The ethical implications of the growth of for-profit health care institutions are complex. Two major moral criticisms of for-profit medicine are analyzed. The first claim is that for-profit health care institutions fail to fulfill their obligations to do their fair share in providing health care to the poor and so exacerbate the problem of access to health care. The second claim is that profit seeking in medicine will damage the physician-patient relationship, creating conflicts of interest that will diminish the quality (...) of care and erode patients' trust in their physicians and the public's trust in the medical profession. The authors conclude that while the continued expansion of for-profit health care may exacerbate in some respects problems of access, trust and conflicts of interest, it is a mistake to consider these problems as unique to for-profit health care; they are problems for not for-profit health care as well. Though these issues justify continuing moral concern, they do not at this time provide decisive grounds for substantially curbing or eliminating for-profit enterprise in health care. (shrink)

: Pharmacogenetics offers the prospect of an era of safer and more effective drugs, as well as more individualized use of drug therapies. Before the benefits of pharmacogenetics can be realized, the ethical issues that arise in research and clinical application of pharmacogenetic technologies must be addressed. The ethical issues raised by pharmacogenetics can be addressed under six headings: regulatory oversight, confidentiality and privacy, informed consent, availability of drugs, access, and clinicians' changing responsibilities in the era of pharmacogenetic medicine. We (...) analyze each of these categories of ethical issues and provide policy approaches for addressing them. (shrink)

This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance (...) directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)

This article reviews the strengths and limitations of five major paradigms of medical computer-assisted decision making (CADM): (1) clinical algorithms, (2) statistical analysis of collections of patient data, (3) mathematical models of physical processes, (4) decision analysis, and (5) symbolic reasoning or artificial intelligence (Al). No one technique is best for all applications, and there is recent promising work which combines two or more established techniques. We emphasize both the inherent power of symbolic reasoning and the promise of artificial intelligence (...) and the other techniques to complement each other. (shrink)

In Beyond Humanity a leading philosopher offers a powerful and controversial exploration of urgent ethical issues concerning human enhancement.

This book articulates a systematic vision of an international legal system grounded in the commitment to justice for all persons. It provides a probing exploration of the moral issues involved in disputes about secession, ethno-national conflict, "the right of self-determination of peoples," human rights, and the legitimacy of the international legal system itself. Buchanan advances vigorous criticisms of the central dogmas of international relations and international law, arguing that the international legal system should make justice, not simply peace among (...) states, a primary goal, and rejecting the view that it is permissible for a state to conduct its foreign policies exclusively according to what is in the "national interest." He also shows that the only alternatives are not rigid adherence to existing international law or lawless chaos in which the world's one superpower pursues its own interests without constraints. This book not only criticizes the existing international legal order, but also offers morally defensible and practicable principles for reforming it. Justice, Legitimacy, and Self-Determination will find a broad readership in political science, international law, and political philosophy. (shrink)

This is a systematic evaluation of the main arguments for and against the market as an instrument of social organization, balancing efficiency and justice. It links the distinctive approaches of philosophy and economics to this evaluation.

: The mandate of the U.S. Advisory Committee on Human Radiation Experiments required that the Committee take a position on the validity of retrospective moral judgments. However, throughout its period of operation, the Committee remained divided on the question of whether sound judgments of individual culpability and wrongdoing should be included in its Final Report. This essay examines the arguments that various committee members marshalled to support their opposing views on retrospective moral judgment and explains the significance of the controversy.

Among analytic philosophers in the past few years there has been a growing commitment to taking Marx seriously. Since the publication in 1971 of John Rawls’ book A Theory of Justice there has been a growing commitment to taking problems of Justice and rights seriously. These two developments intersect in mutual criticism: Marx's radical critique challenges the resources of recent theories of rights and Justice, while the sophistication of recent theories raises the possibility that they escape Marx's most basic criticism.

Among analytic philosophers in the past few years there has been a growing commitment to taking Marx seriously. Since the publication in 1971 of John Rawls’ book A Theory of Justice there has been a growing commitment to taking problems of Justice and rights seriously. These two developments intersect in mutual criticism: Marx's radical critique challenges the resources of recent theories of rights and Justice, while the sophistication of recent theories raises the possibility that they escape Marx's most basic criticism.

There are no first principles etched in stone from which all moral philosophers must take their bearings. We must deliberately choose our point of departure in any attempt to respond to the question: “Must any defensible theory of justice incorporate both a commitment to personal liberty and to economic equality?” Basic to our own approach is a suspicion of seers and visionaries who espy an external source of values independent from human choices. We presuppose, instead, that political philosophy commences with (...) individual evaluation. 1 A near-corollary of this presupposition is that each individual's preferences ought to be taken into account equally with those of others. That is, we suppose that there is no privileged evaluator, whose preferences are accorded decisive weight. Conceptual unanimity as a criterion for institutional evaluation follows naturally from the other two presuppositions. If there is neither an external standard of value nor a corps of resident value experts, only unanimity can ultimately be satisfactory as a test of social desirability. Our perspective then is subjectivist, individualist, and unanimitarian. These presuppositions inform our contractarian analysis. There are, however, two separate contractarian traditions that we shall find useful to distinguish, the “Hobbesian” and the “Rawlsian.” In the first, persons find themselves in the anarchistic war of each against all. They contract away their natural liberties in exchange for the order that civil society – through its sovereign – affords. In this contracting process, individuals are assumed to possess full self-knowledge; they know who they are, what conceptions of the good they hold, and what their endowments are. (shrink)

Containing over 750 in-depth entries, this is the most wide-ranging and up-to-date dictionary of critical theory available. It covers the whole range of critical theory, including the Frankfurt school, cultural materialism, cultural studies, gender studies, film studies, literary theory, hermeneutics, historical materialism, internet studies, and sociopolitical critical theory. Entries clearly explain even the most complex of theoretical discourses, such as Marxism, psychoanalysis, structuralism, deconstruction, and postmodernism. There are biographies of important figures in the field, with feature entries for those who (...) have heavily influenced areas of the discipline, e.g. Deleuze. -/- Entries are fully cross-referenced and contain further reading where appropriate. To provide extra information this edition features an appendix of recommended web links, which are accessible via the Dictionary of Critical Theory companion website, where they are also checked regularly and kept up to date. -/- Covering all aspects of the subject from globalization and race studies, to queer theory and feminism, this multidisciplinary A-Z is essential for students of literary and cultural studies and is useful for anyone studying a humanity subject requiring a knowledge of theory. (shrink)

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

Our society has long sanctioned, at least tacitly, a degree of conflict of interest in medical practice and clinical research as an unavoidable consequence of the different interests of the physician or clinical investigator, the patient or clinical research subject, third party payers or research sponsors, the government, and society as a whole, to name a few. In the past, resolution of these conflicts has been left to the conscience of the individual physician or clinical investigator and to professional organizations. (...) The public is no longer willing to allow health care providers to wholly govern their own conflicts of interest for several reasons. These include: new forms of health care financing and delivery that provide innovative and lucrative opportunities for physician or insurer enrichment at patient expense; the increased importance of commercial research support as peer-reviewed governmental research support has decreased; evidence that physicians and clinical investigators too frequently resolve conflicts of interest in their own favor; and a general societal mistrust of authority. This volume represents a multidisciplinary effort, drawing from philosophy, medicine, law, economics and public policy to identify and categorize conflicts of interest in medical practice and clinical research, and, where possible, to offer a mechanism for resolving them. Part I addresses conflicts of interest from a theoretical perspective, offering basic concepts and analytical frameworks. The second part discusses two topics prominent in current health care policy debates--self-referral and financial incentives to limit care. Part III examines conflicts of interest generated by pharmaceutical industry involvement in clinical practice and research. The final section deals with conflicts of interest in clinical research in several contexts, including institutional reviews boards, clinical trials, Cooperative Research and Development Agreements between government and private researchers, brokerage of research subjects by Contract Research Organizations, and cost-effectiveness studies. (shrink)

Brian Loar [1976] observed that, even in the simplest of cases, such as an utterance of (1): ‘He is a stockbroker’, a speaker's audience might misunderstand her utterance even if they correctly identify the referent of the relevant singular term, and understand what is being predicated of it. Numerous theorists, including Bezuidenhout [1997], Heck [1995], Paul [1999], and Récanati [1993, 1995], have used Loar's observation to argue against direct reference accounts of assertoric content and communication, maintaining that, even in these (...) simple cases, the propositional contribution of a referring expression must be more than just its referent. -/- I argue here that, while Loar's observation is correct, the conclusion he and others have sought to draw from it simply does not follow. Rather, his observation helps to remind us of an important Gricean insight into the nature of communicative acts—including acts of speaker-reference—namely, that there is more to understanding a communicative act than merely entertaining what a speaker is intending to communicate thereby. Once we remember this insight, we see that the phenomenon to which Loar is calling our attention should actually be expected given the direct reference theorist's assumptions, together with independently plausible Gricean principles concerning how we make our referential intentions manifest in communication. More generally, the Gricean strategy for explaining the challenge posed by Loar cases suggests a novel way to account for certain crucial anti-direct reference intuitions—one requiring no modification of the original theory (e.g., no invocation of ‘descriptive enrichments’ as in Soames [2002]), thereby allowing for a direct reference account of what is asserted in utterances of ‘simple sentences’ such as (1). (shrink)

E-games are a dramatically expanding dimension of contemporary exploitations of computing and computer network technologies - one that, thus far, has evoked much more heat among parents and politicians than light in the form of serious scholarly and philosophical analysis. We argue that e-games deserve such analysis in part because of their intrinsic philosophical interest as they raise primary philosophical questions of ontology, epistemology, human nature, the character of "gameplay," - and most especially, of ethics. We further suggest that such (...) analyses - exemplified by the articles collected here - may also contribute to resolving the larger social and political debates evoked by e-games. (shrink)

Michael Williams believes that scepticism about the externalworld seems compelling only because the considerations that underpin it are thoughtto be ``mere platitudes'' about e.g., the nature and source of human knowledge, and hence,that if it shown through a ``theoretical diagnosis'' that it does not rest upon suchplatitudes, but contentious theoretical considerations that we are no means bound toaccept, we can simply dismiss the absurd sceptical conclusion. Williams argues thatscepticism does presuppose two extremely contentious doctrines, however, he admits thatif these doctrines (...) are themselves motivated by ``platitudes'' then scepticism follows. Iaddress Williams's arguments for thinking scepticism must presuppose these doctrines,and argue that he overlooks a way that they can be seen as motivated by mere platitudes.Thus, I conclude that William's novel rejection of scepticism fails. (shrink)

Recent events at Enron, K-Mart, Adelphia, and Tyson would seem to suggest that managers are still experiencing ethical lapses. These lapses are somewhat surprising and disappointing given the heightened focus on ethical considerations within business contexts during the past decade. This study is designed, therefore, to increase our understanding of the forces that shape ethical perceptions by considering the effects of business school education as well as a number of other individual-level factors (such as intra-national culture, area of specialization within (...) business, and gender) that may exert an influence on ethical perceptions. We found significant effects for business education, self-reported intra-national culture, area of specialization within business, and gender for some and/or all areas of ethics examined (i.e., deceit, fraud, self-interest, influence dealing, and coercion). One of our most encouraging findings is that tolerance for unethical behavior appears to decrease with formal business education. Despite the prevalent stereotype that business students are only interested in the bottom line or that business schools transform idealistic freshman into self-serving business graduates, our results suggest otherwise. Given the heightened criticism of the ethicality of contemporary managerial behavior, it is heartening to note that, even as adults, individuals can be positively affected by integration of ethics training. (shrink)

The experience of time and temporally extended events is a fundamental property of mind, and of time-based media arts. In dealing with properties of time, does the operational logic of contemporary media production tools cohere with philosophical views on the experience of time? This article considers a range of views on the phenomenal experience of time as they relate to the production of time-based media. Embedded within our production technologies, the artist is faced with a new philosophical instrument: the production (...) timeline. The timeline utility in most time-based media software (and non-digital precursors) adopts the cinematic model as its operating metaphor; a series of frames, assembled one after the other in sequence. But the timeline brings new temporal complications such as reversibility, hierarchy and modifiability. The timeline also contorts time into a spatialized dimension, represented as a linear vector within the software interface. Automatic adoption of the linear timeline and the frame as the base unit of temporal thinking is problematic. J. M. E. McTaggart’s argument for the unreality of time based on contradictions within a range of possible temporal modal logics is compared with approaches to animation and editing software, and also interactive media software and their unique approach to time as potential events is considered. (shrink)

During the COVID-19 pandemic, questions have been raised about the impact of face masks on communication in classroom settings. However, it is unclear to what extent visual obstruction of the speaker’s mouth or changes to the acoustic signal lead to speech processing difficulties, and whether these effects can be mitigated by semantic predictability, i.e., the availability of contextual information. The present study investigated the acoustic and visual effects of face masks on speech intelligibility and processing speed under varying semantic predictability. (...) Twenty-six children and twenty-six adults performed an internet-based cued shadowing task, in which they had to repeat aloud the last word of sentences presented in audio-visual format. The results showed that children and adults made more mistakes and responded more slowly when listening to face mask speech compared to speech produced without a face mask. Adults were only significantly affected by face mask speech when both the acoustic and the visual signal were degraded. While acoustic mask effects were similar for children, removal of visual speech cues through the face mask affected children to a lesser degree. However, high semantic predictability reduced audio-visual mask effects, leading to full compensation of the acoustically degraded mask speech in the adult group. Even though children did not fully compensate for face mask speech with high semantic predictability, overall, they still profited from semantic cues in all conditions. Therefore, in classroom settings, strategies that increase contextual information such as building on students’ prior knowledge, using keywords, and providing visual aids, are likely to help overcome any adverse face mask effects. (shrink)

“A fine collection of essays exploring, and in many cases extending, Jim Buchanan’s many contributions and insights to economic, political, and social theory.”– Bruce Caldwell, Professor of Economics, Duke University, USA"The overwhelming impression the reader gets from this very fine collection is the extraordinary expanse of James Buchanan's work. Everyone interested in economics and related fields can profit mightily from this book."– Mario Rizzo, Professor of Economics, New York University, USA This book explores the academic contribution of James (...) Buchanan, who received the Nobel Prize for economics in 1986. Buchanan’s receipt of the Prize is noteworthy because he was a maverick within the economics profession. In contrast to the preponderance of economists, Buchanan made little use of mathematics and no use of econometrics, preferring to used logic and language to insert his ideas into the scholarly community. Moreover, his ideas extended the domain of economic inquiry along many paths that numerous economists subsequently pursued. Buchanan’s scholarship brought economics and political science together under the rubric of public choice. He was also was a prime figure in bringing economic theory into closer contact with moral and social philosophy.This volume includes essays distributed across the extensive domain of Buchanan’s scholarly contributions, reflecting the range of his scholarly interests. Chapters will examine Buchanan’s scholarly work on public finance, social insurance, public debt, public choice, economic methodology, constitutional political economy, law and economics, and ethics and social theory. The book also examines Buchanan in relation to other prominent economists, both from the distant past and the recent past. (shrink)

This essay introduces a collection of 49 essays that exemplify the breadth and the depth of James M. Buchanan’sBuchanan, James M. contributions to economics in the post-war period. Buchanan started his career in 1948 as someone who wanted to provide a different scholarly framework for a theory of public finance and managed to do so. What resulted was a scholarly output that was published in 20 volumes in 2002, to which he continued to add until his death. The (...) essays in this volume reflect the breadth and depth of Buchanan’s contributions to political economy and social philosophy. While these essays are written by people who admired and learned from Buchanan’s work, these are not essays in hagiography. They explore various questions and topics that interested Buchanan. A good number of these explorations have critical overtones, but most significantly they build upon lines of inquiry that animated Buchanan’s scholarly curiosity. (shrink)

In the past decade, the notion of a neural correlate of consciousness has become a focal point for scientific research on consciousness. A growing number of investigators believe that the first step toward a science of consciousness is to discover the neural correlates of consciousness. Indeed, Francis Crick has gone so far as to proclaim that ‘we need to discover the neural correlates of consciousness. For this task the primate visual system seems especially attractive. No longer need one spend time (...) attempting to endure the tedium of philosophers perpetually disagreeing with each other. Consciousness is now largely a scientific problem’. Yet the question of what it means to be a neural correlate of consciousness is actually far from straightforward, for it involves fundamental empirical, methodological, and philosophical issues about the nature of consciousness and its relationship to the brain. Even if one assumes, as we do, that states of consciousness causally depend on states of the brain, one can nevertheless wonder in what sense there is, or could be, such a thing as a neural correlate of consciousness. (shrink)

This chapter explores the cognitive and moral significance of the kind of imaginative experience poetry offers. It identifies two forms of imaginative experience that are especially important to poetry: ‘experiencing-as’ and ‘experience-taking’. Experiencing-as is ‘inherently first-personal, embodied, and phenomenologically characterized’ while in experience-taking one ‘takes the perspective of another, simulating some aspect or aspects of his psychology as if they were his own’. Through a sensitive and probing reading of Paul Celan’s Psalm, the chapter shows the role these two forms (...) of experience play in producing the unique form of ethical and epistemic value poetry can bear. The chapter’s argument for this has important implications for our understanding of the poetic imagination and nature of our experience of meaning in poetic contexts. (shrink)