Objective: In all western countries health care budgets are under considerable constraint and therefore a reflection process has started on how to gain the most health benefit for the population within limited resource boundaries. The field of ethics of resource allocation has evolved only recently in order to bring some objectivity and rationality in the discussion. In this article it is argued that priority setting is the prerequisite of ethical resource allocation and that for purposes of operationalization, instruments such as (...) need assessment and health technology assessment (HTA) are essential worktools for making more rational decisions. Thresholds (deduced from the need assessment and HTA) areâwithin this contextâguiding but not binding principles. Method: Discussion of theoretical concepts of not only priority setting, need assessment and HTA complemented by practical examples for showing the challenges and the need, but also the chances of a more explicit and transparent policy of resource allocation in health care. Results: Priority setting in health care is based on the values of equity, justice and solidarity. Health packages decisions are determined from medical need (the severity of the condition) and/or the appropriateness of medical interventions (their cost-effectiveness). With growing awareness that originally effective and cost-effective services and programmes are eventually provided inappropriately, the focus is shifting towards the organisational aspects of provision and application. Therefore, need assessment is based on the distinction of health care needs from demand, supply, or actual care. Additionally HTA provides the evidence on health care interventions in a way that it becomes obvious who benefits from an intervention and who definitely does not benefit, but eventually is harmed. Conclusions: Health services research on effective and cost-effective interventions and research/monitoring of performance that the effective and cost-effective services are provided appropriately are of increasing importance for guiding the decision-making process on priority setting and need assessment. Effective healthcare for all is sustainable, if we start to put expenditures in perspective and focus health policies and research strategies on managing expectations through patient information and a more realistic notion of medical advancements and, on the other hand, on encouraging need-based and cost-effective innovations. (shrink)
Health policy is increasingly confronted with the demand for financing genetic testing on inherited susceptibility to disease. Tests on polymorphism/SNP associated with multicausal and chronic conditions are already offered in private commercial institutions or in academic hospitals. The increasing pressure on public health services to offer SNP testing leads to first methodological approaches for a generally valid regulatory framework applicable for inclusion or refusal of genetic tests into the public health services. Systematic search in Medline, Embase and the Web for (...) methodological papers or guidelines for the assessment of polymorphism-screening. Since genetic testing has not only clinical and economic effects on health care, but also primarily ethical consequences by profiling our understanding of health and disease , this paper gives an overview of relevant aspects and background information to consider in the assessment of genetic tests. Although 2â3Â million SNPs are identified and the journals are full of reported significant associations between disease and mutation, only a few can be replicated unequivocally. The ACCE (Analytic and Clinical Validity, Clinical utility; Ethical, legal and social implications)-framework was developed by the Center of Disease Control for the assessment of genetic testing. This standardised appraisal approach proposes collecting and evaluating: (a) Prevalence, genotype-/phenotype-relation. (b) Clinical presentation: natural history; the different expressions of disease. (c) Performance of the genetic test. (d) Implications for therapy and prevention. (e) Conclusion for clinical applications of risk-profiling of health on their susceptibility to disease and/or for clarification of disease for therapy planning. Since genetic testing is urging its way into the health care system, the actual danger is, that population screening starts before valid evidence from big prospective studies have been carried out and delivered proofs of direct causal associations. Before diffusing into the health care system we are suggesting to take a cautious and standardised approach. (shrink)
According to Marin Cureau de La Chambre—steering a middleway between the Aristotelian and the Cartesian conception of the soul—everything that lives cognizes and everything that cognizes is alive. Cureau sticks with the general tripart distinction of vegetative, sensitive, and intellectual soul. Each part of the soul has its own cognition. Cognition is the way in which living beings regulate bodily equilibirum and environmental navigation. This regulative activity is gouverned by acquired or by innate images. Natural cognition (or instinct) is cognition (...) by innate images only. Cureau develops a highly originel theory of natural (or 'specialized') instinct. His theory attempts to explain five features of instinct (innateness, specialization, species-specifitiy, coerciveness, teleological nature). According to my interpretation, Cureau proposes a species of what is called a 'teleosemantic theory' of innate cognition. (shrink)
Despite the attempts to promote the inclusion of pregnant women in clinical research, this group is still widely excluded and thus hindered in benefiting from medical progress (Lyerly, Little, and Faden 2009). There are two interconnected reasons why pregnant women continue to be excluded from clinical trials. First, the traditional background assumptions associated with pregnancy, pregnant women, and the fetus still involve a harmful separation of woman and fetus that in some cases leads to an unbalanced prioritization of fetal needs. (...) The second reason is that pregnant women are included in the category of "vulnerable groups." It is therefore essential to examine and reassess the general understanding of .. (shrink)
The efforts of the European Commission to create a European Research Area in the field of biotechnology are accompanied by a growing demand for an ethical discourse. Cultural differences between the European Union's member states create a vital need to improve bioethical information structures in Europe so as to foster European bioethics discourses and to cope with ethical pluralism. Responding to the need for an increased European contribution to the international discussion on ethics in medicine and biotechnology, some of Europe's (...) leading bioethics institutions have joined forces to establish the international network EURETHNET . 18 partners from nine European countries agreed to develop an information network and knowledge base in the field of ethics in medicine and biotechnology. This short communication displays the aims, scope and realisation of the network. (shrink)
Insight, by F. H. Parker.--Why be uncritical about the life-world? By H. B. Veatch.--Homage to Saint Anselm, by R. Jordan.--Art and philosophy, by J. M. Anderson.--The phenomenon of world, by R. R. Ehman.--The life-world and its historical horizon, by C. O. Schrag.--The Lebenswelt as ground and as Leib in Husserl: somatology, psychology, sociology, by E. Paci.--Life-world and structures, by C. A. van Peursen.--The miser, by E. W. Straus.--Monetary value and personal value, by G. Schrader.--Individualisms, by W. L. McBride.--Sartre the individualist, (...) by W. Desan.--The nature of social man, by M. Natanson.--The problem of the will and philosophical discourse, by P. Ricoeur.--Structuralism and humanism, by M. Dufrenne.--The illusion of monolinear time, by N. Lawrence.--Can grammar be thought? By J. M. Edie.--The existentialist critique of objectivity, by S. J. Todes and H. L. Dreyfus.--Bibliography (p. 391-400). (shrink)
The extended mind hypothesis (Clark and Chalmers in Analysis 58(1):7–19, 1998; Clark 2008) is an influential hypothesis in philosophy of mind and cognitive science. I argue that the extended mind hypothesis is born to be wild. It has undeniable and irrepressible tendencies of flouting grounding assumptions of the traditional information-processing paradigm. I present case-studies from social cognition which not only support the extended mind proposal but also bring out its inherent wildness. In particular, I focus on cases of action-understanding (...) and discuss the role of embodied intentionality in the extended mind project. I discuss two theories of action-understanding for exploring the support for the extended mind hypothesis in embodied intersubjective interaction, namely, simulation theory and a non-simulationist perceptual account. I argue that, if the extended mind adopts a simulation theory of action-understanding, it rejects representationalism. If it adopts a non-simulationist perceptual account of action-understanding, it rejects the classical sandwich view of the mind. (shrink)
In this paper I argue that we can learn much about wild justice and the evolutionary origins of social morality – behaving fairly – by studying social play behavior in group-living animals, and that interdisciplinary cooperation will help immensely. In our efforts to learn more about the evolution of morality we need to broaden our comparative research to include animals other than non-human primates. If one is a good Darwinian, it is premature to claim that only humans can be (...) empathic and moral beings. By asking the question What is it like to be another animal? we can discover rules of engagement that guide animals in their social encounters. When I study dogs, for example, I try to be a dogocentrist and practice dogomorphism. My major arguments center on the following big questions: Can animals be moral beings or do they merely act as if they are? What are the evolutionary roots of cooperation, fairness, trust, forgiveness, and morality? What do animals do when they engage in social play? How do animals negotiate agreements to cooperate, to forgive, to behave fairly, to develop trust? Can animals forgive? Why cooperate and play fairly? Why did play evolve as it has? Does being fair mean being more fit – do individual variations in play influence an individual''s reproductive fitness, are more virtuous individuals more fit than less virtuous individuals? What is the taxonomic distribution of cognitive skills and emotional capacities necessary for individuals to be able to behave fairly, to empathize, to behave morally? Can we use information about moral behavior in animals to help us understand ourselves? I conclude that there is strong selection for cooperative fair play in which individuals establish and maintain a social contract to play because there are mutual benefits when individuals adopt this strategy and group stability may be also be fostered. Numerous mechanisms have evolved to facilitate the initiation and maintenance of social play to keep others engaged, so that agreeing to play fairly and the resulting benefits of doing so can be readily achieved. I also claim that the ability to make accurate predictions about what an individual is likely to do in a given social situation is a useful litmus test for explaining what might be happening in an individual''s brain during social encounters, and that intentional or representational explanations are often important for making these predictions. (shrink)
It has been argued that if non-human animals had rights we should be obliged to defend them against predators. I contend that this either does not follow, follows in the abstract but not in practice, or is not absurd. We should defend non-humans against large or unusual dangers, when we can, but should not claim so much authority as to regulate all the relationships of wild things. Some non-human animals are members of our society, and the rhetoric of 'the (...) land as a community' is an attempt, paralleling that of humanism, to create the moral ideal of Earth's Household. But wild animals should be considered as Nozick's 'independents' and have correspondingly fewer claims on our assistance than members of our society. They still have some claims, often strong ones. (shrink)
The source of the value of naturalness is of considerable relevance for the conservation movement, to philosophers, and to society generally. However, naturalness is a complex quality and resists straightforward definition. Here, two interpretations of what is “natural” are explored. One of these assesses the naturalness of species and ecosystems with reference to a benchmark date, such as the advent of industrialization. The value of naturalness in this case largely reflects prioritization of the value of biodiversity. However, the foundation of (...) our understanding of naturalness is that it describes processes that are free of human intervention. Conflict between the two interpretations of naturalness is apparent in the claim that naturalness can be enhanced by human intervention, in the form of ecological restoration. Although naturalness in its purest form precludes human intervention, some human activities are also apparently more natural than others. This continuum of naturalness relates to the autonomy of the individual from abstract instrumentalism, which describes a particular form of influence ubiquitous in contemporary society. The value of naturalness reflects both dissatisfaction with these threats to personal autonomy, and respect for wild nature as the embodiment of a larger-than-human realm. (shrink)
The author draws on arguments from contemporary philosophy of mind to provide an argument for sociological collectivism. This argument for nonreductive individualism accepts that only individuals exist but rejects methodological individualism. In Part I, the author presents the argument for nonreductive individualism by working through the implications of supervenience, multiple realizability, and wild disjunction in some detail. In Part II, he extends the argument to provide a defense for social causal laws, and this account of social causation does not (...) require any commitment to intentionality or agency on the part of individuals. (shrink)
The leading question of this article is whether it is acceptable, from a moral point of view, to take wild animals that are ill out of their natural habitat and temporarily bring them under human control with the purpose of curing them. To this end the so-called 'seal debate' was examined. In the Netherlands, seals that are lost or ill are rescued and taken into shelters, where they are cured and afterwards reintroduced into their natural environment. Recently, this practice (...) has been criticised because it is thought to interfere with the wildness of the animals and population. In this research, the moral assumptions behind the arguments of both the proponents and opponents of sheltering have been analysed within a morally pluralistic framework. It is concluded that sheltering on too large a scale would be contrary to the efforts of the last few decades to maintain an independent or wild seal population, which means that a certain amount of caution is called for. However, in the current situation there is no decisive reason to completely prohibit shelters either. Good arguments can even be given in favour of sheltering. It also becomes clear that the acceptability of sheltering wild animals depends on the specific circumstances in which an animal is encountered. (shrink)
As a reflection on recent debates on the value of wild animals we examine the question of the intrinsic value of wild animals in both natural and man-made surroundings. We examine the concepts being wild and domesticated. In our approach we consider animals as dependent on their environment, whether it is a human or a natural environment. Stressing this dependence we argue that a distinction can be made between three different interpretations of a wild animal’s intrinsic (...) value: a species-specific, a naturalistic, and an individualistic interpretation. According to the species-specific approach, the animal is primarily considered as a member of its species; according to the naturalistic interpretation, the animal is seen as dependent on the natural environment; and according to the individualistic approach, the animal is seen in terms of its relationship to humans. In our opinion, the species-specific interpretation, which is the current dominant view, should be supplemented—but not replaced by—naturalistic and individualistic interpretations, which focus attention on the relationship of the animal to the natural and human environments, respectively. Which of these three interpretations is the most suitable in a given case depends on the circumstances and the opportunity for the animal to grow and develop according to its nature and capabilities. (shrink)
Ignoring most published evidence on wild chimpanzees, Tomasello et al.'s claim that shared goals and intentions are uniquely human amounts to a faith statement. A brief survey of chimpanzee hunting tactics shows that group hunts are compatible with a shared goals and intentions hypothesis. The disdain of observational data in experimental psychology leads some to ignore the reality of animal cognitive achievements.
In this essay, I use encounters with the white-tailed deer of Fire Island to explore the “call of the wild”—the attraction to value that exists in a natural world outside of human control. Value exists in nature to the extent that it avoids modification by human technology. Technology “fixes” the natural world by improving it for human use or by restoring degraded ecosystems. Technology creates a “new world,” an artifactual reality that is far removed from the “wildness” of nature. (...) The technological “fix” of nature thus raises a moral issue: how is an artifact morally different from a natural and wild entity? Artifacts are human instruments; their value lies in their ability to meet human needs. Natural entities have no intrinsic functions; they were not created for any instrumental purpose. To attempt to manage natural entities is to deny their inherent autonomy: a form of domination. The moral claim of the wilderness is thus a claim against human technological domination. We have an obligation to struggle against this domination by preserving as much of the natural world as possible. (shrink)
Most discussions on animal experimentation refer to domesticated animals and regulations are tailored to this class of animals. However, wild animals are also used for research, e.g., in biological field research that is often directed to fundamental ecological-evolutionary questions or to conservation goals. There are several differences between domesticated and wild animals that are relevant for evaluation of the acceptability of animal experiments. Biological features of wild animals are often more critical as compared with domesticated animals because (...) of their survival effects. An important issue is what is called here ``natural suffering'''': the suffering from natural circumstances. Should this type of suffering be taken into account when suffering from experimentation is evaluated? As an answer, it is suggested that ``natural functioning'''' should be considered as an additional standard in the evaluation of wild animal experimentation. Finally, two topics related to the ecological context are considered. Firstly, the often inevitable involvement of non-research animals in wild animal experimentation, and secondly, the eco-centric approach to nature conservation. According to the latter position, animals are subordinated to ecosystems. All these aspects make the evaluation of wild animal experiments much more complex than experiments with domesticated animals. Preliminary scores are proposed to deal with these aspects. It is argued that this should not lead to a more complex governmental regulation, since an effective maintenance and control are hard to realize and one may loose the cooperation of researchers themselves. In addition, non-governmental professional organizations such as research societies and funding organizations play a pivotal role. (shrink)
The communicative behavior of chimpanzees has been cited in support of the hypothesis that language evolved from gesture. In this commentary, I compare gestural and vocal communication in wild chimpanzees. Because the use of gesture in wild chimpanzees is limited, whereas their vocal behavior is relatively complex, I argue that wild chimpanzee behavior fails to support the gestural origins hypothesis.
This commentary was suggested to me in part by a colleague's remark that it would be nice if we could make William James's The Varieties of Religious Experience "respectable." The implication was that though there was something redeemable about the book, it somehow wasn't philosophically or scientifically proper. The remark awakened me to—or at least reminded me of—the fact that this has been a traditional take on James's text. As Julius Bixler points out, ridicule began soon after the book was (...) published: "The Varieties of Religious Experience, appearing at about the same time as Ernest Thompson Seton's book of animal stories, was soon nicknamed 'Wild Religions I Have Known'" (1926, 1). My awakening to this attitude—a prevalent if not a pervasive one among contemporary intellectuals—led me to consider that it would be better, and crucially important to James himself, to keep James "unrespectable." James may have been a renegade and... (shrink)
This study looks at the lives of the most famous "wild children" of eighteenth-century Europe, showing how they open a window onto European ideas about the potential and perfectibility of mankind. Julia V. Douthwaite recounts reports of feral children such as the wild girl of Champagne (captured in 1731 and baptized as Marie-Angelique Leblanc), offering a fascinating glimpse into beliefs about the difference between man and beast and the means once used to civilize the uncivilized. A variety of (...) educational experiments failed to tame these feral children by the standards of the day. After telling their stories, Douthwaite turns to literature that reflects on similar experiments to perfect human subjects. Her examples range from utopian schemes for progressive childrearing to philosophical tales of animated statues, from revolutionary theories of regenerated men to Gothic tales of scientists run amok. Encompassing thinkers such as Rousseau, Sade, Defoe, and Mary Shelley, Douthwaite shows how the Enlightenment conceived of mankind as an infinitely malleable entity, first with optimism, then with apprehension. Exposing the darker side of eighteenth-century thought, she demonstrates how advances in science gave rise to troubling ethical concerns, as parents, scientists, and politicians tried to perfect mankind with disastrous results. (shrink)
"An American psychologist, Daniel N. Robinson, traces the development of the insanity plea...[He offers] an assured historical survey." Roy Porter, The Times [UK] "Wild Beasts and Idle Humours is truly unique. It synthesizes material that I do not believe has ever been considered in this context, and links up the historical past with contemporaneous values and politics. Robinson effortlessly weaves religious history, literary history, medical history, and political history, and demonstrates how the insanity defense cannot be fully understood without (...) consideration of all these sources." Michael L. Perlin, New York Law School "Daniel N. Robinson has written a graceful history of insanity and the law stretching from Homer to Hinckley. He attempts no final theory as to how the law should cope with the insane; he seeks, rather, to use the shifting notions of when madness exculpates criminal activity to illuminate the core self-perceptions of the cultures developing ever-evolving resolutions of the problem...[T]he grandeur of the theme...commands attention and respect." --Neal Johnston, The Nation . (shrink)
Mueller's gibbons ( Hylobates muelleri ) sing both sex-specific and duet songs. These songs are thought to be involved in territory maintenance, as well as the maintenance of pair or family bonds. However, few observational studies have examined how gibbons interact with their neighbors through song in the wild. We have been conducting field observations of wild gibbon groups in northeast Borneo since 2001. In the Borneo Rainforest Lodge (BRL) and Danum Valley Field Center (DVFC) at the Danum (...) Valley Conservation Area (DVCA), we observed seven episodes of alternating songs between males. Here, we describe the process of song exchange between males. During male interactions, song bouts rarely overlapped and were alternately emitted. Several studies have reported antiphonal vocalizations in New World and Old World primate species, but rarely in apes. Our observations of antiphonal songs in gibbons indicate that gibbons not only unilaterally advertise information, but also interactively communicate with neighbors and family members through songs. Since gibbons are phylogenetically similar to humans, and turn-taking has an important role in human conversation, our research on gibbon communication may provide insight into the evolution of human language. (shrink)
: This paper deals with Claudia Card's important contributions to a theory of evil that steps out from traditional models of thinking about this problem (theodicies, metaphysical theories, etc.). Instead, our author seeks to explore important elements from other theorists (such as Kant and Nietzsche) in order to build up her ideas of what she calls the "atrocity paradigm." This critical essay focuses mainly in the spaces where Card's conclusions need to rethink the limits and constraints of her theory.
The land ethic of Aldo Leopold has increasingly received attention as an example of an environmental virtue ethic. However, an important remaining question is how to cultivate and transmit environmental virtues. The answer to this question can be found in the pursuit of wild leisure. The classical view of leisure primarily as articulated in Aristotle’s Politics provides a good starting point for an examination of wild leisure. Leopold thought wild leisure was important and associated it with his (...) land ethic. Leopold’s view of wild leisure focused on the role of perception in ecological education and the habituation of virtue. The classical virtue of moderation when habituated by wild leisure becomes the central virtue required by an ecological conscience. Wild leisure educates just those intellectual and scientific virtues necessary for refined perception and prudence. These virtues provide connections between good citizenship and land citizenship. (shrink)
The medical treatment of wild animals is an accepted practice in our society. Those who take it upon themselves to treat wildlife are well-intentioned and genuinely concerned about their charges. However, the doctoring of sick animals is of extremely limited value and for the most part based on biological illiteracy. It wastes scarce resources and diverts attention from more worthwhile goals. While it is not wrong to minister to wildlife, it is not right either. The person who refuses to (...) do so has not violated any moral duty and is not necessarily morally callous. The treatment of wildlife is based on the mistaken belief that value lies in individual wild animals rather than the entire ecosystern. The genuine concern of those who doctor wild animals should be channeled in to more constructive directions. (shrink)
