It is common to distinguish moral rules, reasons, or values that are agent-relative from those that are agent-neutral. One can also distinguish moral rules, reasons, or values that are moment-relative from those that are moment-neutral. In this article, I introduce a third distinction that stands alongside these two distinctions—the distinction between moral rules, reasons, or values that are patient-relative and those that are patient-neutral. I then show how patient-relativity plays an important role in several moral theories, gives (...) us a better understanding of agent-relativity and moment-relativity, and provides a novel objection to Derek Parfit’s “appeal to full relativity” argument. (shrink)

Discussion of whether values and norms are neutral or not has mainly appeared in works on the nature of prudential rationality and morality. Little systematic has yet appeared in the up and coming field of the meaning of life. What are the respects in which the value of meaningfulness is neutral or, in contrast, partial, relational, or ‘biased’? In this article, I focus strictly on answering this question. First, I aim to identify the salient, and perhaps exhaustive, respects in which (...) issues of neutrality arise in the contexts of life’s meaning. In addition to providing a taxonomy of the key points of contention, a second aim is to advance reflection about them by considering the most important arguments that have been marshalled in favour of one side or the other, particularly as they appear in recent neutral positions. I conclude that meaning in life is neutral with respect to time but not any other conditions such as agents and patients, with a third aim being to point out that this makes the value of meaning different from the kinds of non/neutrality encountered in some salient conceptions of prudence and morality. (shrink)

Subjective rights enjoy limited import in Kelsenian theory for whereas the concept of duty underlies every legal norm, that of rights is merely possible and only emerges when the imposition of the sanction attached to the breach of the duty is made dependent upon a subject's will to bring legal action. The presence of secondary norms establishing certain duties of medical professionals on informed consent displays the existence of correlative reflex rights of patients. Yet, together with secondary norms, Western legal (...) systems typically institute norms of competence enabling patients to take legal action when those duties correlative to their reflex right to informed consent have been infringed. Thus, informed consent constitutes a set of subjective legal positions of patients and medical professionals. Despite its excessive formalism and questionable neutrality, the Kelsenian approach permits to define and clearly distinguish patients' genuine rights from mere aspirations devoid of legal basis. (shrink)

A key objective of the law in the assessment of decision-making capacity in clinical settings is to allow clinicians and judges to avoid making value judgements about the reasons that patients use to refuse treatment. This paper advances two lines of argument in respect of this objective. The first is that authorities cannot rationally avoid significant evaluative judgements in the assessment of a patient’s own assessment of the facts of their case. Assessing reasoning is unavoidably value-laden. Yet the underlying (...) motivation behind clinicians’ and the law’s value-neutral aims, ie, the avoidance of undue paternalism, is worth preserving. That being so, the second line of argument will try to show that that underlying motivation is better served in a limited range of cases by embedding a ‘reversibility standard’ in the assessment process so that the patient can, if they wish, and in due course, bring about the consequences that they were prevented from realising as a result of a determination of incapacity. (shrink)

This article advances two views on the role of evaluative judgment in clinical assessments of decision-making capacity. The first is that it is rationally impossible for such assessments to exclude judgments of the values a patient uses to motivate their decision-making. Predictably, and second, attempting to exclude such judgments sometimes yields outcomes that contain intractable dilemmas that harm patients. These arguments count against the prevailing model of assessment in common law countries—the four abilities model—which is often incorrectly advertised as (...) being value-neutral in respect of patient decision-making both by its proponents and in statute. A straightforward evaluative model of capacity assessment which wears its values on its sleeves and is biased against what are called ‘serious prudential mistakes’ avoids these rational and practical problems. (shrink)

This dissertation examines the idea of _ethical revaluation_ — taking things we normally see as good for our flourishing and seeing them as neutral or bad, and vice versa — in the Mahāyāna Buddhist thinker Śāntideva. It shows how Śāntideva’s thought on the matter is more coherent than it might otherwise appear, first by examining the consistency of Śāntideva’s own claims and then by applying them to contemporary ethical thought. In so doing, it makes four significant contributions. Śāntideva claims that (...) property and relationships are bad for us because they promote attachment, and that others’ wrongdoing is good for us because it allows us to generate patient endurance. Yet he also urges his readers to give property to others, and to prevent their wrongdoing. Is he caught in contradiction? The dissertation argues that he is not, because giving to others is not intended to benefit them materially, but rather to produce beneficial mental states in them, and preventing wrongdoing is intended to benefit the wrongdoer and not the victim. In both cases, Śāntideva emphasizes individual action in a way that makes social or political action more difficult to justify. The dissertation’s first contribution is to show how this interpretation of Śāntideva contrasts notably with standard presentations of Mahāyāna ethics. Its second contribution is to refute claims that Buddhists have no normative ethics. Śāntideva’s resolutions of these apparent contradictions also have relevance for contemporary ethical thought. Martha Nussbaum argues against an ethical revaluation similar to Śāntideva’s, on the grounds that such a revaluation makes it contradictory to argue for providing goods to others, preventing others’ wrongdoing or engaging in political action. Śāntideva’s views show that ethical revaluation is a more sustainable position than these criticisms of Nussbaum’s would imply; if it is to be rejected, it must be rejected on other grounds. To show this point is the dissertation’s third contribution. The fourth contribution is methodological; by finding similarities of concern and differences of opinion between Śāntideva and a contemporary thinker, it helps bridge the gap between normative and comparative religious ethics. (shrink)

I consider the current best interests of patients who were once thought to be either completely unaware (to be in PVS) or only minimally aware (MCS), but who, because of advanced fMRI studies, we now suspect have much more “going on” inside their minds, despite no ability to communicate with the world. My goal in this chapter is twofold: (1) to set out and defend a framework that I think should always guide thinking about the best interests of highly cognitively (...) compromised patients, and then (2) to defend a particular conclusion that applies to this specific patient population. The framework requires us to ask two questions: Is the individual suffering? Is the individual gaining any benefit from life? There must be benefit of some sort for life to be worth preserving, and the benefit must outweigh any suffering (if there is suffering present). I then argue it would be best overall to allow these patients to die. Either these patients are not really very aware at all, in which case they are most likely not suffering, but not benefiting from life either, or they are mentally intact enough to make benefit a theoretical possibility, but in fact they are not benefiting because they cannot communicate with anyone. Such patients would most likely suffer. As there is no way currently to address their suffering, we should allow them to die. No matter the truth about their cognitive lives, death would either be a neutral event, or a blessing. (shrink)

Background: Rumination, a tendency to focus on negative self-related thoughts, is a central symptom of depression. Studying the self-related aspect of such symptoms is challenging because of the need to distinguish self effects from the emotional content of task stimuli. This study employed an emotionally neutral self-related paradigm to investigate possible altered self-processing in depression and its link to rumination. Methods: People with major depressive disorder (n = 25) and controls (n = 25) underwent task-based electro-encephalogram recording. We studied late (...) event-related potentials, along with low-frequency oscillatory power. We compared electroencephalogram metrics between groups and correlated them with depressive symptoms and reported rumination. Results: Participants with major depressive disorder displayed a difference in late positive potentials across frontocentral electrodes between self-related and non-self-related conditions. We found no such difference in controls. The magnitude of this difference was positively correlated with depressive symptoms and reported rumination. Participants with major depressive disorder also had elevated theta oscillation power at central electrodes in self-related conditions, a finding that we did not see in controls. Limitations: Patients with major depressive disorder were medicated at the time of the study. The group studied was primarily female, so the observed effects may have been sex-specific. Conclusion: Rumination appears to be linked to altered self-related processing in depression, independent of stimuli-related emotional confounds. This connection between self-related processing and depression may point to a self disorder as a core component of depression. (shrink)

Payment models directly impact the way patients experience care. Historically, payment model innovations have been examined mostly from economic, organizational, and public health lenses. Financial incentives exist in all healthcare systems, whether a socialized, private or public insurance, or single payer system. This article examines the alignment of current predominant payment models of fee-for-service, capitation, and value-based payments with patient care ethics. The volume-based incentive of fee-for-service is misaligned with patient care, while capitation is a relatively neutral and (...) highly modifiable model. Value-based payments offer a unique benefit in improving patient agency and have a larger benefit of cost control. However, no model adequately addresses health disparities, and a larger consideration for justice is needed by payment model designers when considering incentives. In consideration of related values, bioethics must expand the discourse around patient care ethics to cover patient interactions with the health system and market forces outside the clinical context. (shrink)

Aims and Objectives The purpose of this paper was to clarify the concept of ethical conflict in nursing and highlight the importance of tackling this issue. -/- Background Ethical conflict is on the rise in the nursing context. It is associated with the compromise of nurses' well-being and patient care. However, there is no thorough conceptual understanding of this concept. -/- Design Concept analysis. -/- Methods Databases (PubMed, PsycINFO, CINAHL, Scopus, Embase, Web of Science and SocINDEX) were searched for (...) studies between 1984 and 2021. Both quantitative and qualitative studies related to ethical conflict in nursing were included. Walker and Avant's method of concept analysis was used to identify the defining attributes, antecedents and consequences of the concept of ethical conflict in nursing. We followed the PRISMA-ScR checklist to report the study. -/- Results Thirty studies were included for conceptualization. Defining attributes were divided into four categories: (1) emotional responses, (2) incompatible values, (3) competing interests and (4) ambiguous obligations. The antecedents were (1) ethical sensitivity, (2) negative ethical climate, (3) insufficient authority, (4) unrealistic expectations, (5) poor collaboration and (6) inadequate resources. The consequences were identified as (1) moral residue, (2) loss of identity, (3) professional burnout and (4) poor patient care. -/- Conclusions A unified conceptual model of ethical conflict in nursing shed light on the ethical issues nurses might come across in practice. Despite the fact that ethical conflict is inherently negative, we conceptualised this concept as a neutral fact and an opportunity for nursing action. The construct identification provides basis for both the development of practice and the development of staff support and education. (shrink)

Some philosophers think that life is worth living not merely because of the goods and the bads within it, but also because life itself is good. I explain how this idea can be formalized by associating each version of such of a view with a function from length of life to the value generated by life itself. Then I argue that every version of the view that life itself is good faces some version of the following dilemma: either (1) good (...) human lives are worse than very long lives wholly devoid of pleasure, desire-satisfaction, knowledge, or any other goods, or (2) very short lives containing nothing but suffering are worth living. Since neither result is plausible, we ought to reject the view that life itself is good. On the view I favor, any given life may be worth living because of the goods that it contains, but life itself is neutral. (shrink)

Neutral monism is a position in metaphysics defended by Mach, James, and Russell in the early twentieth century. It holds that minds and physical objects are essentially two different orderings of the same underlying neutral elements of nature. This paper sets out some of the central concepts, theses and the historical background of ideas that inform this doctrine of elements. The discussion begins with the classic neutral monism of Mach, James, and Russell in the first part of the paper, then (...) considers recent neo-Russellian versions in the second half. The chances for a revival of neutral monism are probably slight; its key ideas and starting points lie far from those in contemporary philosophy of mind. A better route might be through the philosophy of science and a deeper understanding of causation. (shrink)

According to the “Textbook View,” there is an extensional dispute between consequentialists and deontologists, in virtue of the fact that only the latter defend “agent-relative” principles—principles that require an agent to have a special concern with making sure that she does not perform certain types of action. I argue that, contra the Textbook View, there are agent-neutral versions of deontology. I also argue that there need be no extensional disagreement between the deontologist and consequentialist, as characterized by the Textbook View.

Field’s challenge to platonists is the challenge to explain the reliable match between mathematical truth and belief. The challenge grounds an objection claiming that platonists cannot provide such an explanation. This objection is often taken to be both neutral with respect to controversial epistemological assumptions, and a comparatively forceful objection against platonists. I argue that these two characteristics are in tension: no construal of the objection in the current literature realises both, and there are strong reasons to think that no (...) version of Field’s epistemological objection which has both Neutrality and Force can be construed. (shrink)

An idea that has attracted a lot of attention lately is the thought that consequentialism is a theory characterized basically by its agent neutrality.1 The idea, however, has also met with skepticism. In particular, it has been argued that agent neutrality cannot be what separates consequentialism from other types of theories of reasons for action, since there can be agent-neutral non-consequentialist theories as well as agent-relative consequentialist theories. I will argue in this paper that this last claim is (...) false. The paper is divided into four sections. Section one specifies two senses in which consequentialism is agent-neutral. Section two and three examine and reject, respectively, the claim that there are agent-relative consequentialist views as well as agent-neutral non-consequentialist views. I end the paper with some remarks on the plausibility, or better, the implausibility of characterizing consequentialism in terms other than agent neutrality. (shrink)

In Beyond Neutrality, George Sher criticises the idea that state neutrality between competing conceptions of the good helps protect society from oppression. While he is correct that some governments are non-neutral without being oppressive, I argue that those governments may be neutral at the core of their foundations. The possibility of non-neutrality leading to oppression is further explored; some conceptions of the good would favour oppression while others would not. While it is possible that a non-neutral state (...) may avoid oppression, it is argued that the risks are so great that it is better to bet on government being neutral, thereby minimizing the possibility of oppression. (shrink)

(Winner of The Res Publica Essay Prize) This article defends a moderate version of state perfectionism by using Gerald Gaus’s argument for liberal neutrality as a starting point of discussion. Many liberal neutralists reject perfectionism on the grounds of respect for persons, but Gaus has explained more clearly than most neutralists how respect for persons justifies neutrality. Against neutralists, I first argue that the state may promote the good life by appealing to what can be called “the qualified (...) judgments about the good life,” which have not been considered by liberal perfectionists including Joseph Chan and Steven Wall. Then I clear up several possible misunderstandings of these judgments, and argue that: (a) moderate perfectionism does not rely on controversial rankings of values and is committed to promoting different valuable ways of life by pluralistic promotion; and (b) moderate perfectionism requires only an indirect form of coercion in using tax money to support certain moderate perfectionist measures, which is justifiable on the grounds of citizens’ welfare. Thus, I maintain that moderate perfectionism does not disrespect citizens, and is not necessarily unfair to any particular group of people. It is, in fact, plausible and morally important. The defence of moderate perfectionism has practical implications for the state’s policies regarding art development, drug abuse, public education, and so on. (shrink)

Epistemologists often claim that in addition to belief and disbelief there is a third, neutral, doxastic attitude. Various terms are used: ‘suspending judgment’, ‘withholding’, ‘agnosticism’. It is also common to claim that the factors relevant to the justification of these attitudes are epistemic in the narrow sense of being factors that bear on the strength or weakness of one’s epistemic position with respect to the target proposition. This paper addresses two challenges to such traditionalism about doxastic attitudes. The first concerns (...) the relevance of non-epistemic factors we might call "future-comparative" – e.g., that you’ll have more decisive evidence on whether p tomorrow – to the justification of suspending judgment. The second, from Jane Friedman, is to explain the point of the neutral attitude without appealing to inquiry and thus taking goal-related factors, which are not epistemic, such as the value of the goal or the prospects for finding means to achieve it, to bear on the justification of the neutral attitude. My defense of traditionalism relies on distinguishing three ways of being neutral on a question: agnosticism, inquiry and suspension of judgment. Traditionalism is saved because, of these, agnosticism alone is a genuine doxastic attitude. (shrink)

The ecologist today finds scarce ground safe from controversy. Decisions must be made about what combination of data, goals, methods, and theories offers them the foundations and tools they need to construct and defend their research. When push comes to shove, ecologists often turn to philosophy to justify why it is their approach that is scientific. Karl Popper’s image of science as bold conjectures and heroic refutations is routinely enlisted to justify testing hypotheses over merely confirming them. One of the (...) most controversial theories in contemporary science is the Neutral Theory of Ecology. Its chief developer and proponent, Stephen Hubbell, presents the neutral theory as a bold conjecture that has so far escaped refutation. Critics of the neutral theory claim that it already stands refuted, despite what the dogmatic neutralists say. We see the controversy through a Popperian lens. But Popper’s is an impoverished philosophy of science that distorts contemporary ecology. -/- The controversy surrounding the neutral theory actually rests on a methodological fault. There is a strong but messy historical link between the concepts of being neutral and being null in biology, and Hubbell perpetuates this when he claims that the neutral theory is supplies the appropriate null for testing alternative theories. What method is being followed here? There are three contenders: -/- Null hypothesis testing tests for whether a there is a pattern to be explained. Null modeling tests for whether a process is causally relevant to a pattern. Baseline modeling apportions relative responsibility to multiple processes each relevant to a pattern. -/- Whether the neutral theory supplies an appropriate “null” depends upon whether null hypothesis, null modeling, or baseline model is intended. These methods prescribe distinct inference patterns. If they are null hypothesis testing or null modeling, the neutralists’s reasoning is invalid. If they are baseline modeling, the justification of a crucial assumption remains opaque. Either way, the neutral-null connection is being exploited rhetorically to privilege the neutral theory over its rivals. Clarifying the reasoning immunizes us against the rhetoric and foregrounds the underlying virtues of the neutralist approach to ecology. -/- The Popperian lens distorts theoretical development as dogmatism. Lakatos’s view of science as the development of research programmes clarifies the epistemology of the neutral theory. Focusing philosophical attention on the neutralist research programme illuminates (1) the synchronic uses of the neutral theory to make predictions and give descriptions and explanations; (2) its diachronic development in response to theoretical innovation and confrontation with data; (3) its complex relationships to alternative theories. For example, baseline modeling is now seen to be its primary explanatory heuristic. The justification for baseline modeling with the neutral theory, previously hidden from view, is seen in the logic of in the neutralist research programme. (shrink)

Recent pragmatic accounts of slurs argue that the offensiveness of slurs is generated by a speaker's free choice to use a slur opposed to a more appropriate and semantically equivalent neutral counterpart. I argue that the theoretical role of neutral counterparts on such views is overstated. I consider two recent pragmatic analyses, Bolinger (Noûs, 51, 2017, 439) and Nunberg (New work on speech acts, Oxford University Press, 2018), which rely heavily upon the optionality of slurs, namely, that a speaker exercises (...) a deliberate lexical choice to use a slur when they could have easily used a neutral counterpart instead. Against such views, I argue that across a range of different offensive uses of slurs, a speaker's choice to use a slur opposed to a neutral counterpart plays little to no role in accounting for why the slur generates offence. Such cases cast serious doubt upon the explanatory depth of these pragmatic analyses, and raise more general concerns for views which draw upon the relationship between a slur and its neutral counterpart. The main upshot is this: theorists should exercise caution in assuming that neutral counterparts play any fundamental or systemic role in explaining why slurs are offensive. (shrink)

In this work we answer a long standing request for temporal embeddings of deontic STIT logics by introducing the multi-agent STIT logic TDS . The logic is based upon atemporal utilitarian STIT logic. Yet, the logic presented here will be neutral: instead of committing ourselves to utilitarian theories, we prove the logic TDS sound and complete with respect to relational frames not employing any utilitarian function. We demonstrate how these neutral frames can be transformed into utilitarian temporal frames, while preserving (...) validity. Last, we discuss problems that arise from employing binary utility functions in a temporal setting. (shrink)

I argue that traditional views on which beliefs are subject only to purely epistemic assessment can reject demographic profiling, even when based on seemingly robust evidence. This is because the moral failures involved in demographic profiling can be located in the decision not to suspend judgment, rather than supposing that beliefs themselves are a locus of moral evaluation. A key moral reason to suspend judgment when faced with adverse demographic evidence is to promote social equality—this explains why positive profiling is (...) dubious, along with more familiar cases of negative profiling, and why profiling is suspect even when no particular action is at stake. My suspension-based view, while compatible with revisionary normative positions, does not presuppose them. Philosophers of all stripes can reject demographic profiling both in thought and deed. (shrink)

I defend the idea that a liberal commitment to value neutrality is best honoured by maintaining a pure cardinality component in our rankings of opportunity or liberty sets. I consider two challenges to this idea. The first holds that cardinality rankings are unnecessary for neutrality, because what is valuable about a set of liberties from a liberal point of view is not its size but rather its variety. The second holds that pure cardinality metrics are insufficient for (...) class='Hi'>neutrality, because liberties cannot be individuated into countable entities without presupposing some relevantly partisan evaluative perspective. I argue that a clear understanding of the liberal basis for valuing liberty shows the way to satisfying responses to both challenges. (shrink)

Despite the widespread presence of public arts funding in liberal societies, some liberals find it unjustified. According to the Neutrality Objection, arts funding preferences some ways of life. One way to motivate this challenge is to say that a public goods-styled justification, although it could relieve arts funding of these worries of partiality, cannot be argued for coherently or is, in the end, too susceptible to impressions of partiality. I argue that diversity-based arts funding can overcome this challenge, because (...) it invests in non-excludable infrastructure that fosters cultural literacy. We all have some interest as citizens in living in a society which fosters cultural literacy, seeing as this helps others to understand us, supports us to understand ourselves, and helps alleviate confusion and alienation we feel toward social difference. While some of these benefits can be enjoyed by those who make and consume art, they are also gained by those who don’t, because arts funding affects the makeup of public spaces and the communicative practices we all use to make sense of the world. (shrink)

According to the Value-Neutrality Thesis, technology is morally and politically neutral, neither good nor bad. A knife may be put to bad use to murder an innocent person or to good use to peel an apple for a starving person, but the knife itself is a mere instrument, not a proper subject for moral or political evaluation. While contemporary philosophers of technology widely reject the VNT, it remains unclear whether claims about values in technology are just a figure of (...) speech or nontrivial empirical claims with genuine factual content and real-world implications. This paper provides the missing argument. I argue that by virtue of their material properties, technological artifacts are part of the normative order rather than external to it. I illustrate how values can be empirically identified in technology. The reason why value-talk is not trivial or metaphorical is that due to the endurance and longevity of technological artifacts, values embedded in them have long-term implications that surpass their designers and builders. I further argue that taking sides in this debate has real-world implications in the form of moral constraints on the development of technology. (shrink)

Except in extraordinary circumstances, patients' clinical care should reflect their preferences. Incapacitated patients cannot report their preferences. This is a problem. Extant solutions to the problem are inadequate: surrogates are unreliable, and advance directives are uncommon. In response, some authors have suggested developing algorithmic "patient preference predictors" (PPPs) to inform care for incapacitated patients. In a recent paper, Earp et al. propose a new twist on PPPs. Earp et al. suggest we personalize PPPs using modern machine learning (ML) techniques. (...) In this paper, I argue that, contrary to Earp et al.'s claim, personalized patient preference predictors are neither technically feasible nor ethically desirable. (shrink)

In Liberalism with Excellence, Matthew Kramer makes an argument for how excellence may enter in into liberalism, despite liberalism’s strong commitment to neutrality. Kramer seeks to challenge not only the uncompromising rejection of this position by liberals such a Jonathan Quong, but also the so-called “blended” approach of “soft-perfectionist” scholars such as Joseph Raz and George Sher. In this essay, I do not so much challenge Kramer’s approach as offer an alternative for accomplishing the same thing. Under my proposal, (...) certain forms of excellence and neutrality can both be accommodated as long as state support for the form of excellence at issue is proportional to the support for such a form of excellence within the relevant polity, competing forms of excellence are non-rivalrous, and no one is forced to embrace a form of excellence with which they disagree. My proposal is therefore not what Ronald Dworkin derogatively characterized as “a checkerboard solution.” Rather than allowing the state to support contrary moral positions at one and the same time, it is a solution that takes morally compatible but nevertheless competing conceptions of excellence seriously, and exhibits neutrality by giving them proportional rather than full support. This neither forces anyone to pursue the particular forms of excellence the state supports nor prevents them from pursuing some other form of excellence entirely or, if they wish, no form of excellence at all. (shrink)

Abstract. The neutral monism suggested by Constantin Rădulescu-Motru was a theoretical frame intended to match the general idea of Kant’s apriorism with the results reached by physics and psychology at the beginning of the 20th Key words: transcendental aesthetic; consciousness in general; empirical consciousness; psychophysical parallelism; phenomenal ontology; scientistic ontology.

To date, both the United States federal government and twenty-one individual states have passed Religious Freedom Restoration Acts that aim to protect religious persons from having their sincere beliefs substantially burdened by governmental interests. RFRAs accomplish this by offering a three-pronged exemption test for religious objectors that is satisfied only when (1) an objector has a sincere belief that is being substantially burdened; (2) the government has a very good reason (e.g., health or safety) to interfere; and (3) there is (...) a reasonable alternative to serve the compelling interest. Legal balancing tests like those found in RFRA are content neutral insofar as they sideline the belief-content of conscientious objections as irrelevant when determining the permissibility of granting legal accommodations. However, some theorists worry that this legal picture may be backward: perhaps balancing tests should be content non-neutral given the usual features of conscientious objections. For example, Yossi Nehushtan contends that, contrary to their typical codification, religious conscience beliefs seem undeserving of special legal accommodations because they possess uniquely strong empirical and theoretical ties to intolerance. Thus, the illiberally intolerant content of these conscientious objections might actually give the state a reason to refuse to grant legal exemptions. In this paper, I offer a cursory defense of content neutrality with respect to balancing tests like those found in RFRA. To begin, I outline Nehushtan’s argument for content non-neutrality. The cornerstone of his argument is that illiberal intolerance is intolerable such that conscientious objections that are based upon illiberally intolerant values provide the state with strong, normally prevailing reason not to grant an exemption. I argue that, even when the illiberally intolerant content of one’s conscience constitutes a weighty and relevant factor in determining the permissibility of granting a legal exemption, there remain significant problems. It is difficult, for example, to determine which views are illiberally intolerant and difficult to say whether illiberally intolerant views can effectively serve as the principled demarcating line in balancing tests. To conclude, I offer several cursory arguments in favor of adopting content-neutral approaches without necessarily making a comprehensive case. By drawing on the work of Amy Sepinwall, Nadia Sawicki, and Nathan Chapman, I show that content-neutral approaches can help to safeguard robust protections for conscience by permitting atypical exercises of conscience, protect minority thoughts and practices from being coercively supplanted by majoritarian understandings of morality, appropriately maintain the skepticism and humility that we owe each other as compatriots in a pluralistic society, and allow the kind of justifiable civil disobedience that has an important place in political history among other things. (shrink)

It is commonly held that all deontological moral theories are agent-relative in the sense that they give each agent a special concern that she does not perform acts of a certain type rather than a general concern with the actions of all agents. Recently, Tom Dougherty has challenged this orthodoxy by arguing that agent-neutral deontology is possible. In this article I counter Dougherty's arguments and show that agent-neutral deontology is not possible.

Ecological neutral theory has been controversial as an alternative to niche theory for explaining community structure. Neutral theory, which explains community structure in terms of ecological drift, is frequently charged with being unrealistic, but commentators have usually not provided an account of theory or model realism. In this paper, I propose a framework for comparing the “realism” or accuracy of alternative theories within a domain with respect to the extent to which the theories abstract and idealize. Using this framework I (...) argue, contrary to most previous commentators, that neutral and niche theories are similarly realistic. Realism cannot provide a basis for accepting or rejecting either type of theory; instead, community ecologists should continue working with a plurality of models. While theoretical unification may become possible, we should treat a plurality of complementary, partial models as the expected situation within community ecology. (shrink)

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)

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)

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and (...) Merleau-Ponty in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making. (shrink)

Robust technological enhancement of core cognitive capacities is now a realistic possibility. From the perspective of neutralism, the view that justifications for public policy should be neutral between reasonable conceptions of the good, only members of a subset of the ethical concerns serve as legitimate justifications for public policy regarding robust technological enhancement. This paper provides a framework for the legitimate use of ethical concerns in justifying public policy decisions regarding these enhancement technologies by evaluating the ethical concerns that arise (...) in the context of testing such technologies on nonhuman animals. Traditional issues in bioethics, as well as novel concerns such as the possibility of moral status enhancement, are evaluated from the perspective of neutralism. (shrink)

Algorithms wield increasing control over our lives—over the jobs we get, the loans we're granted, the information we see online. Algorithms can and often do wield their power in a biased way, and much work has been devoted to algorithmic bias. In contrast, algorithmic neutrality has been largely neglected. I investigate algorithmic neutrality, tackling three questions: What is algorithmic neutrality? Is it possible? And when we have it in mind, what can we learn about algorithmic bias?

This chapter provides an introduction to panpsychism, panprotopsychism, and neutral monism to an interdisciplinary audience.

Background: Patient participation in clinical ethics support services has been marked as an important issue. There seems to be a wide variety of practices globally, but extensive theoretical or empirical studies on the matter are missing. Scarce publications indicate that, in Europe, patient participation in CESS varies from region to region, and per type of support. Practices vary from being non-existent, to patients being a full conversation partner. This contrasts with North America, where PP seems more or less (...) standard. While PP seems to be on the rise in Europe, there is no data to confirm this. This study sought a deep understanding of both habits and the attitudes towards PP in the Netherlands, including respondents’ practical and normative perspectives on the matter. Methods and Results: We developed a national survey on PP for Dutch CESS staff. Our survey comprised a total of 25 open and close-ended questions, focused on four topics related to PP goals of CESS, status quo of PP, ideas and ideals concerning PP, and obstacles for PP. Discussion: The four most important findings were that: Patient participation in Dutch CESS is far from standard. Views on patient participation are very much intertwined with the goals of ethics support. Hesitations, fears and perceived obstacles for PP were not on principle and Most respondents see PP as a positive opportunity, yet requiring additional training, practical guidance and experience. Conclusions: Various normative reasons require PP. However, PP seems far from standard and somewhat rare in Dutch CESS settings. Our respondents did not raise many principled objections to PP. Instead, reasons for the lack of PP are intertwined with viewpoints on the goals of CESS, which seemingly focus on supporting health care professionals. Training and practical guidance was thought to be helpful for gaining experience for both CESS staff and HCPs. (shrink)

Abstract:Respect for persons protects patients regarding their own healthcare decisions. Patient informed choice for altruism (PICA) is a proposed means for a fully autonomous patient with decisionmaking capacity to limit his or her own treatment for altruistic reasons. An altruistic decision could bond the patient with others at the end of life. We contend that PICA can also be an advance directive option. The proxy, family, and physicians must be reminded that a patient’s altruistic treatment refusal (...) should be respected. (shrink)

Slurs have been standardly assumed to bear a very direct, very distinctive semantic relationship to what philosophers have called “neutral counterpart” terms. I argue that this is mistaken: the general relationship between paradigmatic slurs and their “neutral counterparts” should be assumed to be the same one that obtains between ‘chick flick’ and ‘romantic comedy’, as well a huge number of other more prosaic pairs of derogatory and “less derogatory” expressions. The most plausible general relationship between these latter expressions — and (...) thus, I argue, between paradigmatic slurs and “neutral counterpart” terms — is one of overlap in presumed extension, grounded in overlap in associated stereotypes. The resulting framework has the advantages of being simple, unified, and, unlike its orthodox rivals, neatly accommodating of a much wider range of data than has previously been considered. More importantly, it positions us to better understand, identify, and confront the insidious mechanisms of ordinary bigotry. (shrink)

This paper aims to clarify Plato’s notions of the natural and the neutral state in relation to hedonic properties. Contra two extreme trends among scholars—people either conflate one state with the other, or keep them apart as to establish an unsurmount- able gap between both states, I argue that neither view accurately reflects Plato’s position because the natural state is real and can coincide with the neutral state in part, whereas the latter, as an umbrella term, can also be realized (...) in a non-natural condition. The clarification of the relation between the two states will shed light on the degree to which Plato admits and constrains the hedonic value for a good human life; further, this will call attention to some (not well explored) parallel thoughts in the medical tradition to which Plato is indebted. (shrink)

Patient-funded trials are gaining traction as a means of accelerating clinical translation. However, such trials sidestep mechanisms that promote rigor, relevance, efficiency, and fairness. We recommend that funding bodies or research institutions establish mechanisms for merit review of patient-funded trials, and we offer some basic criteria for evaluating PFT protocols.

Institutions promoting republican freedom as non-domination are commonly believed to differ significantly from institutions promoting negative freedom as non-interference. Philip Pettit, the most prominent contemporary defender of this view, also maintains that these republican institutions are neutral between the different conceptions of the good that characterise a modern society. This paper shows why these two views are incompatible. By analysing the institutional requirements Pettit takes as constitutive of republican freedom, I show how they also promote negative freedom by reducing overall (...) interference. To avoid this result, republican institutions must be more restrictive and require that citizens conform to a life of political engagement. But then republican freedom will not be a neutral ideal. Rejecting negative freedom therefore means sacrificing neutrality. (shrink)

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in a (...) decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

This chapter examines the distinction that is sometimes drawn between neutral and relative attributions of value. It asks whether a plausible interpretation can be found for claims about relative value; whether an interpretation can be found for claims about neutral value which best captures the thoughts that people express by using this distinction; whether the distinction can be used to produce a satisfactory way of formulating a relative-value consequentialist theory; and whether a theory of that kind is plausible. A positive (...) answer is given to the first three questions, but a negative one to the fourth. (shrink)

Notes for a talk exploring Timothy Williamson's arguments against evidence neutrality.

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of a (...) series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values. (shrink)

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

Patient preference predictors aim to solve the moral problem of making treatment decisions on behalf of incapacitated patients. This commentary on a case of an unrepresented patient at the end of life considers 3 related problems of such predictors: the problem of restricting the scope of inputs to the models (the “scope” problem), the problem of weighing inputs against one another (the “weight” problem), and the problem of multiple reasonable solutions to the scope and weight problems (the “multiple (...) reasonable models” problem). Each of these problems poses challenges to reliably implementing patient preference predictors in important, high-stakes health care decision making. This commentary also suggests a way forward. (shrink)

This Handbook focuses on value theory as it pertains to ethics, broadly construed, and provides a comprehensive overview of contemporary debates pertaining not only to philosophy but also to other disciplines-most notably, political theory...