The article begins by reconstructing the just distribution of the social bases of self-respect, a principle of justice that is covert in Rawls’s writing. I argue that, for Rawls, justice mandates that each social basis for self-respect be equalized (and, as a second priority, maximized). Curiously, for Rawls, that principle ranks higher than Rawls’s two more famous principles of justice - equal liberty and the difference principle. I then recall Rawls’s well-known confusion between self-respect and another form of self-appraisal, namely, (...) confidence in one’s determinate plans and capacities. Correcting that confusion forces Rawls to accept objectionable and illiberal politics. Surprisingly, a consistent Rawls must endorse absolute economic equality, deny liberty any priority whatsoever, or sponsor still other illiberal political views - evidence of a flaw in the ethical basis of Rawls’s politics. -/- Key Words: self-respect • self-esteem • distributive justice • Rawls • maximin • primary goods • liberty • equality • lexicographical order. (shrink)
This article argues that, in its standard formulation, luck-egalitarianism is false. In particular, I show that disadvantages that result from perfectly free choice can constitute egalitarian injustice. I also propose a modified formulation of luck-egalitarianism that would withstand my criticism. One merit of the modification is that it helps us to reconcile widespread intuitions about distributive justice with equally widespread intuitions about punitive justice.
Next SectionAccess to medicines, vaccination and care in resource-poor settings is threatened by the emigration of physicians and other health workers. In entire regions of the developing world, low physician density exacerbates child and maternal mortality and hinders treatment of HIV/AIDS. This article invites philosophers to help identify ethical and effective responses to medical brain drain. It reviews existing proposals and their limitations. It makes a case that, in resource-poor countries, ’locally relevant medical training’—teaching primarily locally endemic diseases and practice (...) in scarcity conditions, training in rural communities and admitting rural students preferentially—could help improve retention. Locally relevant training would arguably diminish medical brain drain in five ways. It would (i) make graduates less attractive for Western employers, (ii) align graduates’ expectations with actual practice, diminishing ‘burn-out’, (iii) enhance the professional prestige of local practice, (iv) hold rotations in, and recruit applicants from, rural areas, which is known to improve retention there, and (v) create local career development options that attract practitioners to stay. Such educational reform may raise worries about poor-quality care, breach of the freedom of education and occupation, breach of the freedom of movement, unequal distribution of opportunities among students, hypocrisy and resistance from influential actors. We address these worries. (shrink)
Commentators on the ethics of translational research find it morally problematic. Types of translational research are said to involve questionable benefits, special risks, additional barriers to informed consent, and severe conflicts of interest. Translational research conducted on the global poor is thought to exploit them and increase international disparities. Some commentators support especially stringent ethical review. However, such concerns are grounded only in pre-approval translational research (now called T1 ). Whether or not T1 has these features, translational research beyond approval (...) ( T2 : phase IV, health services, and implementation research) is unlikely to and, when conducted on the global poor, may support development. Therefore, insofar as T1 is morally problematic, and no independent objections to T2 exist, the ethics of translational research is diverse: while some translational research is problematic, some is not. Funding and oversight should reflect this diversity, and T2 should be encouraged, particularly when conducted among the global poor. (shrink)
The majority of deaths due to tobacco in the twenty-first century will occur in the developing world, where over 80% of current tobacco users live. In November 2010 guidelines were adopted for implementing Article 14 of the World Health Organization’s Framework Convention on Tobacco Control (FCTC). The guidelines call on all countries to promote tobacco treatment programs. Nevertheless, some experts argue for a strict focus, at least in developing countries, on population-based measures such as taxes and indoor air laws, which (...) they consider more cost-effective than individual treatment. In this article we defend tobacco dependence treatment in developing countries. First, these experts understate the comparative cost-effectiveness of individual treatment programs. Second, they overlook numerous ethical considerations beyond cost-effectiveness that support individual tobacco treatment in developing countries. We conclude that the strict population-based focus in developing country tobacco control advocated by some experts is misplaced. In general, developing nations should combine population-based measures and individual tobacco treatment programs. (shrink)
We analyse three moral dilemmas involving resource allocation in care for HIV-positive patients. Ole Norheim and Kjell Arne Johansson have argued that these cases reveal a tension between egalitarian concerns and concerns for better population health. We argue, by contrast, that these cases reveal a tension between, on the one hand, a concern for equal *chances*, and, on the other hand, both a concern for better health and an egalitarian concern for equal *outcomes*. We conclude that, in these cases, there (...) is much less tension than Norheim and Johansson claim between egalitarian concerns and concerns for better population health. (shrink)
Patients’ medical conditions can result from their own avoidable risk taking. Some lung diseases result from avoidable smoking and some traffic accidents result from victims’ reckless driving. Although in many nonmedical areas we hold people responsible for taking risks they could avoid, it is normally harsh and inappropriate to deny patients care because they risked needing it. Why? A popular account is that protecting everyone’s "decent minimum," their basic needs, matters more than the benefits of holding people accountable. This account (...) is deficient. Protecting the decent minimum is not always served by offering noncompliant patients either nonbasic or basic care. Nor is protecting that minimum always served by unconditional medical care better than by nonmedical interventions. To interpret the decent minimum in democratic terms is a futile response to these challenges. Ideas for new accounts are suggested. (shrink)
Increasingly, bioethicists defend informed consent as a safeguard for trust in caretakers and medical institutions. This paper discusses an ‘ideal type’ of that move. What I call the trust-promotion argument for informed consent states: 1. Social trust, especially trust in caretakers and medical institutions, is necessary so that, for example, people seek medical advice, comply with it, and participate in medical research. 2. Therefore, it is usually wrong to jeopardise that trust.3. Coercion, deception, manipulation and other violations of standard informed (...) consent requirements seriously jeopardise that trust. 4. Thus, standard informed consent requirements are justified.This article describes the initial promise of this argument, then identifies challenges to it. As I show, the value of trust fails to account for some commonsense intuitions about informed consent. We should revise the argument, commonsense morality, or both. (shrink)
Michael Bloomberg's three terms in New York City's mayoral office are coming to a close. His model of governance for public health influenced cities and governments around the world. What should we make of that model? This essay introduces a symposium in which ethicists Sarah Conly, Roger Brownsword and Alex Rajczi discuss that legacy.
In many countries worldwide, especially in Sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. (...) Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas. (shrink)
This article proffers an invitation to neoclassical sociology. This is understood as a Habermasian reconstruction of the fundamental vision of the discipline as conceptualized by classical theorists, particularly Weber. Taking the cases of Eastern and Central Europe as a laboratory, we argue against the idea of a single, homogenizing globalizing logic. Currently and historically what we see instead is a remarkable diversity of capitalist forms and destinations. Neither sociological theories of networks and embeddedness nor economic models of rational action adequately (...) comprehend this diversity. A neoclassical approach enjoins an empirical research agenda comparing capitalisms, and an ironic, historical approach to analysis to inform an immanent critique of capitalist possibilities. (shrink)
We should note, however, that the achievements of the control system cannot in and of themselves explain the success of the discourse on the Arab village. Indeed, with the benefit of hindsight, one must acknowledge today that what the control system produced was a “secondary order” reality at best, a representation superimposed over, and obscuring other social realities. It never managed (nor did it try) to stop the proletarianization of peasants. It never managed (though it did try) to put an (...) end to illegal construction and de-facto urbanization. It did not even manage to repress the emergence of grass-roots national political organization in the villages. More often than not, its sole achievement was to obscure official (and academic) perception of these processes. Thus, one often finds nowadays settlements to which the term “village” is officially applied, while their physical structure already merits urban status. Urbanization took place in the villages regardless of the designs of planners, and this fact alone is enough to demonstrate how discourse detached them from reality. This was also why, in 1976, Orientalists and government experts were completely taken by surprise, when the “committee for national direction” (composed of “village” mayors!) organized mass demonstrations to protest government plans to confiscate more Palestinian lands. The events of this day, later known as “land day,” signaled the emergence of rural Palestinians as a national political force to be reckoned with. Quite contrary to what the notion of “hamula struggle” led them to believe, experts discovered that the villages were an effective mobilizing ground for national political action.I think it is precisely the dubious character of the achievements of the control system, arising from the systematic blindness inculcated by discourse, which demonstrates that these achievements were indeed of secondary importance in comparison with what was the raison d'etre of the control system and the discourse on the Arab village: their premier achievement was to reproduce the separatist character of Israeli identity. The origins of the control system were diverse indeed: they included “divide and conquer” practices developed by “Arabists”; land planning practices; modernization discourse formulated in response to immigration; cooptation strategies developed by the Labor party for electoral purposes; bifurcation of the labor market by Jewish labor unions. There is no one person or group responsible for these. What organized all these diverse practices together was the specific rationality of the control system. This rationality was not an economic one, nor political, nor scientific, nor was it given in any of these practices. It was identical with Israeli identity and the procedures that separate it from its “other.” This is why Israelis still adhere to the control system and the discourse on the Arab village, even though they fail to predict Palestinian behavior or control it (i.e., it was not their goal to begin with).It is ironic that the discourse on the Arab village would reach the height of its prestige just as the achievements of the control system were evaporating. The conjunction of these two events cannot be explained by the Weberian view of power as the realization of a will, i.e., by focusing on the interest of Jews in maintaining control over Palestinians. Such a view leads to an unavoidable contradiction: If the action of participants in the discourse and the control system is based on “their” interests, why are they unable to recognize their failure? And if they are not capable of monitoring “their own” interests, how were they able to create a coherent and effective control system? The answer is that their action is circumscribed by what discourse and the control system permit them to grasp, and this understanding is indeed both limited and enabled by the premier achievement of discourse and the control system: a position of a Western-modern Israeli subject, strictly demarcated from that of the traditional-Oriental rural Palestinian. Power is not so much “exercised” to realize an Israeli interest, as it is constitutive of the very self-understanding that underlies this interest, a self-understanding predicated on the rejection of the “Orient” and its exclusion.In this sense, this article merely provides the rough outlines for a future debate on the origins and nature of Israeli separatism. Such a debate has scarcely begun, but implicit understandings of separatism are implicated in the contemporary political debate in Israel. The mainstream of Israeli political thought tends to treat the separation between Jews and Palestinians as a taken-for-granted fact, a direct consequence of Zionism as a nation-building project. Others, on the political left, question this assumption and suggest that separatism should be understood as an institutional system erected in response to certain economic, military, or political interests, a system based on the control and exploitation of Palestinians by Jews.I think both positions limit the debate about separatism. By ignoring the cultural side of separatism, its character as an identity that requires a permanent effort of constitution, they supply an “alibi” for intellectuals and academics. These can continue using their disciplines and discourses, and even present these as sufficiently “detached” for a critique of Israeli politics, without examining their role in the reproduction of a separatist identity. Moreover, if separatism is understood merely as control over Palestinians, thus ignoring its side as the subjection of Jews, the consequence is that the “distinction” usurped by the Israeli upper class is mis-recognized. This class can continue to present its taste, values, and style of life - all those cultural arbitraries that are marked by the double exclusion of the “Orient” and the “diaspora” - as the sacred cultural consensus of Israeli society. It was my aim in this article, on the contrary, to demonstrate that separatism informs the core of Israeli culture, and thus the intellectual tools to understand it and fight it can not be taken from among what it consecrates. (shrink)
Reflecting, in conclusion, upon the significance of our inquiry into the social origins of the nomenklatura, we suggest that the main reason the term nomenklatura remains a loaded one in East European political discourse is that it raises the question of what the Communist period in East Europe meant, and what it might mean now. Was Communism an artificial break in the “organic” history of these societies, a history that now resumes? Or, were Communist institutions deeply embedded in the social (...) logic of East European development in ways that mean the Communist legacy will endure into postcommunism? Our usage of the term “upper class” was calculated precisely to capture this notion of embeddedness. We argue that in some East European countries, most notably Russia, and probably Hungary as well, where the Communist elite became an organic component of the emerging social order as an upper class, it is not enough to ask if the Communistelites have “reproduced” or “circulated.” Whether an upper class existed, and to what degree, forms the class context of personnel changes: a lot of circulation at the individual level, for example, may mean nothing but the reproduction of privileges and advantages institutionalized during the Communist period via the upper class. Reproduction on the individual level, on the other hand, may indicate precisely the opposite; that an upper class did not form and therefore nomenklatura members were unable to enjoy such institutionalized mechanisms during the transition to postcommunism. To put it in the language of our introduction: to answer the question of whether the Communists are still in power, one has first to determine what kind of a social order Communism was in each country. It was these different social orders, comprising concrete groups and group identities, as distinct from the mechanisms of surplus allocation or the individuals who staffed them, which may have been left intact through the post-Communist transition. (shrink)
Bitton and Eyal's lengthy critique of our article on unassisted cessation was premised on several straw-man arguments. These are corrected in our reply. It also confused the key concepts of efficacy and effectiveness in assessing the impact of cessation interventions and policies in real-world settings; ignored any consideration of reach (cost, consumer acceptability and accessibility) and failed to consider that clinical cessation interventions which fail more than they succeed also may ‘harm’ smokers by reducing agency. Our article addresses each (...) of these problems, concluding that any consideration of the ethics of promoting smoking cessation in low-income nations should begin and end with the question of whether the strategies to be adopted have any prospect of influencing significant numbers of smokers to quit. (shrink)
Law, Economics, and Morality examines the possibility of combining economic methodology and deontological morality through explicit and direct incorporation of moral constraints into economic models. Economic analysis of law is a powerful analytical methodology. However, as a purely consequentialist approach, which determines the desirability of acts and rules solely by assessing the goodness of their outcomes, standard cost-benefit analysis (CBA) is normatively objectionable. Moderate deontology prioritizes such values as autonomy, basic liberties, truth-telling, and promise-keeping over the promotion of good outcomes. (...) It holds that there are constraints on promoting the good. Such constraints may be overridden only if enough good (or bad) is at stake. While moderate deontology conforms to prevailing moral intuitions and legal doctrines, it is arguably lacking in methodological rigor and precision. -/- Eyal Zamir and Barak Medina argue that the normative flaws of economic analysis can be rectified without relinquishing its methodological advantages and that moral constraints can be formalized so as to make their analysis more rigorous. They discuss various substantive and methodological choices involved in modeling deontological constraints. Zamir and Medina propose to determine the permissibility of any act or rule infringing a deontological constraint by means of mathematical threshold functions. Law, Economics, and Morality presents the general structure of threshold functions, analyzes their elements and addresses possible objections to this proposal. It then illustrates the implementation of constrained CBA in several legal fields, including contract law, freedom of speech, antidiscrimination law, the fight against terrorism, and legal paternalism. (shrink)
The paper explores the role played by concepts of temporality in shaping the self's identity and its moral responsibility. This theme is examined in both Kant and Benjamin, two theorists who view the modern self as an essentially historical being. For Kant, teleological and uniform time shoulders the heightening of the self's universal attributes and the constant expansion of a moral community. The desired end is the establishment of an integrated and homogeneous human space, a cosmopolitan stage wherein history is (...) finally redeemed. This progressive notion of time is seen as dangerous by Benjamin, since it generates forgetfulness and inner impoverishment of the self. Instead, Benjamin advances a fragmented conception of time, one allowing conversation between distant moments and grounding identity in concrete images. While the poetic recovery of memory leads to the distinct and exclusive, Benjamin follows Kant in demanding universal moral responsibility of the self. However, Benjamin's strategy, so to speak, is the integration of our temporal - not spatial - experience. Key Words: Benjamin history Kant nation-state space time. (shrink)
Reingold and MerikleÕs (1988, 1990) critique of the classic dissociation paradigm identiﬁed several issues as inherent problems that severely undermine the utility of this paradigm. Erdelyi (2004) extending his prior analysis (Erdelyi, 1985, 1986) points out several additional factors that may complicate the interpretation of empirically obtained dissociations. The goal of the present manuscript is to further discuss some of these commonly neglected interpretive diﬃculties. Ó 2003 Elsevier Inc. All rights reserved.
In a recent paper, Graf and Komatsu (1994) argued that the process dissociation procedure (Jacoby, 1991) is limited in its ability to separate and measure conscious and unconscious forms of memory and so should be "handIed with caution". Given that the study of unconscious influences has always posed a difficult problem for memory researchers, we agree with the general emphasis on caution. In this paper, we too advocate caution, especially as it applies to the use of indirect tests, assessing Graf (...) and Komatsu’s critique, and using the process dissociation procedure. We address the substantive issues raised by Graf and Komatsu and also point out the errors, both factual and logical, in their paper. Any method proposing to provide separate measures of conscious and unconscious influences requires judicious use and a careful examination of its underlying assumptions. The assumptions underlying the process dissociation framework are supported by a large number of experiments spanning a diverse range of.. (shrink)
The present paradigm involved manipulating the congruency of the perceptual processing during the study and test phases of a recognition memory task. During each trial, a gaze-contingent window was used to limit the stimulus display to a region either inside or outside a 108 square centred on the participant’s point of gaze, constituting the Central and Peripheral viewing modes respectively. The window position changed in real time in concert with changes in gaze position. Four experiments documented better task performance when (...) viewing modes at encoding and retrieval matched than when they mismatched (i.e., perceptual specificity effects). Viewing mode congruency effects were demonstrated with both verbal and non-verbal stimuli. The present research is motivated and discussed in terms of theoretical views proposed in the 1970s including the levels-of-processing framework and the proceduralist viewpoint. In addition, implications for current processing and multiple systems views of memory are outlined. (shrink)
How might revolutions and other processes of institutional disintegration inform political processes preceding them? By mapping paths of agency through processes of institutional disintegration, the trajectory improvisation model of institutional breakdown overcomes "action-structure" binaries by framing political revolutions as possible outcomes of such disintegrative processes. The trajectory improvisation approach expands the trajectory adjustment model of social change developed by Gil Eyal, Iván Szelényi, and Eleanor Townsley. An overview of political revolution in Soviet Russia between 1989 and 1991 illustrates trajectory (...) improvisation. The recent American invasion and occupation of Iraq shows alternative routes to institutional disintegration, indicating the independence of models of institutional breakdown from those of social movements. These cases illustrate both the diversity of situations the trajectory improvisation model speaks to, and the limitation of models of trajectory adjustment, improvisation, social movements, and invasions, illustrating why such models at best enable what are called "explanatory narratives" of actual historical processes. (shrink)
There are hundreds of indications leading us to conclude that at every moment there is in us an infinity of perceptions, unaccompanied by awareness or reflection; that is, of alterations in the soul itself, of which we are unaware because the impressions are either too minute or too numerous, or else too unvarying, so that they are not sufficiently distinctive on their own. But when they are combined with others they do nevertheless have their effect and make themselves felt, at (...) least confusedly, within the whole. (Leibniz, 1704/1981, p. 53). (shrink)