Norman Daniels' and James Sabin's theory of “accountability for reasonableness” (A4R) is a much discussed account of due process for decision-making on health care priority setting. Central to the theory is the acceptance that people may justifiably disagree on what reasons it is relevant to consider when priorities are made, but that there is a core set of reasons, that all centre on fairness, on which there will be no disagreement. A4R is designed as an institutional decision process which will (...) ensure that only those reasons which everybody will agree are relevant and appropriate form part of decision-making. The argument which we will put forward in this paper questions whether it is a simple matter to delineate the core set of reasons and claims that it is a potential problem in A4R that it does not provide an indication of the exact content of this process. The paper first briefly outlines the content of A4R. It is argued that disagreement on what services should be high priorities cannot be resolved solely with a reference to “due process.” In order to retain consistency over time, decision-makers are required to agree and articulate what reasons qualify as relevant and how conflicting reasons are to be balanced in the course of the process. The second and main part of the paper then considers how the reason of “solidarity” can be handled within the A4R framework, and it is shown that deciding whether solidarity should be admitted to the core set of allowable reasons is not a simple matter. (shrink)

abstract The argument that scarce health care resources should be distributed so that patients in ‘need’ are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this (...) account may not be a completely exhaustive reflection of what people mean when they refer to need, the three interpretations provide a starting‐point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs‐based priority setting to social welfare maximisation. (shrink)

On June 3, 2003, the European Council of health ministers rejected a proposal from the European Commission to allow drug manufacturers to advertise directly to particular groups of patients; the proposal had already been rejected by the European Parliament subsequent to a heated public debate in which consumer and patient groups almost unanimously argued that it was not the role of drug companies to provide information to patients. The pilot scheme suggested by the Commission would only have applied to patients (...) with three chronic diseases, AIDS, diabetes, and asthma, and would, it was argued, not undermine an overall ban. Drug companies would have been required to abide by a special code of conduct and clear any information given to patients—on web sites or in specialized publications—with national authorities. (shrink)

In this paper I review empirical methods applied in recent analysis of decision-making on priorities in health care. I outline a number of discrete methods and discuss their applicability and efficacy in the field of bioethics. Three key methodological issues seem to be important: choice of subject group; choice of approach and the extent of background information given to respondents. I conclude that a combination method is needed to give a comprehensive representation of values in priority setting and thus to (...) meet the overall objectives of empirical ethics. (shrink)

A principle claiming equal entitlement to continued life has been strongly defended in the literature as a fundamental social value. We refer to this principle as ‘equal value of life'. In this paper we argue that there is a general incompatibility between the equal value of life principle and the weak Pareto principle and provide proof of this under mild structural assumptions. Moreover we demonstrate that a weaker, age-dependent version of the equal value of life principle is also incompatible with (...) the weak Pareto principle. However, both principles can be satisfied if transitivity of social preference is relaxed to quasi-transitivity. Footnotes1 The authors are grateful to Luc Bovens, Kristian Schultz Hansen, Søren Holm, Franz Huber, Wiebke Kuklys, Gabriella Pigozzi, and two anonymous referees for detailed and very helpful comments on earlier versions of this paper. Any errors and shortcomings are the responsibility of the authors alone. (shrink)

The concept of need is often proposed as providing an additional or alternative criterion to cost-effectiveness in making allocation decisions in health care. If it is to be of practical value it must be sufficiently precisely characterized to be useful to decision makers. This will require both an account of how degree of need for an intervention is to be determined and a prioritization rule that clarifies how degree of need and the cost of the intervention interact in determining the (...) relative priority of the intervention. Three common features of health care interventions must be accommodated in a comprehensive theory of need: the probabilistic nature of prognosis (with and without the intervention); the time course of effects; and the fact that the most effective treatments often combine more than one intervention. These common features are problematic for the concept of need. We outline various approaches to prioritization on the basis of need and argue that some approaches are more promising than others. (shrink)

Tobacco consumption is believed to be one of the world’s greatest preventable health problems. According to the World Health Organisation, 1.1 billion people worldwide are addicted to nicotine with tobacco causing an estimated four million premature deaths every year. The development of a nicotine conjugate vaccine suggests that immunisation may hold promise as a future therapeutic and preventive strategy for tobacco smoking and nicotine addiction. Allowing parents to immunise their children against smoking could be an infringement of children’s right to (...) an open future, however, and is not ethically unproblematic. (shrink)

Background: Priority setting is necessary in current healthcare services. Discussion of fair process has highlighted the value of developing reasons for allocation decisions on the basis of experience gained from real cases.Aim: To identify the reasons that those with experience of real decision-making concerning resource allocation think relevant in deciding on the priority of a new but expensive drug treatment.Methods: Semistructured interviews with members of committees with responsibility for making resource allocation decisions at a local level in the British National (...) Health Service, analysed using modified grounded theory.Results: 22 interviews were carried out. 14 reasons were identified. Four reasons were almost universally considered most important: cost effectiveness; clinical effectiveness; equality and gross cost. No one reason was considered dominant. Some considerations, such as political directives and fear of litigation, were thought by many participants to distort decision-making. There was a substantial lack of agreement over the relevance of some reasons, such as the absence of alternative treatment for the condition.Conclusions: There is a clear consensus on the importance and role of a limited number of reasons in allocation decisions among participants. A focus on the process of decision-making, however, does not obviate the need for those involved in the process to engage with problematical ethical issues, nor for the importance of further ethical analysis. (shrink)

A student's future as a knowledge worker (one who "thinks for a living" with the task of problem solving) is the starting point of this book. With this in mind, the book combines a review of philosophical positions and problems with practical examples and perspectives gained from everyday challenges faced by knowledge workers in their businesses and organizations. Through the use of summative chapters, highlighted key concepts, questions for reflection, and illustrative examples on how to work with the theories presented, (...) the book provides a clear and accessible introduction to this challenging subject. Philosophy of Science primarily addresses students studying language, communication, marketing, economics, and management. However, the survey of the theoretical schools of thought - as well as the discussions on research ethics and the role of research in society - will be equally relevant for other students in the humanities and the natural and social sciences. (shrink)

Wittgenstein’s and Heidegger’s objections against the possibility of a science of aesthetics were influential on different sides of the analytic/continental divide. Heidegger’s anti-scientism leads him to an alētheic view of artworks which precedes and exceeds any possible aesthetic reduction. Wittgenstein also rejects the relevance of causal explanations, psychological or physiological, to aesthetic questions. The main aim of this paper is to compare Heidegger with Wittgenstein, showing that: there are significant parallels to be drawn between Wittgenstein’s and Heidegger’s anti-scientism about aesthetics, (...) and that their anti-scientism leads both towards partly divergent criticisms of what I will call ‘aestheticism’. The divergence is mainly due to a broader metaphilosophical disagreement concerning appeals to ordinary language. Thus situating the two philosophers’ positions facilitates a possible critical dialogue between analytic and continental approaches in aesthetics. (shrink)

Anche se siamo comunemente abituati a pensare alla scienza come a un qualcosa di assolutamente atemporale e indipendente da tutto, in realtà essa è profondamente influenzata dalla cultura e dalla società del tempo in cui vive. Infatti né la scienza è isolabile dalla società, né la società è isolabile dalla scienza, tanto meno come si sta configurando oggi. Per approfondire questi aspetti, esistono però due visioni antagoniste che bisogna superare: secondo la visione scolastica, retaggio del positivismo ottocentesco ancora molto diffuso (...) fra scienziati e pubblico di non esperti, la scienza è conoscenza senza soggetto conoscente. All'opposto, la visione cinica della scienza, sull'onda di talune elaborazioni della sociologia della scienza, la riduce a nient'altro che a una costruzione di soggetti che partecipano al gioco scientifico, una cultura come altre e da "mediare", e comunque una conoscenza relativa, se non frutto di una costruzione puramente soggettiva, arbitraria, ideologica. Un'analisi della costituzione sociale della scienza può, invece, mirare a un'indagine scientifica sulla scienza proprio configurando una relatività della conoscenza che supera sia l'assolutismo idealistico sia il relativismo soggettivistico. (shrink)

Friedrich Nietzsche was among the figures from the history of nineteenth century philosophy that, perhaps surprisingly, some of the Vienna Circle’s members had presented as one of their predecessors. While, primarily for political reasons, most Anglophone figures in the history of analytic philosophy had taken a dim view of Nietzsche, the Vienna Circle’s leader Moritz Schlick admired and praised Nietzsche, rejecting what he saw as a misinterpretation of Nietzsche as a militarist or proto-fascist. Schlick, Frank, Neurath, and Carnap were in (...) different ways committed to the view that Nietzsche made a significant contribution to the overcoming of metaphysics. Some of these philosophers praised the intimate connection Nietzsche drew between his philosophical outlook and empirical studies in psychology and physiology. In his 1912 lectures on Nietzsche, Schlick maintained that Nietzsche overcame an initial Schopenhauerian metaphysical-artistic phase in his thinking, and subsequently remained a positivist until his last writings. Frank and Neurath made the weaker claim that Nietzsche contributed to the development of a positivistic or scientific conception of the world. Schlick and Frank took a further step in seeing the mature Nietzsche as an Enlightenment thinker. (shrink)

In metasemantics, semantic dispositionalism is the view that what makes it the case that, given the value of the relevant parameters, a certain linguistic expression refers to what it does are the speakers’ dispositions. In the literature, there is something like a consensus that the fate of dispositionalism hinges on the status of three arguments, first put forward by Saul Kripke ‒ or at least usually ascribed to him. This paper discusses a different, and strangely neglected, anti-dispositionalist argument, which develops (...) some remarks first put forward by Paul Boghossian and Anandi Hattiangadi and revolves around the idea that semantic dispositionalists have no way to justify their privileging certain dispositions, the ones they take to be reference-determining, over all the others. After some background (Section 1) and a first presentation of the argument (Section 2), I discuss three ways a dispositionalist might try to answer it and find them all wanting (Section 3). (shrink)

Émile Durkheim remains one of the most controversial, and deeply misunderstood, classics of social theory. His work differs from the dominant version of sociology that has essentially accepted the modernist self-description of contemporary societies; and it contradicts the individualism that has come to dominate the social sciences. For everybody who is interested in constructing theoretical alternatives to this individualism, Durkheim's sociology can be a useful inspiration - not only because of the solutions it suggests, but already because of the questions (...) it asks. Making use of the theoretical possibilities offered by the Durkheimian tradition, however, requires going beyond the familiar appropriations. The Oxford Handbook of Émile Durkheim takes stock of the different recent debates on Durkheimian sociology, and makes them accessible to a wide audience spanning various disciplines; this includes crucial debates that, due to language barriers, are not easily accessible for an English-reading public. The handbook's chapters elucidate the controversial key concepts of Durkheimian sociology; situate them within the contemporary political and theoretical debates they were originally responding to; offer surveys of empirical research that uses Durkheimian concepts (on topics that were already central for Durkheim's own work as well as on topics that Durkheim hardly touched upon), thus demonstrating the possibilities of a Durkheimian sociology; bring out the divergent, and competing, ways in which Durkheim's ideas have been appropriated and reformulated within more recent theoretical developments in the social sciences. In doing so, this volume is an important resource for all scholars and students looking to understand Durkheimian sociology. (shrink)

Abstract:We discuss the role that transnational corporations (TNCs) should play in developing global governance, creating a framework of rules and regulations for the global economy. The central issue is whether TNCs should provide global rules and guarantee individual citizenship rights, or instead focus on maximizing profits. First, we describe the problems arising from the globalization process that affect the relationship between public rules and private firms. Next we consider the position of economic and management theories in relation to the social (...) responsibility of the firm. We argue that instrumental stakeholder theory and business and society research can only partially solve the global governance issue, and that more recent concepts of corporate citizenship and republican business ethics deliver theoretically and practically helpful, fresh insights. However, even these need further development, especially with regard to the legitimacy of corporate political activity. (shrink)

This article investigates the hitherto under-examined relations between affirmative action, paternalism and respect. We provide three main arguments. First, we argue that affirmative action initiatives are typically paternalistic and thus disrespectful towards those intended beneficiaries who oppose the initiatives in question. Second, we argue that not introducing affirmative action can also be disrespectful towards these potential beneficiaries because such inaction involves a failure to adequately recognize their moral worth. Third, we argue that the paternalistic disrespect involved in affirmative action is (...) alleviated when the potential beneficiaries’ preferences against such initiatives are adaptive. We conclude that although there is a relevant sense in which paternalistic affirmative action is disrespectful, it may well be more disrespectful not to pursue such policies. (shrink)

Simondon adopts some concepts of social psychology as ‘in group’ and ‘out group’, namely from Kurt Lewin and Gordon Allport, that allow him to describe the fundamental processes shaping the domain of collective individuation, and to challenge Bergson’s distinction between a ‘closed’ community and an ‘open’ society. Reconstructing Simondon’s sources is necessary to understand how he tries to provide an analysis of the social system without presupposing a given anthropology, but rather exploring different perspectives on the human/nature threshold through the (...) concept of transindividual. In his study of the social system Simondon progressively gives conceptual shape to the processes he calls transindividual thanks to the ontogenetic analysis of the phenomena of belief, work and language. In all these domains, a ‘basic community’ emerges just over the threshold of the biological group, where the structural ambivalence of all collective processes as simultaneously closed and open becomes clear. That is why Simondon does not present the concept of the transindividual as a solution to the epistemological problem of psychic and collective individuation, but rather as the ‘field’ in which a whole series of social, biological and technical dimensions can be made converge towards a science of anthropogenic processes. (shrink)

There is little question as to whether there is good boring art, though its existence raises a number of questions for both the philosophy of art and the philosophy of emotions. How can boredom ever be a desideratum of art? How can our standing commitments concerning the nature of aesthetic experience and artistic value accommodate the existence of boring art? How can being bored constitute an appropriate mode of engagement with a work of art as a work of art? More (...) broadly, how can there be works of art whose very success requires the experience of boredom? Our goal in this paper is threefold. After offering a brief survey of kinds of boring art, we: i) derive a set of questions that we argue constitutes the philosophical problem of boring art; ii) elaborate an empirically informed theory of boredom that furnishes the philosophical problem with a deeper sense of the affect at the heart of the phenomenon; and iii) conclude by offering and defending a solution to the problem that explains why and how artworks might wish to make the experience of boredom key to their aesthetic and artistic success. (shrink)

Many people are worried about the harmful effects of climate change but nevertheless enjoy some activities that contribute to the emission of greenhouse gas (driving, flying, eating meat, etc.), the main cause of climate change. How should such people make choices between engaging in and refraining from enjoyable greenhouse-gas-emitting activities? In this chapter, we look at the answer provided by decision theory. Some scholars think that the right answer is given by interactive decision theory, or game theory; and moreover think (...) that since private climate decisions are instances of the prisoner’s dilemma, one rationally should engage in these activities provided that one enjoys them. Others think that the right answer is given by expected utility theory, the best-known version of individual decision theory under risk and uncertainty. In this chapter, we review these different answers, with a special focus on the latter answer and the debate it has generated. (shrink)

Memory of historical trauma has a unique power to generate works of art. This book analyzes the relation of public memory to history, forgetting, and selective memory in Berlin, Buenos Aires, and New York—three late-twentieth-century cities that have confronted major social or political traumas. Berlin experienced the fall of the Berlin Wall and the city’s reemergence as the German capital; Buenos Aires lived through the dictatorships of the 1970s and 1980s and their legacy of state terror and disappearances; and New (...) York City faces a set of public memory issues concerning the symbolic value of Times Square as threatened public space and the daunting task of commemorating and rebuilding after the attack on the World Trade Center. Focusing on the issue of monumentalization in divergent artistic and media practices, the book demonstrates that the transformation of spatial and temporal experience by memory politics is a major cultural effect of globalization. (shrink)

Im dreizehnten Aphorismus von Jenseits von Gut und Böse distanziert sich Nietzshe von Spinozas Begriff der Selbsterhaltung. Hierfür gibt Nietzsche zwei Gründe an: Zum einen hält er den Selbsterhaltungstrieb, als Prinzip genommen, für überflüssig und setzt ihm den Willen zur Macht als fundamentaleres, die Selbsterhaltung bereits in sich begriefendes Prinzip entgegen. Zum anderen sei besagter Trieb zudem noch eine "Inconsequenz", sofern Spinozas antiteleologisches System durch den teleologischen Gedanken der Selbsterhaltung unterminiert werde. Die Abhandlung macht Adolf Trendelenburgs Aufsatz Ueber Spinoza's Grundgedanken (...) und dessen Erfolg als mutmaßliche Quelle für Nietzsches Diktum "Inconsequenz Spinoza's" ausfinding und umreißt kurz Trendelenburgs diesbezügliche Argumentation. Im Anschluss daran wird die Frage diskutiert, ob Nietzsche's Kritik an Spinoza ihre berechtigung hat, oder ob sie selbst inkonsequent ist.In the thirteenth aphorism of Beyond Good and Evil Nietzsche refuses Spinoza's concept of self-preservation. Nietzsche gives two reasons: First, he considers self-preservation a superfluous principle while the will to power is a more fundamental one. Secondly, Nietzsche calls the self-preservation an "inconsistency" since it would ruin Spinoza's anti-teleological system by infiltrating it with a teleological concept. The article detects Adolf Trendelburg's treatise Ueber Spinoza's Grundgedanken und desen Erfolog as most likely to be the source of Nietzsche's words "Spinoza's inconsistency" and summarize Trendelenburg's argumentation against Spinoza. Afterwards it is discussed whether Nietzsche's criticism at Spinoza is accurate or inconsistent itself. (shrink)

The central contention of this article is that the classificatory scheme of contemporary affective science, with its traditional categories of emotion, anger, fear, and so on, is no longer suitable to the needs of affective science. Unlike psychological constructionists, who have urged the transition from a discrete to a dimensional approach in the study of affective phenomena, I argue that we can stick to a discrete approach as long as we accept that traditional emotion categories will have to be transformed (...) in order to do any scientific work. I conclude by articulating some general rules for turning traditional emotion categories into suitable scientific tools. (shrink)

Edmund Husserl is regarded as the founder of transcendental phenomenology, one of the major traditions to emerge in twentieth-century philosophy. In this book Andrea Staiti unearths and examines the deep theoretical links between Husserl's phenomenology and the philosophical debates of his time, showing how his thought developed in response to the conflicting demands of Neo-Kantianism and life-philosophy. Drawing on the work of thinkers including Heinrich Rickert, Wilhelm Dilthey and Georg Simmel, as well as Husserl's writings on the natural and human (...) sciences that are not available in English translation, Staiti illuminates a crucial chapter in the history of twentieth-century philosophy and enriches our understanding of Husserl's thought. His book will interest scholars and students of Husserl, phenomenology, and twentieth-century philosophy more generally. (shrink)

According to relational egalitarianism, justice requires equal relations. The theory applies to those who stand in the relevant social relations. In this paper, I distinguish four different accounts of what it means to be socially related and argue that in all of them, self-relations—how a person relates to themselves—fall within the scope of relational egalitarianism. I also point to how this constrains what a person is allowed to do to themselves.

Traditionally, the manufacturer/operator of a machine is held (morally and legally) responsible for the consequences of its operation. Autonomous, learning machines, based on neural networks, genetic algorithms and agent architectures, create a new situation, where the manufacturer/operator of the machine is in principle not capable of predicting the future machine behaviour any more, and thus cannot be held morally responsible or liable for it. The society must decide between not using this kind of machine any more (which is not a (...) realistic option), or facing a responsibility gap, which cannot be bridged by traditional concepts of responsibility ascription. (shrink)

Responsibility as accountability is normally taken to have stricter control conditions than responsibility as attributability. A common way to argue for this claim is to point to differences in the harmfulness of blame involved in these different kinds of responsibility. This paper argues that this explanation does not work once we shift our focus from other-directed blame to self-blame. To blame oneself in the accountability sense is to feel guilt and feeling guilty is to suffer. To blame oneself in the (...) attributability sense, it will be argued, is to feel shame and feeling shame is also to suffer. The different control conditions cannot be explained by a difference in the harm of blame. Instead, this paper argues that accountability and attributability are governed by different kinds of appropriateness: an agent S is accountability blameworthy for X only if S deserves to feel guilty; an agent S is attributability blameworthy for X only if it is fitting that S feels shame for X. (shrink)

The aim of this paper is to defend the structural concept of representation, as defined by homomorphisms, against its main objections, namely: logical objections, the objection from misrepresentation, theobjection from failing necessity, and the copy theory objection. The logical objections can be met by reserving the relation ‘to be homomorphic to’ for the explication of potential representation (or, of the representational content). Actual reference objects (‘targets’) of representations are determined by (intentional or causal) representational mechanisms. Appealing to the independence of (...) the dimensions of ‘content’ and ‘target’ also helps to see how the structural concept can cope with misrepresentation. Finally, I argue that homomorphic representations are not necessarily ‘copies’ of their representanda, and thus can convey scientific insight. (shrink)

The paper defends the structural concept of representation, defined by homomorphisms, against the main objections that have been raised against it: Logical objections, the objection from misrepresentation, the objection from failing necessity, and the copy theory objection. Homomorphic representations are not necessarily ‘copies’ of their representanda, and thus can convey scientific insight.

Neural devices have the capacity to enable users to regain abilities lost due to disease or injury – for instance, a deep brain stimulator (DBS) that allows a person with Parkinson’s disease to regain the ability to fluently perform movements or a Brain Computer Interface (BCI) that enables a person with spinal cord injury to control a robotic arm. While users recognize and appreciate the technologies’ capacity to maintain or restore their capabilities, the neuroethics literature is replete with examples of (...) concerns expressed about agentive capacities: A perceived lack of control over the movement of a robotic arm might result in an altered sense of feeling responsible for that movement. Clinicians or researchers being able to record and access detailed information of a person’s brain might raise privacy concerns. A disconnect between previous, current, and future understandings of the self might result in a sense of alienation. The ability to receive and interpret sensory feedback might change whether someone trusts the implanted device or themselves. Inquiries into the nature of these concerns and how to mitigate them has produced scholarship that often emphasizes one issue – responsibility, privacy, authenticity, or trust – selectively. However, we believe that examining these ethical dimensions separately fails to capture a key aspect of the experience of living with a neural device. In exploring their interrelations, we argue that their mutual significance for neuroethical research can be adequately captured if they are described under a unified heading of agency. On these grounds, we propose an “Agency Map” which brings together the diverse neuroethical dimensions and their interrelations into a comprehensive framework. With this, we offer a theoretically-grounded approach to understanding how these various dimensions are interwoven in an individual’s experience of agency. (shrink)

Importation in fictional discourse is the phenomenon by which audiences include information in the story over and above what is explicitly stated by the narrator. This paper argues that importation is distinct from generation, the phenomenon by which truth in fiction may outstrip what is made explicit, and draws a distinction between fictional truth and fictional records. The latter comprises the audience’s picture of what is true according to the narrator. The paper argues that importation into fictional records operates according (...) to principles that also govern ordinary conversation. An account of fictional records as a species of common ground information is proposed. Two sources of importation are described in detail, presupposition accommodation and conversational implicatures. It is shown that presuppositions are both mandatorily imported and mandatorily generated. By contrast, conversational implicatures are neither mandatorily imported nor mandatorily generated. The paper distinguishes conversational implicatures from contextual inferences. Both rely on background assumptions, yet conversational implicatures moreover depend on assumptions concerning Gricean cooperation. (shrink)

The paper defends the structural concept of representation, defined by homomorphisms, against the main objections that have been raised against it: Logical objections, the objection from misrepresentation, the objection from failing necessity, and the copy theory objection. Homomorphic representations are not necessarily ‘copies’ of their representanda, and thus can convey scientific insight.

Affirmative action is standardly pursued in relation to admissions to prestigious universities, in hiring for prestigious jobs, and when it comes to being elected to parliament. Central to these forms of affirmative action is that they have to do with competitive goods. A good is competitive when, if we improve A’s chances of getting the good, we reduce B’s chances of obtaining the good. I call this Competitive Affirmative Action. I distinguish this from Non-competitive Affirmative Action. The latter has to (...) do with non-competitive goods, e.g., being granted early parole or freedom from arbitrary arrest. I argue that some of the most prominent objections against affirmative action—in particular, the reverse discrimination objection and the merit objection—speak less against Non-competitive Affirmative Action. And that some of the most prominent arguments in favor of affirmative action, insofar as they justify Competitive Affirmative Action, also justify Non-competitive Affirmative Action. (shrink)