system. The health care professionals primarily identify themselves as regulators who protect the correctness of their actions and show little interest in considering experiential knowledge on opioid addiction. Conclusion: The participation of patients has been one of the prominent reforms implemented in health care. The goal of client-centered thinking is often emphasised; however, the implementation is not simple due to the strongly institutionalised knowledge and related working patterns and practices in health care. (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)

This paper tackles a highly relevant issue, namely the relationship between climate justice and democracy. The driving motivation of the paper is to ask what principles of climate justice demand from democracies. The paper explores intrinsic and instrumental arguments and develops a sufficiency account: citizens are entitled to the emissions necessary not only to realize their basic needs but to participate as equals in political decision making.

It is Chantal Mouffe’s contention that the central weakness of consensus-driven forms of liberalism, such as John Rawls’ political liberalism and Jurgen Habermas’ deliberative democracy, is that they refuse to acknowledge conflict and pluralism, especially at the level of the ontological. Their defence for doing so is that conflict and pluralism are the result of attempts to incorporate unreasonable and irrational claims into the public political sphere. In this context, unreasonable and irrational claims are those that cannot be translated into (...) universalizable terms. However, for Mouffe, it is this intentional exclusionary act itself that is detrimental to a well- functioning democratic polity. It is only through the inclusion of a diverse body of subject positions that a democratic polity can be said to be truly representative of the polity, and therefore constitute a functioning and inclusive democracy. -/- This paper will examine Mouffe’s account of agonistic pluralism. In doing so, it will demonstrate that instead of being a source of instability within the democratic discourse and therefore relegated into the private non-political sphere, passions and values that are constitutive of these subject positions ought to be incorporated into the public political sphere. Mouffe’s rationale for doing so is that it is precisely through their incorporation that citizens will retain their allegiance to the democratic polity. However, as part of this examination, this paper will also draw attention to an under-developed aspect of Mouffe’s account of agonistic democracy, specifically problems regarding both participation and exclusion. Whilst Mouffe does provide a robust counterpoint to both Rawls’ political liberalism and Habermas’ deliberative democracy, it is my contention that she fails to explain adequately what it is that persuades participants to act democratically and adhere to the requirements of agonal respect, nor what should happen when the ethico- political principles of liberty and equality are not accepted. (shrink)

Low back pain (LBP) carries a high risk of chronicization and disability, greatly impacting the overall demand for care and costs, and its treatment is at risk of scarce adherence. This work introduces a new scenario based on the use of a mobile health tool, the Dress-KINESIS, to support the traditional rehabilitation approach. The tool proposes targeted self-manageable exercise plans for improving pain and disability, but it also monitors their efficacy. Since LBP prevention is the key strategy, the tool (...) also collects real-patient syndromic information, shares valid educational messages and fosters self-determined motivation to exercise. Our analysis is based on a comparison of the performance of the traditional rehabilitation process for non-specific LBP patients and some different scenarios, designed by including the Dress-KINESIS’s support in the original process. The results of the simulations show that the integrated approach leads to a better capacity for taking on patients while maintaining the same physiotherapists’ effort and costs, and it decreases healthcare costs during the two years following LBP onset. These findings suggest that the healthcare system should shift the paradigm towards citizens’ participation and the digital support, with the aim of improving its efficiency and citizens’ quality of life. (shrink)

The study investigated factors that influence the uptake of maternal healthcare services by women in Zimbabwe, using a logit model. Data from the Zimbabwe Demographic Health Survey (ZDHS, 2015) was used. Deteriorating maternal health indicators motivated the study. The effect of socio-economic and demographic factors on the probability of utilising maternal healthcare services was examined. Descriptive statistics and a logit model were used for data analysis. Results from the logit model show that region of residence, insurance cover, (...) educational level, employment status, maternal age, birth order, place of residence, number of living children, maternal age and household income all influence the utilisation of maternal healthcare services by women in Zimbabwe. Basing on research findings, the study recommends that relevant authorities make more available vocational training centres and education institutions since education was found to influence the uptake of maternal healthcare services. There is need to encourage family planning so as to reduce the number of children, especially among the apostolic sect, which affects the uptake of maternal healthcare. Compulsory national health insurance schemes could be adopted to mitigate the effect of low income that discourages the use of institutional facilities for delivery. The issue of balanced regional development needs to be pursued through accelerating devolution to ensure equal access to maternal healthcare facilities in all provinces. (shrink)

This paper looks at Alexander Guerrero’s epistemic case for ‘lottocracy’, or government by randomly selected citizen assemblies. It argues that Guerrero fails to show that citizen expertise is more likely to be elicited and brought to bear on democratic politics if we replace elections with random selection. However, randomly selected citizen assemblies can be valuable deliberative and participative additions to elected and appointed institutions even when citizens are not bearers of special knowledge or virtue individually or collectively.

As part of recent epistemic challenges to democracy, some have endorsed the implementation of epistemic constraints on voting, institutional mechanisms that bar incompetent voters from participating in public decision-making procedures. This proposal is often considered incompatible with a commitment to political equality. In this paper, I aim to dispute the strength of this latter claim by offering a theoretical justification for epistemic constraints on voting that does not rest on antiegalitarian commitments. Call this the civic accountability justification for epistemic constraints (...) on voting. On this view, voters stand to one another in a normative relation of reciprocal accountability that requires them to uphold an epistemically responsible conduct. Modest epistemic constraints on voting are justifiable because they secure that participation in voting is conforming to this normative requirement. Thanks to its distinctive features, the civic accountability justification can overcome two problems that egalitarians commonly associate with the idea of epistemic constraints on voting: the disrespect problem and the hierarchy problem. (shrink)

The idea that healthcare should become more person-centred is extremely influential. By using recent English policy developments as a case study, this article aims to critically analyse an important element of person-centred care, namely, the belief that to treat patients as persons is to think that care should be ‘co-produced’ by formal healthcare providers and patients together with unpaid carers and voluntary organizations. I draw on insights from political philosophy to highlight overlooked tensions between co-production and values like equality and (...) liberty. Regarding equality, I argue that co-production compounds both problems of gender inequality in the distribution of care labour and the challenges associated with securing equal access to care. Turning to liberty, I identify important commonalities between co-production and republicanism in political philosophy, given their shared insistence on common citizens’ civic virtue. Then, I use against co-production some liberal arguments against republicanism, to highlight a problem of over-demandingness. In bringing my argument to a close, however, I wish to caution against hastily rejecting co-production as a policy programme. (shrink)

Informal political representation can be a political lifeline, particularly for oppressed and marginalized groups. Such representation can give these groups some say, however mediate, partial, and imperfect, in how things go for them. Coeval with the political goods such representation offers these groups are its particular dangers to them. Mindful of these dangers, skeptics challenge the practice for being, inter alia, unaccountable, unauthorized, inegalitarian, and oppressive. These challenges provide strong pro tanto reasons to think the practice morally impermissible. This paper (...) considers the question: On what conditions is the informal political representation of oppressed and marginalized groups permissible? By responding to skeptics’ challenges, I develop a systematic account of moral constraints that, if adopted, would make such representation permissible. The account that emerges shows that informal political representatives (IPRs) must aim to fulfill two sets of sometimes conflicting duties to the represented: democracy within duties, which concern how the representative treats and relates to the represented, and justice without duties, which concern how the representative’s actions advance the aims of the representation. (shrink)

Are rights to privacy consistent with sexual equality? In a brief, but influential, article Catherine MacKinnon trenchantly laid out feminist criticisms of the right to privacy. In “Privacy v. Equality: Beyond Roe v. Wade” she linked familiar objections to the right to privacy and connected them to the fate of abortion rights in the U.S.A. (MacKinnon, 1983, 93-102). For many feminists, the Supreme Court’s decision in Roe v. Wade (1973) had suggested that, notwithstanding a dubious past, legal rights to privacy (...) might serve feminist objectives, and prove consistent with sexual equality. By arguing that Roe’s privacy justification of abortion rights was directly responsible for the weakness and vulnerability of abortion rights in America, MacKinnon took aim at feminist hopes for the right to privacy at their strongest point. Maintaining that Roe’s privacy justification of abortion is intimately, and not contingently, related to the Supreme Court’s subsequent decision in Harris v. McRae, (1980) MacKinnon concluded that privacy rights cannot be reconciled with the freedom and equality of women, and so can have no place in a democracy.1 In Harris, the Supreme Court held that the State need not provide Medicaid coverage for abortions that are necessary to preserve the health, but not the life, of a pregnant woman, effectively depriving poor women of almost all state aid for abortions.2 Moreover, the Court’s subsequent decision in Bowers v . Hardwick (1986) appeared to confirm the truth of MacKinnon’s observation – though this case concerned gay rights, rather than abortion rights, and occurred several years after MacKinnon’s condemnation of Harris. -/- This paper examines MacKinnon’s claims about the relationship of rights to privacy and equality in light of the reasoning in Harris and Bowers. When we contrast the Majority and Minority decisions in these cases, it shows, we can distinguish interpretations of the right to privacy that are consistent with sexual equality from those that are not. This is not simply because the two differ in their consequences – though they do - but because the former, unlike the latter, rely on empirical and normative assumptions that would justify sexual inequality whatever right they were used to interpret. So while I agree with MacKinnon that the Majority’s interpretation of the right to privacy in Harris is inconsistent with the equality of men and women, I show that there is no inherent inconsistency in valuing both privacy and equality, and no reason why we must chose to protect the one, rather than the other. Indeed, an examination of MacKinnon’s article, I suggest, can help us to see why rights to privacy can be part of a scheme of democratic rights, and how we might go about democratising the right to privacy in future. To avoid confusion I should emphasise that my arguments are of a philosophical, not a legal, nature. Thus, I will be ignoring the specifically legal and constitutional aspects of MacKinnon’s article, and of the Supreme Court decisions, in order to bring their philosophical significance into focus. -/- . (shrink)

Regarding the relation of Plato’s early and middle period dialogues, scholars have been divided to two opposing groups: unitarists and developmentalists. While developmentalists try to prove that there are some noticeable and even fundamental differences between Plato’s early and middle period dialogues, the unitarists assert that there is no essential difference in there. The main goal of this article is to suggest that some of Plato’s ontological as well as epistemological principles change, both radically and fundamentally, between the early and (...) middle period dialogues. Though this is a kind of strengthening the developmentalistic approach corresponding the relation of the early and middle period dialogues, based on the fact that what is to be proved here is a essential development in Plato’ ontology and his epistemology, by expanding the grounds of development to the ontological and epistemological principles, it hints to a more profound development. The fact that the bipolar and split knowledge and being of the early period dialogues give way to the tripartite and bound knowledge and benig of the middle period dialogues indicates the development of the notions of being and knowledge in Plato’s philosophy before the dialogues of the middle period. -/- Keywords Plato; early dialogues; middle dialogues; being; knowledge; development -/- Introduction The differences between two groups of the early and middle period dialogues have always been a matter of dispute. Whereas the developmentalists like Vlastos, Silverman (2002), Teloh (1981), Dancy (2004) and Rickless (2007) think that from the early to the middle dialogues Plato’s philosophy changes, at least in some essential points, the unitarists like Kahn, Cherniss and Shorey believe that there happens no development and the differences must be taken as natural, ignorable and even pedagogic. In his well-known article, Socrates contra Socrates in PLATO, Vlastos lists ten theses of difference between two groups of dialogues. The first group which includes Plato’s early dialogues he divides to 'elenctic' (Apology, Charmides, Crito, Euthyphro, Gorgias, Hippias Minor, Ion, Laches, Protagoras and Republic I) and 'transitional' (Euthydemus, Hippias Major, Lysis, Menexenus and Meno) dialogues. These transitional come after all the elenctic dialogues and before all the dialogues of the second group which compose Plato’s middle period dialogues, including (with Vlastos' chronological order) Cratylus, Phaedo, Symposium, Republic II-X, Phaedrus, Parmenides and Theaetetus (1991, 46-49). Vlastos asserts strictly that his list of differences are 'so diverse in content and method that they contrast as sharply with one another as with any third philosophy you care to mention, beginning with Aristotole’s' (ibid, 46). Vlastos’ list of differences between two Socrateses is considered a view breaking sharply between the early and the middle dialogues. Besides all ten differences between the two Socrateses in Vlastos’ list that can be supportive for our doctrine here, we intend to focus on some ontological as well as epistemological distinctions that have not completely been discussed hitherto. Contrary to the developmentalist theory of Vlastos, unitarian theory of Charles Kahn wishes to eliminate any substantial difference between the early and the middle dialogues. He distinguishes seven 'pre-middle' or 'threshold' dialogues including Laches, Charmides, Euthyphro, Protagoras, Meno, Lysis and Euthydemus from the other Socratic dialogues which he calls 'earliest group' (1996, 41). The threshold dialogues, Kahn thinks, 'embarke upon a sustained project' that is to reach to its climax in the middle period dialogues, namely Phaedo, Symposium and Republic. Believing in that there is no 'fundamental shift'between the early and middle dialogues (ibid, 40), Kahn thinks the Socratic dialogues are just the 'first stage' with a 'deliberate silence' towards the theories of later periods (ibid, 339). One of the reasons of the surprising fact that Plato gives no hint of the metaphysics and epistemology of the Forms in the early dialogues, he thinks, is the pedagogical advantages of aporia. He thinks that Plato 'obscurely', and mostly because of education, hinted to some doctrines and conceptions in his early dialogues and with the aim of clarifying them only in the later ones (ibid, 66). The seven threshold dialogues, Kahn asserts, 'had been designed from the first' to prepare the pupils and readers for the views expounded in the middle period dialogues (ibid, 59-60). To show that the differences of the two Socrateses of the early and middle period dialogue are in their onto-epistemological grounds and thence cannot be explained by a unitaristic view, we try to draw the ontological and epistemological principles of the early dialogues in the first part below in order to show, in the second part, that those principles have been developed in the middle period dialogues. -/- A. The Onto-Epistemologic Principles of the Early Dialogues Socratic dialogues are paradoxical about knowledge because while being knowledge-oriented always searching for knowledge, they deny it and even never discuss it directly. Three elements of Socrates’ way of searching Knowledge throughout the early dialogues, i.e. Socratic 'what is X?' question, his disavowal of knowledge and his elenctic method combined together produce something like a circle which works, more or less, in the same way in these dialogues. Though this circle is an embaressing inquiry always resulting in ignorance instead of knowledge, its motivation is surprisingly Socrates’ passionate enthusiasm for knowledge, an intensive love of wisdom. The starting point of this circle is Socrates’ confession of having no knowledge which might be explicitly asserted or presupposed, maybe because it was one of the famous characteristics of Socrates; a confession always paradoxically accompanied with his intense longing for knowledge (e.g., Gorgias 505e4-5). Every time Socrates encounters with someone who thinks he knows something (οἴεταί τι εἰδέναι) (Apology 21d5) and tries to examine him. This examination seems to be the simplest one asking just what it is that he knows. Socrates’ elenchus, therefore, is always connected with 'what is X?' (τίς ποτέ ἐστιν) question, a question that most of the early dialogues of Plato are concerned with; 'what is courage?' in the Laches, 'what is piety?' in Euthydemus, 'what is temperance?' in Charmides and 'what is beauty?' in Hippias Major. This question we call here 'Socratic question' and probably is the very question the historical Socrates used to employ, is tightly interrelated with both his disavowal and his elenchus. He disclaims knowledge because he cannot find the answer to the question himself and he rejects others’ since they cannot offer the correct answer too. Every interlocutor can claim he knows X, if and only if he can answer the Socratic question. Otherwise, he is more of an ignorant than of a knower of τί ποτέ ἐστι X. Knowing the answer to this question is, thus, knowledge’s criterion for Socrates. Having found out that he cannot answer what it is which he would claim to know, the interlocutor comes to the point Socrates was there at the beginning. The least advantage of this circle is that he becomes as wise as Socrates does about the subject, becoming aware that he does not know it. At the end of the circle they are both still at the beginning, not knowing what X is. So let us first take a glance at these three elements. Socratic disavowal of knowledge is strictly asserted in some passages. At Apology 21b4-5, Socrates says: -/- I do not know of myself being wise at all (οὔτε μέγα οὔτε σμικρὸν σύνοιδα ἐμαυτῷ σοφὸς ὤν) -/- Moreover, at 21d4-6: -/- None of us knows anything worthwhile (καλὸν κἀγαθὸν εἰδέναι) …. I do not know (οἶδα) neither do I think I know. -/- In Charmides Socrates speaks about a fear about his probable mistake of thinking that he knows (εἰδέναι) something when he does not (166d1-2). The somehow generalization of this disavowal can be seen in Gorgias. After calling his disavowal 'an account that is always the same' (509a4-5), Socrates continues (a5-7): -/- I say that I do not know (οἶδα) how these things are, but no one I have ever met, like now, who can say anything else without being absurd. -/- At the end of Hippias Major (304d7-8), Socrates affirms his disavowal of knowledge of 'what is X?' this time about the fine: -/- I do not know (οἶδα) what that is itself (αὐτὸ τοῦτο ὅτι ποτέ ἐστιν). Some other passages, however, made a number of scholars dubious about Socrates’ disavowal. Vlastos mentions Apology 29b6-7 as an evidence : 'that to do wrong and to disobey one’s master, both god and men, I know (οἶδα) to be evil and shameful'. He thinks that if we give this single text 'its full weight' it can suffice to show that Socrates does claim knowledge of a moral truth (1985, 7). Vlastos’ claim is not admittable since it would be too strange, I think, for a man like Socrates to violate his disavowal claim just after emphasizing it. We can see his claim just before the already mentioned passage: -/- And surely it is the most blameworthy ignorance to believe that one knows what one does not know. It is perhaps on this point and in this respect, gentlemen, that I differ from the majority of men and if I were to claim that I am wiser than anyone in anything it world be in this, that, as I have no adequate knowledge (οὐκ εἰδὼς ἱκανῶς) of things in the underworld, so I do not think I have (οὐκ εἰδέναι) (Apology 29b1-6) Vlastos tries to solve what he calls the 'paradox' of Socrates’ disavowal of knowledge distinguishing the 'certain' knowledge from 'elenctic' knowledge (1985, 11) and thinking that when Socrates avows knowledge, we must perceive it as an elenctic knowledge, a knowledge its content 'must be propositions he thinks elenctically justifiable' (ibid, 18). Irwin’s solution is the distinction of knowledge and belief. He approves that Socrates does not 'explicitly' make such a distinction, but still thinks that Socrates’ 'test for knowledge would make it reasonable for him to recognize true belief without knowledge, and his own claims are easily understood if they are claims to true belief alone' (1977, 40). While I agree with Vlastos up to a point, I strongly disagree with Irwin about the early dialogues. As I will try to show below, we are not permitted to consider any kind of distinction within knowledge in Socratic dialogues because only one category of knowledge is alluded to there and the distinction of knowledge and belief thoroughly belongs to the second Sorcates. Although no kind of distinction can be admittable here, I think Vlastos’ distinction can be accepted only if we regard it as a distinction between knowledge, which is unique and without any, even incomparable, rival, and a semi-idiomatic and ordinary one that is a necessary requirement for any argument, and thus, unavoidable even for someone who does not claim any kind of knowledge. An apparent evidence of this is Gorgias 505e6-506a4: -/- I go through the discussion as I think it is (ὡς ἄν μοι δοκῇ ἔχειν), if any of you do not agree with admissions I am making to myself, you must object and refute me. For I do not say what I say as I know (οὐδὲ γάρ τοι ἔγωγε εἰδὼς λέγω ἃ λέγω) but as searching jointly with you (ζητῶ κοινῇ μεθ᾽ ὑμῶν). -/- The minimal degree of knowledge everyone must have to take part in an argument, conduct it and use the phrase "I know" when it is necessary is what Socrates cannot deny. We can call it elenctic knowledge only if we agree that it is not the kind of knowledge that Socrates has always been searching, the one that can be accepted as the answer of Socratic 'what is X?' question. His disavowal of knowledge is applied only to the knowledge which can truly be the answer of Socratic question and pass the elenctic exam; a knowledge that, I believe, is never claimed by first Socrates. Socrates conducts his method of examining his interlocutors’ knowledge, our second element here, by almost the same method repeated in Socratic dialogues. That whether we are allowed to regard all the examinations of Socrates in the early dialogues as based on the same or not has been a matter of dispute. Vlastos himself (1994, 31) distinguished Euthydemas, Lysis, Menexenns and Hippias Major from the other Socratic dialogues because he thinks Socrates has lost his faith to elenchus in there. Irwin (1977, 38) distinguishes Apology and Crito where Socrates’ own convictions is present. Contrary to some scholars like Benson (2002, 107) who take elenchus in all the Socratic dialogues as a unique method, Michelle Carpenter and Ronald M. Polansky (2002, 89-100) argue pro the variety of methods of elenchus. Thomas C. Brickhouse and Nicholas D. Smith (2002, 145-160) even reject such a thing as Socratic elenchus which can gather all of the Socrates’ various arguments under such a heading. There can be no solution for the problem of elenchus, they think, is due to 'the simple reason that there is no such thing as 'the Socratic elenchos"'(p.147). Though we consider elenchus a somehow determined process and a part of Socratic circle in the early dialogues, all we assume is that whatever differences it might have in different dialogues, it has the same onto-epistemological principles and, thus, we are not going to take it necessarily as a unique method. This method sets out to prove that the interlocutors are as ignorant as Socrates himself is. That whether elenchus is constructive, capable of establishing doctrines as Vlastos (1994) or Brickhouse and Smith (1994, 20-21) believe or not is another issue to which this paper is not to claim anything. What is crucial for our discussion here is that elenchus does not reach to the very knowledge Socrates is looking for. This is strictly against Irwin who thinks that not only elenchus leads to positive results, 'it should even yield knowledge to match Socrates’ conditions'(1977, 68, cf. 48). He does not explain where and how they really yield to that kind of knowledge. He explains his elenctic method in his apology in the court (Apology 21-22), that how he used to examine wise men, politicians, poets and all those who had the highest reputation for their knowledge and every time found that they have no knowledge. If we accept, as I strongly do, that Socrates’ disavowal of his knowledge is not irony, it might seem more reasonable to agree that the process that has that disavowal as its first step cannot be irony as well. The key of the circle which can explain why Socrates disclaims knowledge and how he can reject others’ claim of having any kind of knowledge lies in the third element, Socratic question. In Hippias Major (287c1-2), Socrates asks: 'Is it not by Justice that just people are Just? (ἆρ᾽ οὐ δικαιοσύνῃ δίκαιοί εἰσιν οἱ δίκαιοι). He insists at 294b1 that they were searching for that by which (ᾧ) all beautiful things are beautiful (cf. b4-5, 8). At Euthyphro 6d10-11 it is said that the Socratic question is waiting for 'the form itself (αὐτὸ τὸ εἶδος) by which (ᾧ) all the pious actions are pious; and at 6d11-e1: -/- Through one form (που μιᾷ ἰδέᾳ) impious actions are impious and pious actions pious. -/- Since the X itself is that by which X is X, knowing 'X itself' is the only way of knowing X. It is probably because of this that Socrates makes the distinction between the ousia as a right answer to the question and effect as a wrong one: -/- I am afraid, Euthyphro, that when you were asked what piety is (τὸ ὅσιον ὅτι ποτ᾽ ἐστίν) you did not wish to make clear its nature itself (οὐσίαν … αὐτοῦ) to me, but you said some effect (πάθος) about it. (Euthp. 11a6-9) -/- 1. Knowledge of what X is Now it is time to look for the onto-epistemological principles of Socratic circle and its three elements. It cannot reasonably be expected from the first Socrates to present us explicitly and clearly formulated principles of his onto-epistemology when such explications cannot be found even in the second Socrates who has some obviously positive theoris. Since there must be some principles underlying this first systematic inqury of knowledge, we must seek to them and be satisfied with elicitation of the first Socratas’ principle. What will be drawn out as his principles cannot and must not, thus, be taken as very fix and dogmatic principles. Some very slightest principles and grounds suffice for our purposes here. The first principle that is the prima facie significance of the Socratic question and his implementation of all those elenctic arguments I call the principle of 'Knowledge of What X is' (KWX): -/- KWX To know X, it is required to know what X is. -/- Aristotle (Metaphysics 1078b23-25, 27-29, 987b4-8) takes Plato’s τί ἐστι question as seeking the definition of a thing that is the same as historical Socrates’ search but applying to a different field. That Plato’s 'what is X?' question was a search for definition became the prevailed understanding of this question up to now. I am going neither to discuss the answer of Socratic question nor to challenge taking it as definition. What I am to insist is that knowledge is attached firmly to the answer of the question: Knowledge of X is not anything but the knowledge of what X is. It entails, certainly, the priority of this knowledge to any other kind of knowledge about X but it also has something more fundamental about the relation of knowledge and Socratic question. Socrates’ exclusive focus on the answer of his question can authorize the consideration of such an essential role for KWX in his epistemolgoy. The total rejection of his interlocutors’ knowledge when they are unable to answer the question can be regarded as a strong evidence for it. Socrates’ elenctic method and his rejection of others’ knowledge in the early dialogues, which all end aporetically with no one accepted as knower and nothing as knowledge, prevent us from finding any positive evidence for this. We have to be content, therefore, of negative evidences which, I think, can be found wherever Socrates rejects his interlocutors’ knowledge when they are not able to give an acceptable answer to his 'what is X?' question. 2. Bipolar Epistemology Socrates’ rejection of his interlocutors’ knowledge has another epistemological principle as its basis. Let me call this principle Bipolar Epistemology' (BE): BE There is no third way besides knowledge and Ignorance. -/- BE says that about every object of knowledge there are only two subjective statuses: knowledge and Ignorance. Socrates’ disavowal, however, says nothing but that he is ignorant of knowledge of X because he does not know what X is. This means that BE is presupposed here. Socrates’ elenchus and his rejection of interlocutors’ having any kind of knowledge are the necessary results of the fact that he does not let any third way besides knowledge and ignorance. The first Socrates never let anyone partly know X or have a true opinion about it, as he would not let anyone know anything about X when he did not know what X is. -/- 3. Bipolar Ontology The principle of BE in first Socrates’ epistemology is parallel to another principle in his ontology. Plato’s bipolar distinction between being and not being is as strict and perfect as his distinction between knowledge and ignorance. This principle I shall call the principle of 'Bipolar Ontology' (BO): BO Being is and not being is not. BO is apparently the same with the well-known Parmenidean Principle of being and not being (cf. Diels-Kranz (DK) Fr. 2.2-5). Euthydemus’ statement against the possibility of false knowledge can be good evidence for this principle: -/- The things which are not surely do not exist (τὰ δὲ μὴ ὄντα … ἄλλο τι ἢ οὐκ ἔστιν). (Euthydemus 284b3-4) -/- He continues (b4-5): -/- There is nowhere for not being to be there (οὖν οὐδαμοῦ τά γε μὴ ὄντα ὄντα ἐστίν). -/- That BE does not let true opinion as a third option besides knowledge and ignorance seems to be related to BO’s rejecting a third option besides being and not being, which is itself the basis of the impossibility of false belief. Socrates’ elaborate discussion of the problem of false belief in Theatetus that leads to a more decisive discussion and finally to some solutions in Sophist can make our consideration of BO for the first group of dialogues authentive. -/- 4. &5. Split Knowledge and Split Being The fourth principle I shall call the principle of 'Split Knowledge' (SK): -/- SK Knowledge of X is separated from any other knowledge (of anything else) as if the whole knowledge is split to various parts. -/- This Principle is hinted and criticized as Socrates’ way of treating with knowledge in Hippias Major: -/- But Socrates, you do not contemplate the entireties of things, nor do people you have used to talk with (τὰ μὲν ὅλα τῶν πραγμάτων οὐ σκοπεῖς, οὐδ᾽ ἐκεῖνοι οἷς σὺ εἴωθας διαλέγεσθαι). (301b2-4) -/- Contrary to Rankin who regards the passage as 'antilogical, almost eristic in tone rather than presenting a serious philosophy of being' (1983, 54), I think it can be taken as serious. Hippias criticizes Sorcates that he does not contemplate (σκοπεῖς) the entireties of things (ὅλα τῶν πραγμάτων), a critique which Socrates is not its only subject but all those whom Socrates accustomed to talk with (ἐκεῖνοι οἷς σὺ εἴωθας διαλέγεσθαι). This last phrase, I think, extends this critic beyond this dialogue to other Socratic dialogues. Hippias’ use of the perfect tense of the verb ἔθω (to be accustomed) is a good evidence of this extension. We can get, thus, these ἐκεῖνοι as Socrates’ interlocutors in his other dialogues that hints that this criticism has the epistemological groundings of the previous dialogues as its subject. What ἐκεῖνοι οἷς σὺ εἴωθας διαλέγεσθαι points to is that Hippias does not have in mind Socrates’ way of treating things only in this dialogue, but he is also criticizing Socrates’ way throughout his dialogues. At 301b4-5, Socrates and his interlocutors’ way of beholding things is described as such: -/- You people knock (κρούετε) at the fine and each of the beings (ἕκαστον τῶν ὄντων) by taking each being cut up in pieces (κατατέμνοντες) in words (ἐν τοῖς λόγοις). This leads us to our next principle that is parallel to, and the ontological side of, SK, the principle of 'Split Being'(SB): -/- SB Everything (being) is separated from any other thing as if the whole being is split to many beings. -/- Socrates and his interlocutors and thus, as we saw, the Socratic dialogues are accused to regard everything as it is separated from all other things. This separation is en tois logois that, I think, can reasonably be taken as saying that Socratic dialogues (it refers of course to the dialogues before Hippias Major) cut up all things which have the same name/definition from all other things and try to understand them separately, without considering other things that are not in their logos. They, for example in Hippias Major, are cutting up to kalon and try to understand what it and all others inside this logos are by separating it from all other things. This is directed straightly against Socratic question and the way Socratic dialogues follow to find its answer, every time separating one logos. As Meyer (1995, 85) points out, every question 'presupposes that the X in question in a logos is something' and 'every answer to every question aims at unity' (84). The critique of Hippias Major is, therefore, at the same time a critique of SK and SB. It is also a critique of KWX because it is only based on KWX that Socratic dialogues could search for the answer of 'what is X' question supposing that knowing what X is is enough for the knowledge of X. SK and KWX are absolutely interdependent. What Socrates and all his previous interlocutors have neglected in Socratic dialogues, Hippias says, was 'continuous bodies of being' (διανεκῆ σώματα τῆς οὐσίας) (301b6). Either this theory actually belongs to the historical Hippias as it is being said or not, it is strictly criticizing SB. We have the same phrase with changing sūma to logos some lines later at 301e3-4: διανεκεῖ λόγῳ τῆς οὐσίας. Although this theory that can be observed as both an ontological and an epistemological theory is rejected by Socrates (301cff.), it is still against first Socrates’ onto-epistemological principles and might let us look at what is rejected as Socratic prineple. -/- 6. Knowledge is of Being The sixth principle that I think is presupposed by the first Socrates, is the 'Knowledge of Being' Principle (KB): -/- KB Knowledge is of Being. -/- This principle is obviously the source of the problem of false knowledge, a very important problem throughout Plato’s philosophy. We face this problem maybe for the first time in Euthydemus. In less than 20 Stephanus’ pages, 276-295, we are encountered with different interwoven problems about knowledge , all grounded in the problem of false opinion. Having challenged the obvious possibility of telling lies at 283e, at 284 Euthydemus discusses it saying that the man who speaks is speaking about 'one of those things that are (ἓν μὴν κἀκεῖνό γ᾽ ἐστὶν τῶν ὄντων)' (284a3) and thus speaks what is (λέγων τὸ ὄν) (a5). He must necessarily be saying truth when he is speaking what is because he who speaks what is (τὸ ὄν) and the things that are (τὰ ὄντα) speaks truth (τἀληθῆ λέγει) (a5-6). This is based on Parmenidean principle of the impossibility of being of not being which Euthydemus restates (284b3-4) and we mentioned discussing BO principle above. The things that are not are nowhere (οὐδαμοῦ) and there is no possibility for anyone to do (πράξειεν) anything with them because they must be made as being before anything else can be done, which is impossible (b5-7). The words, then, are of things that exist (εἰσὶν ἑκάστῳ τῶν ὄντων λόγοι) (285e9) and as they are (ὡς ἔστιν) (e10). The result is that no one can speak of things as they are not. It is this impossibility of false speach that is extended to thinking (δοξάζειν) at 286d1 and leads to the impossibility of false opinion (ψευδής … δόξα) (286d4). The general conclusion is asserted at 287a extending this impossibility to actions and making any kind of mistake. Not only knowledge is of being but speech, thought and action are of being simply because of the fact that nothing can be of not being. -/- B. First Socrates’ Principles in the Middle Period Dialogues Out of what were presupposed or criticized mostly in five dialogues, Euthyphro, Euthydemus, Hippias Major, Laches and Charmides, we tried to draw the first Socrates’ principles. Our inquiry here is directed to find out the fate of these principles in the three dialogues of the middle period, Meno, Phaedo and Republic. To do this, first we ought to check the situation of Socratic circle in these dialogues. The Socratic circle that was predominant in the early dialogues, does not look like a circle here anymore though they certainly have some features in common. Meno, Phaedo and Republic II-X are not committed to the principles of the circle and the whole circle in disrupted in them. The difference of the two Socrateses towards acquiring knowledge is obvious. The Socrates of Meno, Phaedo and Republic is evidently more self-confident that he can get to some truths during his arguments as he does. They are in their first appearance, as almost all other dialogues, committed to Socrates’ disavowal. All of them try to keep the shape of the Socratikoi Logoi genre, which is committed to the historical Socrates’ way of discussion; a dramatic personage who is to challenge his interlocutors, ask them and refuse the answers. Nevertheless, the fact is that what we have in common between two groups of dialogues is mostly a dramatic structure. Whereas the first group’s arguments are based on Socrates’ disavowal and lead to no positive results, the second group is decisively going to achieve some positive results. The aim of the first Socrates was to show others that they are ignorant of what they thought they knew. The new Socrates of Meno, on the opposite, makes so much efforts to show that the slave boy has within himself true opinions (ἀληθεῖς δόξαι) about the things that he does not know (οἶδε) (85c6-7). Despite his lack of knowledge, he has true opinions nevertheless. The way from these true opinions to knowledge, as Socrates states, is not so long. These true opinions are now like a dream but 'can become knowledge of the same things not less accurate than anyone’s' (οὐδενὸς ἧττον ἀκριβῶς ἐπιστήσεται περὶ τούτων) (c11-d1), if they be repeated by asking the same questions. The most outstanding text regarding Socrates’ disavowal is Meno 98b where he explicitly claims knowledge: -/- And indeed I also speak as (ὡς) one who does not know (εἰδὼς) but is guessing (εἰκάζων). However, [about the fact] that true opinion and knowledge are different, I do not altogether expect (δοκῶ) myself to be guessing (εἰκάζειν), but if I say about anything that I know (εἰδέναι) -which about few things I say- this is one of the things that I know (οἶδα). (98b1-5) This passage is very significant about Plato’s disavowal of knowledge. There can hardly be found, I think, anywhere else in Plato’s corpus where Socrates speaks about his knowledge of something as such. He says first that he speaks as someone who does not know. This ὡς οὐκ εἰδὼς λέγω comparing with what he used to say in the first group, οὐκ οἶδα, has this added ὡς. Socrates does not claim strongly anymore that he does not know anything but speaks only as someone who does not know. He needs this ὡς not only because he is going to accept that he does know some, though few, things immediately after this sentence, but also because he needs his previous disavowal to be loosened from Meno on. He does not merely say here that he knows something. It is then different from the examples mentioned before which could be taken as idiomatic or at least not emphatic. Socrates’ remarkable emphasis on distinguishing εἰδέναι from εἰκάζειν departs it from all other passages where he says only he knows something. Moreover, he claims definitely that he has knowledge about few (ὀλίγα) things. From the early to the middle dialogues, Socrates’ attitude to knowledge has totally renewed its face. He brings forth a new concept, true opinion, and he does not speak of knowledge as he used to before; the rough, perfect and unachievable knowledge of the first group has turned to something more smooth, realistic and achievable. Comparing with the early dialogues that did not set out from the first to reach positive results, the middle ones are extraordinarily and surprisingly positive and hence destroy the basis of the Socratic circle. The questions and answers are purposely directed to some specific new theories; most of them are not directly related to the topics or the main questions of the dialogues. They are suggested when Socrates draws the attention of the interlocutor away from the main question because of the necessity of another discussion. Even if the main question remains unanswered, we have still many positive theories, prominently of metaphysical type. These theories are so abundant and dominant in these dialogues, especially Phaedo and Republic, that one might think that they may appear to be arbitrarily sandwiched in there. This helps dialogues to keep their original Socratic structure while they are suggesting new theories. Hence, the Socratic question of 'what is X?', though is still used to launch the discussion, is loosened and is forgotten for most part of the dialogues. Meno that has first a differently formulated question, 'can virtue be taught?', leads finally to the Socratic question of 'What is virtue?'. Phaedo is dedicated to the demonstration of the immortality of soul and the life after death without having a central Socratic question. The case of Republic is more complicated. The first book, on the one hand, has all the criteria of a Socratic circle: its 'what is justice?' question, Socrates’ strong disavowal (e.g. 337d-e), his rejection of all answers and coming back to the first point without finding out any answer. This Book, considered alone, is a perfect Socratic dialogue, as many scholars regard it as early and separated from other books. The books II-X are, on the other hand, far from implementing a Socratic circle. They have still the 'what is justice?' question as their incentive leading question, but they are, in most of the positive doctrines and methods that encompass the main parts, ignoring the question. Even these books that, I believe, are the farthest discussions from the Socratic circle are so cautious not to break the Socratic structure of the dialogue as long as it is possible. What is changed is not the structure of the dialogue but the ontological and epistemological grounds based on which new theories are suggested. -/- 1. Knowledge of the Good We can clearly see in the second group of dialogues that the KWX principle loses the place it had before in our first group. It is not, of course, rejected, but still we cannot say that it has the same situation. KWX that was based on Socratic question, as we discussed before, was the leading principle of the first Socrates’ epistemology and of the highest position. Other epistemological principles, SK directly and BE indirectly, were relying on Socratic question and therefore on KWX. Such a position does not belong to KWX from Meno on. What makes it different in the second Socrates is another principle that is needed it not only as its complementary principle but also as what is more fundamental. Plato, then, does not reject KWX in this period, but, it seems, he transcends to another more basic principle; a principle we shall call the principle of 'Knowledge of the Good' (KG): -/- KG Knowledge of X requires knowledge of the Good. -/- Whereas all the dialogues of our first group are free from any discuscon about KG, it bears a very important role in the second group so as becomes the superior principle of knowledge in Republic. Trying to solve the problem of teachability of virtue, Socrates says that it can be teachable only if it is a kind of knowledge because nothing can be taught to human beings but knowledge (ἐπιστήμην) (Meno 87c2). The dilemma will be, then, whether virtue is knowledge or not (c11-12) and since virtue is good, we can change the question to: whether is there anything good separate from knowledge (εἰ μέν τί ἐστιν ἀγαθὸν καὶ ἄλλο χωριζόμενον ἐπιστήμης) (d4-5). Therefore, the conclusion will be that if there is nothing good which knowledge does not encompass, virtue can be nothing but knowledge (d6-8). What let us discuss KG as an epistemological principle for the second Secrates is the relation he tries to establish between knowledge and the Good which, though is alongside with the mentioned thesis and the idea of virtue as knowledge, goes much deeper inside epistemology asking to regard the Good as the basis of knowledge. The effort of Phaedo cannot succeed in establishing the Good as the criterion of explanation and knowledge since, I think, it needs a far more complicated ontology of Republic where Socrates can finally announce KG. What is said in Republic is totally compatible with Phaedo 99d–e and the metaphor of watching an eclipse of the sun. In spite of the fact that we do not have adequate knowledge of the Idea of the Good, it is necessary for every kind of knowledge: 'If we do not know it, even if we know all other things, it is of no benefit to us without it' (505a6-7). The problem of our not having sufficient knowledge of the Idea of Good is tried to be solved by the same method of Phaedo 99d-e, that is to say, by looking at what is like instead of looking at thing itself (506d8-e4). It is this solution that leads to the comparison of the Good with sun in the allegory of Sun (508b12-13). What the Good is in the intelligible realm corresponds to what the sun is in the visible realm; as sun is not sight, but is its cause and is seen by it (b9-10), the Good is so regarding knowledge. It has, then, the same role for knowledge that the sun has for sight. Socrates draws our attention to the function of sun in our seeing. The eyes can see everything only in the light of the day being unable to see the same things in the gloom of night (508c4-6). Without the sun, our eyes are dimmed and blind as if they do not have clear vision any longer (c6-7). That the Good must have the same role about knowledge based on the analogy means that it must be considered as a required condition of any kind of knowledge: -/- The soul, then, thinks (νόει) in the same way: whenever it focuses on what is shined upon by truth and being, understands (ἐνόησέν), knows (ἔγνω) and apparently possesses understanding (νοῦν ἔχειν). (508d4-6) -/- Socrates does not use agathon in this paragraph and substitutes it with both aletheia and to on. He links them with the Idea of the Good when he is to assert the conclusion of the analogy: -/- That which gives truth to the objects of knowledge and the power of knowing to the knower, you must say, is the Idea of the Good: being the cause of knowledge and truth (αἰτίαν δ᾽ ἐπιστήμης οὖσαν καὶ ἀληθείας) so far as it is known (ὡς γιγνωσκομένης μὲν διανοοῦ). (508e1-4) Knowledge and truth are called goodlike (ἀγαθοειδῆ) since they are not the same as the Good but more honoured (508e6-509a5). KG, which had been implicitly contemplated and searched in Phaedo, is now explicitly being asserted in Republic. As what was quoted clearly proves, this principle is the very one which we can observe as the most fundamental principle of the second Socrates in Republic, corresponding to the role KWX had in the first Socrates. The Form of the Good in Republic, of which Santas speaks as 'the centerpiece of the canonical Platonism of the middle dialogues, the centerpiece of Plato’s metaphysics, epistemology, ethics and …' (1983, 256) much more can be said. Plato’s Cave allegory in Book VIII dedicates a similar role to the Idea of the Good. The Idea of the Good is there as the last thing to be seen in the knowable realm, something so important that its seeing equals to understanding the fact that it is the cause of all that is correct and beautiful (517b). Producing both light and its source in visible realm, it controls and provides truth and understanding in the intelligible realm (517c). -/- 2. Tripartite Epistemology BE is thoroughy rejected in the second Socrates and substituted by its opposite, the principle of 'Tripartite Epistemolgy' (TE): -/- TE Opinion is an epistemological status between knowledge and ignorance. BE of the first Socrates was denying any third way besides knowledge and ignorance which was the foundation of Socratic circle without which Socrates could not reject his interlocutors’ possessing any kind of knowledge. We cannot say, however, that the first Socrates had a third epistemological status in mind but rejected it. Such a status was unacceptable for him so that one can say that he would reject any kind of such status if suggested. There were only two possibilities about knowledge: either one knows something or he does not know it. TE, thus, was not the first Socrates’ discovery and, I think it is not the second Socrates’discovery. All we can see in our second group of dialouges is that he uses this principle as an already demonstrated one. Having examined the slave boy in Meno for the prupose of showing the working of recollection, it truns out that he has some opinions in him while he still does not know. Without trying to prove it, Socrates takes this as the distinction between knowledge and opinion: -/- So, he who does not know (οὐκ εἰδότι) about what he does not know (περὶ ὧν ἂν μὴ εἰδῇ) has within himself true opinions (ἀληθεῖς δόξαι) about the same things he did not know (περὶ τούτων ὧν οὐκ οἶδε) (85c6-7). -/- The same distinction is set between ὀρθὴν δόξαν and ἐπιστήμην at 97b5-6 ff. (also cf. 97b1-2: ὀρθῶς μὲν δοξάζων … ἐπιστάμενος). He connects then their difference to the myth of Daedalus, the statue that would run away and escape. So are true opinions, not willing to remain long in mind and thus not worthy until one ties them down by αἰτίας λογισμῷ (98a3-4). Socrates says that this tying down is anamnesis. We face, in Phaedo, the same relation is settled between knowledge as the process of being tied down and getting the capability to give an account, on the one hand, and anamnesis, on the other hand. When a man knows, he must be able to give an account of what he knows (Phaedo 76b5-6) and since not all people are able to give such an account, those who recollect, recollect what once they learned (76c4). Although the distinction between knowledge and opinion is not explicitly used in Phaedo, referring to the parallel link between knowledge plus account and anamnesis in Phaedo and Meno, one can say that those who cannot recollect are not able to give account and, thus, are in a state of opinion. What is said at Phaedo 84a, though not yet a definite distinction between knowledge and opinion, makes a distinction between their objects so as we can agree that it is presupposed. The soul of the philosopher, Socrates says, follows reason, stays with it forever and contemplates the divine, which is not the object of opinoin (ἀδόξαστον) (84a8, cf. Meno 98b2-5). The distinction of knowledge and belief in Republic has a significant difference with what we discussed in Meno and Phaedo since the distinction of Meno was based on anamnesis and thus more an epistemological distinction. Even in Phaedo that we do not have any elaborate discussion about the distinction, the only hint to the matter at 76 is bound to the theory of anamnesis. In addition to the relation of the distinction with this theory, there is another evidence that does not permit us to consider the distinction as an ontological distinction. Let’s see Meno 85c6-7: -/- So, he who does not know about what he does not know has within himself true opinions about the same things he did not know (τῷ οὐκ εἰδότι ἄρα περὶ ὧν ἂν μὴ εἰδῇ ἔνεισιν ἀληθεῖς δόξαι περὶ τούτων ὧν οὐκ οἶδε). (85c6-7) -/- This last sentence persists that the objects of knowledge and true opinion are the same. What Socrates is to say here is that whereas he does not know X he has true opinion about the same X. I think Socrates’ sentence that the slave boy οὐκ εἰδότι ἄρα περὶ ὧν ἂν μὴ εἰδῇ and his restatement of it by saying περὶ τούτων ὧν οὐκ οἶδε is because he wants to emphasize that the slave boy who does not know, has true opinion about the same thing. Socrates could say this just with using τούτων and there would be no necessity to bring περὶ ὧν ἂν μὴ εἰδῇ for οὐκ εἰδότι if he did not want to emphasize. -/- 3. Tripartite Ontology The distinction between knowledge and true opinion in Republic, on other side, has nothing to do with recollection, but is based on an ontological principle, 'Tripartite Ontology' (TO): -/- TO There are things that both are and are not. -/- This principle I confine, among our three dialogues of the second group, to Republic not extended to Meno and Phaedo, is obviously the opposite of BO. Speaking about the lovers of sights and sounds in the fifth book, Socrates distinguishes them from philosophers because their thought is unable to understand the nature of beautiful itself besides beautiful things (476a6-8) and hence they can only have opinions. The philosopher who, on the contrary, believes in beautiful itself and can distinguish it from beautiful things (476c9-d3), has knowledge because he knows, contrasting others who have opinion because they only opine (d5-6). Since those whose knowledge were degraded as opinion will complain about Socrates’ such calling their thought, he provides them the following argument (476e7-477b1): -/- - Does the person who knows, knows (γιγνώσκει) something (τὶ) or nothing (οὐδέν)? - He knows something (τί). - Something that is (ὂν) or is not (οὐκ ὄν)? - Something that is (ὂν) for how could something that is not be known (πῶς γὰρ ἂν μὴ ὄν γέ τι γνωσθείη)? - Then we have an adequate grasp of this: No matter how many ways we examine it, what completely is (παντελῶς ὂν) is completely knowable (παντελῶς γνωστόν) and what is in no way (μὴ ὂν δὲ μηδαμῇ) is in every way unknowable (πάντῃ ἄγνωστον). - A most adequate one. - Good. Now, if anything is such as to be and also not to be (ὡς εἶναί τε καὶ μὴ εἶναι), won’t it be intermediate (μεταξὺ) between what purely is (εἰλικρινῶς ὄντος) and what in no way is (μηδαμῇ ὄντος)? - Yes, it’s intermediate. - Then as knowledge (γνῶσις) is set over what is (τῷ ὄντι), while ignorance (ἀγνωσία) is of necessity set over what is not (μὴ ὄντι) mustn’t we find an intermediate between ignorance (ἀγνοίας) and knowledge (ἐπιστήμης) to be set over the intermediate, if there is such a thing? -/- From the third status of being we must reach to the third status of knowledge. The simple reading of this text can be an existential reading, taking the "is" of the mentioned sentences as existence. The problem is that when it is said that there is something that both is and is not reading "is" existentially, it sounds too bizarre to be acceptable. It cannot easily be understandable to have something as both existent and non-existent at the same time. This problem arose so many debates and led many scholars to reject the existential reading of "is" and suggest some other readings like predicative or veridical readings. I think though Plato’s complicated ontology of Republic cannot be correctly understood by a simple existential reading, this "is" cannot be free from existential sense of being and, thus, cannot be reduced to just a predicative or veridical sense of being. -/- 4. Bound Knowledges In addition to KG, the Good is also the basis of another principle in the second Socrates, namely the principle of 'Bound Knowledge' (BK): -/- BK Knowledge of everything is bound to the knowledge of the Good. -/- We distinguished BK from KG because we want to insist, in BK, on what had not been insisted upon in KG, that is, the binding role that the Good plays in the second Socrates, contrasting the absence of such a role in the first Socrates. Socrates remembers, in Phaedo, his wonderful keen on natural philosophers' wisdom when he was young. The origin of this enthusiasm was Socrates’ hope to know the cause of everything as they used to claim. When he was searching the matters of his interest on their basis, Socrates says, he became convinced he can get no acceptable answer from them and found himself blind even to the things he thought he knew before. One day he hears Anaxagoras’ theory that 'it is Mind that arranges and is the cause of everything (ὡς ἄρα νοῦς ἐστιν ὁ διακοσμῶν τε καὶ πάντων αἴτιος)' (Phd. 97c1-2 cf. DK, Fr.15.8-9, 11-12, 12-14) and thinks that he can finally find what he has always expected, i.e. something which can explain all things. What I intend to show here is that what makes Socrates hopeful is that Anaxagoras’ theory tries 1) to explain all things by one thing and 2) this explanation is understood by Socrates as if it is based on the concept of the Good. That Socrates was searching for one explanation for all things can be proved even from what he has been expecting from natural philosophers. The case is, nonetheless, more clearly asserted when he speaks about Anaxagoras’ theory. In addition to διακοσμῶν τε καὶ πάντων αἴτιος of 97c2 mentioned above, we have τὸ τὸν νοῦν εἶναι πάντων αἴτιον (c3-4) and τόν γε νοῦν κοσμοῦντα πάντα κοσμεῖν (c4-5) all emphasizing on the cause of all things (πάντα) which can clearly prove that one of the reasons which caused Socrates to embrace it delightfully was its claim to provide the cause of all things by one thing. Another reason was that Anaxagoras’ Mind, at least in Socrates’ view, was attempting to explain everything by the concept of the Good. This connection between Mind and Good belongs more to the essential relation they have in Socrates’ thinking than Anaxagoras’ theory because there are almost nothing about such a relation in Anaxagoras. The reason for Socrates’ reading can be that Mind is substantially compatible with Socrates’ idea of the relation between good and knowledge. Both the thesis 'no one does wrong willingly' and the theory of virtue as knowledge we pointed to above are evidences of this essential relation. Nobody who knows that something is bad can choose or do it as bad. The reason, when it is reason, that means when it is as it should be, when it is wise or when it knows, works only based on good-choosing. In this context, when Socrates hears that Mind is considered as the cause of everything, it sounds to him like this: good should be regarded as the basis of the explanation of all things. We see him, thus, passing from the former to the latter without any proof. This is done in the second sentence after introducing Mind: -/- I thought that if this were so, the arranging Mind would arrange all things and put each thing in the way that was Best (ὅπῃ ἂν βέλτιστα ἔχῃ). If one then wished to find the cause of each thing by which it either perishes or exists, one needs to find what is the best way (βέλτιστον αὐτῷ ἐστιν) for it to be, or to be acted upon, or to act. On these premises then it befitted a man to investigate only, about this and other things, what is the most excellent (ἄριστον) and best (βέλτιστον). The same man must inevitably also know what is worse (χεῖρον), for that is part of the same knowledge. (97c4-d5) This passage is a good evidence of Socrates’ leap from Anaxagoras’ Mind to his own concept of the Good that can explain why Socrates found Anaxagoras theory after his own heart (97d7). Mind is welcomed because of its capability for explanation on the basis of good to 'explain why it is so of necessity, saying which is better (ἄμεινον), and that it was better (ἄμεινον) to be so' (97e1-3). What Socrates thought he had found in Anaxagoras can indicate what he had been expecting from natural scientists before. Socrates could not be satisfied with their explanations because they were unable to explain how it is the best for everything to be as it is. It can probably be said, then, that it was the lack of the unifying Good in their explanation that had disappointed him. We must insist that we are discussing what Socrates thought that Anaxagoras’ theory of Mind should have been, not about Anaxagoras’ actual way of using Mind. Phaedo 97c-98b, is not about what Socrates found in Anaxagoras but what he thought he could find in it. On the contrary, it should also be noted that it was not this that was dashed at 98b, but Anaxagoras’ actual way of using Mind. It was Anaxagoras’ fault not to find out how to use such an excellent thesis (98b8-c2, cf. 98e-99b). Socrates gives an example to show how not believing in 'good' as the basis of explanation makes people be wanderers between different unreal explanations of a thing. His words δέον συνδεῖν (binding that binds together) as a description for the Good we chose as the name of BK principle: They do not believe that the truly good and binding binds and holds them together (ὡς ἀληθῶς τὸ ἀγαθὸν καὶ δέον συνδεῖν καὶ συνέχειν οὐδὲν οἴονται). (99c5-6) -/- Having in mind Plato’s well-known analogy of the sun and the Good at Republic 508-509, we can dare to say that his warning of the danger of seeing the truth directly like one watching an eclipse of the sun in Phaedo (99d-e) is more about the difficulty of so-called good-based explanation than its insufficiency, a difficulty which is precisely confirmed in Republic (504e-505a, 506d-e). Moreover, BK is asserted in a more explicit way in the Republic, where the Good is considered not only as a condition for the knowledge of X, as was noted above discussing KG, but also as what binds all the objects of knowledge and also the soul in its knowing them. At Republic VI, 508e1-3, when Socrates says that the Form of the Good 'gives truth to the things known and the power to know to the knower (τοῦτο τοίνυν τὸ τὴν ἀλήθειαν παρέχον τοῖς γιγνωσκομένοις καὶ τῷ γιγνώσκοντι τὴν δύναμιν ἀποδιδὸν)', he wants to set the Good at the highest point of his epistemological structure by which all the elements of this structure are bound. This binding aspect of the Good is by no means a simple binding of all knowledges or all the objects of knowledge, but the most complicated kind of binding as it is expected from the author of the Republic. The kind of unity the Good gives to the different knowledges of different things is comparable with the unity which each Form gives to its participants in Republic: as all the participants of a Form are united by referring to the ideas, all different kinds of knowledge are united by referring to the Good. If we observe Aristotle's assertion that for Plato and the believers of Forms, the causative relation of the One with the Forms is the same as that of the Forms with particulars (e.g. Metaphysics 988a10-11, 988b4), that is to say the One is the essence (e.g., ibid, 988a10-11: τοῦ τί ἐστὶν, 988b4-6: τὸ τί ἢν εἶναί) of the Forms besides his statement that for them One is the Good (e.g., ibid, 988b11-13) the relation between the Good and unity may become more understandable. Since the quiddity of the Good (τί ποτ᾽ ἐστὶ τἀγαθὸν) is more than discussion (506d8-e2), we cannot await Socrates to tell us how this binding role is played. All we can expect is to hear from him an analogy by which this unifying role is envisaged, the sun. The kind of unity that the Good gives to the knowledge and its objects in the intelligible realm is comparable to the unity that the sun gives to the sight and its objects in the visible realm (508b-c). The allegory of Line (Republic VI, 509d-511), like that of the Sun, tries to bind all various kinds of knowledges. The hierarchical model of the Line which encompasses all kinds of knowledge from imagination to understanding can clearly be considered as Plato’s effort to bind all kinds of knowledges by a certain unhypothetical principle. The method of hypothesis starts, in the first subsection of the intelligible realm, with a hypothesis that is not directed firstly to a principle but a conclusion (510b4-6). It proceeds, in the other subsection, to a 'principle which is not a hypothesis' (b7) and is called the 'unhypothetical principle of all things' (ἀνυποθέτου ἐπὶ τὴν τοῦ παντὸς ἀρχὴν) (511b6-7). This παντὸς must refer not only to the objects of the intelligible realm but to the sensible objects as well. Plato does posit, therefore, an epistemological principle for all things, a principle that all things are, epistemologically, bound and, thus, unified by. -/- 5. Bound Beings The ontological aspect of BK we shall call the principle of 'Bound Beings' (BB): -/- BB Being of all things are bound by the Good. -/- We saw in our principle of Split Being (SB) how the first Socrates was criticized because of his approach to split being and separate each thing from other things. The principle of Bound Beings intends to make the things more related, a duty which is done again by the Good. In the allegory of Sun, there are two paragraphs that evidently and deliberately extend the binding role of the Good to the ontological scene: -/- You will say that the sun not only makes the visible things have the ability of being seen but also coming to be, growth and nourishment. (509b2-4) -/- This clearly intends to remind the ontological role the sun plays in bringing to being all the sensible things in order to display how its counterpart has the same role in the intelligible realm (b6-10): -/- Not only the objects of knowledge (γιγνωσκομένοις) owe their being known (γιγνώσκεσθαι) to the Good, but also their existence (τὸ εἶναί) and their being (οὐσίαν) are due to it, though the Good is not being but superior to it in rank and power. That the Good is here represented as responsible for being of things in addition to their being known means, in my opinion, that Plato wants to posit BB in addition to BK. The allegory of Cave at the very beginning of the seventh Book (514aff.) can be taken as another evidence. The role of the Good, one might say, is confined to the intelligible realm because it is asserted that the role the Good plays in this realm is corresponding to that of the sun in the visible realm. The fact that Plato wants to observe the Good also as the ontological cause of the sensible things is obvious from his saying, in the allegory of Cave, that the Form of the Good 'produces light and its source (τὸν τούτου κύριον) [i.e. the sun] in the visible realm' (517c3). We can conclude, then, that the ontological function of the Good is not confined to the intelligible realm in which it is the lord and provides truth and understanding (c3-4) because it is also responsible to produce τὸν κύριον of light. 6. Proportionality of Being and Knowledge Insofaras BE and BO principles of the first Socrates gave way to TE and TO principles of the second Socrates, we cannot expect him to preserve KB in the same way as it was in the first Socrates. The new tripartite ontology and epistemology necessitates some modifications in KB which results in the principle of 'Proportionality of Being and Knowledge' (PBK): -/- PBK To every class of being there is a proportionate category of knowledge. -/- This principle, of course, does not entail the refutation of KB and thus is not kind of rejecting PBK but only a more complicated version of it. Based on PBK, we can still agree that knowledge is of being (KB) but the issue is that since none of the concepts of knowledge and being in the second Socrates are as simple as they were for the first Socrates, we need a more complicated principle for their relation here. Although from Meno 97a where the distinction of knowledge and true opinion is drawn out in the second group of the dialogues, we can expect a new relation, it is articulated in its most complete way in Republic and specifically in the allegory of Line. All the beings are divided there hierarchically to four classes, to each of them belongs a class of knowledge: imagination to images, belief to the sensible things (more correctly: the things of which they[in previous class] were images (ᾧ τοῦτο ἔοικεν)), thought to mathematical objects (?) and understanding to the Forms and the first principle. The degree of clarity that each of the classes of knowledge shares in (σαφηνείας ἡγησάμενος μετέχειν) is proportionate to the degree that its object shares in truth (ἀληθείας μετέχει). (511e2-4) -/- Conclusion From the six onto-epistemilogical principles of the first Socrates, four principles turn to their opposite in the middle period dialogues. While bipolar epistemology and ontology of the early dialogues give place to tripartite epistemology in the middle period dialogues and tripartite ontology in Republic, the split knowledge and being of the first Socrates are inclined to be substituted by bound knowledges and bound beings in the second Socrates and specifically in Republic. Not all our system of principles in this article is necessarily determinative. Either they are rightly formulated or not, our result would not be vulnerable if we accept that 1) making the distinction of knowledge and belief, 2) accepting the being of not being and 3) trying to bind both being and knowledge by the concept of the Good happens only in middle period dialogues, having been absent in the early ones. These are the favourite results all those somehow arbitrary and even oversimplified principles were to illustrate; that there is kind of a development in the epistemological as well as the ontological grounds of Plato’s philosophy. -/- Notes . (shrink)

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

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

Many contemporary democratic theorists are democratic egalitarians. They think that the distinctive value of democracy lies in equality. Yet this position faces a serious problem. All contemporary democracies are representative democracies. Such democracies are highly unequal: representatives have much more power than do ordinary citizens. So, it seems that democratic egalitarians must condemn representative democracies. In this paper, I present a solution to this problem. My solution invokes popular control. If representatives are under popular control, then their extra power is (...) not objectionable. Unfortunately, so I argue, in the United States representatives are under loose popular control. (shrink)

Background: The World Health Organization has endorsed a community-based health insurance scheme (CBHIS) as a shared financing plan to improve access to health services and ensure universal coverage of the healthcare delivery system. Such a contributory scheme is the most likely option to provide health insurance coverage when governments cannot offer direct health care support. Despite improvements in access to current healthcare services, Ethiopia’s healthcare delivery remained low, owing to the country’s underdeveloped healthcare finance system. (...) As a result, the present study assessed CBHIS coverage and its predictors in Ethiopia at the individual and community level. Methods: The availability of CBHIS was checked via a criterion: at least one of the cluster respondents had to be enrolled in CBHIS. This study was based on secondary data from the Ethiopia Mini Demography and Health Survey (EMDHS) 2019 and included 7724 respondents. The study population was described using percentage and frequency. Four multilevel mixed-effects logistic regression modelling stages were performed to control for variations due to heterogeneity across clusters, and determinant predictors of CBHIS enrollment were outplayed. Results: The prevalence of CBHIS enrollment in Ethiopia was 33.13%. Rural residents were 3.218 times (AOR = 3.218; 95% CI: 1.521, 6.809), male household heads were 1.574 times (AOR = 1.574, 95% CI: 1.105, 2.241), getting funds from the safety net program were times 2.062 (AOR = 2.062, 95% CI: 1.297, 3.279), attending the primary educational level was 1.686 times (AOR = 1.686, 95% CI: 1.007, 2.821), bank accounts were 1.373 times (AOR = 1.373, 95% CI: 1.052, 1.792), and wealth index was 1.356 times (AOR = 1.356, 95% CI: 1.001, 1.838) more likely associated with CBHIS coverage, whereas the regions, the other religions, and women aged 20– 24 had lower odds of CBHIS coverage. Conclusion: In Ethiopia, regional healthcare expenditure per capital, religious affiliation, women age range, residents, sex of household head, funds from the safety net program, formal educational level, and having bank accounts were associated with community-based health insurance scheme coverage. (shrink)

Voting Advice Applications (VAAs) are interactive online tools designed to assist voters by improving the basis on which they decide how to vote. In recent years, they have been widely adopted, but their design is the subject of ongoing and often heated criticism. Most of these debates focus on whether VAAs accurately measure the standpoints of political parties and the preferences of users and on whether they report valid results while avoiding political bias. It is generally assumed that if their (...) methodology is sound, then VAAs can be seen as strengthening the democratic process. But as we argue in this chapter, the setup of VAAs raises basic questions of normative democratic theory as well. Insofar as VAAs are supposed to improve the functioning of the democratic process, it must be clarified in what sense they aim to make a contribution, before it even makes sense to discuss their effectiveness at doing so. -/- VAAs are often intended to enhance the democratic process by one or all of the following: (I) informing voters about the policy standpoints of political parties (or individual candidates), (2) increasing voter turnout, and (3) ensuring that the composition of parliaments more accurately reflects the political attitudes of the electorate. In the next three sections, we discuss three central bones of contention in current democratic theory that are crucial to these ways in which VAAs typically take themselves to contribute to strengthening the democratic process: -/- 1. Questions about citizen competence: What forms of competence do citizens need to have, and to what extent, for a democracy to function properly? -/- 2. Questions about political participation: What forms and extent of participation are vital to democracy? -/- 3. Questions about democratic representation: How should the relation between the elected and the electorate be understood? -/- For each issue we aim to show, first, how the design and setup of mainstream VAAs are tacitly structured by a specific conception of the democratic aim at issue and, second, what some alternative positions on these questions are within contemporary political theory. In the final section, we will discuss some of the implications of this analysis for the responsibilities of VAA developers, and particularly for the procedural neutrality to which they are typically committed. Our conclusion will be that once these issues are identified, developers of VAAs should either argue in favour of their views on democratic competence, participation and representation, or they should rethink the design of VA As in ways that move beyond their current assumptions, or both. (shrink)

Given the unprecedented novel nature and scale of coronavirus and the global nature of this public health crisis, which upended many public/environmental research norms almost overnight. However, with further waves of the virus expected and more pandemics anticipated. The COVID-19 pandemic of 2020 opened our eyes to the ever-changing conditions and uncertainty that exists in our world today, particularly with regards to environmental and public health practices disruption. This paper explores environmental and public health evidence-based practices (...) toward responding to Covid-19. A literature review tried to do a deep dive through the use of various search engines such as Mendeley, Research Gate, CAB Abstract, Google Scholar, Summon, PubMed, Scopus, Hinari, Dimension, OARE Abstract, SSRN, Academia search strategy toward retrieving research publications, “gray literature” as well as reports from expert working groups. To achieve enhanced population health, it is recommended to adopt widespread evidence-based strategies, particularly in this uncertain time. As only together can evidence-informed decision-making (EIDM) can become a reality which include effective policies and practices, transparency and accountability of decisions, and equity outcomes; these are all more relevant in resource-constrained contexts, such as Nigeria. Effective and ethical EIDM though requires the production as well as use of high-quality evidence that are timely, appropriate and structured. One way to do so is through co-production. Co-production (or co-creation or co-design) of environmental/public health evidence considered as a key tool for addressing complex global crises such as the high risk of severe COVID-19 in different nations. A significant evidence-based component of environmental/public health (EBEPH) consist of decisions making based on best accessible, evidence that is peer-reviewed; using data as well as systematic information systems; community engagement in policy-making; conducting sound evaluation; do a thorough program-planning frameworks; as well as disseminating what is being learned. As researchers, scientists, statisticians, journal editors, practitioners, as well as decision makers strive to improve population health, having a natural tendency toward scrutinizing the scientific literature aimed at novel research findings serving as the foundation for intervention as well as prevention programs. The main inspiration behind conducting research ought to be toward stimulating and collaborating appropriately on public/environmental health action. Hence, there is need for a “Plan B” of effective behavioral, environmental, social as well as systems interventions (BESSI) toward reducing transmission. (shrink)

This study explores freedom and equality as necessary constituents of a liberal democratic state. At the same time, equality and freedom conflict in various respects. It is examined how such conflicts may optimally be resolved while taking seriously the interests involved. These inquiries have far-reaching consequences for the justification of the liberal democratic state. Equal rights are generally considered to be an integral part of a liberal democratic state, but on what foundation are such rights based? Various attempts have been (...) made to provide such a foundation from a moral framework. Some important and influential positions are examined critically and an alternative perspective is offered. "Equality" is approached straightforwardly, without appealing to obscure notions while seeking an outcome that may universally be accepted. Rationality is an important feature in this respect. The question to what extent freedom should be allowed to citizens is another important issue. Granting citizens freedom is beneficial for the liberal democratic state as a whole and for citizens themselves. The limits of freedom must, however, be defined carefully. The search for a simple solution is balanced against the need to do the complexities of individual cases justice. In addition, it is not the task of a liberal democratic state to influence people’s convictions concerning equality ; only equal treatment should be guaranteed. (shrink)

Proceeding from serendipitous observations, three studies and two pilot experiments examined how the way mental representations are conceived varies as the subjective status of the representations is manifest or otherwise. Participants were found to produce simple line drawings differently when the drawings were assumed to represent mental contents (beliefs, imaginations, percepts). The results challenged particular lay epistemological concepts. They were partly accounted for by Gricean conversational rules, but a "subjective status bias" was postulated to have them fully explained. The discussion (...) and recommendations for research--completed with two pilot studies--center on the nature of this bias relating it either to a tendency to conceive subjective representations as vague "shadows of reality", or to a tendency to have an increased impact of the law of pregnance. The empirical outcomes of the pilot studies argue for the latter tendency. (shrink)

This article contributes to the debate concerning the identification of politically relevant cases of corruption in a democracy by sketching the basic traits of an original liberal theory of institutional corruption. We define this form of corruption as a deviation with respect to the role entrusted to people occupying certain institutional positions, which are crucial for the implementation of public rules, for private gain. In order to illustrate the damages that corrupt behaviour makes to liberal democratic institutions, we discuss the (...) case of health care professionals’ abuse of their right to conscientious objection to abortion services. We show that the conscience clause can be instrumentally abused to sabotage democratically established public rules and thus exert undue private influence on their implementation. In this sense, from a liberal democratic perspective, institutional corruption is problematic because it is disruptive of such fundamental liberal ideals as the impartiality of public institutions and citizens’ political equality. (shrink)

Liberal democracy aims to treat all adult citizens as politically equal, at least in ideal cases: Once a citizen is over the age of majority, she is deemed a full-fledged member of the community and in theory has equal standing with all other adult citizens when it comes to making policy and participating in the political realm in general. I consider three questions: (1) Is there any plausible alternative to a standard "all adult citizens have equal political standing" model (...) of democracy that could be drawn from a specifically Confucian valuing of elder members of the community? (2) Insofar as there is a plausible alternative, what might it reveal about differences between how liberalism and Confucianism think of human selves as located in time? (3) What sort of difference would it make if the Confucian valuing of age were implemented via informal social norms, on the one hand, or via explicit institutional mechanisms and procedures, on the other? (shrink)

The Hanford Advisory Board (HAB) is a broadly representative, deliberative body that provides formal policy advice on Department of Energy (DOE) proposals and decisions at the Hanford nuclear cleanup site near Richland, Washington. Despite considerable skepticism about the effectiveness of citizen advisory boards, we contend that the HAB offers promising institutional innovations. Drawing on our analysis of the HAB’s formal advice as well as our interviews with board members and agency officials, we explore the HAB’s unique design, outline a (...) normative framework for evaluating participatory institutions, and assess the HAB’s effectiveness in rendering the DOE accountable to the local public. (shrink)

Lisa Hill’s response to my critique of compulsory voting, like similar responses in print or in discussion, remind me how much a child of the ‘70s I am, and how far my beliefs and intuitions about politics have been shaped by the electoral conflicts, social movements and violence of that period. -/- But my perceptions of politics have also been profoundly shaped by my teachers, and fellow graduate students, at MIT. Theda Skocpol famously urged political scientists to ‘bring the state (...) back in’ to their analyses, and to recognise that political identities, interests and coalitions cannot be read off straightforwardly from people’s socio-economic position. In their different ways, this was the lesson that Suzanne Berger, Charles Sabel and Joshua Cohen tried to teach us, emphasising the ways that political participation and conflict, themselves, can change people’s identities, their sense of what it is desirable and possible, and their ability to recognise, or oppose, the freedom and equality of others. -/- I do not therefore take it as self-evident that the poor and seemingly powerless should be politically apathetic, unwilling to vote, or incapable of imagining a political solution to at least some of the problems confronting them. Nor do I suppose that non-voters are all-of-a-piece, and that their shared interests are, inevitably, more significant, morally or politically, than those which divide them. Such assumptions seem mistaken in the case of voters, and I see no reason why they should be true of non-voters. The people we find in these categories are not predestined to be in one rather than the other; they do not always stay where they start off; and at an individual level, the reasons why people fall into one group, rather than another, are likely to be complex and sometimes unpredictable. -/- Above all I see nothing in a commitment to democratic government, understood realistically or in more idealistic terms, that requires us to treat raising turnout at national elections (once every four years or so) as of such moral or political importance that we should make it legally mandatory. Realistically, it is an open question how far the ballot box is, for most people, the path to empowerment – important though it is that people should have an equal right to vote and to stand as candidates at national elections. On a more idealistic view of democratic politics it is hard to avoid the thought that the importance of national elections to self-government, posited by proponents of compulsory voting, reflects an alienated and alienating view of democracy, in which the choice of our leaders becomes more important than the development and exercise of our own capacities to lead; and in which our awe at the power our leaders might wield is matched only by our inability to imagine less intimidating, distant and centralised forms of politics. -/- But before saying a little more about these points, and their significance for compulsory voting, I would like to dispel some misunderstandings or misrepresentations of my views in Hill’s essay. I do not believe socio-economic disparities in turnout are not worrying for democratic politics, nor do I believe that abstention is generally synonymous with consent. I do not assume that people have a right not to vote, but try to explain why moral and legal rights to abstain are an important part of democratic politics, including electoral politics. (shrink)

This study examines the concept of “description” and its theoretical foundations. The literature about it is surprisingly limited, and its usage is vague, sometimes even conflicting. Description should be considered in relation to other processes, such as representation, data capturing, and categorizing, which raises the question about what it means to describe something. Description is often used for any type of predication but may better be limited to predications based on observations. Research aims to establish criteria for making optimal descriptions; (...) however, the problems involved in describing something have seldom been addressed. Specific ideals are often followed without examine their fruitfulness. This study provides evidence that description cannot be a neutral, objective activity; rather, it is a theory-laden and interest-based activity. In information science, description occurs in processes such as document description, descriptive metadata assignment, and information resource description. In this field, description has equally been used in conflicting ways that mostly do not evince a recognition of the value- and theory-laden nature of descriptions. It is argued that descriptive activities in information science should always be based on consciously explicit considerations of the goals that descriptions are meant to serve. (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)

The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional role. I examine (...) two types of institutional contexts: (1) public research agencies – agencies or departments of states that fund or conduct clinical research in the public interest; and (2) private-for-profit corporations. I argue that investigators who are employed or have their research sponsored by the former have a distinctive institutional obligation to conduct their research in a way that is consistent with the state's duty of distributive justice to provide its citizens with access to basic health care, and its duty to aid citizens of lower income countries. By contrast, I argue that investigators who are employed or have their research sponsored by private-for-profit corporations do not possess this obligation nor any other institutional obligation that is directly relevant to the ethics of RCTs. My account of the institutional obligations of investigators aims to contribute to the development of a reasonable, distributive justice-based account of standard of care. (shrink)

I outline and defend two egalitarian theories, which yield distinctive and, I argue, complementary answers to why health-related inequalities matter: a brute luck egalitarian view, according to which inequalities due to unchosen, differential luck are bad because unfair, and a social egalitarian view, according to which inequalities are bad when and because they undermine people’s status as equal citizens. These views identify different objects of egalitarian concern: the brute luck egalitarian view directs attention to health-related well-being, while social (...) egalitarianism focuses on health-related capabilities that are central to a person’s status as a citizen. I argue that both views are correct and should jointly guide priority-setting in health. (shrink)

As the quality movement in health care now enters its fourth decade, the language of quality is ubiquitous. Practitioners, organizations, and government agencies alike vociferously testify their commitments to quality and accept numerous forms of governance aimed at improving quality of care. Remarkably, the powerful phrase ‘‘quality of care’’ is rarely defined in the health care literature. Instead it operates as an accepted and assumed goal worth pursuing. The status of evidence-based medicine, for instance, hinges on its (...) ability to improve quality of care, and efforts are made by both proponents and detractors to unpack the contents and outcomes of evidence-based practice while the contents of ‘‘quality of care’’ are presumed to be understood. Because the goals of medicine are far from obvious, this paper investigates the neglected term, ‘‘quality of care,’’ in an effort to understand what it is that health care practices are so uncritically assumed to be striving for. Finding lack of consensus on the terminology in the quality literature, I propose that the term operates rhetorically by way of persuasive appeal (and lack of descriptive meaning). Unsatisfied that ‘‘quality of care’’ operates as a mere buzzword in morally contentious debates over resource allocation and duties of care, I implore health care communities to go beyond mere commitments to quality and, instead, to focus attention on the difficult task of specifying what counts as quality care within an economically constrained health care system. (shrink)

The paper compares three accounts of distributive justice in health (and more specifically healthcare). I discuss two egalitarian accounts—Daniels's fair equality of opportunity for health and Segall's luck-egalitarian equity in health—and contrast them with a sufficientarian account based on sufficiency of capabilities. The discussion highlights some important theoretical differences and similarities among the three accounts. The focus, however, is on the practical implications of each account regarding four hypothetical cases (synthesized growth hormone for short children, non-therapeutic abortion, (...) forms of compensation for paraplegics, and reconstructive breast surgery versus plastic surgery). My aim is to show that by replacing egalitarian concerns with sufficiency, and by focusing on capabilities (versus opportunities), it is possible to provide a more plausible account of justice in healthcare. (shrink)

What does it mean to treat people as equals when the legacies of feudalism, religious persecution, authoritarian and oligarchic government have shaped the landscape within which we must construct something better? This question has come to dominate much constitutional practice as well as philosophical inquiry in the past 50 years. The combination of Second Wave Feminism with the continuing struggle for racial equality in the 1970s brought into sharp relief the variety of ways in which people can be treated unequally, (...) while respecting the formalities of constitutional government. Most obviously, the content of laws can mistreat them by wrongfully assuming that they are either threats to others, or that, like children, they need to be protected from harm through paternalistic limitations on their freedom of action. Or, as those concerned with class inequality have long noted, formal equality can create legal requirements, permissions, and prohibitions whose burdens fall predictably, and often solely, on groups who are already marginalised, and most in need of state protection. (Kairys, David 1990) Above all, what these two great political movements made plain, is that a concern for group inequality and, specifically, group injustice must figure in the formulation and adjudication of individual rights, if legal protections for equality are adequately to combat the causes of inequality. Getting to grips with that challenge, it became obvious, required going beyond the familiar analyses of inequality inherited from Liberalism and Marxism, given the many different ways in which people can be equal or unequal.(Hackett and Haslanger 2006, 3 - 15) In the first part of this chapter, I will seek to illustrate these claims, by focusing on efforts to reframe the theory and practice of constitutional equality given demands for sexual and racial equality. I will then show that analytic philosophy has also come to recognise the various non-reducible dimensions of equality in ways that reinforce the claims of critical legal theory, even as philosophers highlight their disconcerting consequences. If equality has multiple irreducible dimensions, conflicts between the legitimate demands of equality are unavoidable features of law and politics, even in the best possible world, and are likely to be particularly painful when set against a background of historical injustice. The chapter concludes with the challenges to democratic constitutionalism, and the scope for constructive responses to those challenges, which the rapprochement between critical and analytic thinking on equality suggests. (shrink)

In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds (...) in philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making. (shrink)

COVID-19 demonstrated a global catastrophe that touched everybody, including the scientific community. As we respond and recover rapidly from this pandemic, there is an opportunity to guarantee that the fabric of our society includes sustainability, fairness, and care. However, approaches to environmental health attempt to decrease the population burden of COVID-19, toward saving patients from becoming ill along with preserving the allocation of clinical resources and public safety standards. This paper explores environmental and public health evidence-based practices (...) toward responding to Covid-19. A literature review tried to do a deep dive through the use of various search engines such as Mendeley, Research Gate, CAB Abstract, Google Scholar, Summon, PubMed, Scopus, Hinari, Dimension, OARE Abstract, SSRN, Academia search strategy toward reretrieving research publications, “grey literature” as well as reports from expert working groups. To achieve enhanced population health, it is recommended to adopt widespread evidence-based strategies, particularly in this uncertain time. As only together can evidence-informed decision-making (EIDM) can become a reality which includes effective policies and practices, transparency and accountability of decisions, and equity outcomes; these are all more relevant in resource-constrained contexts, such as Nigeria. Effective and ethical EIDM though requires the production as well as use of high-quality evidence that are timely, appropriate and structured. One way to do so is through co-production. Co-production (or co-creation or co-design) of environmental/public health evidence considered as a key tool for addressing complex global crises such as the high risk of severe COVID-19 in different nations. A significant evidence-based component of environmental/public health (EBEPH) consist of decisions making based on best accessible, evidence that is peer-reviewed; using data as well as systematic information systems; community engagement in policy making; conducting sound evaluation; do thorough program-planning frameworks; as well as disseminating what is being learned. As researchers, scientists, statisticians, journal editors, practitioners, as well as decision-makers strive to improve population health, having a natural tendency toward scrutinizing the scientific literature aimed at novel research findings serving as the foundation for intervention as well as prevention programs. The main inspiration behind conducting research ought to be toward stimulating and collaborating appropriately on public/environmental health action. Hence, there is need for a “Plan B” of effective behavioural, environmental, social as well as systems interventions (BESSI) toward reducing transmission. (shrink)

Deliberative democracy aspires to secure political liberty by making citizens the authors of their laws. But how can it do this in the face of deep disagreement, not to mention imperfect knowledge and limited altruism? Deliberative democracy can secure political liberty by affording each citizen an equal position as a co-author of public laws and norms. Moreover, fundamental deliberative democracy—in which institutional design is ultimately accountable to public deliberation but not necessarily subject to its direct control—does not strain knowledge (...) or altruism. Thus, there is a place for deliberative democracy in a robust political economy. (shrink)

Must privacy and freedom of expression conflict? To witness recent debates in Britain, you might think so. Anything other than self-regulation by the press is met by howls of anguish from journalists across the political spectrum, to the effect that efforts to protect people’s privacy will threaten press freedom, promote self-censorship and prevent the press from fulfilling its vital function of informing the public and keeping a watchful eye on the activities and antics of the powerful.[Brown, 2009, 13 January]1 Effective (...) protections for privacy, from such a perspective, inevitably pose a threat to democratic government via the constraints that they place on the press. Such concerns with privacy must be taken seriously by anyone who cares about democratic government, and the freedom, equality and wellbeing of individuals. But if it is one thing to say that privacy and freedom of expression cannot always be fully protected, it is another to suppose that protections for the one must always come at the expense of the other. After all, the economics of contemporary politics and journalism would seem to be partly responsible for our difficulties in protecting personal privacy while sustaining robust and informative forms of public discourse. [Moore, 2010, 10 -141]2 Most newspapers are loss-making businesses and the need to reduce those losses and, if possible, to turn a profit, make investigative journalism an increasingly expensive proposition as compared to both “comment” and more or less elevated forms of gossip. At the same time, politics has increasingly become the prerogative of a narrow group of people with access to the large sums of money necessary successfully to compete for high office. In those circumstances, the need for critical scrutiny is as important as it is difficult. Revising our ideas about privacy and its protection cannot alone reduce the tensions between freedom of expression and personal privacy typical of our societies, necessary though such revision may be. Moreover, this paper can only touch on some aspects of the ways in which we need to rethink our interests in privacy, in order adequately to reflect people’s diverse interests in freedom of expression, and the important role of a free press to democratic government. Nonetheless, I hope to suggest ways of thinking about people’s claims to privacy which can be generalised fairly readily, and can help us to think constructively about the nature, causes and solutions to some important social and political problems, even if, in its nature, philosophical analysis rarely tells us what to do. More specifically, this paper argues that people are entitled to keep some true facts about themselves to themselves, should they so wish, as a sign of respect for their moral and political status, and in order to protect themselves from being used as a public example in order to educate or to entertain other people. The “outing” - or non-consensual public disclosure - of people’s health records or status, or their sexual behaviour or orientation is usually unjustified, even when its consequences seem to be beneficial. Indeed, the paper claims, the reasons to reject outing, as inconsistent with democratic commitments to freedom and equality, are reasons to insist on the importance of privacy to freedom of expression. While a free press is of the utmost importance to democratic government, it is not identical with the free expression of individuals and, on occasion, the former may have to be constrained in order to protect the latter. [Barendt, 2007, 231]. Hence, the paper concludes, we should distinguish the claims of individuals to publish reports about their lives – even if this necessarily involves revealing the private lives of others – from journalistic claims to publish information about the sex lives of consenting adults. I will start by briefly situating my argument within a democratic approach to privacy, before using the “outing” of Oliver Sipple to examine people’s claims to privacy and their implications for freedom of expression and of the press. I will be assuming that some forms of privacy are legitimate, in order to focus more closely on the question of what information, if any, people may keep to themselves. (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)

What makes democracy valuable? One traditional answer holds that participating in democratic self-government amounts to a kind of autonomy: it enables citizens to be the authors of their political affairs. Many contemporary philosophers, however, are skeptical. We are autonomous, they argue, when important features of our lives are up to us, but in a democracy we merely have a say in a process of collective choice. In this paper, we defend the possibility of democratic autonomy, by advancing a conception of (...) it which is impervious to this objection. At the core of our account is the idea of joint authorship. You are a joint author of something when that thing expresses your joint intentions. Democracy may not make any one of us sole author of our political affairs, but it can make us their joint authors. It is in such joint authorship, we claim, that the intrinsic value of democratic self-government consists. (shrink)

According to Corey Brettschneider, we can protect freedom of religion and promote equality, by distinguishing religious groups’ claims to freedom of expression and association from their claims to financial and verbal support from the state. I am very sympathetic to this position, which fits well with my own views of democratic rights and duties, and with the importance of recognizing the scope for political choice which democratic politics offers to governments and to citizens. This room for political choice, I believe, (...) is necessary if people are to have any chance of reconciling the conflicting moral and political obligations they are likely to face, however idealized our conception of democracy or morality. Granted that no amount of personal and political choice will ever guarantee that we do not encounter tragic choices, and painfully conflicting moral demands, it is an important feature of democracy – or so I believe – that its rights reflect the importance of mitigating these conflicts so that people are able, as a rule, to act as they ought, so that they do not experience their moral sentiments, beliefs and capacities simply as grounds for recrimination, alienation and despair. I therefore believe that democracies have good reason not to force the consciences of the undemocratic and the intolerant, where it is possible to accommodate such people without threatening the rights of others. However, the fact that I share many of Brettschneider’s intuitions and beliefs does not mean that I share them all. In particular, I find his conception of democracy unduly narrow, and unduly based on a rather idealized conception of the American constitution which is unlikely to appeal to those whose conceptions of democracy are more republican, more socialist, more pragmatic and more international than his. I have explained these worries elsewhere and drawn out some of their implications for his arguments about privacy and judicial review. There is no need to repeat them here. I will also set to one side my worries about his uninflected, overly abstract and rather reified characterization of the State, in the hope that others will discuss this and that, in the end, a more nuanced conception of the State and a more lively appreciation of the conflicting people, institutions, histories and norms which make up most states, will prove consistent with his arguments. Finally, I do not propose to enter into a detailed discussion of the difficulties of Brettschneider’s overly abstract and reified conception of State ‘speech’ and ‘expression’ which, while motivated by the language of American constitutionalism, appears to cover pretty much anything a government might do, from raising and spending taxes, to accepting judicial interpretations of contested constitutional provisions, or to affirmatively pronouncing on the goals that will animate its legislative agenda and its aspirations for citizen’s lives. Again, while I would have wished for a more nuanced and analytical discussion of so central a concept as ‘expression’ and, in particular, expression by ‘the State’, I am uncertain that anything fundamental in Brettschneider’s account of citizen rights and duties would be altered in the process. Instead, then, I want to focus on points in Brettschneider’s argument that intrigue, and sometimes puzzle, me the most and where issues of nuance and clarification might make a substantial difference to our views of equality and religious freedom. (shrink)

This paper addresses ways of arguing fors ome form of economic democracy from within a broadly Rawlsian framework. Firstly, one can argue that a right to participate in economic decision-making should be added to the Rawlsian list of basic liberties, protected by the first principle of justice. Secondly,I argue that a society which institutes forms of economic democracy will be more likely to preserve a stable and just basic structure over time, by virtue of the effects of economic democratization on (...) the development of an active, democratic character among citizens. Thirdly, I argue that a proper understanding of the demands of the difference principle shows that justice demands more than ex post redistribution, but also requires the ex ante redistribution of power and authority in economic life. This connects to Rawls’s discussion of the badness of inequality, and to his endorsement of a “property-owning democracy”. -/- My conclusion is that, even if we may doubt the success of this first Rawlsian argument,the second and third arguments are both successful, and together establish a strong Rawlsian case forseeing economic democratization as a requirement of justice. (shrink)

Older people are encouraged to participate more in the economic, social, and governmental sectors as part of progressive aging policies worldwide. Very little is known about applying engagement techniques or carrying out strategies in Bangladesh that are important for involving seniors in social engagement. Therefore, this qualitative research was conducted in Dhaka, Bangladesh, among 385 people aged sixty or above to assess their understanding of the quality of life and the gap in government policy. Results showed that between 60 and (...) 65 were more mobile, creative, engaged in productive activity, and had significantly higher decision-making power (p<0.000). Aging greatly enhances dependency (p<0.000). Lower-educated people were significantly dependent on their families (p<0.000).Moreover, elderly income and the cost of treatment were significantly correlated to abuse (p<0.001). Furthermore, 10% of participants reported negative relationships with family members (p<0.031). However, most (61.6%) were unaware of the 2013 Parent's Care Act. Though most participants (73.2%) knew of the government-funded Old Age Allowance, 92.5% received no non-governmental assistance. The research concluded that education and economic condition have a long-term relationship with reducing dependency. In recommendation, Government can increase the retirement age from 59 to 65 years which may increase self of security, respect, and self-esteem and reduce harassment. Parent's Care Act 2013 should implement. Government should include Community Health and Social Service centers for the quality of life of the elderly. (shrink)

PURPOSE—A substantial fraction of the observations made by clinicians and entered into patient records are expressed by means of negation or by using terms which contain negative qualifiers (as in “absence of pulse” or “surgical procedure not performed”). This seems at first sight to present problems for ontologies, terminologies and data repositories that adhere to a realist view and thus reject any reference to putative non-existing entities. Basic Formal Ontology (BFO) and Referent Tracking (RT) are examples of such paradigms. The (...) purpose of the research here described was to test a proposal to capture negative findings in electronic health record systems based on BFO and RT. METHODS—We analysed a series of negative findings encountered in 748 sentences taken from 41 patient charts. We classified the phenomena described in terms of the various top-level categories and relations defined in BFO, taking into account the role of negation in the corresponding descriptions. We also studied terms from SNOMED-CT containing one or other form of negation. We then explored ways to represent the described phenomena by means of the types of representational units available to realist ontologies such as BFO. RESULTS—We introduced a new family of ‘lacks’ relations into the OBO Relation Ontology. The relation lacks_part, for example, defined in terms of the positive relation part_of, holds between a particular p and a universal U when p has no instance of U as part. Since p and U both exist, assertions involving ‘lacks_part’ and its cognates meet the requirements of positivity. CONCLUSION—By expanding the OBO Relation Ontology, we were able to accommodate nearly all occurrences of negative findings in the sample studied. (shrink)