Variant Creutzfeldt–Jakob disease is a fatal, transmissible, neurodegenerative disorder for which there is currently no effective treatment. vCJD arose from the zoonotic spread of bovine spongiform encephalopathy. There is now compelling evidence for human to human transmission through blood transfusions from presymptomatic carriers and experts are warning that the real epidemic may be yet to come. Imperatives exist for the development of reliable, non-invasive presymptomatic diagnostic tests. Research into such tests is well advanced. In this article the ethical implications of (...) the availability of these tests are elaborated and comparisons drawn with predictive genetic testing for Huntington’s disease and screening for HIV. Paramount to considerations is the issue of whom to test, weighing up respect for personal autonomy against obligations to benefit and protect society. A paradigm is proposed similar to that used for HIV screening but with unique features: compulsory testing of all blood/organ donors and individuals undergoing surgery or invasive procedures who have a significant risk of disease transmission. (shrink)

Variant Creutzfeldt–Jakob disease is a fatal, transmissible, neurodegenerative disorder for which there is currently no effective treatment. vCJD arose from the zoonotic spread of bovine spongiform encephalopathy. There is now compelling evidence for human to human transmission through blood transfusions from presymptomatic carriers and experts are warning that the real epidemic may be yet to come. Imperatives exist for the development of reliable, non-invasive presymptomatic diagnostic tests. Research into such tests is well advanced. In this article the ethical implications of (...) the availability of these tests are elaborated and comparisons drawn with predictive genetic testing for Huntington’s disease and screening for HIV. Paramount to considerations is the issue of whom to test, weighing up respect for personal autonomy against obligations to benefit and protect society. A paradigm is proposed similar to that used for HIV screening but with unique features: compulsory testing of all blood/organ donors and individuals undergoing surgery or invasive procedures who have a significant risk of disease transmission. (shrink)

The concept of selecting for a disability, and deafness in particular, has triggered a controversial and sometimes acrimonious debate between key stakeholders. Previous studies have concentrated on the views of the deaf and hard of hearing, health professionals and ethicists towards reproductive selection for deafness. This study, however, is the first of its kind examining the views of hearing children of deaf adults towards preimplantation genetic diagnosis and prenatal diagnosis to select for or against deafness. Hearing children of deaf adults (...) straddle both the deaf and hearing worlds, and this dual perspective makes them ideally placed to add to the academic discourse concerning the use of genetic selection for or against deafness. The study incorporated two complementary stages, using initial, semistructured interviews with key informants as a means to guide the subsequent development of an electronic survey, completed anonymously by 66 individuals. The participants shared many of the same views as deaf individuals in the D/deaf community. The similarities extended to their opinions regarding deafness not being a disability, their ambivalence towards having hearing or deaf children and their general disapproval of the use of genetic technologies to select either for or against deafness. (shrink)

One aspect of the utility of gambling may evidence itself in failures of idempotence, i.e., when all chance outcomes give rise to the same consequence the `gamble' may not be indifferent to its common consequence. Under the assumption of segregation, such gambles can be expressed as the joint receipt of the common consequence and what we call `an element of chance', namely, the same gamble with the common consequence replaced by the status quo. Generalizing, any gamble is indifferent to the (...) joint receipt of its element of chance and a certain consequence, which is called the `kernel equivalent' of the gamble. Under idempotence, the kernel equivalent equals the certainty equivalent. Conditions are reported (Theorem 4) that are sufficient for the kernel equivalents to have the kind of utility representation first discussed by Luce and Fishburn (1991), including being idempotent. This utility representation of the kernel equivalents together with the derived form of utility over joint receipts yields a utility representation of the original structure. Possible forms for the utility of an element of chance are developed. (shrink)

Empirical evidence from both utility and psychophysical experiments suggests that people respond quite differently—perhaps discontinuously—to stimulus pairs when one consequence or signal is set to `zero.' Such stimuli are called unitary. The author's earlier theories assumed otherwise. In particular, the key property of segregation relating gambles and joint receipts (or presentations) involves unitary stimuli. Also, the representation of unitary stimuli was assumed to be separable (i.e., multiplicative). The theories developed here do not invoke separability. Four general cases based on two (...) distinctions are explored. The first distinction is between commutative joint receipts, which are relevant to utility, and the non-commutative ones, which are relevant to psychophysics. The second distinction concerns how stimuli of the form (x, C; y) and the operation of joint receipt are linked: by segregation, which mixes stimuli and unitary ones, and by distributivity, which does not involve any unitary stimuli. A class of representations more general than rank-dependent utility (RDU) is found in which monotonic functions of increments U(x)-U(y), where U is an order preseving representation of gambles, and joint receipt play a role. This form and its natural generalization to gambles with n > 2 consequences, which is also axiomatized, appear to encompass models of configural weights and decision affect. When joint receipts are not commutative, somewhat similar representations of stimuli arise, and joint receipts are shown to have a conjoint additive representation and in some cases a constant bias independent of signal intensity is predicted. (shrink)

This note addresses 3 issues that seem to pervade much of economic thought about individual decisions among uncertain alternatives: (1) Restricting primitives to just orderings of first-order gambles and not admitting, e.g., compound acts or joint receipt of consequences and gambles. (2) Great resistance to experimental findings that strongly suggest that most current theories fail descriptively. (3) Taking for granted the innocence of some assumptions when, in fact, they are not innocent, e.g., that constant acts are idempotent. My conclusion is (...) that these restrictions have greatly inhibited developments in utility theory. (shrink)

One aspect of the utility of gambling may evidence itself in failures of idempotence, i.e., when all chance outcomes give rise to the same consequence the `gamble' may not be indifferent to its common consequence. Under the assumption of segregation, such gambles can be expressed as the joint receipt of the common consequence and what we call `an element of chance', namely, the same gamble with the common consequence replaced by the status quo. Generalizing, any gamble is indifferent to the (...) joint receipt of its element of chance and a certain consequence, which is called the `kernel equivalent' of the gamble. Under idempotence, the kernel equivalent equals the certainty equivalent. Conditions are reported (Theorem 4) that are sufficient for the kernel equivalents to have the kind of utility representation first discussed by Luce and Fishburn (1991), including being idempotent. This utility representation of the kernel equivalents together with the derived form of utility over joint receipts yields a utility representation of the original structure. Possible forms for the utility of an element of chance are developed. (shrink)

Shoemaker (1996) presenteda prioriarguments against the possibility of ‘self‐blindness’, or the inability of someone, otherwise intelligent and possessed of mental concepts, to introspect any of her concurrent attitude states. Ironically enough, this seems to be a position that Gopnik (1993) and Carruthers (2006, 2008, 2009a,b) have proposed as not only possible, but as the actual human condition generally! According to this ‘Objectivist’ view, supposed introspection of one's attitudes is not ‘direct’, but an ‘inference’ of precisely the sort we make about (...) the attitudes of others, an inference that has the advantage in our own case ofonlyour own sensory data and memories, our behavior, and of the context we are in; i.e. we are all substantially self‐ blind. After sorting out a number of methodological and verbal issues, I argue, first, that thea prioriarguments against Objectivism don't succeed, and that Gopnik and Carruthers are right to regard the issue as an empirical one. On the other hand, I think they seriously underestimate the difficulty of establishing Objectivism. It is unlikely there is an inferential procedure from the data of pure sensation, behavior and context to the relevant self‐attributions that would be as spectacularly reliable as people manifestly seem to be. Moreover, there is a simpler model: the mind very likely consists of a panoply of sub‐routines some of whose outputs are ‘tagged’ for their having been so processed, rather in the way that software ‘documents’ are on standard computers. Introspection plausibly consists in a person's simply attending to distinctive constellations of these tags, even though they may lack phenomenal feels. This draws attention to an important independent fact: that much of phenomenology (or ‘what it's like’ to be in a certain state) may be constituted by facts that are not phenomenal. (shrink)

This book is a timely new interpretation of the moral and political philosophy of Thomas Hobbes. Staying close to Hobbes's text and working from a careful examination of the actual substance of the account of natural law, R.E. Ewin argues that Hobbes well understood the importance of moral behavior to civilized society. This interpretation stands as a much-needed corrective to readings of Hobbes that emphasize the rationally calculated, self-interested nature of human behavior. It poses a significant challenge to currently fashionable (...) game theoretic reconstructions of Hobbesian logic. It is generally agreed that Hobbes applied what he took to be a geometrical method to political theory. But, as Ewin forcefully argues, modern readers have misconstrued Hobbes's geometric method, and this has led to a series of misunderstandings of Hobbes's view of the relationship between politics and morality. Important implications of Ewin's reading are that Hobbes never thought that "the war of each against all" was an empirical possibility for citizens; that his political theory actually presupposes moral agency; and that Hobbes's account of natural law forces us to the conclusion that Hobbes was a virtue theorist. This major contribution to Hobbes studies will be praised and criticized, welcomed and challenged, but it cannot be ignored. All philosophers, political theorists, and historians of ideas dealing with Hobbes will need to take account of it. (shrink)

Concepts, Kovesi argued in Moral Notions and elsewhere, are formed from a point of view; they express relevant needs, wants, interests, ideals, and attitudes, and are formed from a point of view that can be anybody’s. The point of view need not be everybody’s (not everybody is interested in chess, for example), but it is a point of view that can be taken by anybody. The point of view expresses our purpose in forming the concept (p. 48)1; it is the (...) point of view of somebody dealing with certain sorts of problems, and that determines which material elements will come under the concept. But Kovesi refuses to explain in any of his writings what the moral point of view is, and says that it is no part of his project to explain that (see especially pp. 105 ff). This is not a matter of his refusing to say whether he is taking a Utilitarian point of view or an Emotivist point of view of anything of that sort. His question is a much more basic one about the logical structure of moral concepts and their relationships to the problems morality is formed to deal with. His refusal to explain the moral point of view is puzzling. The moral point of view that Kovesi envisaged, I think, is the point of view of members of a species the members of which have to get on together, a species members of which have the qualities of character that enable them to get on together. (shrink)

Translational ethics (TE) has been developed into a specific approach, which revolves around the argument that strategies for bridging the theory‐practice gap in bioethics must themselves be justified on ethical terms. This version of TE incorporates normative, empirical and foundational ethics research and continues to develop through application and in the face of new ethical challenges. Here, I explore the idea that the academic field of bioethics has not yet sufficiently analysed its own philosophical foundation for how it can, and (...) should, be practically relevant; neither has it comprehensively discussed the limitations on what impacts bioethicists should pursue. As a result, there has not been adequate training on how to suitably and appropriately impact real‐world practices. Moreover, bioethical perspectives are often competing with other strong interests, for example, economic and political, which may weaken their impact on policy‐making. The TE approach I propose can not only facilitate practical impacts of academic bioethics by being better informed by real‐world ethical issues but it also supports targeted and ethical justifications of the actual impact of academic work in real‐world contexts. In this paper, I clarify the premises for this TE approach, identify further challenges and sketch out potential solutions for the implementation of this methodological framework. (shrink)

Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful perspective on the (...) field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. (shrink)

This study represents an improvement in the ethics scales inventory published in a 1988 Journal of Business Ethics article. The article presents the distillation and validation process whereby the original 33 item inventory was reduced to eight items. These eight items comprise the following ethical dimensions: a moral equity dimension, a relativism dimension, and a contractualism dimension. The multidimensional ethics scale demonstrates significant predictive ability.

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

Rich with historical and cultural value, these works are published unaltered from the original University of Minnesota Press editions.

J. Krishnamurti (1895-1986) was thought by many to be a modern-day equivalent of the Buddha. In fact, he was once even considered to be the second coming of Christ. While many think it wonderful to live and work in close proximity with such a person, it's difficult to understand the depth of what this means and how challenging this might be. In Knocking at the Open Door, author R.E. Mark Lee provides an ordinary person view of what being close-up and (...) working together with such a man means, how it challenges one at every turn, and how it causes one to question ceaselessly, even more deeply than one ordinarily would. Lee offers an insightful, candid, and heartfelt narrative that reveals various unknown facets of the eminent world teacher J. Krishnamurti and highlights his distinctive vision for education worldwide. This comprehensive volume brings alive the practical and everyday interactions Lee had with Krishnamurti during a twenty-year period in India and the United Sates. Knocking at the Open Door shares a clear and honest account that demonstrates the challenges of working with Krishnamurti in running a school that is true to the teaching and yet able to function in the reality of modern parental, student, and educational establishment expectations. (shrink)

The thesis of this article is that there has never been any ground for the controversy between the doctrine of free will and determinism, that it is based upon a misapprehension, that the two assertions are entirely consistent, that one of them strictly implies the other, that they have been opposed only because of our natural want of the analytical imagination. In so saying I do not tamper with the meaning of either phrase. That would be unpardonable. I mean free (...) will in the natural and usual sense, in the fullest, the most absolute sense in which for the purposes of the personal and moral life the term is ever employed. I mean it as implying responsibility, merit and demerit, guilt and desert. I mean it as implying, after an act has been performed, that one " could have done otherwise " than one did. I mean it as conveying these things also, not in any subtly modified sense but in exactly the sense in which we conceive them in life and in law and in ethics. These two doctrines have been opposed because we have not realised that free will can be analysed without being destroyed, and that determinism is merely a feature of the analysis of it. And if we are tempted to take refuge in the thought of an "ultimate ", an "innermost" liberty that eludes the analysis, then we have implied a deterministic basis and constitution for this liberty as well. For such a basis and constitution lie in the idea of liberty. -/- The thesis is not, like that of Green or Bradley, that the contending opinions are reconciled if we adopt a certain metaphysic of the ego, as that it is timeless, and identifies itself with a desire by a " timeless act". This is to say that the two are irreconcilable, as they are popularly supposed to be, except by a theory that delivers us from the conflict by taking us out of time. Our view on the contrary is that from the natural and temporal point of view itself there never was any need of a reconciliation but only of a comprehension of the meaning of terms. (The metaphysical nature of the self and its identity through time is a problem for all who confront memory, anticipation, etc.; it has no peculiar difficulties arising from the present problem.) -/- I am not maintaining that determinism is true; only that it is true insofar as we have free will. That we are free in willing is, broadly speaking, a fact of experience. That broad fact is more assured than any philosophical analysis. It is therefore surer than the deterministic analysis of it, entirely adequate as that in the end appears to be. But it is not here affirmed that there are no small exceptions, no slight undetermined swervings, no ingredient of absolute chance. All that is here said is that such absence of determination, if and so far as it exists, is no gain to freedom, but sheer loss of it; no advantage to the moral life, but blank subtraction from it. -- When I speak below of "the indeterminist" I mean the libertarian indeterminist, that is, him who believes in free will and holds that it involves indetermination. (shrink)

Volume 20, Issue 4, May 2020, Page 71-73.

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

The overall aim of this article is to discuss the organization of limit setting in healthcare in terms of legitimacy. We argue there is a strong ethical demand that such processes should be arranged to provide adversely affected people well-justified reasons to confer legitimacy to the processes despite favouring a different decision-making outcome. Two increasingly popular approaches, Accountability for Reasonableness (A4R) and Multi-Criteria Decision Analysis (MCDA), can both be applied to support legitimate decision-making processes. However, the role played by ‘fair-minded (...) people’ in the A4R framework can be shown to undermine an adequate conceptualization of legitimacy according to the ethical demand. We discuss and specify conditions enabling A4R to meet this ethical demand when being implemented in a real-world setting without having to renounce the aim of striving for ‘reasonableness’ and impartiality. The methodological approach MCDA describes how to arrange for transparent resource allocation. This approach does not encompass any normative guidance on how to shape limit settings in terms of ‘reasonableness’; it basically promotes ‘rational’ decisions. We discuss how this practical methodology can be integrated with the theoretical A4R framework to meet the ethical demand while at the same time promoting politically required impartiality of healthcare limit setting. (shrink)

2. The Meno offers a dramatic demonstration of the validity of the first argument put forward for Anamnesis and the immortality of the soul in the Phaedo.

This distinction has sometimes been read as purely epistemic, resting not on things, but on our knowledge of them: there is one world, not two, though it may be apprehended in two ways. But this view is patently at odds with the text. Knowledge and opinion are δυνάμεις, "faculties," to be distinguished and defined by their objects, no less than by the state of mind they produce, and Plato clearly states that the fallibility and unclearness of opinion is rooted in (...) the relative unreality of opinables. (shrink)