Enormous gaps between HIV burden and health care availability in low-income countries raise severe ethical problems. This article analyzes four HIV-priority dilemmas with interest across contexts and health systems. We explore principled distributive conflicts and use the Atkinson index to make explicit trade-offs between health maximization and equality in health. We find that societies need a relatively low aversion to inequality to favor treatment for children, even with large weights assigned to extending the lives of adults: higher inequality aversion is (...) needed to share resources equally between high-cost and low-cost treatment; higher inequality aversion is needed to favor treatment rather than prevention, and the highest inequality aversion is needed to favor sharing treatment between urban and rural regions rather than urban provision of treatment. This type of ethical sensitivity analysis may clarify the ethics of health policy choice. (shrink)

Next SectionBackground International and national agencies play a major role in setting HIV care-and-treatment priorities in low-income-countries. Little is known about priority setting at lower health-system levels. The objective of this article is to explore experiences of HIV priority decisions, at what levels these decisions are made and how they might influence the distribution of health benefits in a high-endemic region in Tanzania. Methods This is a qualitative study using observations, key documents and semistructured focus-group and individual interviews (43) with (...) health workers, patients and administrators at one regional and one district hospital. The analysis was based on an editing analysis style. Results Health workers did not perceive themselves as bedside rationing agents and they reported following national recommendations and felt they have little impact on important priority decisions. Health benefit distributions were largely determined by priority decisions made at a national level. External factors, such as eligibility criteria, inadequate funding and barriers to access seemed to play a major role in the actual distribution of health services and benefits in the region. Patient groups who were actually given high priority were the sickest patients, those living near a facility and those who could afford long journeys and frequent visits. Low-priority groups were those experiencing other co-morbidities or treatment failure, children, asymptomatic patients and the poorest. Conclusions/significance The interaction of priority setting across health-system levels and their impact on distribution of health outcomes in the population has been underestimated. The distributional pattern of health outcomes calls for further normative assessment. (shrink)

Recent global advances in available technology to prevent mother-to-child HIV transmission necessitate a rethinking of contemporary and previous ethical debates on HIV testing as a means to preventing vertical transmission. In this paper, we will provide an ethical analysis of HIV-testing strategies of pregnant women. First, we argue that provider-initiated opt-out HIV testing seems to be the most effective HIV test strategy. The flip-side of an opt-out strategy is that it may end up as involuntary testing in a clinical setting. (...) We analyse this ethical puzzle from a novel perspective, taking into account the moral importance of certain hypothetical preferences of the child, as well as the moral importance of certain actual preferences of the mother. Finally, we balance the conflicting concerns and try to arrive at an ethically sound solution to this dilemma. Our aim is to introduce a novel perspective from which to analyse testing strategies, and to explore the implications and possible benefits of our proposal. The conclusion from our analysis is that policies that recommend provider-initiated opt-out HIV testing of pregnant mothers, with a risk of becoming involuntary testing in a clinical setting, are acceptable. The rationale behind this is that the increased availability of very effective and inexpensive life-saving drugs makes the ethical problems raised by the possible intrusiveness of HIV testing less important than the child's hypothetical preferences to be born healthy. Health care providers, therefore, have a duty to offer both opt-out HIV testing and available PMTCT (preventing mother-to-child transmission) interventions. (shrink)

There are two main ways of understanding the function of surrogate decision making in a legal context: the Best Interests Standard and the Substituted Judgment Standard. First, we will argue that the Best Interests Standard is difficult to apply to unconscious patients. Application is difficult regardless of whether they have ever been conscious. Second, we will argue that if we accept the least problematic explanation of how unconscious patients can have interests, we are also obliged to accept that the Substituted (...) Judgment Standard can be coherently applied to patients who have never been conscious at the same extent as the Best Interests Standard. We then argue that acknowledging this result is important in order to show patients respect. (shrink)

Recent health legislation in Norway significantly increases access to specialist care within a legally binding time frame. The paper describes the contents of the new legislation and introduces some of the challenges with proliferations of rights to health care. The paper describes some of the challenges associated with the proliferation of legal rights to health care. It explains the benefits of assessing the new law in the light of a rights framework. It then analyses the problematic aspects of establishing additional (...) priority rules as solutions to rights conflicts. It then defends adequacy criteria for acceptable priority rules when such rules are unavoidable. It finally defends our proposed method and explores concrete applications. (shrink)

Scarcity sharpens the conflict between short term gains and long term sustainability. Psychological research documents that decision makers focus on immediate needs under scarcity and use available resources more effectively. However, decision makers also borrow too much from future resources and overall performance decreases as a consequence. Using an online experiment, we study how scarcity affects borrowing decisions in groups. We first document that scarcity affects groups in a similar way as individuals. Then, we go on to show that the (...) negative effect of scarcity is weaker for groups than for individuals. Even in a minimal design that excludes direct interaction or communication, the fact that participants know that their own behavior affects and can be partly observed by another participant disciplines their use of scarce resources. Our results thus highlight the benefit of groups as units of human organization. (shrink)

Plastic changes in spinal cord function like neuronal wind-up and increased receptive field are too short-lived to explain chronic pain without structural changes. It is possible that learning could be a mechanism for longlasting changes in nociceptive regulation. A learning process localized to the spinal cord has been shown to be important for the development of tolerance to the analgetic effect of ethanol, suggesting that nociceptive control systems may be changed by learning. Long term potentiation (LTP) is regarded as a (...) useful model of learning and memory. LTP-like changes have been observed in invitro preparations from the spinal cord and in spinal cord field potentials. Recently a long term increase in spinal A-[beta] and C-fibre evoked responses after painful stimulation has been observed. [coderre & katz, dickenson, wiesenfeld-hallin et al.]. (shrink)

We analyse three moral dilemmas involving resource allocation in care for HIV-positive patients. Ole Norheim and Kjell Arne Johansson have argued that these cases reveal a tension between egalitarian concerns and concerns for better population health. We argue, by contrast, that these cases reveal a tension between, on the one hand, a concern for equal *chances*, and, on the other hand, both a concern for better health and an egalitarian concern for equal *outcomes*. We conclude that, in (...) these cases, there is much less tension than Norheim and Johansson claim between egalitarian concerns and concerns for better population health. (shrink)

ONTOLOGY This book is a book about the world. I am concerned with ontology, not merely with language. Many ontological treatises concentrate largely on the ...

The intellectual relationship between Carl Schmitt and Max Weber has been a point of controversy for at least half a century. At the 1964 convention of the German Sociological Association, in honor of Weber's centenary, Schmitt was famously referred to as Weber's ?legitimate student.? This article uses the chapter Schmitt specifically wrote for an edited volume in Weber's memory, published in 1923, as the starting point for juxtaposing the two scholars, and then expands the analysis to encompass a range of (...) sources and commentaries. The comparison focuses on the approach of each of the two scholars to methodology and didactics, theory and conceptual use, as well as to the society/social science nexus. The article concludes by arguing that Schmitt performed a double rhetorical move: while styling himself as Weber's student, he then drew on that authority to assault Weber's liberalism and concept of scientific integrity. (shrink)

Creativity is the hallmark of human intelligence. Roli et al. (Frontiers in Ecology and Evolution 9:806283, 2022) state that algorithms cannot achieve human creativity. This paper analyzes cooperation between humans and intelligent algorithmic tools to compensate for algorithms’ limited creativity. The intelligent tools have functionality from the neocortex, the brain’s center for learning, reasoning, planning, and language. The analysis provides four key insights about human-tool cooperation to solve challenging problems. First, no neocortex-based tool without feelings can achieve human creativity. Second, (...) an interactive tool exploring users’ feeling-guided creativity enhances the ability to solve complex problems. Third, user-led abductive reasoning incorporating human creativity is essential to human-tool cooperative problem-solving. Fourth, although stakeholders must take moral responsibility for the adverse impact of tool answers, it is still essential to teach tools moral values to generate trustworthy answers. The analysis concludes that the scientific community should create neocortex-based tools to augment human creativity and enhance problem-solving rather than creating autonomous algorithmic entities with independent but less creative problem-solving. (shrink)

The purpose of this paper is to use an anaphoric notion of presupposition for solving the problem of zero argument anaphora. Since Shopen (1973) it has been known that many missing arguments have an anaphoric interpretation, but it has not been known how this interpretation arises. I argue that these arguments are involved in presuppositions. On an anaphoric account of presuppositions as in van der Sandt (1992) or Kamp and Roßdeutscher (1992), it can be shown that the zero arguments acquire (...) an anaphoric interpretation through the presuppositions. The analysis rests on the principle that the Discourse Representation Structure for the presupposition is proper, so that the discourse referents for the zero arguments are in its universe and must be anchored to discourse referents in the context. (shrink)

This volume is devoted to problems within analytic metaphysics. It defends an ontology and theory of categories inspired by Aristotle, but revised in such a way as to be compatible with modern science. The ontology of both natural and social reality is addressed, starting out from the view that universals exist but only in the spatiotemporal world. In attempting to bring Aristotle's ontology up-to-date, the author relies very much on the thinking of Edmund Husserl, conceiving the cement of the universe (...) as Husserlian relations of existential dependence and regarding intentionality as a non-reducible category in the ontology of mind. The work is thoroughly realistic in spirit, but large parts of it should nonetheless be of interest to conceptualists and nominalists, too. (shrink)

Contrary to assumptions that changes in brain networks are possible only during crucial periods of development, research in the past decade has supported the idea of a permanently plastic brain. Novel experience, altered afferent input due to environmental changes and learning new skills are now recognized as modulators of brain function and underlying neuroanatomic circuitry. Given findings in experiments with animals and the recent discovery of increases in gray and white matter in the adult human brain as a result of (...) learning, the old concept of cognitive reserve, that is the ability to reinforce brain volume in crucial areas and thus provide a greater threshold for age-dependent deficits, has been reinforced. The challenge we face is to unravel the exact nature of the dynamic structural alterations and, ultimately, to be able to use this knowledge for disease management. Understanding normative changes in brain structure that occur as a result of environmental changes and demands is pivotal to understanding the characteristic ability of the brain to adapt. (shrink)

Originally published in 1968. Scepticism is generally regarded as a position which, if correct, would be disastrous for our everyday and scientific beliefs. According to this view, a sceptical argument is one that leads to the intuitively false conclusion that we cannot know anything. But there is another, much neglected and more radical form of scepticism, Pyrrhonism, which neither denies nor accepts the possibility of knowledge and is to be regarded not as a philosophical position so much as the expression (...) of a philosophical way of life. Professor Naess argues that, given a sympathetic interpretation, Sextus Empiricus’s outline of Pyrrhonian scepticism provides the essentials of a genuine and rational sceptical point of view. He begins with a brief account of Pyrrhonism, then goes on to argue for the psychological possibility of this kind of scepticism, defending it against common objections, and examining some of its implications. The last two chapters provide detailed support for the rationality of Pyrrhonism, drawing mainly on certain methodological distinctions in semantics which both justify the Pyrrhonist’s failure to make assertions and restrict the scope of recent epistemological arguments against scepticism in such a way as to modify severely the conclusions based on them. (shrink)

I present an analysis of Free Choice Items (FCIs), based on Scandinavian, where FCIs are complex and distinct from polarity sensitive items. Scandinavian FCIs are argued to have two components. One is a universal quantifying into modal contexts. The other is an operator mapping a type (s,t) expression onto itself, adjoining to the closest type t or (s,t) expression. Thus invoking Intensional Functional Application, this operator requires the presence of a modal in the scope of the universal quantifier. Facts concerning (...) ‘essential connections’ and ‘existential import’ are accounted for by assuming that the FC determiner has the option of acting like a quantifier. (shrink)

Axelord’s [(1970), Conflict of Interest, Markham Publishers, Chicago] index of conflict in 2 × 2 games with two pure strategy equilibria has the property that a reduction in the cost of holding out corresponds to an increase in conflict. This article takes the opposite view, arguing that if losing becomes less costly, a player is less likely to gamble to win, which means that conflict will be less frequent. This approach leads to a new power index and a new measure (...) of stubbornness, both anchored in strategic reasoning. The win probability defined as power constitutes an equilibrium refinement which differs from Harsanyi and Selten’s [(1988), A General Theory of Equilibrium Selection in Games, MIT Press, Cambridge] refinement. In contrast, Axelrod’s approach focuses on preferences regarding divergences from imaginary outmost rewards that cannot be obtained jointly. The player who is less powerful in an asymmetric one-shot game becomes more powerful in the repeated game, provided he or she values the future sufficiently more than the opponent. This contrasts with the view that repetition induces cooperation, but conforms with the expectation that a more patient player receives a larger share of the pie. (shrink)

The sociology of research and knowledge use, argue the authors, could be a way of linking important parts of sociology, such as organization studies, the sociology of science to each other. In the article, they discuss the idea that organizational responses to environments are related to research utilization. Based upon an empirical investigation of city welfare departments, four empirical “utilization strategies” are presented and shown to be related to power and control patterns. While negative utilization strategies are hostile to uncontrolled (...) research utilization and enhance the formation of bureaucratic expertise, conflict-oriented strategies are discursively productive and reinforce research use and alliance formation with social scientists to control the environment. (shrink)

There is an international deep ecology social movement with key terms, slogans, and rhetorical use of language comparable to what we find in other activist “alternative” movements today. Some supporters of the movement partake in academic philosophy and have developed or at least suggested philosophies, “ecosophies,” inspired by the movement. R. A. Watson does not distinguish sufficiently between the movement and the philosophical expressions with academic pretensions. As a result, he falsely concludes that deep ecology implies setting man apart from (...) nature-a kind of “anthropocentrism” in his terminology: humans and only humans have no right to interfere with natural processes. What the deep ecology movement insists on is rather that life on Earth has intrinsic value and that human behavior should and must change drastically-and soon. (shrink)

The article describes the founding principles, work program, and accomplishments of a Reference Group with both expert and layperson stakeholders for the corrosion of copper canisters in a proposed deep repository in Sweden for spent nuclear fuel. The article sets the Reference Group as a participatory effort within a broader context of stakeholder and public participation. It is argued that for the future it will be necessary to more precisely define the roles of different approaches to public participation in relation (...) to the actual societal decision-making procedures, and the issue is raised whether an increasing level of their institutionalization is required. In particular, the focus is set on the safe-space approach to stakeholder participation designed to suit situations where independence and autonomy are crucial elements for the participants. To illustrate this we compare experiences from Sweden and the Czech Republic. (shrink)

It is argued that medical science requires a classificatory system that (a) puts functions in the taxonomic center and (b) does justice ontologically to the difference between the processes which are the realizations of functions and the objects which are their bearers. We propose formulae for constructing such a system and describe some of its benefits. The arguments are general enough to be of interest to all the life sciences.

This article analyzes rent seeking with multiple additive efforts for each of two players. Impact on rent seeking occurs even when a player exerts only one effort. This contrasts with models of multiplicative efforts with impact on rent seeking only when a player exerts all its available efforts. An analytical solution is developed when the contest intensities are below one, and equal to one for one effort. Then, additional efforts causing interior solutions give players higher expected utilities and lower rent (...) dissipation, which contrasts with earlier findings for multiplicative efforts. Players cut back on the effort with contest intensity equal to one, and exert alternative efforts instead. Accounting for solutions which have to be determined numerically, a Nash equilibrium selection method is provided. For illustration, an example with maximum two efforts for each player is provided. Equilibria are shown where both players choose both efforts, or one player withdraws from its most costly effort. Both players may collectively prefer to exclude one of their efforts, though in equilibrium, they may prefer both efforts. When all contest intensities are equal to one or larger than one, only the one most cost-effective effort is exerted, due to the logic of linear or convex production. Rent dissipation increases in the contest intensity, and is maximum when the players are equally advantaged determined by unit effort cost divided by impact. (shrink)

It is argued that medical science requires a classificatory system that (a) puts functions in the taxonomic center and (b) does justice ontologically to the difference between the processes which are the realizations of functions and the objects which are their bearers. We propose formulae for constructing such a system and describe some of its benefits. The arguments are general enough to be of interest to all the life sciences.

In this paper we discuss an approach called grounded action cognition, which aims to provide a theory of the interdependencies between motor control and action-related cognitive processes, like perceiving an action or thinking about an action. The theory contrasts with traditional views in cognitive science in that it motivates an understanding of cognition as embodied, through application of Barsalou’s general idea of grounded cognition. To guide further research towards an appropriate theory of grounded action cognition we distinguish between grounding qua (...) acquisition and grounding qua constitution. On this basis, we distinguish three possible theoretical conceptions of grounded action cognition. In addition to these methodological and conceptual analyses, we draw on recent empirical evidence to motivate our inclination towards a particular theory. According to this theory certain representations are involved in action cognition and action perception that are not modality-specific as usually proposed by advocates of grounded cognition. Further, the evidence is in favor of our more specific theory stating that for some cognitive abilities, some motor abilites are constitutive. (shrink)

When the social relevance of robotic applications is addressed today, the use of assistive technology in care settings is almost always the first example. So-called care robots are presented as a solution to the nursing crisis, despite doubts about their technological readiness and the lack of concrete usage scenarios in everyday nursing practice. We inquire into this interconnection of social robotics and care. We show how both are made available for each other in three arenas: innovation policy, care organization, and (...) robotic engineering. First, we analyze the discursive “logics” of care robotics within European innovation policy, second, we disclose how care robotics is encountering a historically grown conflict within health care organization, and third we show how care scenarios are being used in robotic engineering. From this diagnosis, we derive a threefold critique of robotics in healthcare, which calls attention to the politics, historicity, and social situatedness of care robotics in elderly care. (shrink)

In the pursuit of a dramaturgy of telematics as a compositional practice, the author builds a position on technology as externalized technique, develops a dramaturgic strategy with notions of an extended theatre practice and reports on a realized telematized performance where a practical implementation was explored. The theatrical site is viewed as a construct of attention, generated by the performers through the performance composition. The composition determines the audience experience, orchestrated by how the construction of the site manages their perspectives, (...) and how the performers are situated in the consciousness site of the audience. In the performed event the performers articulate as a collective extended entity, incorporating the transformation of the performance site via the articulation strategies implemented in the staging. Telematics is argued to be a technology facilitating specific modes of thinking, generating specific modes of actions and presence, which enable new performance sites and new modes of situating performance. (shrink)

It is suggested how one can imaginatively use a design strategy utilizing performers as tools in the creation of augmented, performative artwork. In order to establish meaningful constructions of performative and augmentative technology, one can use the formal methodologies of advanced formal body language as a tool in the creation process, and thereby have ‘the actual experience’ present in the process as a monitor and a constructive tool. To use a human being as a design tool is a method that (...) uses the skilled performer as a ‘super-’ or ‘extra-’ human tool to investigate through action and analysis. It is a way to test how realities occur under fluid and dynamic conditions within a controlled environment of time and space. This ‘technical’ use of the body as an extra-human behavioural entity, involves the total complex spectrum of intellect, emotions, desires, memory, actions, etc. as a formalized ‘machine’. (shrink)

_In Perception, Empathy, and Judgment_ Arne Johan Vetlesen focuses on the indispensable role of emotion, especially the faculty of empathy, in morality. He contends that moral conduct is severely threatened once empathy is prevented from taking part in an interplay with cognitive faculties in acts of moral perception and judgment. Drawing on developmental psychology, especially British "object relations" theory, to illuminate the nature and functioning of empathy, Vetlesen shows how moral performance is constituted by a sequence involving perception, judgment, (...) and action, with an interplay between the agent's emotional and cognitive faculties occurring at each stage. In the powerful tradition from Kant to present-day theorists such as Kohlberg, Rawls, and Habermas, reason is privileged over feeling and judgment over perception, in such a way that basic philosophical questions remain unasked. Vetlesen focuses our attention on these questions and challenges the long-standing assertion that emotions are damaging to moral response. In the final chapter he relates his argument to recent feminist critiques that have also castigated moral theorists in the Kantian tradition for their refusal to recognize a role for emotion in morality. While the book's argument is philosophical, its method and scope are interdisciplinary. In addition to critiques of such philosophers as Arendt, MacIntyre, and Habermas, it contains discussions of specific historical, ideological, and sociological factors that may cause "numbing"—selective or broad-ranging, pathological insensitivity—in humans. The Nazis' mass killing of Jews is studied to illuminate these and other relevant empirical aspects of large-scale immoral action. (shrink)

Recent theoretical and empirical work in cognitive science and neuroscience is brought into contact with the concept of the flow experience. After a brief exposition of brain function, the explicit–implicit distinction is applied to the effortless information processing that is so characteristic of the flow state. The explicit system is associated with the higher cognitive functions of the frontal lobe and medial temporal lobe structures and has evolved to increase cognitive flexibility. In contrast, the implicit system is associated with the (...) skill-based knowledge supported primarily by the basal ganglia and has the advantage of being more efficient. From the analysis of this flexibility/efficiency trade-off emerges a thesis that identifies the flow state as a period during which a highly practiced skill that is represented in the implicit system’s knowledge base is implemented without interference from the explicit system. It is proposed that a necessary prerequisite to the experience of flow is a state of transient hypofrontality that enables the temporary suppression of the analytical and meta-conscious capacities of the explicit system. Examining sensory-motor integration skills that seem to typify flow such as athletic performance, writing, and free-jazz improvisation, the new framework clarifies how this concept relates to creativity and opens new avenues of research. (shrink)