Jeremy R. Garrett claims that the nature and scope of our rescue duties cannot be properly understood and addressed without reference to social context or institutional background conditions. In my comment I focus not on social or institutional but on psychological background conditions that are also necessary for the conceptualization of rescue cases. These additional conditions are of crucial importance since an entire paradigm of “rescue medicine” is founded, as Garret notices, on the powerful and immediate (...) “impulse to rescue” (Garrett 2015). I understand this “impulse” as the preference toward identified victims, and I argue that it may sometimes distort genuine moral judgments in rescue cases. (shrink)

Anja Karnein has suggested that because of the importance of respect for persons, law and policy should require some human embryos created in vitro to be available for adoption for a period of time. If no one comes forward to adopt the embryos during that time, they may be destroyed (in the case of embryos left over from fertility medicine) or used in research (in the case of embryos created for that purpose or left over from fertility medicine). (...) This adoption option would increase the number of embryos available for couples looking for help in having children, but that effect is less important—Karnein argues—than the observance of respect for human persons. As possible persons, she holds that embryos ought to be treated, as if they will become children, if only for a while. If enacted as a matter of law and policy, an ‘adoption option’ would wrongly interfere with the dispositional rights women and men ought to have over embryos they create in the course of trying to have children. Karnein's proposal would also deprive researchers of certainty that the embryos they create for research would actually be available that way, leading to increased burdens of time and money and maybe even to more embryos than would otherwise be produced. Karnein's analysis does not show, moreover, that any duty of rescue applies to embryos. No woman is required to adopt any embryo, which significantly undercuts the justification for an obligatory adoption period. (shrink)

In The Future of Human Nature, Jürgen Habermas raises the question of whether the embryonic genetic diagnosis and genetic modification threatens the foundations of the species ethics that underlies current understandings of morality. While morality, in the normative sense, is based on moral interactions enabling communicative action, justification, and reciprocal respect, the reification involved in the new technologies may preclude individuals to uphold a sense of the undisposability of human life and the inviolability of human beings that is necessary for (...) their own identity as well as for reciprocal relations. Engaging with liberal bioethics and Catholic approaches to bioethics, the article clarifies how Habermas’ position offers a radical critique of liberal autonomy while maintaining its postmetaphysical stance. The essay argues that Habermas’ approach may guide the question of rights of future generations regarding germline gene editing. But it calls for a different turn in the conversation between philosophy and theology, namely one that emphasizes the necessary attention to rights violations and injustices as a common, postmetaphysical starting point for critical theory and critical theology alike. In 2001, Jürgen Habermas published a short book on questions of biomedicine that took many by surprise.[1] To some of his students, the turn to a substantive position invoking the need to comment on a species ethics rather than outlining a public moral framework was seen as the departure from the “path of deontological virtue,”[2] and at the same time a departure from postmetaphysical reason. Habermas’ motivation to address the developments in biomedicine had certainly been sparked by the intense debate in Germany, the European Union, and internationally on human cloning, pre-implantation genetic diagnosis, embryonic stem cell research, and human enhancement. He turned to a strand of critical theory that had been pushed to the background by the younger Frankfurt School in favor of cultural theory and social critique, even though it had been an important element of its initial working programs. The relationship of instrumental reason and critical theory, examined, among others, by Max Horkheimer, Theodor W. Adorno, and Herbert Marcuse and taken up in Habermas’ own Knowledge and Interest and Theory of Communicative Action became ever-more actual with the development of the life sciences, human genome analysis, and genetic engineering of human offspring. Today, some of the fictional scenarios discussed at the end of the last century as “science fiction” have become reality: in 2018, the first “germline gene-edited” children were born in China.[3] Furthermore, the UK’s permission to create so-called “three-parent” children may create a legal and political pathway to hereditary germline interventions summarized under the name of “gene editing.”In this article, I want to explore Habermas’ “substantial” argument in the hope that philosophy and theology become allies in their struggle against an ever-more reifying lifeworld, which may create a “moral void” that would, at least from today’s perspective, be “unbearable”, and for upholding the conditions of human dignity, freedom, and justice. I will contextualize Habermas’ concerns in the broader discourse of bioethics, because only by doing this, his concerns are rescued from some misinterpretations.[1] Jürgen Habermas, The Future of Human Nature.[2] Ibid., 125, fn. 58. 8[3] Up to the present, no scientific publication of the exact procedure exists, but it is known that the scientist, Jiankui He, circumvented the existing national regulatory framework and may have misled the prospective parents about existing alternatives and the unprecedented nature of his conduct. Yuanwu Ma, Lianfeng Zhang, and Chuan Qin, "The First Genetically Gene‐Edited Babies: It's “Irresponsible and Too Early”," Animal Models and Experimental Medicine ; Matthias Braun, Meacham, Darian, "The Trust Game: Crispr for Human Germline Editing Unsettles Scientists and Society," EMBO reports 20, no. 2. (shrink)

Clinicians and health researchers frequently encounter opportunities to rescue people. Rescue cases can generate a moral duty to aid those in peril. As such, bioethicists have leveraged a duty to rescue for a variety of purposes. Yet, despite its broad application, the duty to rescue is under-analyzed. In this paper, we assess the state of theorizing about the duty to rescue. There are large gaps in bioethicists’ understanding of the force, scope, and justification of the (...) two most cited duties to rescue—the individual duty of easy rescue and the institutional rule of rescue. We argue that the duty of easy rescue faces unresolved challenges regarding its force and scope, and the rule of rescue is indefensible. If the duty to rescue is to help solve ethical problems, these theoretical gaps must be addressed. We identify two further conceptions of the duty to rescue that have received less attention—an institutional duty of easy rescue and the professional duty to rescue. Both provide guidance in addressing force and scope concerns and, thereby, traction in answering the outstanding problems with the duty to rescue. We conclude by proposing and propose research priorities for developing accounts of duties to rescue in bioethics. (shrink)

In a recent paper, Tim Henning argues that the result that we should save the greatest number in rescue cases can be established on procedural grounds without making use of the aggregation of interests. He first argues that we ought to respect the affected persons' equal claims to have a say in the rescue decision and that this can only be achieved by the majority rule, which consists in giving each affected person an equal vote. Then he argues (...) for the second claim that if everyone votes in their self-interest, then the greatest number will be saved. I present a class of cases in which the second claim fails. This establishes that even if self-interested voting is assumed, the majority rule does not always lead to the greatest number being saved. (shrink)

New theological understanding can emerge with the advancement of scientific knowledge and the use of new concepts, or older concepts in new ways. Here, the authors present a proposal to extend the concept of “rescue and recovery” found in the United Nations Law of the High Seas, off‐world and within a broader purview of other intelligent and self‐aware species that humans may someday encounter. The notion of a morality that extends to off‐world species is not new, but in this (...) analysis, rescue and recovery become an imperative when any intelligent and self‐aware species is in harm's way. Rescue and recovery encompass a necessary action component except perhaps in those cases where rescuers are in danger. The authors explore three biblical examples of rescue and recovery to derive a fundamental meaning of the concept. (shrink)

Rescue workers have a stressful and risky occupation where being engaged is crucial to face physical and emotional risks in order to help other persons. This study aims to estimate work engagement levels of rescue workers (namely comparing nurses, firefighters, and police officers) and to assess the validity evidence related to the internal structure of the Portuguese versions of the UWES-17 and UWES-9, namely, dimensionality, measurement invariance between occupational groups, and reliability of the scores. To evaluate the dimensionality, (...) we compared the fit of the three-factor model with the fit of a second-order model. A Portuguese version of the instrument was applied to a convenience sample of 3,887 rescue workers (50% nurses, 39% firefighters, and 11% police officers). Work engagement levels were moderate to high, with firefighters being the highest and nurses being the lowest engaged. Psychometric properties were evaluated in the three-factor original structure revealing acceptable fit to the data in the UWES-17, although the UWES-9 had better psychometric properties. Given the observed statistically significant correlations between the three original factors, we proposed a 2nd hierarchal structure that we named work engagement. The UWES-9 first-order model obtained full uniqueness measurement invariance, and the second-order model obtained partial (metric) second-order invariance. (shrink)

Suppose A is wrongfully attempting to kill you, thereby forfeiting his right not to be harmed proportionately in self-defense. Even if it were proportionate to blow off A's arms and legs to stop his attack, this would be impermissible if you could stop his attack by blowing off just one of his arms. Blowing off his arms and legs violates the necessity condition on imposing harm. Jonathan Quong argues that violating the necessity condition consists in violating a right to be (...) rescued: blowing off four of A’s limbs in proportionate self-defense rather than blowing off one of A’s limbs in proportionate self-defense fails to costlessly rescue three of A's limbs. In response, we present cases which intuitively show that violating the necessity constraint involves the violation of a right that is more stringent than a right to be rescued. (shrink)

In the last seven years, close to twenty thousand people have died trying to reach Europe by crossing the Mediterranean Sea. Rescue missions by private actors and NGOs have increased because both national measures and measures by the EU’s border control agency, Frontex, are often deemed insufficient. However, such independent rescue missions face increasing persecution from national governments, Italy being one example. This raises the question of how potential migrants and dissenting citizens should act towards the EU border (...) regime. In contrast to the literature, which mainly addresses migration on the basis of justice requirements, this article focuses on the legitimate authority of the EU’s border regime. Focusing on the legitimacy criteria for states’ claims to regulate migration opens a fruitful normative perspective, given the pervasive disagreement over the content of justice in migration. What reasons for compliance and non-interference does legitimacy supply for potential immigrants and dissenting citizens? And what legitimacy standard may be appropriate for the power that individual states claim over potential immigrants? We argue that, even assuming a minimal legitimacy standard for the state-migrant relationship, the structure of the EU’s border regime exhibits unique features, which cause it to stand in tension with such a standard. By coordinating its Member States’ border regimes, especially through Frontex, the EU claims and exercises power over potential immigrants. However, the asymmetrical delegation of state powers to the EU means that the power involved in regulating European borders is, in core respects, unaccountable. This unaccountability, we argue, is significant for the legitimacy of the EU’s border regime. This article sheds new light on the morality of unauthorised rescue missions by assessing the permissibility of resistance to the EU’s border regime. (shrink)

The “Embryo Rescue Case” (ERC) refers to a thought experiment that is used to argue against the view that embryos have a right to life (i.e. are persons). I will argue that cognitive science undermines the intuition elicited by the ERC; I will show that whether or not embryos have a right to life, our mental tools will make it very difficult to believe that embryos have said right. This suggests that the intuition elicited by the ERC is not (...) truth indicative. The upshot of this is that we have an undercutting defeater for our intuition that embryos do not have a right to life. (shrink)

We should conceive of illegal covert animal rescue as acts of “subrevolution” rather than as civil disobedience. Subrevolutions are revolutions that aim to overthrow some part of the government rather than the entire government. This framework better captures the relevant values than the opposing suggestion that we treat illegal covert animal rescue as civil disobedience. If animals have rights like the right not to be unjustly imprisoned and mistreated, then it does not make sense that an instance of (...) animal rescue will be justifiable only if it meets criteria for justified civil disobedience, e.g., the requirement that the civil disobedient not rescue more animals than would be necessary to communicate their message. Thus, the framework of subrevolution is a more apt way to analyze animal rescue. (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)

Public reason liberalism is defined by the idea that laws and policies should be justifiable to each person who is subject to them. But what does it mean for reasons to be public or, in other words, suitable for this process of justification? In response to this question, Kevin Vallier has recently developed the traditional distinction between consensus and convergence public reason into a classification distinguishing three main approaches: shareability, accessibility and intelligibility. The goal of this paper is to defend (...) the accessibility approach by demonstrating its ability to strike an appealing middle course in terms of inclusivity between shareability and intelligibility. We first argue against Vallier that accessibility can exclude religious reasons from public justification. Second, we use scientific reasons as a case study to show that accessibility excludes considerably fewer reasons than shareability. Throughout the paper, we connect our discussion of accessibility to John Rawls’s model of public reason, so as to give substance to the accessibility approach and to further our understanding of Rawls’s influential model. (shrink)

In this paper, I argue that the concept of normality in medical research and clinical practice is inextricable from the concept of ambiguity. I make this argument in the context of Edmund Pellegrino's call for a renewed reflection on medicine’s basic concepts and by drawing on work in critical disability studies concerning Deafness and body integrity identity disorder. If medical practitioners and philosophers of medicine wish to improve their understanding of the meaning of medicine as well as (...) its concrete practice, I contend that they should take seriously the import and centrality of ambiguity for biomedicine. (shrink)

During the recent Ebola epidemic, some commentators and stakeholders argued that it would be unethical to carry out a study that withheld a potential treatment from affected individuals with such a serious, untreatable disease. As a result, the initial trials of experimental treatments did not have control arms, despite important scientific reasons for their inclusion. In this paper, we consider whether the duty to rescue entails that it would be unethical to withhold an experimental treatment from patient-participants with serious (...) diseases for which there are no effective treatments, even when doing so is scientifically necessary to test the effectiveness of the treatment. We argue that the duty to rescue will rarely apply. The context of medical research also throws new light on the content of the duty to rescue, since the interests of future patients—who stand to benefit from the fruits of medical research—are relevant to whether the duty applies. (shrink)

Christopher Cowie has recently argued that companions in guilt arguments against the moral error theory that appeal to epistemic reasons cannot work. I show that such companions in guilt arguments can work if, as we have good reason to believe, moral reasons and epistemic reasons are instances of fundamentally the same relation.

Early moderns such as Locke and Descartes thought we could guarantee the justification of our beliefs, even in worlds most hostile to their truth, if only we form those beliefs with sufficient care. That is, they thought it possible for us to be impeccable with respect to justification. This principle has traditionally been used to argue for internalism. By placing all of the normatively relevant conditions in our minds, we ensure reflective access to what those norms require of us and (...) so sustain the possibility of impeccability (unlike externalism). However, recent challenges to transparency leave this reasoning vulnerable. In response, I show how impeccability can be sustained without requiring transparency. The account only works if we define internal states as those directly accessible to our rational belief forming systems. I argue that this sort of causal internalism, while somewhat revisionary, preserves traditional motivations for internalism while avoiding problems faced by other varieties. The result is a renewed argument for internalism that simultaneously moves us away from access internalism and towards a species of mentalism. (shrink)

In cases in which we must choose between either (i) preventing a woman from remaining unwillingly pregnant or (ii) preventing a fetus from being killed, we should prevent the fetus from being killed. But this suggests that in typical cases abortion is wrong: typical abortions involve preventing a woman from remaining unwillingly pregnant over preventing a fetus from being killed. And so abortion is typically wrong—and this holds whether or not fetuses are persons.

Street’s (Philos Stud 127(1):109–166, 2006) Darwinian Dilemma purports to show that evolutionary considerations are in tension with realist theories of value, which include moral realism. According to this argument, moral realism can only be defended by assuming an implausible tracking relation between moral attitudes and moral facts. In this essay, I argue that this tracking relation is not as implausible as most people have assumed by showing that the three main objections against it are flawed. Since this is a key (...) premise in the reasoning, I conclude that the Darwinian Dilemma against moral realism can be resisted. (shrink)

The duty to rescue is a highly plausible and powerful ethical principle. It requires agents to assist others in extreme need in cases where doing so does not conflict with some weighty moral aim; requires little personal sacrifice; and is likely to significantly benefit the recipients.1 As a general obligation, it binds all persons simply qua persons, and it is owed to all persons simply qua persons. Clinical investigators working in low-income countries frequently encounter sick or destitute people to (...) whom they might possess a duty to rescue. Investigators may often ask themselves, what can I do, what should I do, to help? Such investigators often help people in the future by carrying out their... (shrink)

It is wholly uncontroversial that measurements-or, more properly, propositions that are measurement reports-are often paradigmatically good cases of propositions that serve the function of evidence. In normal cases it is also obvious that stating such a report is an utterly pedestrian case of successful assertion. So, for example, there is nothing controversial about the following claims: (1) that a proposition to the effect that a particular thermometer reads 104C when properly used to determine the temperature of a particular patient is (...) evidence that the patient in question has a fever and (2) that there is nothing wrong with asserting the proposition that a particular thermometer reads 104C for appropriate reasons of communication, etc. when the thermometer has been properly used to determine the temperature of a particular patient. Here it will be shown that Timothy Williamson’s commitments to a number of principles about knowledge and assertion imply that a whole class of utterly ordinary statements like these that are used as evidence are not really evidence because they are not knowledge and so are (perversely) unassertable according to his principled commitments. This paper deals primarily with the second of these two problems and an alternative account of the norms of assertion is introduced which allows for the assertability of such measurement reports. (shrink)

ABSTRACT: Abstract Most modern knowledge is not science. The physical sciences have successfully validated theories to infer they can be used universally to predict in previously unexperienced circumstances. According to the conventional conception of science such inferences are falsified by a single irregular outcome. And verification is by the scientific method which requires strict regularity of outcome and establishes cause and effect. -/- Medicine, medical research and many “soft” sciences are concerned with individual people in complex heterogeneous populations. These (...) populations cannot be tested to demonstrate strict regularity of outcome in every individual. Neither randomised controlled trials nor observational studies in medicine are science in the conventional conception. Establishing and using medical and other “soft science” theories cannot be scientific. It requires conceptually different means: requiring expert judgement applying all available evidence in the relevant available factual matrix. -/- The practice of medicine is observational. Prediction of outcomes for the individual requires professional expertise applying available medical knowledge and evidence. Expertise in any profession can only be acquired through experience. Prior cases are the fundament of knowledge and expertise in medicine. Case histories, studies and series can provide knowledge of extremely high reliability applicable to establishing reliable general theories and falsifying others. Their collation, study and analysis should be a priority in medicine. Their devaluation as evidence, the failure to apply their lessons, the devaluation of expert professional judgement and the attempt to emulate the scientific method are all historic errors in the theory and practice of modern medicine. (shrink)

Fiona Woollard argues that when one is personally involved in an emergency, one has a moral requirement to make substantial sacrifices to aid others that one would not otherwise have. She holds that there are three ways in which one could be personally involved in an emergency: by being physically proximate to the victims of the emergency; by being the only person who can help the victims; or by having a personal encounter with the victims. Each of these factors is (...) claimed to be defeasibly sufficient to ground personal involvement, and thus a requirement of substantial sacrifice to aid. Woollard defends this view on the basis of a number of cases. We show that Woollard’s cases contain various confounding factors. In view of the more precisely drawn cases offered here, it is clear that neither proximity nor uniqueness nor personal encounter is intuitively defeasibly sufficient in the way Woollard claims. (shrink)

The success of precision medicine depends on obtaining large amounts of information about at-risk populations. However, getting consent is often difficult. Why? In this commentary I point to the differentials in social status involved. These differentials are inevitable once personal information is surrendered, but are particularly intense when the studied populations are socioeconomically or socioculturally disadvantaged and/or ethnically stigmatized groups. I suggest how the deep distrust of the latter groups can be partially justified as a lack of confidence that (...) their core values or interests will sufficiently be taken into account. Hence, the ethical challenge here lies not in avoiding status differentials, but in dealing with them appropriately. Scientists should not assume trust from others but adopt a norm of “demonstrating trustworthiness”. (shrink)

The debate over whether ‘fair-play’ can serve as a justification for legal punishment has recently resumed with an exchange between Richard Dagger and Antony Duff. According to the fair-play theorist, criminals deserve punishment for breaking the law because in so doing the criminal upsets a fair distribution of benefits and burdens, and punishment rectifies this unfairness. Critics frequently level two charges against this idea. The first is that it often gives the wrong explanation of what makes crime deserving of punishment, (...) since the wrongfulness of murder is not primarily about unfairness. The second is that it implies that all crimes deserve the same degree of punishment, because all crimes create the same degree of unfairness. These objections are viewed as revealing fatal flaws in the theory. Although Dagger attempts to meet these objections by drawing on political theory, Duff responds that this still draws upon the wrong kind of resources for meeting these objections. This paper argues that these two objections rest on a crucial mistake that has been overlooked by both the defenders and critics of fair-play. This mistake results from failing to distinguish between what justifies punishment as a response to crime (which requires a common element to all crime) and what justifies attaching particular penalties to crimes (which requires making distinctions in the severity of crime). The arguments presented will give reasons to consider fair-play as a viable justification for legal punishment. (shrink)

In ‘The Pregnancy Rescue Case: why abortion is immoral’, Hendricks presents The Pregnancy Rescue Case. In this reply I argue that even if it would be better (i.e., less bad) for the abortion to be prevented in The Pregnancy Rescue Case, that does not mean that typical abortions are impermissible. I also argue that there is a possible explanation, consistent with the pro-choice view and empirically testable, as to why people would think it better for the abortion (...) to be prevented in The Pregnancy Rescue Case. (shrink)

If one had to identify the biggest change within the philosophical tradition in the twenty-first century, it would certainly be the rapid rise of experimental philosophy to address differences in intuitions about concepts. It is, therefore, surprising that the philosophy of medicine has so far not drawn on the tools of experimental philosophy in the context of a particular conceptual debate that has overshadowed all others in the field: the long-standing dispute between so-called naturalists and normativists about the concepts (...) of health and disease. In this paper, I defend and advocate the use of empirical methods to inform and advance this and other debates within the philosophy of medicine. (shrink)

This paper addresses the so-called Taurek debate on whether or not to save the greater number of victims in rescue conflicts. In this controversy we take a consequentialist and aggregationist pro-numbers position and defend it against various objections. In particular, we consider it to be compatible with the principle of equal concern. Given that the pro-numbers position hinges to a significant extent on the acceptance of the person-neutral value of personal well-being, we offer a coherentist justification for this value (...) claim. Systematically though, we argue that neither pure welfare aggregationism nor its strict rejection are convincing. Rather, rejoining the two ethical dimensions of individual claims and collective well-being requires a hybrid position. Identifying three possible ways of constructing such a position, we briefly defend them against a recent version of the charge that they cannot be coherently expressed in a rational choice framework. -/- / Zusammenfassung: Im Rahmen der sogenannten Taurek-Debatte wird die Frage diskutiert, ob in Rettungskonflikten die größere Anzahl an Opfern gerettet werden sollte oder nicht. Wir beziehen in dieser Kontroverse eine konsequentialistische und aggregationistische Pro-Anzahl-Position und verteidigen diese gegen verschiedene Einwände. Insbesondere halten wir die Position für kompatibel mit dem Prinzip gleicher Achtung. Angesichts des Umstandes, dass die Pro-Anzahl-Position in maßgeblicher Weise von der Annahme eines personenneutralen Wertes persönlichen Wohlergehens abhängt, bieten wir eine kohärentistische Rechtfertigung für diese Wertbehauptung. Systematisch argumentieren wir, dass weder ein reiner Wohlergehensaggregationismus noch seine komplette Zurückweisung überzeugend sein können. Die Vereinigung der beiden ethischen Dimensionen individueller Ansprüche und kollektiven Wohlergehens erfordert stattdessen eine hybride Position. Wir identifizieren drei mögliche Wege für die Konstruktion einer solchen Hybridposition und verteidigen diese abschließend kurz gegen einen aktuellen Vorwurf, demzufolge diese nicht auf kohärente Weise im Rahmen der rationalen Entscheidungstheorie abgebildet werden können. (shrink)

Deceased organ donation is widely considered as a case of easy rescue―that is, a case in which A may bestow considerable benefits on B while incurring negligent costs herself. Yet, the policy implications of this observation remain unclear. Drawing on Christopher H. Wellman’s samaritan account of political obligations, the paper develops a case for a so-called opt-out system, i.e., a scheme in which people are defaulted into being donors. The proposal’s key idea is that we may arrange people’s options (...) in specific ways for the sake of others. (shrink)

Even in the increasingly individualized American medical system, advocates of 'personalized medicine' claim that healthcare isn't individualized enough. With the additional glamour of new biotechnologies such as genetic testing and pharmacogenetics behind it, 'Me Medicine'-- personalized or stratified medicine-- appears to its advocates as the inevitable and desirable way of the future. Drawing on an extensive evidence base, this book examines whether these claims are justified. It goes on to examine an alternative tradition rooted in communitarian ideals, (...) that of the common good as a goal in medicine. (shrink)

A stunning phenomenon has dramatically changed the way in which we in the West regard the public sphere in particular, and democracy in general in the twenty-first century: the re-emergence of religion.

This is a volume of twelve essays concerning the fundamental tension in personalised medicine between individual choice and the common good.

The connections between medicine and well-being are myriad. This paper focuses on the place of well-being in clinical medicine. It is here that different views of well-being, and their connection to concepts like “autonomy” and “authenticity”, both illuminate and are illuminated by looking closely at the kinds of interactions that routinely take place between clinicians, patients, and family members. -/- In the first part of the paper, I explore the place of well-being in a paradigmatic clinical encounter, one (...) where a competent patient interacts with a clinician. The main question here is how, or even whether, the pursuit of patient well-being – however we construe it – figures into a paradigmatic clinical encounter. In the second part of the paper, I consider what I will call a marginal clinical encounter – one where the patient is, as Agnieska Jaworska (1999) puts it, at the “margins of agency” – to theorize about the nature of well-being and to show how different theories of well-being can have dramatic consequences for clinical decision-making. (shrink)

I think Tongdong Bai's Confucian Meritocracy requires a lot of idealisation. Feasibility aside, should we realise the conditions for Confucian Meritocracy to work, we would have created the ideal situation for democracy to function properly. This challenges the purported advantages Confucian Meritocracy enjoys over democracy.

Part of a symposium devoted to ‘Prediction, Understanding, and Medicine’, in which Alex Broadbent argues that the nature of medicine is determined by its competences, i.e., which things it can do well. He argues that, although medicine cannot cure well, it can do a good job of enabling people not only to understand states of the human organism and of what has caused them, but also to predict future states of it. From this Broadbent concludes that (...) class='Hi'>medicine is (at least in part) essentially a practice of understanding and predicting, not curing. In reply to this bold position, I mount two major criticisms. First, I maintain that the reasons Broadbent gives for doubting that medicine can cure provide comparable reason for doubting that medicine can provide an understanding; roughly, the best explanation of why medicine cannot reliably cure is that we still lack much understanding of health and disease. Second, I object to the claim that a practice is medical only if it facilitates understanding and prediction. Although Broadbent has brought to light certain desirable purposes of medicine that are under-appreciated, my conclusion is that he has not yet provided enough reason to think that understanding and prediction are essential to it. Instead of supposing that medicine has an essence, in fact, I suggest that its nature is best understood in terms of a property cluster. (shrink)

Contrary to popular belief, population-wide preventive measures are rarely cost-reducing. Yet they can still be cost-effective, and indeed more cost-effective than treatment. This is often true of preventive measures that work by slightly reducing the already low risks of death faced by many people. This raises a difficult moral question: when we must choose between life-saving treatment, on the one hand, and preventive measures that avert even more deaths, on the other, is the case for prevention weakened when it works (...) by reducing many healthy people’s already low risks by a further tiny amount? I argue the answer is no. (shrink)

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues relating (...) to the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

The issue of how to incorporate the individual's first‐hand experience of illness into broader medical understanding is a major question in medical theory and practice. In a philosophical context, phenomenology, with its emphasis on the subject's perception of phenomena as the basis for knowledge and its questioning of naturalism, seems an obvious candidate for addressing these issues. This is a review of current phenomenological approaches to medicine, looking at what has motivated this philosophical approach, the main problems it faces (...) and suggesting how it might become a useful philosophical tool within medicine, with its own individual, but interrelated, contribution to make to current medical debates. After the general background, there is a brief summary of phenomenological ideas and their current usage in a medical context. Next is a critique of four key claims within current phenomenological medical works, concerning both the role phenomenology plays and the supposedly clear divide between phenomenology and other approaches. There are significant problems within these claims, largely because they overlook the complexity of the questions they consider. Finally, there is some more in‐depth examination of phenomenology itself and the true complexity of phenomenological debate concerning subjectivity. The aim is to show that it will be both more productive and truer to phenomenology itself, if we use phenomenology as a philosophical method for explicating and gaining deeper understanding of complex and fundamental problems, which are central to medicine, rather than as providing simple, but flawed solutions. (shrink)

Tony Milligan argues that some forms of covert non-human animal rescue, wherein activists anonymously and illegally free non-human animals from confinement, should be understood as acts of civil disobedience. However, most traditional understandings of civil disobedience require that the civil disobedient act publicly rather than covertly. Thus Milligan’s proposal is that we revise our understanding of civil disobedience to allow for covert in addition to public disobedience. I argue we should not. Milligan cannot justify using paradigm cases to expand (...) the scope of civil disobedience without justifying similar reasons to limit the scope, and he does nto give convincing reasons for discarding the communication requirement, according to which an action cannot count as civil disobedience unless it is communicative. The immediate conclusion is that animal rescue is not civil disobedience, while the broader conclusion is one about civil disobedience more broadly: an act must be public to count as civil disobedience. (shrink)

Recent criticisms of medicine converge on fundamental questions about the aim of medicine. The main task of this paper is to propose an account of the aim of medicine. Discussing and rejecting the initially plausible proposal according to which medicine is pathocentric, the paper presents and defends the Autonomy Thesis, which holds that medicine is not pathocentric, but sanocentric, aiming to promote health with the final aim to enhance autonomy. The paper closes by considering the (...) objection that the Autonomy Thesis is overly permissive and allows many highly controversial procedures as legitimate parts of medicine. (shrink)

Amid criticism of medicine's scientific rigor and patient care, this book offers a philosophical examination of the nature and aims of medicine, and new perspectives on how these challenges can be addressed. It offers input for rethinking the agenda of medical research, healthcare delivery, and the education of healthcare personnel.

The paper points out three serious problems in Ruud ter Meulen’s view of solidarity and of its role in healthcare ethics. First, it is not clear whether and to what extent ter Meulen expects normative concepts to be rooted in existing social practices: his criticism of liberal theories of justice seems to imply a different view on this issue than his implicit assumption that normative concepts are independent from social and historical trends. Second, it is not clear at which level (...) his notion of solidarity is meant to be applied: does it provide principles for individuals or for institutions? Nor is it clear at what level of generality it should work: is it meant for healthcare institutions or for states, for citizens or for healthcare practitioners? Third, it is not at all clear how the communitarian and the universalist aspirations in his conception of solidarity can be reconciled. In light of such difficulties it is argued that within philosophical discourse solidarity can be a useful notion only if it can be clearly distinguished from existing and commonly used ethical concepts. Three examples of such narrow and specific uses of solidarity are presented. Finally, a sceptical view of confining the work of applied philosophers to articulating normative concepts is put forward and an alternative view of blending empirical and philosophical analysis is proposed. This vision of field philosophy requires serious attention and careful understanding of the circumstances and constraints within which normative recommendations operate. It is suggested that such a modest and empirically grounded understanding of normative work is a better way of honouring the belief that philosophy is rooted in social institutions and in complex webs of relations. (shrink)

Many philosophers of science think that most laws of nature (even those of fundamental physics) are so called ceteris paribus laws, i.e., roughly speaking, laws with exceptions. Yet, the ceteris paribus clause of these laws is problematic. Amongst the more infamous difficulties is the danger that 'For all x: Fx ⊃ Gx, ceteris paribus' may state no more than a tautology: 'For all x: Fx ⊃ Gx, unless not'. One of the major attempts to avoid this problem (and others concerning (...) ceteris paribus laws) is to claim that the subject matter of laws are ascriptions of dispositions, powers, capacities etc., and not the regular behaviour we find in nature. That we do not know whether the cetera are paria in a specific situation does not matter to the dispositionalist because the objects have the disposition regardless of the circumstances. The defence of the latter claim is that dispositions can be instantiated without being manifested. Hence, the laws that ascribe dispositions are strict and it looks as if they do not face the above mentioned problems of ceteris paribus laws. In this essay I attempt to show that these assumptions are wrong. I hope to illustrate that not only does the ceteris paribus clause reoccur inside the dispositions, moreover, there are laws—laws about non-fundamental entities with instable dispositions—which bear a ceteris paribus clause that cannot be hidden in a disposition. (shrink)

En este texto se presenta un espacio de intercambio de conocimientos desde una perspectiva científica, técnica y jurídica, para contribuir a la protección de los recursos naturales. Debido a la importancia de establecer mecanismos para proteger la biodiversidad y posibilitar la preservación de los conocimientos asociados especialmente al uso de la flora medicinal, la Línea de Investigación en Política y Legislación, del Grupo de Estudios en Sistemas Tradicionales de Salud de la Facultad de Medicina, y la Línea de Derecho Ambiental (...) y Grupos Étnicos, del Grupo de Derechos Humanos de Jurisprudencia de la Universidad del Rosario, desarrollaron este libro a través del cual la Universidad se propone profundizar en el panorama actual de la reglamentación y política –Internacional, nacional y local—respecto a la flora medicinal y al patrimonio cultural inmaterial asociado a ésta. (shrink)

Medicine is increasingly subject to various forms of criticism. This paper focuses on dominant forms of criticism and offers a better account of their normative character. It is argued that together, these forms of criticism are comprehensive, raising questions about both medical science and medical practice. Furthermore, it is shown that these forms of criticism mainly rely on standards of evaluation that are assumed to be internal to medicine and converge on a broader question about the aim of (...) medicine. Further work making medicine’s internal norms explicit and determining the aim of medicine would not only help to clarify to what extent the criticism is justified, but also assist an informed deliberation about the future of medicine. To illustrate some of the general difficulties associated with such a task, the paper concludes by critically engaging Edmund Pellegrino’s account of the aim of medicine as well as the Hastings Center’s consensus report. (shrink)

In "Ordinary Morality Implies Atheism" (2009), I argued that traditional theism threatens ordinary morality by relieving us of any moral obligation to prevent horrific suffering by innocent people even when we easily can. In the current issue of this journal, Jerome Gellman attempts to rescue that moral obligation from my charge that theism destroys it. In this reply, I argue that his attempted rescue fails.

This study constitutes an ethical analysis through the lens of distributive justice in the case of the Troubled Asset Relief Program (TARP), which was enacted in the midst of the Great Recession of 2007–2009. It begins by engaging with the visions of justice constructed by John Rawls and Robert Nozick, using their insights to locate the injustices of TARP according to their moral imaginations. However, this study argues that Rawls’ and Nozick’s theories of justice primarily envision the nature of law (...) as being restrictive of vice, not as instructors of virtue. Thus, it resources the legal philosophy of St. Thomas Aquinas to demonstrate how the positive pedagogy of law can enable a more just construction of economic rescue legislation, one that not only prevents future repetitions of economic vices and injustice, but is also formative for a society that prizes economic justice and virtues. In doing so, the study proposes two criteria for a more just consideration of economic rescue legislation that embraces law’s positive pedagogy. (shrink)

Bruno Latour has been attempting to transform his sociological account of science into an ambitious theory of democracy. In a key early moment in this project, Latour alleges that Plato’s Gorgias introduces an impossibly ratio-nalistic and deeply anti-democratic philosophy which continues to this day to distort our understandings of science and democracy. Latour reckons that if he can successfully refute the Gorgias , then he will have opened up a space in which to authorize his own theory of democracy. I (...) argue that Latour’s refutation of the Gorgias is a failure. Hence, his political theory is, by his own standards, horribly underdetermined. I present another reading of the Gorgias , and consider the dialogue’s possible relevance for current theories of deliberative democracy. Key Words: Latour • Gorgias • Socrates • rhetoric • elenchus • deliberative democracy. (shrink)

The rule of rescue holds that special weight should be given to protecting the lives of assignable individuals in need, implying that less weight is given to considerations of cost-effectiveness. This is sometimes invoked as an argument for funding or reimbursing life-saving treatment in public healthcare even if the costs of such treatment are extreme. At first sight one might assume that an individualist approach to ethics—such as Scanlon’s contractualism—would offer a promising route to justification of the rule of (...) rescue. In this chapter I argue that contractualism cannot endorse the rule of rescue, whereas a collectivist approach that appeals to group solidarity would offer support for rescue cases. The argument, however, has its limitations, and though solidarity is of central concern in shaping public healthcare, there are good reasons for not endorsing the rule of rescue as a moral basis for allocating scarce resources in clinical care. (shrink)