Online research in philosophy

Rationality and reasonableness are often sharply distinguished from one another and are even held to be in conflict. On this construal, rationality consists in means-end calculation of the most efficient means to one's ends (which are usually taken to be self-interested), while reasonableness consists in equitableness whereby one respects the rights of other persons as well as oneself. To deal with this conflict, it is noted that both rationality and reasonableness are based on reason, which is analyzed as the power of attaining truth, and especially necessary truth. It is then shown that, by the rationality involved in reason, the moral principle of reasonableness, the Principle of Generic Consistency (PGC), has a stringently rational justification in that to deny or violate it is to incur self-contradiction. Objections are considered bearing on relevance and motivation. It is concluded that, where reasonableness and egoistic rationality conflict, the former is rationally superior.

According to the standard model of accountability, holding another actor accountable entails sanctioning that actor if it fails to fulfill its obligations without a justification or excuse. Less powerful actors therefore cannot hold more powerful actors accountable, because they cannot sanction more powerful actors. Because inequality appears unlikely to disappear soon, there is a pressing need for second-best forms of accountability: forms that are feasible under conditions of inequality, but deliver as many of the benefits of standard accountability as possible. This article describes a model of second-best accountability that fits this description, which I call surrogate accountability. I argue that surrogate accountability can provide some of the benefits of standard accountability, but not others, that it should be evaluated according to different normative criteria than standard accountability, and that, while surrogate accountability has some benefits that standard accountability lacks, it is usually normatively inferior to standard accountability.

This article makes the case that place-based and environmental education theory and practice must be responsive to, while attempting to transform, the institutional dynamics of schooling. In the present climate of education in the USA two dynamics of schooling deserve particular attention with respect to the possibilities for place-based and environmental education: the discourse of accountability and the discourse of collaboration. Drawing especially on Foucault's analyses of disciplinary power and governmentality, I show how practices associated with accountability and collaboration limit or preclude the deepening and spreading of place-based and environmental education. However, I also argue that even given the serious limitations imposed by current trends of collaboration and accountability, these trends offer place-based and environmental educators powerful entry points through which to initiate change within the formal school setting. The conclusion of the paper outlines three models of collaboration for place-conscious education through which accountability is redefined in the interest of places.

Geneva University Medical School, Switzerland * Corresponding author: Institute for Biomedical Ethics, CMU/1 rue Michel Servet, 1211 Geneva 4, Switzerland. Tel.: +4122-3793479; Fax. +4122-3793472; Email: samia.hurst{at}unige.ch ' + u + '@' + d + ' '//--> . Abstract Fair resource allocation in humanitarian medicine is gaining in importance and complexity, but remains insufficiently explored. It raises specific issues regarding non-ideal fairness, global solidarity, legitimacy in non-governmental institutions and conflicts of interest. All would benefit from further exploration. We propose that some headway could be made by adapting existing frameworks of procedural fairness for use in humanitarian organizations. Despite the difficulties in applying it to humanitarian medicine, it is possible to partly adapt Daniels and Sabin's ‘Accountability for reasonableness’ to this context. This would require: (1) inclusion of internally explicit decisions and rationales; (2) publicity to donors, local staff, community leaders and governments, as well as frank answers to any beneficiary—or potential beneficiary—who asked for clarification of decisions and their rationale; (3) a consistent reasoning strategy to weigh conflicting views of equity in specific situations; (4) advocacy within the organization as a mechanism for revision and appeals; and (5) internal regulation according to publicly accessible mechanisms. Organizations could generate a common corpus of allocation decisions from which to draw in future similar cases. Importantly, the complexity of these challenges should encourage, rather than hinder, broader discussion on ethical aspects of resource allocation in humanitarian medicine. CiteULike Connotea Del.icio.us What's this?

: Decisions about funding health services are crucial to controlling costs in health care insurance plans, yet they encounter serious challenges from intellectual property protection—e.g., patents—of health care services. Using Myriad Genetics' commercial genetic susceptibility test for hereditary breast cancer (BRCA testing) in the context of the Canadian health insurance system as a case study, this paper applies concepts from social contract theory to help develop more just and rational approaches to health care decision making. Specifically, Daniels's and Sabin's "accountability for reasonableness" is compared to broader notions of public consultation, demonstrating that expert assessments in specific decisions must be transparent and accountable and supplemented by public consultation.

The way in which accountability is currently employed in business ethics practice is based on a few central assumptions. It is assumed, for instance, that ethical failures result from the deliberate, rational decision-making of moral agents. A second important assumption is that there is a direct cause and effect relationship between the decisions and actions of individuals and the consequences of those decisions. Furthermore, the current approach towards accountability failures relies on the ability on legal sanctions to deter agents from ethical lapses. This paper will argue that these three assumptions do not survive critical interrogation and that our understanding of accountability therefore has to be reconsidered. It will propose that accountability be reconceived as a relational responsiveness towards stakeholders.

It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is “accountability for reasonableness.” We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients’ rights law in Norway, health technologies coverage recommendations in the UK, and care withheld by HMOs in the US. In each case a process is at the center of controversy, illustrating the difficulties in establishing procedures that are widely accepted as legitimate. Further work must be done in developing procedural frameworks.

PhD, Institute of Public Health, Unit of Medical Philosophy and Clinical Theory, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099 1014 Copenhagen. Tel: +45 30 32 33 63; Email: s.lauridsen{at}pubhealth.ku.dk ' + u + '@' + d + ' '//--> Abstract Citizens’ consent to political decisions is often regarded as a necessary condition of political legitimacy. Consequently, legitimate allocation of healthcare has seemed almost unattainable in contemporary pluralistic societies. The problem is that citizens do not agree on any single principle governing priorities among groups of patients. The Accountability for Reasonableness (A4R) framework suggests an ingenious solution to this problem of moral disagreement. Rather than advocating any substantive distributive principle, its advocates propose a feasible set of conditions, which, if met by decision makers at the institutional level, provide, so it is promised, legitimate decisions. While we agree that A4R represents an important contribution to the priority-setting debate, we challenge the framework in two respects. First, we argue that A4R, and more specifically the relevance condition of A4R, does not enable healthcare institutions to generally distinguish between relevant and irrelevant reasons for priority-setting. Second, we criticize Daniels’ and Sabin's argument that A4R and deliberative democracy constitute necessary and sufficient conditions of a feasible procedure for setting legitimate limits within healthcare. CiteULike Connotea Del.icio.us What's this?.

Healthcare (including public health) is special because it protects normal functioning, which in turn protects the range of opportunities open to individuals. I extend this account in two ways. First, since the distribution of goods other than healthcare affect population health and its distribution, I claim that Rawls's principles of justice describe a fair distribution of the social determinants of health, giving a partial account of when health inequalities are unjust. Second, I supplement a principled account of justice for health and healthcare with an account of fair process for setting limits or rationing care. This account is provided by three conditions that comprise "accountability for reasonableness.".