This paper comes out of a panel honoring the work of Anne Donchin (1940-2014), which took place at the 2016 Congress of the International Network on Feminist Approaches to Bioethics (FAB) in Edinburgh. My general aim is to highlight the contributions Anne made to feminist bioethics, and to feminist reproductive ethics in particular. My more specific aim, however, is to have a kind of conversation with Anne, through her work, about whether reproductive justice could demand insurance coverage for in (...) vitro fertilization. I quote liberally from Anne’s work for this purpose, but also to shower the reader with her words, reminding those of us who knew her well what a wonderful colleague she was. (shrink)

Theorists of the welfare state increasingly recognize that social insurance programs are not well-justified by distributive egalitarianism—meaning concern for equality considered as a pattern in the distribution of some good. However, recent work by several relational egalitarian theorists suggests that these programs may be justified on relational egalitarian grounds. Relational egalitarians hold that the proper object of egalitarian concern is the way that citizens relate to one another. In this paper, I review the problems facing a distributive egalitarian justification (...) for social insurance before considering and rejecting three relational egalitarian justifications. I close by offering a justification for these programs grounded in efficiency, not equality. (shrink)

What level of government subsidy of higher education is justified, in what form, and for what reasons? We answer these questions by applying the hypothetical insurance approach, originally developed by Ronald Dworkin in his work on distributive justice. On this approach, when asking how to fund and deliver public services in a particular domain, we should seek to model what would be the outcome of a hypothetical insurance market: we stipulate that participants lack knowledge about their specific resources (...) and risks, and ask what insurance contracts they would take out to secure different types of benefit and protection in the domain in question. The great benefit of the hypothetical insurance approach is that it allows us to take apparently intractable questions about interpersonal distribution and transform them into questions about intrapersonal distributions: that is, questions about how an individual would choose to distribute risks and resources across the various lives that they might end up living, in light of their individual ambitions and preferences. Applying this approach to higher education, we argue that the UK model of higher education funding in which the costs of an individual's higher education are shared between general taxation and the individual herself, with the latter element to be paid retrospectively through an income-contingent state-backed loan, is vindicated as just. In particular, we argue that it is more just than alternatives such as a graduate tax, full funding through general taxation, and full privatisation. (shrink)

Objectives The study aims to evaluate the impact of the Revised Health Insurance Law 2014 on the utilisation of outpatient and inpatient care services, healthcare services utilisation at different levels of providers, types of providers and types of visits across different entitlement groups. Design/setting Secondary data from two waves of the Vietnam Household Living Standard Survey (VHLSS) 2016, VHLSS 2014 were used. A cross-sectional study applying propensity score matching was conducted. Participants A total of 4900 individuals who reported using (...) healthcare services are analysed. Outcomes measure Numbers of outpatient and inpatient visits, frequency of healthcare service utilisation at commune health stations, district hospitals, provincial hospitals, public and private health facilities, number of visits at health facility for medical treatment and health checks per year. Results The result indicates that health insurance (HI) policy increased the number of outpatient visits for the enrolled between 0.87 and 1.29. The greatest impact was found on participants of heavily subsidised health insurance (HSHI) programmes with 1.29 visits per person per year. Similarly, an increase between 0.08 and 0.16 in the number of inpatient admissions was because of participation in HI. With regard to type of healthcare providers, the study found that participation in HI has the most effect on the use of healthcare services at district hospitals. However, the study demonstrated that the impacts of HI on the increase in the frequency of visiting commune health stations, number of visits at the provincial hospital for HSHI groups, and number of visits at health facilities for health check and consultation were sensitive to unobserved characteristics. Conclusion Our findings imply that policy-makers in Vietnam could continue expanding health insurance coverage to increase access to healthcare services for citizens, especially vulnerable groups. In addition, the government should draw more attention to primary healthcare level. (shrink)

Many widely divergent accounts of luck have been offered or employed in discussing an equally wide range of philosophical topics. We should, then, expect to find some unified philosophical conception of luck of which moral luck, epistemic luck, and luck egalitarianism are species. One of the attempts to provide such an account is that offered by Duncan Pritchard, which he refers to as the modal account. This view commits us to calling an event lucky when it obtains in this world, (...) but fails to obtain in a wide class of nearby possible worlds. In support of this account, Pritchard argues that a theory of luck ought to capture the fact that luck comes in degrees and that luck is closely associated with risk. I argue against this claim by suggesting that an understanding of luck grounded in considerations of probability is better able to satisfy these demands, and that the probability theory better explains exemplary cases of luck like those brought up by Pritchard. (shrink)

Of all the risks we face in life, ranging from unemployment to old age, early death is among the most tragic and yet most neglected by modern states. Liberal egalitarians might find it easy to dismiss social insurance against early death, but I argue they should not. Early in this paper, I explain why social insurance should include the risk of premature death by replying to four common criticisms. What follows is a case for a novel form of (...) insurance that is more liberal and egalitarian across ages than the status quo. More specifically, I show that granting storable pensions in all life stages - youth, middle and old age - promotes liberty and reduces lifetime inequality. Writers on age group and longevity justice often overlook the extent to which liberal lifetime equality can supply insightful arguments against inequality across ages. These call for a policy that gives each age group the freedom to draw a storable pension. I call that policy "freetirement". (shrink)

This study looks at the relationship between organizational support, employee commitment, and human resource management (HRM) practices at Visayan Surety & Insurance Corporation in Cebu City, Philippines. This descriptive-correlational study used a survey questionnaire to gather data from 25 employees. The results show that although the company does a great job in areas like leadership development and talent management, employee development initiatives could need some work. The study also emphasizes the importance of organizational support in promoting employee commitment and (...) the necessity of continual efforts to establish a supportive work environment. Additionally, demographic profiles have little bearing on HRM procedures and organizational support—except educational attainment, which affects several organizational commitment factors. These results highlight how crucial it is to develop tailored HRM strategies that both fit the varied demands of the workforce and the objectives of the company. (shrink)

The 2010 Patient Protection and Affordable Care Act was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance. Opponents of the mandate argue that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Rather than appeal to the collective good, this Viewpoint argues for a duty to buy health insurance based on the moral duty individuals have to (...) reduce certain burdens they pose on others. When some people have a duty to rescue, others may have a duty to take rescue precautions, in this case, to purchase health insurance to cover acute and emergency care needs. Requiring that individuals meet this obligation is consistent with respect of individual liberty. (shrink)

I critically examine a common liberal egalitarian view about the justification for, and proper content of, mandatory health insurance. This view holds that a mandate is justified because it is the best way to ensure that those in poor health gain health insurance on equitable terms. It also holds that a government should mandate what a representative prudent individual would purchase for themselves if they were placed in fair conditions of choice. I argue that this common justification for (...) a mandate is incomplete. A further reason for mandated insurance is that it helps secure social egalitarian public goods that would be underprovided if insurance were optional. I also argue that rather than mandating what a representative individual would choose for themselves, we should design the mandatory package by appealing to a pluralistic egalitarian view, which cares about improving people’s well-being, reducing unfair inequality, and maintaining egalitarian social relations. (shrink)

Third-party property insurance (TPPI) protects insured drivers who accidentally damage an expensive car from the threat of financial ruin. Perhaps more importantly though, TPPI also protects the victims whose losses might otherwise go uncompensated. Ought responsible drivers therefore take out TPPI? This paper begins by enumerating some reasons for why a rational person might believe that they have a moral obligation to take out TPPI. It will be argued that if what is at stake in taking responsibility is the (...) ability to compensate our possible future victims for their losses, then it might initially seem that most people should be thankful for the availability of relatively inexpensive TPPI because without it they may not have sufficient funds to do the right thing and compensate their victims in the event of an accident. But is the ability to compensate one's victims really what is at stake in taking responsibility? The second part of this paper will critically examine the arguments for the above position, and it will argue that these arguments do not support the conclusion that injurers should compensate their victims for their losses, and hence that drivers need not take out TPPI in order to be responsible. Further still, even if these arguments did support the conclusion that injurers should compensate their victims for their losses, then (perhaps surprisingly) nobody should to be allowed to take out TPPI because doing so would frustrate justice. (shrink)

Critics of luck egalitarianism have claimed that, far from providing a justification for the public insurance functions of a welfare state as its proponents claim, the view objectionably abandons those who are deemed responsible for their dire straits. This article considers seven arguments that can be made in response to this ‘abandonment objection’. Four of these arguments are found wanting, with a recurrent problem being their reliance on a dubious sufficientarian or quasi-sufficientarian commitment to provide a threshold of goods (...) unconditionally. Three arguments succeed, showing that luck egalitarians have good reasons for assisting ‘negligent victims’ on account of changes that may occur in an individual between the time of their choice and their subsequent disadvantage, bad option luck, and doubts about free will and responsibility. Luck egalitarianism is therefore shown to offer strong support for public insurance. (shrink)

What would be a fair model for flood insurance? Catastrophic flooding has become increasingly frequent in the UK and, with climate change, is likely to become even more frequent in the future. With the UK's current flood insurance regime ending in 2013, we argues that: -/- - there is an overwhelming case for rejecting a free market in flood insurance after 2013; - this market-based approach threatens to leave many thousands of properties uninsurable, leading to extensive social (...) blight; - there are a number of possible flood insurance models that would be fairer and more sustainable. -/- We outline three approaches to 'fairness' in flood insurance, and argues that the second and third of these would be the most 'solidaristic' – i.e. those at lower risk of flooding would contribute to the support of people at higher risk: -/- 'pure actuarial fairness' – insurance costs directly reflect the level of risk faced by individuals; 'choice-sensitive fairness' – insurance costs should reflect only those risks that result from each individual's choices; 'fairness as social justice' – insurance should be provided independently of individuals' risks and choices when covering basic requirements of social justice. (shrink)

The present article is presenting the ‘Healthcare Hazards and Its Impact on Health Insurance Business – An Overview during COVID-19’. The present paper studied the health insurance, health insurance plans in India, Indian market size, health care industry, government actions for the COVID-19, and healthcare business in India, private health insurance in India, hazardous of the healthcare industry and health insurances, and Indian healthcare issues in 2019. The author has concluded that all insurance policies are (...) levied higher taxes by the government, these lead higher income to the companies, and these are creating how commissions to the agents and other insurance organizations under reinsurance, but no benefits to the insured. It may not be a long term benefit, why because there is no maturity fund/income, because of these are shortterm benefits; how many of the policyholders are getting the benefits from the general health insurance companies. Hence, the research is required to calculate for the need of levy-the tax from the non-claimant portion of the income of the general health insurance on an annual basis to the health department of the nation. (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)

Is a Nozickian theory of rights compatible with a no-fault motor insurance scheme? I say, Yes. The argument turns on an explication of the basis on which a Nozickian justifies the prohibition of merely risky activities.

Given how much importance there is of economics and finance in our lives as humans (materialist side is foremost as per Marx), it should be given more importance by Philosophy and Sociology. This brief report is meant to highlight few research paradigms available in Philosophy and Sociology to give its proper social context and provide deep underlying of Risk, Insurance and Finance.

Abstract: Before now it is believe that it is only company that their activities adversely affect the environment that should be socially responsible. This has change over the years as some country has made it mandatory for business to be socially responsible without which they cannot do business. For insurance company, their activities have to do with rendering of services and as such do not destroy the environment. The main objective of the study was to determine corporate social responsibility (...) accounting and financial performance of insurance companies in Nigeria. The research design adopted for the study is expo facto research design. The population of the study consists of all the 40 companies quoted in the Nigeria Stock Exchange as at December 2016. A sample of 25 insurance companies was selected base on their size from the population of the insurance companies. Data for the study were obtained from annual reports for the period of ten (10) years ranging from 2007 to 2016. Multiple regression analysis was carried out to determine the desire relationship. Findings show a significant relationship between corporate social responsibility accounting and return on capital employed and net profit margin, while a negative relationship with earnings per share. The implication of the findings is that there is evidence of conscious effort of the sampled insurance companies to discharge their social responsibility. The study recommends among other that management should be proactive and ensure that their social responsibility policies are adequately implemented, and ensure that Nigerian companies comply with government laws regarding business regulation in the country. (shrink)

Is drastic action against global warming essential to avoid impoverishing our descendants? Or does it mean robbing the poor to give to the rich? We do not yet know. Yet most of us can agree on the importance of minimising expected deprivation. Because of the vast number of future generations, if there is any significant risk of catastrophe, this implies drastic and expensive carbon abatement unless we discount the future. I argue that we should not discount. Instead, the rich countries (...) should stump up the funds to support abatement both for themselves and the poor states of the world. Yet to ask the present generation to assume all the costs of drastic mitigation.is unfair.Worse still, it is politically unrealistic.We can square the circle by shifting part of the burden to our descendants. Even if we divert investment from other parts of the economy or increase public debt, future people should be richer, so long as we avert catastrophe. If so, it is fair for them to assume much of the cost of abatement.What we must not do is to expose them to the threat of disaster by not doing enough. (shrink)

Decision-making regarding healthcare expenditure hinges heavily on an individual's health status and the certainty about the future. This study uses data on propensity of general health exam (GHE) spending to show that despite the debate on the necessity of GHE, its objective is clear—to obtain more information and certainty about one’s health so as to minimise future risks. Most studies on this topic, however, focus only on factors associated with GHE uptake and overlook the shifts in behaviours and attitudes regarding (...) different levels of cost. To fill the gap, this study analyses a dataset of 2068 subjects collected from Hanoi (Vietnam) and its vicinities using the baseline-category logit method. We evaluate the sensitivity of Vietnamese healthcare consumers against two groups of factors (demographic and socioeconomic-cognitive) regarding payment for periodic GHE, which is not covered by insurance. Our study shows that uninsured, married and employed individuals are less sensitive to cost than their counterparts because they value the information in reducing future health uncertainty. The empirical results challenge the objections to periodic health screening by highlighting its utility. The relevance of behavioural economics is further highlighted through a look at the bounded rationality of healthcare consumers and private insurance companies in using and providing the service, respectively. (shrink)

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

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)

In actuarial parlance, the price of an insurance policy is considered fair if customers bearing the same risk are charged the same price. The estimate of this fair amount hinges on the expected value obtained by weighting the different claims by their probability. We argue that, historically, this concept of actuarial fairness originates in an Aristotelian principle of justice in exchange (equality in risk). We will examine how this principle was formalized in the 16th century and shaped in life (...) insurance during the following two hundred years, in two different interpretations. The Domatian account of actuarial fairness relied on subjective uncertainty: An agreement on risk was fair if both parties were equally ignorant about the chances of an uncertain event. The objectivist version grounded any agreement on an objective risk estimate drawn from a mortality table. We will show how the objectivist approach collapsed in the market for life annuities during the 18th century, leaving open the question of why we still speak of actuarial fairness as if it were an objective expected value. (shrink)

Many hold that distributing healthcare according to medical need is a requirement of equality. Most egalitarians believe, however, that people ought to be equal on the whole, by some overall measure of well-being or life-prospects; it would be a massive coincidence if distributing healthcare according to medical need turned out to be an effective way of promoting equality overall. I argue that distributing healthcare according to medical need is important for reducing individuals' uncertainty surrounding their future medical needs. In other (...) words, distributing healthcare according to medical need is a natural feature of healthcare insurance; it is about indemnity, not equality. (shrink)

There is much philosophical literature on the duty to rescue. Individuals who encounter and could save, at relatively little cost to themselves, a person at risk of losing life or limb are morally obligated to do so. Yet little has been said about the other side of the issue. There are cases in which the need for rescue could have been reasonably avoided by the rescuee. We argue for a duty to take rescue precautions, providing an account of the circumstances (...) in which it arises. This novel duty has important implications for public policy. We apply it to the situation of some of the uninsured in the United States. Given the US clinician's duty to provide emergency care to all people regardless of ability to pay, some of the uninsured have a moral duty to purchase health insurance. We defend the duty against objections, including the possibility that a right to rescue can be waived, thus undermining a duty to take rescue precautions, that the duty of many professionals is voluntarily incurred, and that a distinction between actively assumed and passively assumed risks matters morally. (shrink)

This chapter explores two questions in detail: How should we determine the threshold for costs that individuals are asked to bear through insurance premiums or care-related out-of-pocket costs, including user fees and copayments? and What is an adequate relationship between costs and benefits? This chapter argues that preventing impoverishment is a morally more urgent priority than protecting households against income fluctuations, and that many health insurance plans may not adequately protect individuals from health care costs that threaten to (...) drop their financial status below a decent minimum. A design that places greater emphasis on preventing impoverishment and finances the achievement of that goal by reducing unnecessary subsidies to better-off households would better accord with a sufficientarian approach to health care. -/- . (shrink)

US Senate is considering legislation designed to immunize small businesses from lawsuits brought by customers alleging to have been infected with COVID-19 while on the premises. The legislation seeks to subsidize reopening small businesses by reducing their vulnerability to liability. I argue that the legislation produces worse public health outcomes than existing liability regimes, obliterates claims to redress supported by corrective justice, and unfairly burdens victims by forcing them to become de facto insurers of their injurers. In the US, where (...) health insurance is inextricably linked with employment, and during the pandemic with the consequent loss of employment, the legislation is cruel in addition to being ineffective, unjust, unfair and inappropriate. Since I first uploaded this manuscript to Philpapers, Senate Republicans have in fact introduced specific legislation that is marginally different than the one I discuss in the manuscript. Instead of offering blanket immunity, the current Republican proposal offers a series of substantial barriers both to filing lawsuits and to securing a successful verdict at trial. I discuss these as an addendum to the main paper. In short, though the changes impact some features of my argument, they do not alter any of the conclusions. The current proposal produces worse public health outcomes than would existing tort regime; it leaves the vast majority of those with legitimate claims to repair in corrective justice without a remedy, when providing the opportunity to secure a remedy for wrongs is in large measure, the essential nature of tort liability. Worse still, it continues to render victims the de facto insurers of those who have wronged them; it imposes the burden of spreading risks on victims who are considerably less efficient risk spreaders than are businesses and hospitals; it constitutes an inappropriate response to the challenge it seeks to address, i.e. subsidizing various sectors of the economy by reducing their overall costs; and given the fact that in the US health insurance is too closely linked to employment, it shifts the costs of the pandemic to those who are most at risk of losing their health insurance, rendering the proposal cruel in addition to inefficient, unjust, unfair and inappropriate. For those interested, I am considering a short op-ed piece assessing the particular legislative proposal. If I follow through I will let the readership know where that can be found. (shrink)

This thesis sketches a justification of a welfare state, defending it against both givers and receivers of redistribution. Following the ideas of Luck Egalitarianism, I argue that righteous wealth is the result of responsible decisions, and that the influence of luck should be minimized. Building on Ronald Dworkin's hypothetical insurance markets, I argue that a welfare system should be conceived of as a personal insurance, not a social luxury. The thesis is written in German.

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision on the treatment (...) process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)

What is the value of intellectual playfulness? Traditional characterizations of the ideal thinker often leave out playfulness; the ideal inquirer is supposed to be sober, careful, and conscientiousness. But elsewhere we find another ideal: the laughing sage, the playful thinker. These are models of intellectual playfulness. Intellectual playfulness, I suggest, is the disposition to try out alternate belief systems for fun – to try on radically different perspectives for the sheer pleasure of it. But what would the cog-nitive value be (...) of such playfulness? I suggest that intellectual playfulness function as, at the very least, a kind of intellectual insurance policy against epistemic traps. An epistemic trap is a belief system that re-directs good-faith inquiry to bad results. Am epistemic trap manipulates background beliefs to fend off contrary evidence. For example, a conspiracy theory might include a set of beliefs about how the mainstream media has been taken over by some vicious cabal. Normal epistemic attempts will be captured by a well-wrought epistemic trap, because normal attempts at inquiry are guided by these background beliefs -- which set what counts as a plausible path to explore, and what is implausible or beyond the pale. And a clever epistemic trap will manipulate those background beliefs for ill effect. Intellectual playfulness, on the other hand, isn’t motivated by an epistemic interest in the truth, but in the sheer pleasure of intellectual exploration. Since intellectual playfulness isn’t oriented towards the truth, it won’t be constrained by an agent’s background beliefs – it won’t, for example, prefer to investigate apparently more plausible pathways. Intellectual playfulness offers an opportunity to escape from epistemic traps. But intellectual playfulness has its own limitations. It will only drive us to explore belief systems when that exploration is fun. What we need is an array of differently-motivated exploratory tendencies – empathy, curiosity, playfulness – each of which will each cover for the others’ limitations. (shrink)

We defend, from a contractarian perspective, that the fair price of an insurance policy is the amount that the contracting parties agree when they are both equally uncertain about the insured event. Drawing on the approach developed by R. Sugden in _The Community of Advantage_, we answer two standard objections raised against contractarianism in the actuarial sciences: (1) people are not wise enough to assess their actuarial risks; (2) they are not rational enough to decide which insurance policy (...) suits them better. We show under which circumstances people can make fair actuarial agreements, without presupposing any objective risk or rationality benchmarks. (shrink)

This is a commentary on Andrea Lavazza and Murilo Vilaça's article "Human Extinction and AI: What We Can Learn from the Ultimate Threat" (Lavazza & Vilaça, 2024). I discuss the potential concern that their proposal to create artificial successors to "insure" against the tragedy of human extinction might mean being too quick to accept that catastrophic prospect as inevitable, rather than single-mindedly focusing on avoiding it. I also consider the question of the value that we might reasonably assign to such (...) a future of artificial successors under the assumption that they do not enjoy phenomenal consciousness. (shrink)

Most of us are “time-biased” in preferring pains to be past rather than future and pleasures to be future rather than past. However, it turns out that if you are risk averse and time-biased, then you can be turned into a “pain pump”—in order to insure yourself against misfortune, you will take a series of pills which leaves you with more pain and better off in no respect. Since this vulnerability seems rationally impermissible, while time-bias and risk aversion seem rationally (...) permissible, we are left with a puzzle. (shrink)

Issues of sociopolitical systems’ stability and risks of their destabi-lization in process of political transformations belong to the most important ones as regards the social development perspectives, as has been shown again by the recent events in Ukraine. In this re-spect it appears necessary to note that the transition to democracy may pose a serious threat to the stability of respective sociopolitical systems. This article studies the issue of democratization of countries within globalization context, it points to the unreasonably high (...) economic and social costs of a rapid transition to democracy as a result of revolutions or of similar large-scale events for the countries unprepared for it. The authors believe that in a number of cases the authoritarian regimes turn out to be more effective in economic and social terms in comparison with emerging democracies especially of the revolutionary type, which are often incapable to insure social order and may have a swing to authoritarianism. Effective authoritarian regimes can also be a suitable form of a transition to efficient and stable democracy. The article investigates various correlations between revolutionary events and possibilities of establishing democracy in a society on the basis of the historical and contemporary examples as well as the recent events in Egypt. The authors demonstrate that one should take into account a country’s degree of sociopolitical and cultural preparedness for democratic institutions. In case of favorable background, revolutions can proceed smoothly (“velvet revolutions”) with efficient outcomes. On the contrary, democracy is established with much difficulty, throwbacks, return to totalitarianism, and with outbreaks of violence and military takeovers in the countries with high illiteracy rate and rural population share, with low female status, with widespread religious fundamental ideology, where a substantial part of the population hardly ever hears of democracy while the liberal intellectuals idealize this form, where the opposing parties are not willing to respect the rules of democratic game when defeated at elections. (shrink)

How were reliable predictions made before Pascal and Fermat's discovery of the mathematics of probability in 1654? What methods in law, science, commerce, philosophy, and logic helped us to get at the truth in cases where certainty was not attainable? The book examines how judges, witch inquisitors, and juries evaluated evidence; how scientists weighed reasons for and against scientific theories; and how merchants counted shipwrecks to determine insurance rates. Also included are the problem of induction before Hume, design arguments (...) for the existence of God, and theories on how to evaluate scientific and historical hypotheses. It is explained how Pascal and Fermat's work on chance arose out of legal thought on aleatory contracts. The book interprets pre-Pascalian unquantified probability in a generally objective Bayesian or logical probabilist sense. (shrink)

I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an (...) overly strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort. (shrink)

I came late to philosophy and even later to normative ethics. When I started my undergraduate studies at the University of Toronto in 1970, I was interested in mathematics and languages. I soon discovered, however, that my mathematical talents were rather meager compared to the truly talented. I therefore decided to study actuarial science (the applied mathematics of risk assessment for insurance and pension plans) rather than abstract math. After two years, however, I dropped out of university, went to (...) work for a life insurance company, and started studying on my own for the ten professional actuarial exams. When not studying, I would often go to the public library and I was drawn to the philosophy section—although I had no idea of what philosophy was about. I there saw Logical Positivism, edited by A.J. Ayer. I was interested in logical thinking and I also favored an optimistic attitude towards life (!) and so I thought that the book might be interesting. I checked it out and was absolutely enthralled with the writings of Bertrand Russell, Rudolf Carnap, Carl Hempel and others (if I’m remembering correctly). Of course, I didn’t really understand much of what they were doing, but I did see that they were addressing important problems in a systematic and rigorous manner. I liked it! (shrink)

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with (...) ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)

Credentials play an important role in all modern societies, but the analysis of their nature and function has thus far been neglected by social philosophers. We present a view according to which the function of credentials is certify the identity and the institutional status (including the rights) of individuals. More importantly, credentials enable rights-holders to exercise their rights, so that for a particular right to be exercisable the right-holder should possess, carry and sometimes show to an authority (or QR code (...) scanner) a document of a specific kind. Driving licenses, identity cards, passports, boarding passes, library passes, credit cards, ATM cards, health insurance cards are all examples of credentials in this sense. Credentials have in every case a bearer, and the bearer should be able to carry them easily on his or her person. Credentials should also be inspectable – not least because credentials can be forged. The authors analyse several historical and contemporary examples of credentials, focusing on the credentials carried by the pilgrims of the Way of Saint James. (shrink)

Background: Smart sensors have been developed as diagnostic tools for rehabilitation to cover an increasing number of geriatric patients. They promise to enable an objective assessment of complex movement patterns. -/- Objective: This research aimed to identify and analyze the conflicting ethical values associated with smart sensors in geriatric rehabilitation and provide ethical guidance on the best use of smart sensors to all stakeholders, including technology developers, health professionals, patients, and health authorities. -/- Methods: On the basis of a systematic (...) literature search of the scientific databases PubMed and ScienceDirect, we conducted a qualitative document analysis to identify evidence-based practical implications of ethical relevance. We included 33 articles in the analysis. The practical implications were extracted inductively. Finally, we carried out an ethical analysis based on the 4 principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice. The results are reported in categories based on these 4 principles. -/- Results: We identified 8 conflicting aims for using smart sensors. Gains in autonomy come at the cost of patient privacy. Smart sensors at home increase the independence of patients but may reduce social interactions. Independent measurements performed by patients may result in lower diagnostic accuracy. Although smart sensors could provide cost-effective and high-quality diagnostics for most patients, minorities could end up with suboptimal treatment owing to their underrepresentation in training data and studies. This could lead to algorithmic biases that would not be recognized by medical professionals when treating patients. -/- Conclusions: The application of smart sensors has the potential to improve the rehabilitation of geriatric patients in several ways. It is important that patients do not have to choose between autonomy and privacy and are well informed about the insights that can be gained from the data. Smart sensors should support and not replace interactions with medical professionals. Patients and medical professionals should be educated about the correct application and the limitations of smart sensors. Smart sensors should include an adequate representation of minorities in their training data and should be covered by health insurance to guarantee fair access. (shrink)

A principal challenge facing the progressive bioethics project is the crafting of a consistent message on biopolitical issues that divide progressives. -/- The regulation of enhancement technologies is one of the issues central to this emerging biopolitics, pitting progressive defenders of enhancement, “technoprogressives,” against progressive critics. This essay [PDF] will argue that technoprogressive biopolitics express the consistent application of the core progressive values of the Enlightenment: the right of individuals to control their own bodies, brains and reproduction according to their (...) own conscience, under democratic states that work for the public good. -/- Insofar as left bioconservatives want to ensure the safety of therapies and their equitable distribution, these concerns can be addressed by thorough and independent regulation and a universal health care system, and a progressive bioethics of enhancement can unite both enthusiasts and skeptics. Insofar as bioconservative concerns are motivated by deeper hostility to the Enlightenment project however, by assertion of pre-modern reverence for human uniqueness for instance, then a common program is unlikely. -/- imageAfter briefly reviewing the political history and contemporary landscape of biopolitical debates about enhancement, the essay outlines three meta-policy contexts that will impact future biopolicy: the pressure to establish a universal, cost-effective health insurance system, the aging of industrial societies, and globalization. Technoprogressive appeals are outlined that can appeal to key constituencies, and build a majority coalition in support of progressive change. Finally, some guiding principles for a technoprogressive approach to biopolicy are offered. (shrink)

We present experimental evidence that an interpretation was accurate. Current wisdom notwithstanding, we could interpret from the text alone because its information is redundant: repetition provides internal checks. Knowing neither dreamer nor their associations we made falsifiable predictions that we tested by subsequently gathering information about the dreamer. Predictions were supported. Results were repeated with seven additional dreams. Each dream was tightly crafted, used humor, drama or hyperbole to penetrate the dreamer’s defenses, and furthered the emergence of personality. Our experiment (...) compliments fMRI and statistics because it studies a whole text as a unique narrative: one iteration identified healing steps during therapy; another confirmed the psychological meaning of a myth. Our experiment might generate a body of objective knowledge about interpretation and make interpretation itself more accurate. In the US 20% live with mental illness. Our experiment supports talk therapy against pressure from the drug and insurance industries. (shrink)

One way in which bioethicists can benefit the medical community is by clarifying the concept of disorder. Since insurance companies refer to the DSM for whether a patient should receive assistance, one must consider the consequences of one’s concept of disorder for who should be provided with care. I offer a refinement of Jerome Wakefield’s hybrid concept of disorder, the harmful dysfunction analysis. I criticize both the factual component and the value component of Wakefield’s account and suggest how they (...) might be improved. I propose that the factual component should be statistical variation analyzed in multilevel and chronological compilations of physiological data. I propose that the value component should prioritize the individual’s authority regarding the experience of suffering from a physiological condition. My account preserves the insight of using a factual and a value component while avoiding the problems that Wakefield’s original account faces. (shrink)

‘Moral hazard’ is an economic term which commonly refers to situations in which people have a tendency to increase their exposure to risk when the costs of their actions, should they get unlucky, befall someone else. Once insured, for example, a person might have little reason, financially speaking, to be careful if he will get fully reimbursed for his losses should things go wrong, especially if he does not risk an increase in his insurance premium fees. In this article, (...) I argue that moral hazards are not morally neutral. To this end, I distinguish between concepts that call for a moral value judgement but do not have a fixed moral value and those that call for a moral value judgement and also have a fixed moral value. In short, this article examines questions that lie at the intersection of ethics and economics. (shrink)

2017 saw the occurrence of two major IT disasters: the meltdown that plunged into chaos British Airways’ flights at Heathrow and Gatwick airports, and the WannaCry malware hit on Microsoft Windows systems. Incidents like these exemplify how fragile the digital is and how systemic the problems caused by digital failures can be. This paper explores some possible solutions to ensure that any damage caused by such failures is limited. These include redundancy, reflexivity and insurance, accountability, and collaboration.

We frequently trust others—even strangers—based on little more than the good word of a third party. The purpose of this paper is to explain how such trust is possible by way of certain speech acts. I argue that the speech act of vouching is the primary mechanism at work in many of these cases and provide an account of vouching in comparison to the speech act of guaranteeing. On this account, guaranteeing and vouching both commit the speaker to certain actions (...) conditional on undesirable events. However, while guaranteeing may generate reliance in someone or something by providing insurance against bad outcomes, vouching may generate trust in another agent by way of the vouching party manifesting their own trust in the party vouched for and enjoining the addressee to trust likewise. (shrink)

I try in this essay to accomplish two things. First I offer some first thoughts toward a clarification of the ethical foundations of private property rights that avoids pitfalls common to more strictly Lockean theories, and is thus better prepared to address arguments posed by critics of standard private property arrangements. Second, I'll address one critical argument that has become pretty common over the years. While versions of the argument can be traced back at least to Pierre Joseph Proudhon, I'll (...) focus on a formulation given it by Jeremy Waldron. The basic idea is that the only sound arguments for private property rights lead to the conclusion that society has an obligation to insure that every citizen possess private property. In Waldron's formulation, what is justifiable is a general, rather than a special, right to private property. I shall try to suggest that this conclusion is unwarranted. (shrink)

I explore what BernardWilliams means by regarding one’s action ‘purely externally, as one might regard anyone else’s action’, and how it links to regret and agent-regret. I suggest some ways that we might understand the external view: as a failure to recognize what one has done, in terms of Williams’s distinction between intrinsic and extrinsic luck, and as akin to Thomas Nagel’s distinction between an internal and external view. I argue that none of these captures what Williams was getting at (...) because they do not allow one to take a view on one’s action. I offer two alternative accounts. One turns around what we identify with, the other concerns what we care about. Both accounts capture how I might regret, rather than agent-regret, my own action. I demonstrate that these accounts can explain the relationship between an insurance payout and the external view, and they can explain the agent-relativity of agent-regret. (shrink)

Military doctors and nurses, working neither as pure soldiers nor as merely doctors or nurses, may face a ‘role conflict between the clinical professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, an insurer, the state, or in this context, military command’. This conflict is commonly called dual loyalty. This chapter gives an overview of the military and the medical ethic and of the resulting dual (...) loyalty problem for medical personnel working in the military. It considers how dual loyalties relate to being a professional, something medical personnel are the paradigmatic examples of, but also something military personnel claim to be. Against that background, the chapter elaborates on the medical rules of eligibility used in Afghanistan, and on the policies concerning military involvement in local healthcare, to see what the existing rules and policies are, and whose interests they serve. (shrink)

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within healthcare (...) organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations. (shrink)