ABSTRACT As bioethics emerged in the 1960s and 1970s and began to have enormous impacts on the practice of medicine and research – fuelled, by broad socio‐political changes that gave rise to the struggle of women, African Americans, gay men and lesbians, and the antiauthoritarian impulse that characterised the New Left in democratic capitalist societies – little attention was given to the question of the ethics of public health. This was all the more striking since the core values and practices (...) of public health, often entailing the subordination of the individual for the common good, seemed opposed to the ideological impulses of bioethics. Of what relevance is autonomy‐focused bioethics for public health, with its mix of justifications including those that are either implicitly or explicitly paternalistic or that seek to impose strictures on individuals and communities in the name of collective welfare? To examine the deep divide between the central commitments of bioethics and the values that animate the practice of public health, we focus on a series of controversies implicating the concepts of privacy, liberty, and paternalism. Recognising the role of moral values in decision‐making was a signal contribution of bioethics in its formative period. Over the past three decades a broad array of perspectives emerged under the rubric of bioethics but individualism remains central. As we commence the process of shaping an ethics of public health, it is clear that bioethics is the wrong place to start when thinking about the balances required in defence of the public's health. (shrink)

Alice considered [the idea of un-birthday presents] a little. “I llke birthday presents best,” she said at last.“You don’t know what you’re talking about!” cried Humpty Dumpty. … “[There are three hundred and sixty-four days when you might get un-birthday presents… And only one for birthday presents, you know. There’s a ‘glory’ for you!”“I don’t know what you mean by ‘glory,’” Alice said.Humpty Dumpty smiled contemptuously. “Of course you don’t—till I tell you. I meant ‘there’s a nice knock-down argument for (...) you!’”“But ‘glory’ doesn’t mean ‘a nice knock-down argument,’” Alice objected.“When I use a word,” Humpty Dumpty said in a rather scornful tone, “it means just what I choose it to mean—neither more nor less.”. (shrink)

Alice considered [the idea of un-birthday presents] a little. “I llke birthday presents best,” she said at last.“You don’t know what you’re talking about!” cried Humpty Dumpty. … “[There are three hundred and sixty-four days when you might get un-birthday presents… And only one for birthday presents, you know. There’s a ‘glory’ for you!”“I don’t know what you mean by ‘glory,’” Alice said.Humpty Dumpty smiled contemptuously. “Of course you don’t—till I tell you. I meant ‘there’s a nice knock-down argument for (...) you!’”“But ‘glory’ doesn’t mean ‘a nice knock-down argument,’” Alice objected.“When I use a word,” Humpty Dumpty said in a rather scornful tone, “it means just what I choose it to mean—neither more nor less.”. (shrink)

Fairchild, Center for the History and Ethics of Public Health in the Department of Sociomedical Sciences at Columbia University's Mailman School of Public Health Abstract Surveillance is a cornerstone of public health. It permits us to recognize disease outbreaks, to track the incidence and prevalence of threats to public health, and to monitor the effectiveness of our interventions. But surveillance also challenges our understandings of the significance and role of privacy in a liberal democracy. In this paper we trace the (...) century-long history of public health surveillance in the United States situating that history in the context of the broad social, political, and ideological forces that have shaped our conceptions of privacy. Although we focus here on the United States, the debates over privacy that unfolded in the 1960s were repeated in many European nations. The themes we explore here, then, provide a framework for examining the relationship between privacy and public health in other contexts. CiteULike Connotea Del.icio.us What's this? (shrink)

As therapeutic advances in the treatment of AIDS began to emerge in the late 1980s and public health began to have more to offer than just the threat, or the perceived threat, of quarantine or partner notification, fissures began to appear in the alliance against named HIV reporting that had emerged a few years earlier. In 1989, New York City’s Health Commissioner stated that the prospects of early clinical intervention warranted “a shift toward a disease-control approach to HIV infection along (...) the lines of classic tuberculosis practices,” including the “reporting of seropositives.”Although his proposal met with fierce and effective resistance, it is now clear that his call represented part of a national trend. The CDC continued to press for cases of HIV to he reported by name to health departments, an effort that assumed the dimensions of a campaign. It was supported by a growing number of public health officials. (shrink)

As therapeutic advances in the treatment of AIDS began to emerge in the late 1980s and public health began to have more to offer than just the threat, or the perceived threat, of quarantine or partner notification, fissures began to appear in the alliance against named HIV reporting that had emerged a few years earlier. In 1989, New York City’s Health Commissioner stated that the prospects of early clinical intervention warranted “a shift toward a disease-control approach to HIV infection along (...) the lines of classic tuberculosis practices,” including the “reporting of seropositives.”Although his proposal met with fierce and effective resistance, it is now clear that his call represented part of a national trend. The CDC continued to press for cases of HIV to he reported by name to health departments, an effort that assumed the dimensions of a campaign. It was supported by a growing number of public health officials. (shrink)

ArgumentIn this paper I examine the mass medical inspections of immigrants to the United States from the 1890s through the 1920s. I show how, framed as it was not only by nativism and eugenics but also by national industrial imperatives and priorities, scientific medicine served dual purposes. On the one hand, the medical exam was a tool for managing cultural and biological threats to the nation. There were regional variations in medical inspections that reflected the politics of race. On the (...) other hand, the medical exam played an important role in the process of building an unskilled, highly mobile labor force. The industrial demands of the nation provided a rationale for drawing and absorbing millions of European immigrants into the labor force. It was thus a distinct product of the political economy of immigration. It was this second function that characterized the exam for the majority of immigrants entering the nation. (shrink)

In target articles for this special issue, Fox et al. report that ethics consultation (EC) practices have not improved significantly since 2000, and question whether the status quo affords patients...

In 2012, New York City Mayor Michael Bloomberg proposed capping the size of sugary beverages that could be sold in the city’s restaurants, sporting and entertainment facilities and food carts. After a lawsuit and multiple appeals, the proposal died in June 2014, deemed an unconstitutional overreach. In dissecting the saga of the proposed soda cap, we highlight both the political perils of certain anti-obesity efforts and, more broadly, the challenges to public health when issues of consumer choice and the threat (...) of paternalism are involved. (shrink)

Review of Searching Eyes: Privacy, the State, and Disease Surveillance in America – By Amy L. Fairchild, Ronald Bayer, and James Colgrove.

Understanding of the human genome and its functional significance has increased exponentially since the completion of the Human Genome Project in 2003. The HGP fueled the discovery of more than 1,800 disease genes and paved the way for researchers to identify and test for genes suspected of causing inherited diseases. Currently, there are more than 1000 genetic tests for human diseases and conditions on the market. These tests can play an integral role in the delivery of health care by providing (...) information that could potentially form the basis for profound life decisions, such as whether to undergo a prophylactic mastectomy, whether to terminate a pregnancy, or whether to take a particular drug or medication dose. (shrink)

Understanding of the human genome and its functional significance has increased exponentially since the completion of the Human Genome Project in 2003. The HGP fueled the discovery of more than 1,800 disease genes and paved the way for researchers to identify and test for genes suspected of causing inherited diseases. Currently, there are more than 1000 genetic tests for human diseases and conditions on the market. These tests can play an integral role in the delivery of health care by providing (...) information that could potentially form the basis for profound life decisions, such as whether to undergo a prophylactic mastectomy, whether to terminate a pregnancy, or whether to take a particular drug or medication dose. (shrink)

Understanding of the human genome and its functional significance has increased exponentially since the completion of the Human Genome Project in 2003. The HGP fueled the discovery of more than 1,800 disease genes and paved the way for researchers to identify and test for genes suspected of causing inherited diseases. Currently, there are more than 1000 genetic tests for human diseases and conditions on the market. These tests can play an integral role in the delivery of health care by providing (...) information that could potentially form the basis for profound life decisions, such as whether to undergo a prophylactic mastectomy, whether to terminate a pregnancy, or whether to take a particular drug or medication dose. (shrink)

Although unprecedented in scope and beyond all our life experiences, sweeping social distancing measures are not without historical precedent. Historically, racism, stigma, and discrimination resul...

It is often noted that institutional objects and artifacts depend on human beliefs and intentions and so fail to meet the realist paradigm of mind‐independent objects. In this paper I draw out exactly in what ways the thesis of mind‐independence fails, and show that it has some surprising consequences. For the specific forms of mind‐dependence involved entail that we have certain forms of epistemic privilege with regard to our own institutional and artifactual kinds, protecting us from certain possibilities of ignorance (...) and error; they also demonstrate that not all cases of reference to these kinds can proceed along a purely causal model. As a result, realist views in ontology, epistemology, and semantics that were developed with natural scientific kinds in mind cannot fully apply to the kinds of the social and human sciences. In closing I consider some wider consequences of these results for social science and philosophy. (shrink)

This challenging study places fiction squarely at the centre of the discussion of metaphysics. Philosophers have traditionally treated fiction as involving a set of narrow problems in logic or the philosophy of language. By contrast Amie Thomasson argues that fiction has far-reaching implications for central problems of metaphysics. The book develops an 'artifactual' theory of fiction, whereby fictional characters are abstract artifacts as ordinary as laws or symphonies or works of literature. By understanding fictional characters we come to understand how (...) other cultural and social objects are established on the basis of the independent physical world and the mental states of human beings. (shrink)

Arguments that ordinary inanimate objects such as tables and chairs, sticks and stones, simply do not exist have become increasingly common and increasingly prominent. Some are based on demands for parsimony or for a non-arbitrary answer to the special composition question; others arise from prohibitions against causal redundancy, ontological vagueness, or co-location; and others still come from worries that a common sense ontology would be a rival to a scientific one. Until now, little has been done to address these arguments (...) in a unified and systematic way. Ordinary Objects is designed to fill this gap, demonstrating that the mistakes behind all of these superficially diverse eliminativist arguments may be traced to a common source. It aims to develop an ontology of ordinary objects subject to no such problems, providing perhaps the first sustained defense of a common sense ontology in two generations. The work done along the way addresses a number of major issues in philosophy of language and metaphysics, contributing to debates about analyticity, identity conditions, co-location and the grounding problem, vagueness, overdetermination, parsimony, and ontological commitment. In the end, the most important result of addressing these eliminativist arguments is not merely avoiding their conclusions; examining their failings also gives us reason to suspect that many apparent disputes in ontology are pseudo-debates. For it brings into question widely-held assumptions about which uses of metaphysical principles are appropriate, which metaphysical demands are answerable, and how we should go about addressing such fundamental questions as "What exists?". As a result, the work of Ordinary Objects promises to provide not only the route to a reflective understanding of our unreflective common-sense view, but also a better understanding of the proper methods and limits of metaphysics. (shrink)

The challenge of handling fictional discourse is to find the best way to resolve the apparent inconsistencies in our ways of speaking about fiction. A promising approach is to take at least some such discourse to involve pretense, but does all fictional discourse involve pretense? I will argue that a better, less revisionary, solution is to take internal and fictionalizing discourse to involve pretense, while allowing that in external critical discourse, fictional names are used seriously to refer to fictional characters. (...) I then address two objections to such realist theories of fiction: One, that they can't adequately account for the truth of singular nonexistence claims involving fictional names, and two, that accepting that there are fictional characters to which we refer is implausible or ontologically profligate. (shrink)

Philosophical theories often hinge on claims about what is necessary or possible. But what are possibilities and necessities, and how could we come to know about them? This book aims to help demystify the methodology of philosophy, by treating such claims not as attempted descriptions of strange facts or distant 'possible worlds', but rather as ways of expressing rules or norms.

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing p...

Amie L. Thomasson; The Ontology of Art and Knowledge in Aesthetics: Thomasson The Ontology of Art and Knowledge in Aesthetics, The Journal of Aesthetics and Art.

In “The Standing to Blame: A Critique” (2013), Macalester Bell challenges theories that claim that ‘standing’ plays a central role in blaming practices. These standard accounts posit that it is not enough for the target of blame to be blameworthy; the blamer also must have the proper standing to blame the wrongdoer. Bell identifies and criticizes four different standing conditions, (1) the Business Condition, (2) the Contemporary Condition, (3) the Nonhypocricy Condition, and (4) the Noncomplicity Condition. According to standard accounts, (...) these conditions must be met in order for a would-be blamer to properly blame a wrongdoer. In this paper, I defend the Business Condition against Bell’s critique. My argument, then, is that some version of the standard account survives and ‘standing’ should be part of our theory of properly-wielded blame. I conclude by raising two additional concerns regarding the agency of blamers and the possibility that, without proper standing, a blamer could make things worse. (shrink)

Two major questions have dominated work on the metaphysics of social groups: first, Are there any? And second, What are they? I will begin by arguing that the answer to the ontological question is an easy and obvious ‘yes’. We do better to turn our efforts elsewhere, addressing the question: “What are social groups?” One might worry, however, about this question on grounds that the general term ‘social group’ seems like a term of art—not a well-used concept we can analyze, (...) or can presuppose corresponds to a real kind we can investigate. But while the general notion of ‘social group’ may be a term of art, our terms for clubs and courts, races and genders, are not. It is worth stepping back to ask what function these social group concepts serve. I will argue that individual social group concepts function to give normative structure to our lives together. Paying attention to the role of norms in social groups, I will argue, can enable us to provide a unified understanding of the importance of core social groups, while still respecting the great differences among social groups of different kinds. (shrink)

What justified the Center for Disease Control's1999 determination to require HIV casereporting? Why were names necessary? Why didopponents view the reporting of names with suchalarm? This paper retells the history of theencounters over HIV reporting that had occurredsince the mid 1980s. In placing HIV reportingwithin a larger context, however, we understandthe clash between privacy and public healthnecessity as a complex issue, both inhistorical and contemporary practice. Byunderscoring the similarities and differenceswith the histories of surveillance for otherinfectious diseases, vaccination, occupationaldiseases, cancer, (...) and birth defects, and HIVreporting internationally, we can betterunderstand the implications of the HIV debatefor an ethics of surveillance more generally. (shrink)

It is often noted that institutional objects and artifacts depend on human beliefs and intentions and so fail to meet the realist paradigm of mind-independent objects. In this paper I draw out exactly in what ways the thesis of mind-independence fails, and show that it has some surprising consequences. For the specific forms of mind-dependence involved entail that we have certain forms of epistemic privilege with regard to our own institutional and artifactual kinds, protecting us from certain possibilities of ignorance (...) and error; they also demonstrate that not all cases of reference to these kinds can proceed along a causal model. As a result, realist views in ontology, epistemology, and semantics that were developed with natural scientific kinds in mind cannot fully apply to the everyday world. In closing I consider some wider consequences of these results for social science and philosophy. (shrink)

A good phenomenological theory must be able to account equally well for our experiences of veridical perception and hallucination, for our thoughts about universities, colors, numbers, mythical figures and more. For all of these are characteristic mental acts, and a theory of intentionality should be a theory of conscious acts in general, not just of consciousness of a specific kind of thing or of a specific kind of consciousness. In so far as phenomenology purports to be a general study of (...) intentional acts of consciousness, it must be able to account for acts with all kinds of objects and with all kinds of thetic character. Any limitation of these features puts the theory in danger of being an explanation of only some kinds of mental act, and of mis-characterizing the nature of intentionality in general. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

The existence of a social world raises both the metaphysical puzzle: how can there be a “reality” of facts and objects that are genuinely created by human intentionality? and the epistemological puzzle: how can such a product of human intentionality include objective facts available for investigation and discovery by the social sciences? I argue that Searle’s story about the creation of social facts in The Construction of Social Reality is too narrow to fully solve either side of the puzzle. By (...) acknowledging different forms of rules for constructing social reality paralleling rules for creating ‘make-believe’ truths, we can build a more comprehensive social ontology and allow for a more appropriate range of discovery for the social sciences. Nonetheless, I argue that despite the parallels between methods for constructing make-believe and social facts, it would be mistaken to treat talk about social reality as involving a mere pretense to refer. (shrink)

Talk of the functions of language or concepts plays a central role in developing an appealing pragmatic approach to conceptual engineering. But some have expressed skepticism that we can make any good sense of the idea of function as applied to concepts or language, or argued that the most we can say is that the function of ‘F’ is to refer to the Fs. In this paper, however, I argue that identifying linguistic functions is not hopeless, and that we can (...) make progress by working at the level of system functions, and drawing on work in systemic functional linguistics. For that enables us to develop a better framework for thinking about the functions that language serves, and the ways its subsystems contribute to those functions. This approach to understanding linguistic functions enables us to develop a pragmatic approach to conceptual engineering that provides standards for conceptual engineering without metaphysical mysteries. It also enables us to make progress in figuring out what functions certain philosophically interesting parts of language serve, and how they are introduced into language, in ways that may disentangle us from a range of old philosophical problems. (shrink)

The critics in this volume raise several important challenges to the modal normativist position developed in Norms and Necessity, including whether the relation I claim holds between semantic rules and necessity claims generates spurious claims of metaphysical necessity, whether the view is circular (implicitly relying on a more 'robust' form of modal realism), and whether it conflicts with truth-conditional semantics. They also raise probing questions about how it compares to other views of modality, including a Lewisian view and an essentialist (...) view. In these replies, I respond to these challenges in ways that precisify the relevant understanding of ‘semantic rules' and the forms they can take, that make clearer the direction of explanation in modal normativism in ways that show the view doesn't rely on a more ‘robust’ form of modal realism, and that give reason for thinking that there is actually no conflict between modal normativism and truth-conditional semantics. I also aim to give a fuller assessment of how it compares to other approaches to modality, including an essentialist approach. (shrink)

In this paper, we explore the perspectives of expert stakeholders about who owns data in a medical information commons and what rights and interests ought to be recognized when developing a governance structure for an MIC. We then examine the legitimacy of these claims based on legal and ethical analysis and explore an alternative framework for thinking about participants' rights and interests in an MIC.

Modality presents notorious philosophical problems, including the epistemic problem of how we could come to know modal facts and metaphysical problems about how to place modal facts in the natural world. These problems arise from thinking of modal claims as attempts to describe modal features of this world that explain what makes them true. Here I propose a different view of modal discourse in which talk about what is “metaphysically necessary” does not aim to describe modal features of the world, (...) but, rather, provides a particularly useful way of expressing constitutive semantic and conceptual rules in the object language. The result is a “modal normativist” view that enables us to avoid the epistemic problems of modality and mitigate the metaphysical worries, while also leaving open the possibility of a unified account of the function of modal language. Finally, I address a serious challenge: we have the norms we do in order to track the modal facts of the world, so that the order of explanation must go in the opposite direction. I close by showing how the normativist may answer that challenge. (shrink)

Surveillance serves as the eyes of public health. It has provided the foundation for planning, intervention, and disease prevention and has been critical for epidemiology research into patterns of morbidity and mortality for a wide variety of disease and conditions. Registries have been essential for tracking individuals and their conditions over time. Surveillance has also served to trigger the imposition of public health control measures, such as contact tracing, mandatory treatment, and quarantine. The threat of such intervention and long-term monitoring (...) has provoked alarm and rendered surveillance suspect for those concerned about the unwarranted exercise of state authority in the name of public health. Thus the history of surveillance has been bounded by promise of disease control and a specter of intrusion. In this article we address the tension between the public's need for knowledge as a foundation for rational policy-making and the centrality of norms of privacy for democratic societies. (shrink)

Surveillance serves as the eyes of public health. It has provided the foundation for planning, intervention, and disease prevention and has been critical for epidemiology research into patterns of morbidity and mortality for a wide variety of disease and conditions. Registries have been essential for tracking individuals and their conditions over time. Surveillance has also served to trigger the imposition of public health control measures, such as contact tracing, mandatory treatment, and quarantine. The threat of such intervention and long-term monitoring (...) has provoked alarm and rendered surveillance suspect for those concerned about the unwarranted exercise of state authority in the name of public health. Thus the history of surveillance has been bounded by promise of disease control and a specter of intrusion. In this article we address the tension between the public's need for knowledge as a foundation for rational policy-making and the centrality of norms of privacy for democratic societies. (shrink)

The challenge of handling fictional discourse is to find the best way to resolve the apparent inconsistencies in our ways of speaking about fiction. A promising approach is to take at least some such discourse to involve pretense, but does all fictional discourse involve pretense? I will argue that a better, less revisionary, solution is to take internal and fictionalizing discourse to involve pretense, while allowing that in external critical discourse, fictional names are used seriously to refer to fictional characters. (...) I then address two objections to such realist theories of fiction: One, that they can’t adequately account for the truth of singular nonexistence claims involving fictional names, and two, that accepting that there are fictional characters to which we refer is implausible or ontologically profligate. (shrink)

While fights about ontology rage on in the ring, there’s long been a suspicion whispered in certain corners of the stadium that some of the fights aren’t real. Granted the disputants all think they are really disagreeing—it’s not the sincerity of the serious ontologists that’s in question, but rather their judgment that they are engaged in a real debate about genuine issues of substance.

Those who aim to give an account of modal knowledge face two challenges: the integration challenge of reconciling an account of what is involved in knowing modal truths with a plausible story about how we can come to know them, and the reliability challenge of giving a plausible account of how we could have evolved a reliable capacity to acquire modal knowledge. I argue that recent counterfactual and dispositional accounts of modal knowledge cannot solve these problems regarding specifically metaphysical modal (...) truths—leaving us with the threat of skepticism about large portions of metaphysics, and certain other areas of philosophy. I argue, however, that both of these problems look insuperable only if we assume that metaphysical modal discourse serves a describing or tracking function. If we adopt instead a normativist approach to metaphysical modal discourse, which sees the basic function of modal discourse as giving us perspicuous ways of conveying, reasoning with, and renegotiating semantic rules, the problems show up very differently. The modal normativist can give a plausible response to both of the classic problems of how we can come to know metaphysical modal truths. (shrink)

I argue that the ontological status of fictional characters is determined by the beliefs and practices of those who competently deal with works of literature, and draw out three important consequences of this. First, heavily revisionary theories cannot be considered as ‘discoveries’ about the ‘true nature’ of fictional characters; any acceptable realist theory of fiction must preserve all or most of the common conception of fictional characters. Second, once we note that the existence conditions for fictional characters are extremely minimal, (...) it makes little sense to deny the existence of fictional characters, leaving anti-realist views of fiction unmotivated. Finally, the role of ordinary beliefs and practices in determining facts about the ontology of fictional characters explains why non-revisionary theories of fiction are bound to yield no determinate or precise answer to certain questions about fictional characters, demonstrating the limits of a theory of fiction. (shrink)

This chapter contains sections titled: A Range of Views Criteria of Assessment The Road to a Solution.