The idea that war is sometimes justified is deeply embedded in public consciousness. But it is only credible so long as we believe that the ethical standards of just war are in fact realizable in practice. In this engaging book, Christopher Finlay elucidates the assumptions underlying just war theory and defends them from a range of objections, arguing that it is a regrettable but necessary reflection of the moral realities of international politics. Using a range of historical and (...) contemporary examples, he demonstrates the necessity of employing the theory on the basis of careful moral appraisal of real-life political landscapes and striking a balance between theoretical ideals and the practical realities of conflict. This book will be a crucial guide to the complexities of just war theory for all students and scholars of the ethics and political theory of war. (shrink)

Growing data on the socioeconomic determinants of health pose a challenge to analysis and application of fairness in health. In Just health: meeting health needs fairly, Norman Daniels argues for a change in the population end of our thinking about just health. What about clinical care? Given our knowledge of the importance of wealth, education or social status to health, is fairness in medicine served better by continuing to avoid considering our patients’ social status in setting clinical priorities, (...) or by attempting to equalise existing health inequalities by giving priority to the socioeconomically disadvantaged at the point of care? In this article, I argue that doctors should not attempt the latter. Granted, giving priority to low status would go some way towards compensating unjust health inequalities and the impression of being left aside in other social spaces. It would represent reverse discrimination, but could still be justified inasmuch as disadvantaged groups could be identifiable, and as long as the intent was compensation rather than retribution. However, under current circumstances such priority would risk being attributed arbitrarily, would represent a form of medical proselytising, risk leaving the worst-off with less by alienating the powerful, and require teaching doctors to act in strongly counter-cultural ways—possibly at great cost. Crucially, however, we protect both equal health and equal regard by treating all alike: priority to low status would promote the first somewhat, but at the expense of sacrificing the second. (shrink)

Health reform must include health care rationing, both for reasons of fairness and efficiency. Few politicians are willing to accept this claim, including the Clinton Administration. Brown and others have argued that enormous waste and inefficiency must be wrung out of our health care system before morally problematic cost constraining options, such as rationing, can be justifiably adopted. However, I argue that most of the policies and practices that would diminish waste and inefficiency include implicit (and therefore morally problematic) rationing. (...) Critics of rationing see as its most morally and psychologically troubling feature that an identified individual is denied potentially beneficial care. That psychic anguish may not be eliminable, and perhaps ought not be eliminated. But if rationing protocols are fairly adopted through a process of free and informed rational democratic deliberation to which all have access, the moral objections are largely overcome. Such a process is possible only if implicit rationing is recognized and rejected. Keywords: Justice, health care rationing, health reform, democratic decision-making CiteULike Connotea Del.icio.us What's this? (shrink)

What does it mean to be a “just” and “caring” society in meeting the health care needs of the terminally ill when we have only limited resources to meet virtually unlimited health care needs? That question is the focus of this essay. Put another way: relative to all the other health care needs in our society, especially the need for lifesaving or life-prolonging health care, how high a priority ought the health care needs of persons who are terminally (...) ill have? On the one hand, we might see the terminally ill as being among the “medically least well off” and therefore deserving very high priority. On the other hand, we might see them as squandering vast medical resources for marginal medical benefits, thereby denying needed resources to others who would benefit much more. We begin the essay by making a number of morally relevant distinctions with regard to the category of “being terminally ill.” We note, given contemporary medicine, that individuals may be terminally ill several times in the course of a life. Not all such circumstances make equal just claims to needed health care. We also note that our conceptions of health care justice are ultimately incapable of making very fine-grained, morally justified rationing judgments in complex medical circumstances. We conclude that we must finally rely upon fair processes of rational democratic deliberation to articulate such judgments for our own future, possibly terminally ill selves, thereby undercutting the rhetoric of “death panels.”. (shrink)

There has long been a debate on the possible similarity between some forms of Indian and Greek idealistic monism ( Advaita and Neoplatonism ). After a basic historical introduction to the debate, the text proposes that Paramādvaita , also known as Kashmiri Shaivism , is a more suitable comparandum for Neoplatonism than any other form of Advaita , suggested in the debate. Paramādvaita ’s dynamic view of reality summarized in the terms prakāśa-vimarśa or unmeṣa-nimeṣa , corresponds quite precisely to (...) the viewpoint of Neoplatonism , summarized in the similar bipolar terms such as prohodos-epistrophe . The context of the dynamic nature of reality doctrine is also quite similar ( svataḥsiddhatva, authypostasis ). My arguments are based on the texts of Plotinus and Proclus ( Neoplatonism ) and the texts of Abhinavagupta, Utpaladeva and Kṣemarāja ( Paramādvaita ) . Several parallel doctrines of both systems are further discussed: the doctrine of creative multilevel subjectivity , the doctrine of mutual omnipresence of all in all , the doctrine of creative multilevel speech , and some corresponding doctrines on aesthetic beauty and its important role in the Soul’s return towards its ultimate source. Some implications of the high degree of correspondence between both systems are considered at the end of the paper, for instance whether some similarities of compared systems might be explained on a structural basis, since both schools ware facing similar sceptical critique ( Mādhyamika, Hellenistic scepticism ). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Rhetoricians Identified:A Call to Interdisciplinary Action and How it Resonated in the Field of RhetoricChristine Isager and Sine Nørholm Just"I actually like this book a lot, but I am not sure how comfortable I am with liking it," wrote William Keith (1995, 488) in a review of the original 1993 edition of Steve Fuller's Philosophy, Rhetoric, and the End of Knowledge (PREK), in which rhetoric is invited to (...) participate in the interdisciplinary reconfiguration of Science and Technology Studies (STS). This hesitant enthusiasm aptly exemplifies how an interdisciplinary invitation is likely to make its addressees squirm as they watch their professional aims being defined and then redefined by a disciplinary outsider who points out a place for them in a novel disciplinary constellation. Moreover, and more specifically, Keith's comment exemplifies how PREK was received by rhetoricians. On the surface, the reviews were glowing. In Philosophy and Rhetoric as well as in Philosophy of the Social Sciences, Keith expressed certain doubts about Fuller's work, but still he described it as "important," "exceptional," "superb" (1996; 1995). In the Quarterly Journal of Speech, Kenneth S. Zagacki called PREK both "excellent" and "exciting" (1995), and he was backed by John Angus Campbell and Keith R. Benson a year later when the same journal included PREK in an omnibus review entitled "The Rhetorical Turn in Science Studies" (Campbell and Benson 1996). Like Alan Gross, who reviewed the book in College English together with a number of works on workplace writing (1994), Campbell and Benson placed PREK at the cutting edge of rhetorical theory.The initial excitement over PREK forms a sharp contrast to the quite negligible impact that the book has had on the field of rhetoric in the decade that has passed since it was first published. In this essay we will undertake a close reading of the book along with the five above-mentioned reviews, looking for an explanation of the peculiar fate that met Steve [End Page 248] Fuller's proposal in the rhetorical disciplinary context. Our conclusion is that on reading the book, rhetoricians felt so flattered by Fuller's confident handling of rhetoric that the task of introducing and applying rhetorical theory in STS seemed, on the whole, to have been done for them. Furthermore, Fuller's attempts to construct a rhetorical agency are subverted by his idiosyncratic, i.e., inimitable, professional approach, which is also reflected in his style of writing. At once presumptuous and colloquial, his rhetoric serves to impress and entertain, but it fails to engage his audience substantially and to enact the interpenetrative stance that was intended to be the hallmark of PREK and that continues to be the commendable chief concern of Steve Fuller and his fellow social epistemologists.Text-Intertext and IdentificationInterdisciplinary invitations or, rather, interdisciplinary inspirational works of science were originally described as a noteworthy rhetorical genre by Leah Ceccarelli (2001). Ceccarelli explores how claims to scientific unity have handled a primary constraint: their multiple audiences. Fuller explicitly positions PREK within the genre of interdisciplinary inspiration by asserting that "the success of this book... should be measured in terms of its ability to persuade philosophers, theoretical humanists and social scientists, STS practitioners, and rhetoricians of science to see each other as engaged in a common enterprise" (1993, xii-xiii). We will not, however, be examining PREK's ability to be strategically opaque (as Fuller puts it), polysemous(Ceccarelli's term), or otherwise adapted to address its multiple audiences. Instead, we focus solely on Fuller's address to rhetoricians and study how he identifies with this particular audience. Ceccarelli recognizes the importance of ethical appeal in interdisciplinary invitations by positing the establishment of both an authoritative and personal authorial persona as a generic criterion. We follow this lead and add a Burkean emphasis on identification.According to Kenneth Burke, identification is a prior condition for persuasion "precisely because there is division" (Burke 1969, 22). The speaker's success depends on his ability to imitate the ways of his audience and to create a common ground or perspective that makes collective action possible. Burke's work allows us to distinguish three rhetorical strategies of identification. The first strategy... (shrink)

The British National Health Service (BNHS) was founded, to quote Minister of Health Aneurin Bevan, to ‘universalise the best’. Over time, however, financial constraints forced the BNHS to turn to incrementalist budgeting, to rationalise care and to ask its practitioners to act as gatekeepers. Seeking a way to ration scarce tertiary care resources, BNHS gatekeepers began to use chronological age as a rationing criterion. Age-rationing became the ‘done thing’ without explicit policy directives and in a manner largely invisible to patients, (...) to Parliament, and to the public. The invisibility of the practice, however, violates the publicity principle that John Rawls and other philosophers believe essential to fairness. BNHS invisible age-rationing practices are thus a test case of the principle that fairness presupposes publicity; they raise the question: is it possible to preserve equitability in a system that uses non-public criteria to allocate scarce resources? To seek an answer, published data on access to end-stage renal disease (ESRD) treatment in Britain and the European Community (EC) are analysed. Among the findings are: that BNHS age-rationing acts as an excuse for denying care to those most likely to need ESRD treatment; and is, moreover, arbitrary and inequitable. It is further argued that no age-rationing policy can sustain visibility, and that, if the BNHS is to be fair to its patients, it must reform its present age-rationing practices, replacing them by a publicly visible, outcome-based rationing policy that rations either in terms of QALYs or triage categories. (shrink)

The preventative paradigm of preconception care is receiving increasing attention, yet its boundaries remain vague in three respects: temporally; agentially; and instrumentally. Crucially, it remains unclear just who is to be considered a ‘potential parent’, how soon they should take up preconception responsibilities, and how weighty their responsibilities should be.

This article is concerned with Ngarrindjeri nation building in the ‘contact zone’ with the Australian settler state by decentring the colonizer within a range of bureaucratic regimes. Ngarrindjeri engagement with natural resource and cultural heritage management will be used to illustrate the relationship between globalization, community governance, education, sustaining ‘culture’, Indigenous well-being, and reconciliation and its links to the Australian government Closing the Gap initiatives. This article connects Ngarrindjeri lived experience to the theorization of processes for self-recovery and social transformation (...) that open possibilities for broad-based local and global coalitions, which include political solidarity in the interests of just Indigenous ‘reinhabitation’ and decolonization. (shrink)

This article tries to analyze the meaning of a decent minimum of health care, by confronting the idea of decent care with the concept of justice. Following the ideas of Margalith about a decent society, the article argues that a just minimum of care is not necessarily a decent minimum. The way this minimum is provided can still humiliate individuals, even if the end result is the best possible distribution of the goods as seen from the viewpoint of (...) justice. This analysis is combined with an analysis from the perspective of solidarity, particularly of reflective solidarity, as a way to develop decent care, which is care that does not humiliate individuals and maintains their dignity. (shrink)

Over many years, different theories have been developed to guide the social practices and policies of institutions so that they demonstrate equal concern and respect for all, and satisfy the requirements of justice. Although the normative principles described in a theory may support just institutions, whether this results in just outcomes will depend on how the decisions that implement the principles are made and actioned. As a societal institution charged with caring for people, ensuring just outcomes (...) is a distinct concern in healthcare. Relationships within this institution are constitutive of human flourishing and are also important to justice. Yet, it is not possible to create, maintain or evaluate interpersonal relationships in the same manner as institutions because rather than being universal and impartial, they are particular and partial. Consequently, the link between theories of justice that guide decision-making in relation to structures or institutions, and the relationships that influence those with a proximate effect on individuals, is not explicit. To address this gap, this article argues that a focus on human flourishing provides a nexus between the decision-making for just institutions and just outcomes for individuals. (shrink)

This article tries to analyze the meaning of a decent minimum of health care, by confronting the idea of decent care with the concept of justice. Following the ideas of Margalith about a decent society, the article argues that a just minimum of care is not necessarily a decent minimum. The way this minimum is provided can still humiliate individuals, even if the end result is the best possible distribution of the goods as seen from the viewpoint of (...) justice. This analysis is combined with an analysis from the perspective of solidarity, particularly of reflective solidarity, as a way to develop decent care, which is care that does not humiliate individuals and maintains their dignity. (shrink)

The cornerstone of contemporary nursing practice is the provision of individualised nursing care. Sustaining and nourishing the stream of research frameworks that inform individualised care are the findings from qualitative research. At the centre of much qualitative research practice, however, is an assumption that experiential understanding can be delivered through a thematisation of meaning which, it will be argued, can lead the researcher to make unsustainable assumptions about the relations of language and meaning‐making to experience. We will show that an (...) uncritical subscription to such assumptions can undermine the researcher's capacity to represent experience at the high level of abstraction consistent with experience itself and to thus inform genuinely individualised care. Instead, using qualia as a touchstone for the possibilities of understanding and representing experience, we trace the ‘designative’ and ‘expressive’ distinction to language in order to raise critical questions concerning both these assumptions and common practices within qualitative research. Following the ‘expressive’ account of language, we foreground in particular the hermeneutic work of Gadamer through which we explore the possibilities for a qualitative research approach that would better seek the mot juste of individual experience and illuminate qualia in order to better inform genuinely individualised care. (shrink)

Among the various human forms alluded to in the Hebrew prayer, mental retardation appears to be one of the most difficult to celebrate. It is the disability that other disabled persons do not want attributed to them. It is the disability for which prospective parents are most likely to use selective abortion (Wertz 2000). And it is the disability that prompted one of the most illustrious United States Supreme Court Justices to endorse forced sterilization, because "three generations of imbeciles are (...) enough." The mentally retarded have at times been objects of pity, compassion, or abuse by their caretakers and society at large. But they have rarely been seen as subjects, as citizens, as persons with equal entitlement to fulfillment. (shrink)

There is general agreement about the very broad outlines of a just tax structure in the Roman Catholic tradition, and these are sketched in part I. There has been, however, no sustained, systematic, in-depth treatment of the question. Part II develops those aspects of the Roman Catholic ethical tradition which ground a just tax structure-the role of the state in working for the common good, distributive justice with its proportional equality, the universal destiny of the goods of creation (...) to serve the needs of all. In addition, some attention is given to the historical practice of tithing, the state's obligation to care for the poor, and the moral obligation to pay just taxes. Part III proposes the goals which should govern a just tax structure in the Roman Catholic perspective and defends these goals against other possible interpretations. (shrink)

Whether practiced by ethics committees or clinical ethicists, medical ethics enjoys a solid foundation in acute care hospitals. However, medical ethics fails to have a strong presence in the primary care setting. Recently, some ethicists have argued that the reason for this disparity between ethics in the acute and primary care setting is that primary care ethics is distinct from acute care ethics: the failure to translate ethics to the primary care setting stems from the incorrect belief that acute care (...) ethics can be applied to the primary care setting. In this paper, I argue that primary care ethics and acute care ethics are species of the same ethical genus, and that the ethical differences are not ones of kind but of circumstance. I do this by appealing to the role obligations that underlie acute care and primary care clinicians’ medical ethical obligations and the shared institutions that ground those obligations. (shrink)

Traditional considerations of justice for those who require caregiving have centered on what is due to the dependent person. However, considerations of justice also bear strongly on what is due to the caregiver. I focus on unpaid dependency work, too long treated as a private matter rather than a public concern. More is owed to those who render care: the division of labor is unjust, the nature of dependency work creates vulnerabilities for caregivers, and unpaid caregivers are disadvantaged in the (...) world of paid work. Obligations to mitigate these facts are ultimately based on the truth that all members of society at some point in their lives benefit from caregiving and that noncaregivers benefit unfairly from the heavy distribution of dependency work to a small number of certain kinds of individuals. It is necessary to ask which agents of justice are responsible for remedying this state of affairs, and how. I propose a distributed scheme of obligation in which members of society and the state, as arbiter of social responsibility, share responsibility for the remedy. It is incumbent upon us as a society to refrain from making vulnerable the most essential among us, to reap benefits without sowing unjust burdens. (shrink)

This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must learn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democratic deliberation. Part I of this essay notes that rationing is a ubiquitous feature of our health care system at present, but it is mostly hidden (...) rationing, which is presumptively unjust. Part II argues that the need for health care rationing is inescapable. Although Oregon is flawed as a model of health rationing, it gives us worthy moral lessons for health reform at the national level, which I analyze and defend in Part III. The most significant of these lessons is the importance of rational democratic deliberation in articulating fair rationing protocols for a community. In Part IV I sketch the philosophic justification for this approach and respond to some important criticisms from Daniels. Keywords: cost containment, democratic deliberation, fairness, justice, rationing CiteULike Connotea Del.icio.us What's this? (shrink)

What should be the content of a package of health care services that we would want to guarantee to all Americans? This question cannot be answered adequately apart from also addressing the issue of fair health care rationing. Consequently, as I argue in this essay, appeal to the language of "basic," "essential," "adequate," "minimally decent," or "medically necessary" for purposes of answering our question is unhelpful. All these notions are too vague to be useful. Cost matters. Effectiveness matters. The clinical (...) circumstances of a patient matters. But what we must ultimately determine is what we mutually agree are the just claims to needed health care of each American in a relatively complex range of clinical circumstances. Answering this question will require a public moral conversation, a fair process of rational democratic deliberation aimed at defining both just claims to needed health care and just limits. (shrink)

This personal narrative tugs at the heart strings. However, personal narratives are not sufficient to justify public funding for any screening policy. We have to take seriously the ‘just caring’ problem. We have only limited resources to meet virtually unlimited health care needs. No doubt, screening tests often save lives. The author wants public funding for prostate-specific antigen screening for prostate cancer. However, why only prostate cancer? Numerous cancers at various stages can be screened for. Are all of (...) them equally deserving of public funding? What about screening for a very long list of other life-threatening medical disorders? There is nothing ethically special about cancer. Where does the money come from to pay for all these screening tests? Do we reduce expensive life-prolonging care for patients in late-stage diseases? Ultimately, a balance must be struck between saving statistical lives through screening and saving identifiable lives in the intensive care unit. Achieving a just balance requires rational democratic deliberation as justification for these choices, not personal narratives. (shrink)

The prelims comprise: The Scope of Public Health: Challenges and Choices Health Care Justice and Public Health: When Is Enough Enough? Setting Public Health Priorities Justly: The Limits of Moral Theory References.

Social media has invaded our private, professional, and public lives. While corporations continue to portray social media as a celebration of self-expression and freedom, public opinion, by contrast, seems to have decidedly turned against social media. Yet we continue to use it just the same. What is social media, and how should we live with it? Is it the promise of a happier and more interconnected humanity, or a vehicle for toxic self-promotion? In this essay I examine the very (...) structure of social media communications in order to sketch how we should engage with social media. Social media communications are, I argue, a public communication of private content. This allows connections to be made with others in ways that would not otherwise be possible; however, it also submits the private to a status competition, which in turn is linked to mental health challenges. A ‘virtuous’ engagement with social media means being aware of these dynamics, and choosing to subordinate social media to other, more important goods. (shrink)

Adolescence is a valuable phase of life, not just because it is the phase of learning in school and preparing for a working life. During the COVID-19 pandemic it became clear that the rights, experiences, and lifeworlds of adolescents are considered less important than the needs of school, work, and productivity. However, there is an ethical claim for people to have a good adolescence, and this means that the losses of social contact, experiences, time, and space demanded of adolescents, (...) in order to protect older and vulnerable groups during the COVID-19 pandemic, should be taken seriously. A distinctive quality of adolescence is that it cannot be repeated, nor can these experiences be replicated as adults. First experiences of independence, friendship, love, informality, recklessness, and youthful exuberance are intrinsically valuable and cannot be substituted for later in life. It is therefore not surprising that adolescents have sought and found their own spaces during the pandemic, some of them forbidden, because lock downs and closed social spaces have relegated them to the confines of their childhood bedrooms. In this paper, I explore an ethic of a good adolescence, which was impacted on by the COVID-19 pandemic, and consider what can be learned from this situation. Adolescents are to be taken seriously, their experiences are no less valuable than those of adults, and the losses they have suffered for the benefit of others should be honored. As far as possible, young people should be supported to have a voice in public discourse and in finding spaces to be adolescents. (shrink)

The debate around age-based healthcare rationing was precipitated by two books in the late 1980s, one by Daniel Callahan and the other by Norman Daniels. These books ignited a firestorm of criticism, best captured in the claim that any form of age-based healthcare rationing was fundamentally ageist, discriminatory in a morally objectionable sense. That is, the elderly had equal moral worth and an equal right to life as the nonelderly. If an elderly and nonelderly person each had essentially the same (...) medical problem requiring the same medical treatment, then they had an equal right to receive that treatment no matter what the cost of that treatment. Alternatively, if cost was an issue because the benefits of the treatment were too marginal, then both the elderly and nonelderly patients requiring that treatment ought to be denied it. If there were something absolutely scarce about the treatment, then some fair process would have to be used to make an allocation decision. (shrink)

Social justice is concerned with fair distribution of the benefits and burdens of living together in society. Regarding nursing care, social justice is concerned with who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it. A specific thesis is offered: ‘Health care, including nursing care, should be distributed on the basis of need, free at the point of use, the cost being born by the community involved.’ This (...) thesis is shown to be incompatible with consequentialist (utilitarian) and libertarian approaches to social justice, but reasons are given for rejecting these theories. It is shown that it may be compatible with Rawl's liberal theory of justice and definitely compatible with a version of the teleological (Aristotelian) theory. The thesis is then defended against criticisms concerned with desert and responsibility: that the provident ought not to pay for the improvident, and that those who are responsible for their health do not deserve free care. There are answered by an epistemological argument concerning what we need to know before we can decide what people deserve, and an argument about social cohesion. The conclusion is that the thesis can be offered as a moral principle for a fair society. (shrink)

What does it mean to be a “just” and “caring” society in meeting the health care needs of the terminally ill when we have only limited resources to meet virtually unlimited health care needs? This is the question that will be the focus of this essay. Another way of asking our question would be the following: Relative to all the other health care needs in our society, especially the need for lifesaving or life-prolonging health care, how high a (...) priority ought the health care needs of persons who are terminally ill have? Should any of the health care needs of the terminally ill be assigned very low priority? Or should all their health care needs be assigned the highest priority? If we reflect a bit, we will find ourselves greatly internally conflicted. On the one hand, the “caring” side of our moral self might see terminally ill individuals as being among the “medically least well off,” and therefore, deserving virtually any medical resources that will yield any degree of good for them. (shrink)

Midway in Martha Holstein’s article, these words occur: “[P]eople [should] get the help they need, when they need it, in the way that they would like to receive it, without exploiting family members or imperiling their dignity or self-respect” (24). In an essay that brims over with worrisome news, that this seemingly anodyne sentence appears in the section devoted to utopian thinking is perhaps the most dispiriting thought it conveys. Not that there isn’t keen competition for the role. Holstein reminds (...) her readers that the roots of the present and building crisis in long-term care sink deeply into an ideology especially entrenched in the United States; she suggests, as well, that the pernicious norms.. (shrink)

Studies have shown that using robot pets in dementia care contributes to a reduction in loneliness and anxiety, and other benefits. Studies also show that, even when people know they are dealing with robots, they often treat the robot as though it is a real pet with genuine emotions. This disconnect between beliefs and behavior occurs not just for people living with dementia, but with cognitively healthy adults, including those who are knowledgeable about how robots work. One possible (...) explanation is that robot pets prompt contradictory beliefs, and so the use of robot pets encourages self‐deception. Sparrow argues that this makes the use of robot pets in dementia care morally objectionable. We disagree. We argue that Gendler's concept of alief offers a better explanation of the belief‐behavior disconnect observed when people interact with robot pets. An alief is a mental state composed of an automatic, arational, emotional, and behavioral response to representational input. Aliefs are not beliefs and are not subject to truth norms. Thus, on our view, harms associated with the use of robot pets in dementia care are not likely to include the self‐deceptions that Sparrow suggests. It might seem like philosophical hair‐splitting to claim that deception has not occurred because discordant aliefs rather than false beliefs have been formed, but this distinction matters. We argue that aliefs carry their own risks. These risks are important to consider when using robot pets in dementia care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Just Revolution: A Christian Ethic of Political Resistance and Social Transformation by Anna Floerke ScheidRamon LuzarragaJust Revolution: A Christian Ethic of Political Resistance and Social Transformation Anna Floerke Scheid lanham, md: lexington books, 2015. 208 pp. $84.00Anna Floerke Scheid argues that the Christian just war and just peacemaking ethical traditions lack a comprehensive ethic for revolutionary nonviolent activity and warfare. She proposes to fill this (...) lacuna through a theological exploration of what constitutes a just revolution. While Scheid maintains a consistent [End Page 212] preference for nonviolent resistance against tyranny, she remains open to the possibility of revolutionary warfare.The author articulates four stages of a just revolution. The first stage is jus ante, nonviolent resistance against a tyrannical government. Here the opposition develops a democratic and revolutionary vision of society that respects human rights, models that vision within its organizations, and resists through nonviolent acts. Second is jus ad, the stage where a tyrannical government eliminates all avenues for negotiation and represses peaceful resistance. This forces the revolutionary opposition to consider armed resistance as a last resort. Here Scheid grapples with two limitations of traditional just war theory. The first reserves the authority to start a war with governments. She argues that the legitimacy for a just revolution comes from a revolutionary organization's ability to envision and model a just society. Because a tyrannical government's authority is illegitimate, a revolutionary movement's just vision and practices gain for it a de facto legitimate authority. This legitimacy is reinforced by a revolutionary movement's ultimate intention to effect reconciliation with their oppressors postwar. The second limitation is the reasonable hope of success. Scheid analyzes the history of this criterion and demonstrates how it supports defensive wars despite the uncertainty of success. Oppressed persons, as the subjects of their own hope of liberation, ought to decide what constitutes the probability for success in fighting tyranny. Throughout this stage, revolutionary warfare must be practiced in tandem with continuing nonviolent resistance.The third stage is jus in, the justice practiced during armed revolutionary resistance. Fighting is deemed necessary to force a tyrannical government to negotiations. Meanwhile, revolutionary military units would work to minimize violence and loss of life. The last stage is jus post, the reconciliation needed to prevent revolutionary warfare from spiraling into revenge. Here the exercise of restorative justice—where responsibility for past injustices is assumed by all sides and a just resolution developed for social reconciliation and the development of a new, democratic society that respects human rights—is all important. Throughout the book, Scheid uses the African National Congress's revolutionary struggle against the South African apartheid government as a successful example of her theory in practice.Scheid's well-argued proposal deserves careful consideration by ethicists. Students will profit from her excellent summary of just war theory, where she brilliantly recovers some of its forgotten features. On the other hand, her concluding chapter considering the Arab Spring's potential for just revolution would have been stronger if she extended beyond a comparison to South Africa to incorporate similar features found in other successful revolutions. The 1986 Philippine People Power Revolution, the 1989 collapse of Eastern European Communist regimes, and the 1974 Carnation Revolution in Portugal come to mind. Moreover, important for South Africa's success was the durability of the [End Page 213] political institutions the British left behind. These institutions provided the framework that handled the transition of power from the pro-apartheid National Party to the post-apartheid African National Congress government. This feature could have been brought to light, as many recognize this structure as contributive to the peaceful transition of power in other countries that won independence through revolution, from the United States in the eighteenth century to India and the Caribbean in the twentieth.Ramon LuzarragaBenedictine University at MesaCopyright © 2018 Society of Christian Ethics... (shrink)

Recent research points to the fact that new medical technological innovations are just as relevant in the context of long‐term care or chronic care as they are in the context of acute care. In the spirit of the Nuffield Foundation recommendations, this paper explores the possibilities of using robotic aides in long‐term care and identifies the tensions that must be considered and addressed if robotics is to be introduced successfully in nursing homes. Our examination is two‐pronged. First, we delve (...) into a fundamental issue surrounding AI, namely that of consciousness. We argue that automation will always have only a limited use in caregiving since caregiving as an activity requires the use of human‐type, that is, organic, consciousness. We support the thesis that the emergence and formation of human‐type consciousness require feelings such as empathy and the sense of touch, which, in turn, create the sense of kinship with fellow human beings. And second, we examine the benefits as well as risks of using robotic aides such as ZORA and PARO in long‐term care facilities. More specifically, we look at ZORA's use in a group setting, and PARO's use in an individual setting. We emphasize that long‐term care is one‐on‐one care, including but not limited to intimate care. Crucially, we argue that touch is at the heart of this type of care. We argue that some of the tensions with the use of robotic aides are generated precisely because of the lack of human touch. (shrink)

Turtles are among the most intriguing amniotes but their communication and signaling have rarely been studied. Traditionally, they have been seen as basically just silent armored ‘walking stones’ with complex physiology but no altruism, maternal care, or aesthetic perception. Recently, however, we have witnessed a radical change in the perception of turtle behavioral and cognitive skills. In our study, we start by reviewing some recent findings pertaining to various highly developed behavioral and cognitive patterns with special emphasis on turtles. (...) Then we focus on freshwater turtles and use data about their sexual behavior and size sexual dimorphism to test whether conspicuous coloration of the head is in these animals related to sexual processes. We found that absence of aggressive mating behavior is statistically associated with the presence of conspicuous coloration on turtles’ heads. It also seems that while species with female-biased SSD are characterised by conspicuously colored head ornaments, in species with male-biased SSD conspicuous coloration is absent. Unlike large females, males thus seem to be under pressure to develop conspicuous coloration and engage in non-aggressive behavior using signaling to succeed in courtship. And finally, we discuss possible roles of head color patterns in turtle communication during mating. (shrink)

How can we as health-care providers, along with those committed to advocating for health-care equity, draw on our work to tell stories that can make a difference in people’s lives? As a pediatrician and television writer, I’m in the unique position to promote public health through dramatic television stories that are grounded in data. By telling emotionally compelling stories that are informed by peer-reviewed research, we can improve public health, particularly in these COVID-19 times, when conspiracies and anecdotes swirl around (...) and crowd out the science.Today, all of us are fixated on what it means to be infectious, derived from the Latin inficere, “to spoil or stain.” The word itself is emotionally resonant... (shrink)

What is a just way of spending public resources for health and health care? Several significant answers to this question are under debate. Public spending could aim to promote greater equality in health, for example, or maximize the health of the population, or provide the worst off with the best possible health. Another approach is to aim for each person to have "enough" so that her health or access to health care does not fall under a critical level. (...) This latter approach is called sufficientarian. Sufficientarian approaches to distributive justice are intuitively appealing, but require further analysis and assessment. What exactly is sufficiency? Why do we need it? What does it imply for the just distribution of health or healthcare? This volume offers fresh perspectives on these critical questions. Philosophers, bioethicists, health policy-makers, and health economists investigate sufficiency and its application to health and health care in fifteen original contributions. (shrink)

The factions debating health care reform in the United States have gravitated toward one of two positions: that just health care is an individual responsibility or that it must be regarded as a national concern. Both arguments overlook a third possibility: that justice in health care is multilayered and requires the participation of multiple and diverse communities. _Communities of Health Care Justice_ makes a powerful ethical argument for treating communities as critical moral actors that play key roles in defining (...) and upholding just health policy. Drawing together the key community dimensions of health care, and demonstrating their neglect in most prominent theories of health care justice, Charlene Galarneau postulates the ethical norms of community justice. In the process, she proposes that while the subnational communities of health care justice are defined by shared place, including those bound by culture, religion, gender, and race that together they define justice. As she constructs her innovative theorization of health care justice, Galarneau also reveals its firm grounding in the work of real-world health policy and community advocates. _Communities of Health Care Justice_ not only strives to imagine a new framework of just health care, but also to show how elements of this framework exist in current health policy, and to outline the systemic, conceptual, and structural changes required to put these justice norms into fuller practice. (shrink)

When patients are not able to speak for themselves, surrogate decision makers are asked to guide treatment decisions and formulate a plan of care in accordance with what the patients would have wanted. This necessitates an exploration into the patients’ views about life and how it should be lived, how the patients constructed their identity or life story, and their attitudes towards sickness and suffering. When an individual appoints a surrogate, such as a healthcare power of attorney, a common presumption (...) is that this designation evinces merit. This obscures the possibility of multiple other considerations that influence individual choice. This article presents a clinical case in which the claim to know someone best created a controversy that brought treatment decisions to a standstill. Further, it illuminates how the question, “Given the current medical condition, what would this person want?” risks presuming that a singular, unambiguous preference exists and that one person can provide the answer. Clinical ethicists can play a vital role in situations when there is a dispute among a designated surrogate and family members over a patient’s preference. By embracing the complexity of the desire to synthesize seemingly irreconcilable perspectives about identity, uncovering the reasons that underlie disagreement, and guiding inquiry in such a way that allows stakeholders to move beyond the conflict, clinical ethicists can facilitate decision making that honors the patient and may mitigate moral distress. (shrink)

Health care organization is entering a new age. Focus is increasingly shifting from individual health care institutions to interorganizational collaboration and health care networks. Much hope is set on such networks which have been argued to improve economic efficiency and quality of care. However, this does not automatically mean they are always ethically justified. A relevant question that remains is what ethical obligations or duties one can ascribe to these networks especially because networks involve many risks. Due to their often (...) amorphous and complex structure, collective responsibility and accountability may increase while individual responsibility goes down. We argue that a business ethics approach to ethical obligations for health care networks, is problematic and we propose to opt for a patient perspective. Using the classic four principles of biomedical ethics it is possible to identify specific ethical duties. Based on the principle of justice, health care networks have an ethical duty to provide just and fair access for all patients and to be transparent to patients about how access is regulated. The principle of nonmaleficence implies an obligation to guarantee patient safety, whereas the principle of beneficence implies an obligation for health care networks to guarantee continuity of care in all its dimensions. Finally, the principle of autonomy is translated into a specific obligation to promote and respect patient choice. Networks that fail to meet any of these conditions are suspect and cannot be justified ethically. Faced with daunting challenges, the health care system is changing rapidly. Currently many hopes ride on integrated care and broad health care networks. Such networks are the topic of empirical debate, but more attention should be given to the ethical aspects. Health care networks raise new and pressing ethical issues and we are in need of a framework for assessing how and when such networks are justified. (shrink)

We care not just how things are but how they could have been otherwise – about possibility and necessity as well as actuality. Many philosophers regard such talk as beyond the reach of respectable science, since observation tells us how things are but not how they could have been otherwise. I argue that, on the contrary, such criticisms are ill-founded: possibility and necessity are studied in natural science, for example through phase spaces, abstract mathematical representations of the possible (...) states of a physical system. The possibility is objective, not merely epistemic, though it may be more restricted than pure metaphysical possibility. The elements of a phase space are very similar to Kripke's possible worlds, despite being time slices rather than total histories. The absence of explicit modal operators in the mathematical models used by scientists does not show science to be non-modal; rather, it manifests reliance on a mathematical framework for theorizing about objective possibility similar to the mathematical framework of possible worlds model theory. (shrink)

A recalcitrant emotion is an emotion that we experience despite a judgment that seems to conflict with it. Having been bitten by a dog in her childhood, Jane cannot shake her fear of dogs, including Fido, the cute little puppy that she knows to be in no way dangerous. There is something puzzling about recalcitrant emotions, which appear to defy the putatively robust connection between emotions and judgments. If Jane really believes that Fido cannot harm her, what is she afraid (...) of? This article seeks to show how recalcitrant emotion is possible. I argue that reductive theories that identify emotions with judgments, desires, or some combination thereof, cannot explain the possibility of emotional irrationality without contradiction. I then show that the appeal to sui generis attitudes also fails to solve the puzzle of recalcitrant emotions, and diagnose this failure as stemming from a misleading analogy between emotions and perceptions, and in particular, between recalcitrant emotions and perceptual illusions. The solution can be found in a different analogy: between emotions and actions; more specifically, between recalcitrant emotions and weakness of the will, akrasia. Like akratic actions, recalcitrant emotions entail responding to reasons, but to inferior reasons. Irrational but non-contradictory emotions are possible just as weakness of will is possible. (shrink)

What is a just way of spending public resources for health and health care? Several significant answers to this question are under debate. Public spending could aim to promote greater equality in health, for example, or maximize the health of the population, or provide the worst off with the best possible health. Another approach is to aim for each person to have "enough" so that her health or access to health care does not fall under a critical level. (...) This latter approach is called sufficientarian. Sufficientarian approaches to distributive justice are intuitively appealing, but require further analysis and assessment. What exactly is sufficiency? Why do we need it? What does it imply for the just distribution of health or healthcare? This volume offers fresh perspectives on these critical questions. Philosophers, bioethicists, health policy-makers, and health economists investigate sufficiency and its application to health and health care in fifteen original contributions. (shrink)

A language of care and relationship-building has recently appeared with prominence in the business literature, driven by the realities of the marketplace. Thus, it seems a propitious time to reflect on a decade of writing in feminist morality that has focussed on the concept of an ethic of care, and examine its relevance for today's business context. Is the idea of creating organizations that “care” just another management fad that subverts the essential integrity of concepts of ethical caring? (...) Conversely, are these concepts capable of beginning an important dialogue that may help us to see new possibilities for simultaneously enhancingboththe effectiveness and the moral quality of organizations in the future? (shrink)

The American system of long‐term care is disorganized and expensive. Obtaining care for a loved one is a confusing and difficult journey. When it comes to paying for that care, a bit over half who receive care are supported at least partially by insurance, and those with no insurance pay entirely out of pocket. The costs are exorbitant. What makes the system function is reliance on unpaid family members, who care for their loved ones often at considerable cost to themselves.As (...) the baby boom generation ages, this creaky system will become increasingly dysfunctional, and a likely shortage of caregivers will be at the heart of the difficulties. The supply of unpaid family caregivers will become limited, as the ratio of people in the category of ages forty‐five to sixty‐four compared to those who are eighty and older shrinks from just above seven to one in 2010 to just above four to one in 2030. Paid caregivers will be needed to take up the slack, yet they are poorly paid, work under very difficult conditions, and receive little respect from the health care system. In this essay, I discuss the circumstances facing these paid home‐care workers and a possible path forward, illustrating the current problems by drawing on interviews I conducted for a book‐length study published in 2017. (shrink)

Does life have meaning? What is flourishing? How do we attain the good life? Philosophers, and many others of us, have explored these questions for centuries. As Eva Feder Kittay points out, however, there is a flaw in the essential premise of these questions: they seem oblivious to the very nature of the ways in which humans live, omitting a world of co-dependency, and of the fact that we live in and through our bodies, whether they are fully abled or (...) disabled. Our dependent, vulnerable, messy, changeable, and embodied experience colors everything about our lives both on the surface and when it comes to deeper concepts, but we tend to leave aside the body for the mind when it comes to philosophical matters. Disability offers a powerful challenge to long-held philosophical views about the nature of the good life, what provides meaning in our lives, and the centrality of reason, as well as questions of justice, dignity, and personhood. These concepts need not be distant and idealized; the answers are right before us, in the way humans interact with one another, care for one another, and need one another--whether they possess full mental capacities or have cognitive limitations. We need to revise our concepts of things like dignity and personhood in light of this important correction, Kittay argues. This is the first of two books in which Kittay will grapple with just how we need to revisit core philosophical ideas in light of disabled people's experience and way of being in the world. Kittay, an award-winning philosopher who is also the mother to a multiply-disabled daughter, interweaves the personal voice with the philosophical as a critical method of philosophical investigation. Here, she addresses why cognitive disability can reorient us to what truly matters, and questions the centrality of normalcy as part of a good life. With profound sensitivity and insight, Kittay examines other difficult topics: How can we look at the ethical questions regarding prenatal testing in light of a new appreciation of the personhood of disabled people? What do new possibilities in genetic testing imply for understanding disability, the family, and bioethics? How can we reconsider the importance of care, and how does it work best? In the process of pursuing these questions, Kittay articulates an ethic of care, which is the ethical theory most useful for claiming full rights for disabled people and providing the opportunities for everyone to live joyful and fulfilling lives. She applies the lessons of care to the controversial alteration of severely cognitively disabled children known as the Ashley Treatment, whereby a child's growth is halted with extensive estrogen treatment and related bodily interventions are justified. This book both imparts lessons that advocate on behalf of those with significant disabilities, and constructs a moral theory grounded on our ability to give, receive, and share care and love. Above all, it aims to adjust social attitudes and misconceptions about life with disability. (shrink)

Grey zone attacks tend to paralyze response for two reasons. First, they present us with choice scenarios of inherently dilemmatic structure, e.g., Prisoners’ Dilemmas and games of chicken, complicated by difficult conditions of choice, such as choice under risk or amid vagueness. Second, they exploit our uncertainty about how much we do or should care about the things under attack¬—each attack is small in effect, but their effects accumulate: how should we decide whether to treat a given attack as something (...) meriting a serious response rather than a mere irritation to be ignored? This chapter brings standard decision theoretic tools to bear on the issues, tools such as the maximization of expected utility principle, and the precautionary principle. But it also develops three innovations. It shows that seeing it as possible to make choices not just of actions given our values, but also choices of values themselves, can extricate us from certain kinds of decision paralysis. It shows how we can rationally regard ourselves as having bright decision lines even when nothing in the circumstance of choice has these lines in its structure. And it shows how certain conflict escalation risks from the former two strategies can be managed by both parties seeing that cooperation can yield a sharable surplus of goods, and that cooperation can be rational upon a rationally defensible change in their values so that each comes to derive utility from the success of both parties. This yields cooperative solutions to what amount to Prisoners’ Dilemmas. The Cold War was prosecuted on the logic of strategic rationality and that part of game theory that is deterrence theory. We need a new logic from decision theorists for the games that constitute grey zone conflict. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Just Share: Justice and Fairness in Resource Allocation*Pat Milmoe Mccarrick (bio) and Martina Darragh (bio)Each of us has some basic sense of what the words “fair” or “just” or “fairness” or “justice” mean. Each of us probably also has an idea of what is “fair” in health care. The attempt by the state of Oregon in the mid-1980s to quantify this notion made a previously private (...) exercise a public one. This transition has been chronicled in the bioethics literature that focuses on resource allocation. These works examine both theories of justice and concepts of “health”; the fair distribution of health resources has been of continuing interest since the beginning of bioethics in the 1960s. Early writing on justice includes authors Tom L. Beauchamp, Robert H. Blank, James F. Childress, H. Tristram Engelhardt, Paul T. Menzel, Paul Ramsey, and Robert M. Veatch (VII).During the 1980s, bioethicists such as Daniel Callahan and Norman Daniels proposed thinking of health care decisions not as moments of personal crisis but as choices that span a lifetime, possibly involving tradeoffs in other areas of one’s life, e.g., education. The Oregon experience added another dimension to the discussion. The initial rank-ordering of health services by cost produced a skewed list—for example, surgery for life-threatening conditions ranked below minor, elective procedures. For the project to make sense, the ranking algorithm could not be based on cost alone, but rather on a combination of costs and benefits both to individuals and to the community—“concatenations of individual and group goods” (I, Jecker and Jonsen 1995). Various metaphors have been used in the literature to facilitate discussion of this shift from individual to individual/community trade-offs: medical services as a “commons” (I, Asch 1995, Jecker and Jonsen 1995, Michels 1994); resource allocation as a “lifeboat” (I, Campbell 1995; III, Kaveny 1994); medical care as “shares” in a community health (III, Nelson 1992, Ford and Kissick 1995; II, Anderson 1993); and rationing as traveling through the desert with one jug of water for two people (a story from the Halachah literature) (I, Zoloth-Dorfman 1995). [End Page 81]Such metaphors do not promote any one “theory of justice” but rather draw from the work of a number of bioethicists as well as from theological, sociological, economic, and business literature. The five major conceptions of justice that are referenced most frequently are: “(1) a libertarian conception, which takes liberty to be the ultimate political ideal; (2) a socialist conception, which takes equality to be the ultimate political ideal; (3) a welfare liberal conception, which takes contractual fairness or maximal utility to be the ultimate political ideal; (4) a communitarian conception, which takes the common good to be the ultimate political ideal; and (5) a feminist conception, which takes a gender-free society to be the ultimate political ideal” (I, Sterba 1995).The use of new metaphors also draws on expanded concepts of “health.” “As health care is currently practiced, the most powerful symbols for public and professional alike are those that promise the defeat of time” (I, Campbell 1995). When medical care is perceived as an unrelated series of individual cures, the fact that health care resources are finite cannot be addressed.Reflections concerning the difficulties in limiting the use of health care resources have an ancient lineage and reveal a tight bond with the obsession to postpone death at all costs. Plato in Book 3 of the Republic recognizes the quandary of infinite expectations and finite resources that characterizes the challenge of health care choices. (I, Engelhardt 1996)The proliferation of expensive medical technologies and the loss of autonomy by health care professionals further complicates perceptions of the crucial issues at hand. Some have said that Americans place too much emphasis on individualism to address these issues. Daniels et al. believe that this is too pessimistic a view and that the American commitment to protecting equal opportunity for all provides a firm basis for developing a public consensus on what is fair in health care (III, Daniels, Light, and Caplan 1996). Finally, several authors suggest that the nature of all four principles of medical ethics, not justice alone, must be... (shrink)