The interrogation of Meletus in the Apology at 24c4–28al is not infrequently seen as a typical case of all that is intellectually and artistically dissatisfying in Plato's practice of the genre of philosophical dialogue: not only are we presented with a philosopher who makes some claim to being committed to setting a particularly stringent standard for honesty in argumentation making sophistical arguments, but we are presented also with a cardboard interlocutor who is forced by the hand of Plato to acquiesce (...) to those arguments in a fashion that is completely dissatisfying to the reader. The best anyone seems to do to save Plato from these charges of artistic incompetence and intellectual dishonesty is to appeal to such a level of historical accuracy for the text that the stupidity of Meletus' responses can be attributed to the stupidity of Meletus himself, or to point out features of the political and legal situation that might prevent Meletus from answering the questions by drawing on his true motivation—which is presumably more coherent. Taylor says of this passage:The humour of the situation is that the prosecutor cannot venture to say what he means by either of his charges without betraying the fact that, owing to the ‘amnesty’, the matters complained of are outside of the competency of the court… Hence, when Meletus is pressed to explain what he means, he has to take refuge in puerile nonsense. (shrink)

The interrogation of Meletus in the Apology at 24c4–28al is not infrequently seen as a typical case of all that is intellectually and artistically dissatisfying in Plato's practice of the genre of philosophical dialogue: not only are we presented with a philosopher who makes some claim to being committed to setting a particularly stringent standard for honesty in argumentation making sophistical arguments, but we are presented also with a cardboard interlocutor who is forced by the hand of Plato to acquiesce (...) to those arguments in a fashion that is completely dissatisfying to the reader. The best anyone seems to do to save Plato from these charges of artistic incompetence and intellectual dishonesty is to appeal to such a level of historical accuracy for the text that the stupidity of Meletus' responses can be attributed to the stupidity of Meletus himself, or to point out features of the political and legal situation that might prevent Meletus from answering the questions by drawing on his true motivation—which is presumably more coherent. Taylor says of this passage: The humour of the situation is that the prosecutor cannot venture to say what he means by either of his charges without betraying the fact that, owing to the ‘amnesty’, the matters complained of are outside of the competency of the court… Hence, when Meletus is pressed to explain what he means, he has to take refuge in puerile nonsense. (shrink)

In Canada, laws and policies consistently reject the commodification of human organs and tissues, and Canadian practice is consistent with international standards in this regard. Until the Assisted Human Reproduction Act of 2004, gamete donation in Canada was an exception: Canadians could pay and be paid open market rates for gametes for use in in vitro fertilization. As sections of the AHR Act forbidding payment for gametes and permitting only reimbursement of receipted expenses gradually came into effect in 2005, Canada (...) did away with this anomaly. Medical practice and legal prohibitions in assisted human reproduction are now consistent with other areas of medicine where tissues and organs are taken from one person to benefit others: Altruistic donation, rather than selling and buying, will be the norm. (shrink)

Some ethicists assert that there is a consensus that maximising medical outcomes takes precedence as a principle of resource allocation in emergency triage of absolutely scarce resources. But the nature of the current severe acute respiratory syndrome-related coronavirus 2 pandemic and the history of debate about balancing equity and efficiency in resource allocation do not support this assertion. I distinguish a number of concerns with justice and balancing considerations that should play a role in critical care triage policy, focusing on (...) discrimination and on fundamental egalitarian and social justice concerns. (shrink)

Are the small and indolent cancers found in abundance in cancer screening normal variations, risk factors, or disease? Naturalists in philosophy of medicine turn to pathophysiological findings to decide such questions objectively. To understand the role of pathophysiological findings in disease definition, we must understand how they mislead in diagnostic reasoning. Participants on all sides of the definition of disease debate attempt to secure objectivity via reductionism. These reductivist routes to objectivity are inconsistent with the Bayesian nature of clinical reasoning; (...) when they appeal to the sciences, they are inconsistent with what philosophy of biology tells us about its natural kinds. Proposals that we narrow the scope of our claims in the disease definition debates are useful, but paradigms can still distort our reasoning in particular cases, even when we are self-conscious about their status. (shrink)

The seriousness of the risk that healthcare workers faced during SARS, and their response of service in the face of this risk, brings to light unrealistic assumptions about duty and risk that informed the debate on duty to care in the early years of HIV/AIDS. Duty to care is not based upon particular virtues of the health professions, but arises from social reflection on what response to an epidemic would be consistent with our values and our needs, recognizing our shared (...) vulnerability to disease and death. Such reflection underwrites a strong duty of care, but one not to be borne solely by the altruism and heroism of individual healthcare workers. (shrink)

Some argue that the concept of medical need is inadequate to inform the design of a universal health care system—particularly an institutional rather than a residual system. They argue that the concept contradicts the idea of comprehensiveness; leads to unsustainable expenditures; is too indeterminate for policy; and supports only a prioritarian distribution. I argue that ‘comprehensive’ understood as ‘including the full continuum of care’ and ‘medically necessary’ understood as ‘prioritized by medical criteria’ are not contradictory, and that UHC is a (...) solution to the problem of sustainability, not its cause. Those who criticize ‘medical need’ for indeterminacy are not transparent about the source of their commitment to their standards of determinacy: they promote standards that are higher than is necessary for legitimate policy, ignoring opportunity costs. Furthermore, the indeterminacy of concepts affects all risk-sharing systems and all systems that rely on medical standard of care. I then argue that the concept of need in itself does not imply a minimal sufficientist standard or a prioritarian distribution; neither does the idea of legitimate public policy dictate that public services be minimalist. The policy choice for a system of health care that is comprehensive and offers as good care as can be achieved when delivered on equal terms and conditions for all is a coherent option. (shrink)

Temkin asks how we should distribute resources between the social determinants of health and health care; Sreenivasan argues that if our goal is fair opportunity, funding universal health coverage is the wrong policy. He argues that social equality in health has not improved under UHC and concludes that fair opportunity would be better served by using the resources to address the SDOH instead. His criticism applies more broadly than he claims: it applies to any argument for UHC based on health (...) equity. However, neither his strong causal conclusion nor his stark policy proposal is justified. I review methodological challenges for establishing the relative causal contributions of health care and social policy, concluding that we may never have a robust causal account to support a consequentialist choice. Fortunately, we may not need to answer the allocation question as a dichotomy. Given what Sen calls the multidimensional nature of health equity and the role of UHC in cost containment, UHC may not be a threat to health equity. I also argue against Sreenivasan's claim that the data he discusses should not trouble sufficientists and prioritarians. The worst-off are not simply lagging in improvement; rather, their health status is stagnating or worsening. (shrink)

Verweij and Dawson claim that population health has a distributive dimension; Coggon argues that this presupposes a normative commitment to equity in the very definition of population health, which should, rather, be neutral. I describe possible sources of the distributive view, several of which do not presuppose egalitarian commitments. Two relate to the nature of health as a property of individuals ; two relate to the epistemology and pragmatics of public and population health. A fifth source of the distributive view (...) is a critical stance on the concept of population health; I contrast this with Coggon’s account of the public as a shared political imaginary. None of these views is ‘neutral’: they exhibit several different kinds of normativity and quasi-normativity, but this is not problematic. I argue that the critical stance appropriately distinguishes and relates social justice and public health. (shrink)

I discuss some reservations about the exegetical power of the claim that the Tractatus is “anti-metaphysical.” The “resolute” reading has the virtue of fidelity to important and neglected features of the work, both its anti-metaphysical moves and its account of the nature of the activity of philosophy and its status. However, its proponents underestimate the barriers to maintaining a consistent fidelity to these features of the text. The image of a ladder suggests a mere instrumental means to arrive at a (...) place that can itself be characterized independently of our means of arrival; where we arrive via the process of the TLP is the conclusion of an argument, and so cannot be characterized independently of the argument that got us there. In his commitments about the process of logical analysis “within language,” he strives as much as in his statements about the world to return us to our ordinary ways of talking and making sense of what we say to one another. Given the internal relationship Wittgenstein is at pains to emphasize between language, thought, and reality, he could hardly have philosophical commitments about one of these terms (have a residual metaphysics of language) and isolate this from how he thinks about the others. In a discussion of “Senator, you’re no Jack Kennedy” and “Chairman Mao is rare,” I argue that, pace Conant and Diamond’s claims to the contrary, logical categories are being invoked to explain why one cannot mean what one thinks one means in this phrase, and that Wittgenstein is both more anti-metaphysical in his treatment of these logical categories (in contrast with Frege) than the resolute readers consider him to be, and less successful in his treatment of how logical categories rule our judgments of sense and nonsense than they imply he is. Finally, I question the sharp boundary between logic and psychology and the “claustrophobic” feel that is created by a narrow construal of what one can make sense of in another’s words and person that underwrites their account of nonsense via a conflict between the meaning words can contain and our confused desires. Throughout, I discuss relevant passages of the Investigations that resolute readers treat as a re-expression of the themes of the Tractatus, to contrast the “anti-metaphysical” treatment these themes express in the Tractatus with the less dogmatic treatment they receive in the Investigations. (shrink)

Systems of universal health coverage may aspire to provide care based on need and not ability to pay; the complexities of this aspiration call for normative analysis. This special issue arises in the wake of a judicial inquiry into preferential access in the Canadian province of Alberta, the Vertes Commission. I describe this inquiry and set out a taxonomy of forms of differential and preferential access. Papers in this special issue focus on the conceptual specification of health system boundaries and (...) on the normative questions raised by complex models of funding and delivery of care, where patients, providers, and services cross system boundaries. (shrink)

The professionalism movement has animated medical education and practice; an extensive literature expresses and categorizes many interpretations of the concept (Hafferty 2006a; Hafferty and Levinson 2008). The inception of the current wave of the movement was in the American Board of Internal Medicine's Project Professionalism. In the face of threats from the growth of managed care and public concerns about conflict of interest, the ABIM's "Physician Charter" called for the profession to publically commit to values of patient welfare, social justice, (...) and respect for patient autonomy (Brennan et al. 2002). The concept of professionalism, or the physician as occupying the role of professional, has taken hold in .. (shrink)

In Capital in the Twenty-First Century, Thomas Piketty argues that markets, absent political intervention, tend toward economic divergence and that this has deleterious consequences for democratic ideals of equal voice and meritocracy. His goal is to foster a public conversation about what a society dominated by wealth—which we already beginning to experience as the twenty-first century begins—would look like if we wish to maintain an egalitarian ethos. His work will contribute to and further motivate several discussions in feminist bioethics, namely, (...) on the funding and organization of care labor, reproductive rights, global health, and commodification. (shrink)

In Capital in the Twenty-First Century, Thomas Piketty argues that markets, absent political intervention, tend toward economic divergence and that this has deleterious consequences for democratic ideals of equal voice and meritocracy. His goal is to foster a public conversation about what a society dominated by wealth—which we already beginning to experience as the twenty-first century begins—would look like if we wish to maintain an egalitarian ethos. His work will contribute to and further motivate several discussions in feminist bioethics, namely, (...) on the funding and organization of care labor, reproductive rights, global health, and commodification. (shrink)

Scientism in medical education distracts educators from focusing on the content of learning; it focuses attention instead on individual achievement and validity in its measurement. I analyze the specific form that scientism takes in medicine and in medical education. The competencies movement attempts to challenge old “scientistic” views of the role of physicians, but in the end it has invited medical educators to focus on validity in the measurement of individual performance for attitudes and skills that medicine resists conceptualizing as (...) objective. Academic medicine should focus its efforts instead on quality and relevance of care. The social accountability movement proposes to shift the focus of academic medicine to the goal of high quality and relevant care in the context of community service and partnership with the institutions that together with medicine create and cope with health and with health deficits. I make the case for this agenda through a discussion of the linked histories of the opioid prescribing crisis and the professionalism movement. (shrink)

: This paper examines the nature of the harm-benefit tradeoff in early clinical research for interventions that involve remote possibility of direct benefit and likelihood of direct harms to research participants with fatal prognoses, by drawing on the example of gene transfer trials for glioblastoma multiforme. We argue that the appeal made by the component approach to clinical equipoise fails to account fully for the nature of the harm-benefit tradeoff—individual harm for social benefit—that would be required to justify such research. (...) An analysis of what we label "collateral affective benefits," such as the experience of hope or exercise of altruism, shows that the existence of these motivations reinforces rather than mitigates the necessity of justification by reference to social benefit. Evaluations of social benefit must be taken seriously in the research ethics review process to avoid the exploitation of research participants' motivations of hope or altruism and to avoid the possibility of inadvertent exploitation of high-risk research participants and the harms that would associate with such exploitation. (shrink)

In bioethics and health policy, we often discuss the appropriate boundaries of public funding; how the interface of public and private purchasers and providers should be organized and regulated receives less attention. In this paper, I discuss ethical and regulatory issues raised at this interface by three medical practice models in which physicians provide insured services while requiring or requesting that patients pay for services or for the non-insured services of the physicians themselves or their associates. This choice for such (...) practice models is different from the decision to design an insurance plan to include or exclude user fees, co-payments and deductibles. I analyze the issues raised with regards to familiar health care values of equity and efficiency, while highlighting additional concerns about fair terms of access, provider integrity, and fair competition. I then analyze the common Canadian regulatory response to block fee models, considering their extension to wellness clinics, with regards to fiduciary standards governing the physician–patient relationship and the role of informed consent. I close by highlighting briefly issues that are of common concern across different fundamental normative frameworks for health policy. (shrink)

Lisa A. Eckenwiler, Long-term care, globalization, and justice, Baltimore: The Johns Hopkins University Press, 2012, reviewed by Lynette Reid.

Lisa A. Eckenwiler, Long-term care, globalization, and justice, Baltimore: The Johns Hopkins University Press, 2012, reviewed by Lynette Reid.

As we have now completed 15 years of journal content, it seems like a good time to take stock and reflect upon the development and nature of public health ethic.

In "Public Health and Precarity," Michael Doan and Ami Harbin have done important work extending Sherwin's concept of relational autonomy to encompass relational agency—including agents such as communities and states. This opens up new ways of thinking about responsibility for public health in long-standing debates about the role of the state in public health.The case studies Doan and Harbin analyze are also important for thinking of the account of relational solidarity that Sherwin developed together with Baylis and Kenny, one element (...) of relational public health. The discussion may even open the space for a reformulation of relational solidarity. I will use the... (shrink)

Reflecting on Smith (2021) in this issue, this commentary extends our consideration of issues in carceral health and questions the dehumanizing language we sometimes use—including in public health and public health ethics—to talk about persons held in incarceration. Even the language we use for the carceral system itself (such as ‘criminal justice system’) is fraught: it casts a laudatory light on the system and papers over its role in compounding racial health inequities and in sustaining colonialism. A host of issues (...) call out for ethical analysis, using lenses that can encompass the tensions and contradictions experienced by people within the system who deliver healthcare and those within the system trying to access that care. Beyond access to health care (promotion, prevention, treatment and palliation), the societal commitment to dealing with social issues by depriving people of many key social determinants of health is at the heart of many of these tensions and contradictions. (shrink)

This volume brings together for the first time a significant number of Reid's manuscript papers on natural history, physiology and materialist metaphysics. An important contribution not only to Reid studies but also to our understanding of eighteenth-century science and its context.

The Scottish philosopher Thomas Reid first published Essays on Active Powers of Man in 1788 while he was Professor of Philosophy at King's College, Aberdeen. The work contains a set of essays on active power, the will, principles of action, the liberty of moral agents, and morals. Reid was a key figure in the Scottish Enlightenment and one of the founders of the 'common sense' school of philosophy. In Active Powers Reid gives his fullest exploration of sensus (...) communis as the basis of all philosophical inquiry. He uses common sense realism to argue for the existence of a stable external world, the existence of other minds, and to offer a powerful challenge to versions of the Theory of Ideas advocated by Hume and Locke . This is a key work of the Scottish Enlightenment that made important contributions to fundamental debates about the basis of philosophical inquiry. (shrink)

Thomas Reid was a philosopher who founded the Scottish school of 'common sense'. Much of Reid's work is a critique of his contemporary, David Hume, whose empiricism he rejects. In this work, written after Reid's appointment to a professorship at the university of Glasgow, and published in 1785, he turns his attention to ideas about perception, memory, conception, abstraction, judgement, reasoning and taste. He examines the work of his predecessors and contemporaries, arguing that 'when we find philosophers (...) maintaining that there is no heat in the fire, nor colour in the rainbow … we may be apt to think the whole to be only a dream of fanciful men, who have entangled themselves in cobwebs spun out of their own brain'. Written by one of the Scottish Enlightenment's most important thinkers, this work brings to life the intellectual debates of the time. (shrink)

In their article, “Rare Disease, Advocacy and Justice: Intersecting Disparities in Research and Clinical Care,” Halley et al. (2023) use three case examples to describe challenges patients with rar...

The feminist in academe, says Paula Bennett, is like Procne married to Tereus, "inextricably wedded to the sources of her harm." An ethical justification of academic feminism can be found, not in cooperation and affiliation, but in the strategies currently necessary to ensure curricular and cultural diversity. Historically contextualized and strategically politicized, this ethic is founded on the claim that universities are places where we may all learn to know what is other than ourselves.

Basileia and tyrannis: exploding myths -- Arete and the right to rule -- Ruling families -- Rulers in the polis -- Epilogue: Athens, ruling and arete.

Contentivo de las memorias del "III Seminario de Filosofía y Derecho Contemporáneo", en homenaje al profesor Günther Jakobs, en el cual se analizan algunos de los componentes del derecho penal al tenor de la filosofía del derecho. Esta obra retoma los conceptos de Günther Jakobs, Jaime Bernal Cuéllar, Manuel Cancio Meliá y Teresa Manso Porto, entre otros.

All athletes experience victory and defeat, but how many truly learn from the experience of sport? For ancient Greek philosophers, sport was an integral part of education. Today, athletics programs remain in schools, but we face a growing gap between the modern sports experience and enduring educational values. This book seeks to bridge that gap by advocating a philosophical approach to the sports experience. Combining issues and ideas from traditional philosophy with contemporary analyses of sport and applied "thinking activities," this (...) book invites athletes to learn about life from their experience of sport. The text works its way from internal reflection to social interaction by addressing four important topics: self-discovery, responsibility, respect, and citizenship. This sequence is important because authentic self-knowledge is an essential foundation for effectively dealing with the personal and social challenges faced by philosophical athletes. Reid discusses specific issues such as violence, racism, and performance-enhancing drugs in their relevant contexts, although philosophical athletes focus on the big picture, approaching each issue from a complete vision of themselves, their moral commitments, and their social roles. Athletes as diverse as the teenage college recruit and the aging weekend-warrior will gain insight into their sports experience and into their lives. This philosophical approach maximizes what we can learn from sport and gives us the best chance for leading better lives because of it. (shrink)

The multi-disciplinary unit Social Responsibility in Action was developed for students with an interest in ethics who were completing undergraduate degrees in Arts, Commerce, Design or Science at an Australian research-intensive university. The academic objectives of this unit were to increase student awareness, knowledge, understanding and critical thinking skills related to various ethical issues. Lecturers from five disciplines collaborated in the design and delivery of SRA, which comprised lectures, tutorials and a research-based project. Anonymous surveys were administered at the start (...) and end of the semester to obtain feedback on student expectations and learning experience, respectively. Data across three student cohorts showed that at the start of semester, 80% of student comments indicated a desire to expand their interest of ethical matters, 59% a desire to gain understanding and knowledge and 59% to gain critical thinking or communication skills. SRA was extremely well received by students, with 98% of respondents indicating that this multi-disciplinary ethics unit had met their expectations. Students also found that the variety of teaching styles, unit content and multi-disciplinary approach stimulated learning. (shrink)

In writing about `whiteness' we are trying to enact a `way of talking' that draws in part on Aboriginal ideas about how to conduct a conversation or tell a story. We also use Homi Bhabha's ideas of `third space' (an `interruptive, interrogative, and enunciative' space) and hybridity as a related way to think through the problems of essentializing binaries and rigid identities. In Aboriginal cultures in Australia and Canada, rather than adopting the `neutral' or `objective' stance common in the academy, (...) it is customary to introduce oneself to one's audience, providing a context to assist in interpretation and exchange. Without such an introduction, real stories cannot be told and productive conversations cannot happen. We thus begin our conversation with each other and with you by examining our personal relationship to the idea of whiteness in order to reveal some of its complexity in Canada and Australia. `Whiteness' as an abstraction has proved useful in moving the invisible norm to visibility, but we show how an awareness of `whiteness' in the two locations can be recuperated to re-privilege the already privileged. Aboriginal speakers and writers have theorized `whiteness', in many cases from outside the academy, in the process `hybridizing' traditional genres. For many of them, Aboriginality, like whiteness, is a construct that often stands in the way of thinking clearly about where to go next in the fight against racism. (shrink)