In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume XXIV, Number 1, April 1998, pp. 53-70 Hume on Justice to Animals, Indians and Women ARTHUR KUFLIK I. The Circumstances of Humean Justice For Hume, the virtue of justice is its "usefulness" to the support of society.1 To help prove this point, he guides us through a series of imaginative thought-experiments. Suppose that resources were infinitely available or that human beings were generous and (...) kind without limit: in such unusual circumstances, nobody would have even "dreamed of" the various property restrictions associated with justice. If the supposition seems too fanciful, the same point can be illustrated, at least to some extent, by special real-life circumstances as well: e.g., by the way that air or water or land go unregulated in those places where they are super-abundant or the way in which the line between what is "mine" and "thine" blurs in loving families or between intimate friends. Moving to the opposite extreme: suppose that resources were so scarce as to render it impossible for most people (regardless of their cooperative exertions) even to subsist. Or suppose that people were not merely limited in their benevolent concern but "perfectly malicious"! Once again, there would be little or no point to the observance of rules of justice. On Hume's account, such rules define a scheme of social cooperation. But by hypothesis, extreme scarcity makes even well-meaning cooperative effort unproductive. Extreme villainy makes it pointlessly dangerous. Indeed, in a world wholly villainous, just cooperative schemes would be altogether impossible. Arthur Kuflik is at the Department of Philosophy, The University of Vermont, 70 South Williams Street, Burlington, Vermont 05401-3404 USA. email: [email protected] 54 Arthur Kuflik What can we conclude? There is a range of circumstances within which schemes of justice make sense: (1) moderate scarcity (resources are adequate to sustain people, but not so extensive that everyone could have as much as might be desired); and (2) limited benevolence (people are neither saintly nor satanic; though clearly concerned about themselves, they are not incapable of caring about what happens to others). John Rawls has dubbed these conditions "the Humean circumstances of justice."2 Hume wants us to notice that they are the very conditions under which justice is both practically possible and socially necessary. Fortunately, they are also the conditions that most commonly prevail. ("The common situation of society is a medium amidst all these extremes" [EPM 188].) II. A More Puzzling Thought-experiment Suppose we grant that the foundation of justice is its usefulness to society. This raises a certain worry: aren't there groups whose members ought to be treated justly even though "society" could flourish just as well if they weren't? (Another way to put the point is to ask: just who are the members of "society"?) This very issue underlies one more puzzling, and even disturbing, Humean thought-experiment: Were there a species of creatures intermingled with men, which, though rational, were possessed of such inferior strength, both of body and mind, that they were incapable of all resistance, and could never, upon the highest provocation, make us feel the effects of their resentment; the necessary consequence, I think, is that we should be bound by the laws of humanity to give gentle usage to these creatures, but should not, properly speaking, lie under any restraint of justice with regard to them, nor could they possess any right or property, exclusive of such arbitrary lords. Our intercourse with them could not be called society, which supposes a degree of equality; but absolute command on one side, and servile obedience on the other.... And as no inconvenience ever results from the exercise of a power, so firmly established in nature, the restraints of justice and property, being totally useless, would never have place in so unequal a confederacy. (EPM 190-191) What can we learn from this thought-experiment? What insight into justice do we gain by imagining a "species of creatures intermingled" among us who, though endowed with some ability to think and to reason, are: (i) greatly inferior to us both physically and mentally; (ii) "incapable of all resistance" to our provocations; and... (shrink)

abstract According to “legal moralism” it is part of law's proper role to “enforce morality as such”. I explore the idea that legal moralism runs afoul of morality itself: there are good moral reasons not to require by law all that there is nevertheless good moral reason to do. I suggest that many such reasons have broad common‐sense appeal and could be appreciated even in a society in which everyone completely agreed about what morality requires. But I also critique legal (...) moralism from the special perspective of liberal political justice. Liberalism requires that citizens who disagree with one another on a number of morally significant matters nevertheless coexist and cooperate within a political framework of basic rights protections. When it comes to working out the most basic terms of their political association, citizens are expected to address one another within the limits of what Rawls has called “public reason”. Critics of liberalism claim that this is an essentially a‐moral (or expedient) attempt to evade substantive moral issues — such as the moral status of the fetus. I argue, on the contrary, that liberalism's emphasis on public reason is itself grounded in very deep — though (suitably) “non‐comprehensive”— moral considerations. (shrink)

abstract According to “legal moralism” it is part of law's proper role to “enforce morality as such”. I explore the idea that legal moralism runs afoul of morality itself: there are good moral reasons not to require by law all that there is nevertheless good moral reason to do. I suggest that many such reasons have broad common‐sense appeal and could be appreciated even in a society in which everyone completely agreed about what morality requires. But I also critique legal (...) moralism from the special perspective of liberal political justice. Liberalism requires that citizens who disagree with one another on a number of morally significant matters nevertheless coexist and cooperate within a political framework of basic rights protections. When it comes to working out the most basic terms of their political association, citizens are expected to address one another within the limits of what Rawls has called “public reason”. Critics of liberalism claim that this is an essentially a‐moral (or expedient) attempt to evade substantive moral issues — such as the moral status of the fetus. I argue, on the contrary, that liberalism's emphasis on public reason is itself grounded in very deep — though (suitably) “non‐comprehensive”— moral considerations. (shrink)

The authors of “The Two Front War on Reproductive Rights” make a profoundly important observation—“Because zygotes, embryos and fetuses early in gestation are neither viable nor independent without...

To what extent should humans transfer, or abdicate, responsibility to computers? In this paper, I distinguish six different senses of responsible and then consider in which of these senses computers can, and in which they cannot, be said to be responsible for deciding various outcomes. I sort out and explore two different kinds of complaint against putting computers in greater control of our lives: (i) as finite and fallible human beings, there is a limit to how far we can acheive (...) increased reliability through complex devices of our own design; (ii) even when computers are more reliable than humans, certain tasks (e.g., selecting an appropriate gift for a friend, solving the daily crossword puzzle) are inappropriately performed by anyone (or anything) other than oneself. In critically evaluating these claims, I arrive at three main conclusions: (1) While we ought to correct for many of our shortcomings by availing ourselves of the computer''s larger memory, faster processing speed and greater stamina, we are limited by our own finiteness and fallibility (rather than by whatever limitations may be inherent in silicon and metal) in the ability to transcend our own unreliability. Moreover, if we rely on programmed computers to such an extent that we lose touch with the human experience and insight that formed the basis for their programming design, our fallibility is magnified rather than mitigated. (2) Autonomous moral agents can reasonably defer to greater expertise, whether human or cybernetic. But they cannot reasonably relinquish background-oversight responsibility. They must be prepared, at least periodically, to review whether the expertise to which they defer is indeed functioning as he/she/it was authorized to do, and to take steps to revoke that authority, if necessary. (3) Though outcomes matter, it can also matter how they are brought about, and by whom. Thus, reflecting on how much of our lives should be directed and implemented by computer may be another way of testing any thoroughly end-state or consequentialist conception of the good and decent life. To live with meaning and purpose, we need to actively engage our own faculties and empathetically connect up with, and resonate to, others. Thus there is some limit to how much of life can be appropriately lived by anyone (or anything) other than ourselves. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS I. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[i] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[ii] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. II. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[iii] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[iv] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[v] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[vi] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[vii] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[viii] In democratic societies, one must take into consideration community morals and values.[ix] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[x] III. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[xi] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[xii] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[xiii] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[xiv] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. IV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[xv] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[xvi] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[xvii] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[xviii] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[xix] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[xx] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[xxi] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. VI. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[xxii] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[xxiii] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[xxiv] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. VII. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [i] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [ii] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [iii] Moss, p. 1295-1298. [iv] Moss, p. 1296. [v] Moss, p. 1295-1298. [vi] Moss, p. 1295-1298. [vii] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [viii] Cohen, p. 1299-1301. [ix] Moss, p. 1297. [x] Cohen, p. 1300. [xi] Cappelen, p. 478-480. [xii] Cappalen, p. 478-480. [xiii] Cappelen, p.479. [xiv] Cappelen, p. 479. [xv] Cappelen, p. 479 [xvi] Cohen, p. 1301. [xvii] Cappelen, p. 478. [xviii] Cohen, p. 1299-1301. [xix] Cohen, p. 1301. [xx] Cappelen, p. 476-480. [xxi] Cappelen, p. 476-480. [xxii] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [xxiii] Kawachi, p. 18-33. [xxiv] Kawachi, p. 18-33. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

In this masterful work, both an illumination of Kant's thought and an important contribution to contemporary legal and political theory, Arthur Ripstein gives a comprehensive yet accessible account of Kant's political philosophy. In addition to providing a clear and coherent statement of the most misunderstood of Kant's ideas, Ripstein also shows that Kant's views remain conceptually powerful and morally appealing today.

The relationship between formal logic and general philosophy is discussed under headings such as A Re-examination of Our Tense-Logical Postulates, Modal Logic in the Style of Frege, and Intentional Logic and Indeterminism.

What is it to be a work of art? Renowned author and critic Arthur C. Danto addresses this fundamental, complex question. Part philosophical monograph and part memoiristic meditation, _What Art Is _challenges the popular interpretation that art is an indefinable concept, instead bringing to light the properties that constitute universal meaning. Danto argues that despite varied approaches, a work of art is always defined by two essential criteria: meaning and embodiment, as well as one additional criterion contributed by the (...) viewer: interpretation. Danto crafts his argument in an accessible manner that engages with both philosophy and art across genres and eras, beginning with Plato’s definition of art in _The Republic_, and continuing through the progress of art as a series of discoveries, including such innovations as perspective, chiaroscuro, and physiognomy. Danto concludes with a fascinating discussion of Andy Warhol’s famous shipping cartons, which are visually indistinguishable from the everyday objects they represent. Throughout, Danto considers the contributions of philosophers including Descartes, Kant, and Hegel, and artists from Michelangelo and Poussin to Duchamp and Warhol, in this far-reaching examination of the interconnectivity and universality of aesthetic production. (shrink)

I examine the phenomenon of implicit learning, the process by which knowledge about the rule-governed complexities of the stimulus environment is acquired independently of conscious attempts to do so. Our research with the two seemingly disparate experimental paradigms of synthetic grammar learning and probability learning, is reviewed and integrated with other approaches to the general problem of unconscious cognition. The conclusions reached are as follows: Implicit learning produces a tacit knowledge base that is abstract and representative of the structure of (...) the environment; such knowledge is optimally acquired independently of conscious efforts to learn; and it can be used implicitly to solve problems and make accurate decisions about novel stimulus circumstances. Various epistemological issues and related problems such as intuition, neuroclinical disorders of learning and memory, and the relationship of evolutionary processes to cognitive science are also discussed. (shrink)

In this new volume in the Oxford Psychology Series, the author presents a highly readable account of the cognitive unconscious, focusing in particular on the problem of implicit learning. Implicit learning is defined as the acquisition of knowledge that takes place independently of the conscious attempts to learn and largely in the absence of explicit knowledge about what was acquired. One of the core assumptions of this argument is that implicit learning is a fundamental, "root" process, one that lies at (...) the very heart of the adaptive behavioral repertoire of every complex organism. The author's goals are to outline the essential features of implicit learning that have emerged from the many studies that have been carried out in a variety of experimental laboratories over the past several decades; to present the various alternative perspectives on this issue that have been proposed by other researchers and to try to accommodate these views with his own; to structure the literature so that it can be seen in the context of standard heuristics of evolutionary biology; to present the material within a functionalist approach and to try to show why the experimental data should be seen as entailing particular epistemological perspectives; and to present implicit processing as encompassing a general and ubiquitous set of operations that have wide currency and several possible applications. Chapter 1 begins with the core problem under consideration in this book, a characterization of "implicit learning" as it has come to be used in the literature. Reber puts this seemingly specialized topic into a general framework and suggests a theoretical model based on standard heuristics of evolutionary biology. In his account, Reber weaves a capsule history of interest in and work on the cognitive unconscious. Chapter 2 turns to a detailed overview of the experimental work on the acquisition of implicit knowledge, which currently is of great interest. Chapter 3 develops the evolutionary model within which one can see learning and cognition as richly intertwining issues and not as two distinct fields with one dominating the other. Finally, Chapter 4 explores a variety of entailments and speculations concerning implicit cognitive processes and their general role in the larger scope of human performance. (shrink)

In The Sleepwalkers and The Act of Creation Arthur Koestler provided pioneering studies of scientific discovery and artistic inspiration, the twin pinnacles of human achievement. The Ghost in the Machine looks at the dark side of the coin: our terrible urge to self-destruction... Could the human species be a gigantic evolutionary mistake? To answer that startling question Koestler examines how experts on evolution and psychology all too often write about people with an 'antiquated slot-machine model based on the naively (...) mechanistic world-view of the nineteenth century. His brilliant polemic helped to instigate a major revolution in the life sciences, yet its 'glimpses of an alternative world-view' form only the background to an even more challenging analysis of the human predicament. Perhaps, he suggests, we are a species in which ancient and recent brain structures - or reason and emotion - are not fully co-ordinated. Such in-built deficiencies may explain the paranoia, violence and insanity that are central strands of human history. And however disturbing we find such issues, Koestler contends, it is only when we face our limitations head-on that we can hope to find a remedy. (shrink)

This book was designed primarily as a textbook; though the author hopes that it will prove to be of interests to others beside logic students. Part I of this book covers the fundamentals of the subject the propositional calculus and the theory of quantification. Part II deals with the traditional formal logic and with the developments which have taken that as their starting-point. Part III deals with modal, three-valued, and extensional systems.

The realist programme has degenerated by now to the point where it is quite beyond salvage. A token of this degeneration is that there are altogether too many realisms. It is as though by splitting into a confusing array of types and kinds, realism has hoped that some one variety might yet escape extinct. I shall survey the debate, and some of these realisms, below. Here I would just point out the obvious; that in so far as the successes of (...) science mount while realism continues to decline we must conclude that scientific success lends no support to realism. Since it is unlikely to support anti-realism, we have some reason to suspect that the philosophical debate over realism does not concern issues that can be settled by developments in the sciences, no matter how successful science may be. Further, since that success grounds a culture of acceptance for science and its entities, we have reason to believe that the existence of those entities is also not actually the issue that concerns realism. Afortiori, it is not the issue that concerns anti-realism either; nor, I might add, is anti-realism the winner in the philosophical debate that realism has lost. (shrink)

_A lively meditation on the nature of art by one of America's most celebrated art critics_ What is it to be a work of art? Renowned author and critic Arthur C. Danto addresses this fundamental, complex question. Part philosophical monograph and part memoiristic meditation, _What Art Is _challenges the popular interpretation that art is an indefinable concept, instead bringing to light the properties that constitute universal meaning. Danto argues that despite varied approaches, a work of art is always defined (...) by two essential criteria: meaning and embodiment, as well as one additional criterion contributed by the viewer: interpretation. Danto crafts his argument in an accessible manner that engages with both philosophy and art across genres and eras, beginning with Plato’s definition of art in _The Republic_, and continuing through the progress of art as a series of discoveries, including such innovations as perspective, chiaroscuro, and physiognomy. Danto concludes with a fascinating discussion of Andy Warhol’s famous shipping cartons, which are visually indistinguishable from the everyday objects they represent. Throughout, Danto considers the contributions of philosophers including Descartes, Kant, and Hegel, and artists from Michelangelo and Poussin to Duchamp and Warhol, in this far-reaching examination of the interconnectivity and universality of aesthetic production. (shrink)

This paper is an attempt to put the work of the past several decades on the problems of implicit learning and unconscious cognition into an evolutionary context. Implicit learning is an inductive process whereby knowledge of a complex environment is acquired and used largely independently of awareness of either the process of acquisition or the nature of that which has been learned. Characterized this way, implicit learning theory can be viewed as an attempt to come to grips with the classic (...) epistemological issues of knowledge acquisition, representation and use. The argument is made that the process, despite its seeming cognitive sophistication, is of considerable evolutionary antiquity and that it antedates awareness and the capacity for conscious control of mentation. Various classic heuristics from evolutionary biology are used to substantiate this claim and several specific entailments of this line of argument are outlined. (shrink)

This book discusses and aims to clarify the issue of describing conduct and character as ‘good’ or ‘bad’, or as ‘right’ or ‘wrong’. The book states that one of the main factors that have made this issue obscure is the illusion of some anti-naturalists that purely logical considerations can settle it. It clearly defines the limitations of the discussions: it is not concerned with the ‘other things’ people use to define conduct and character. The book attempts to consider the issue (...) from the purely logician point of view and suggests to the naturalists and anti-naturalists how their positions may be freed from logical faults. The book also introduces the ‘logic of ethics’, which is not a special kind or branch of logic, but rather an application of it. (shrink)

The Cellular Basis of Consciousness theory places the first appearance of sentience at the emergence of life. It makes the radical, and previously unexplored, claim that prokaryotes, like bacteria, possess a primitive form of consciousness. The implications of the theory for the philosophy of mind, cell-biology, and cognitive neurosciences are explored.

This paper considers four lines of objection to the efficacy or worth of Grice's cancellability test for conversational implicatures – the coherence objection, the entailment objection, the sarcasm objection, and the ambiguity objection. I argue that the test survives these objections relatively unscathed; and hence conclude that the cancellability test is still a significant, useful, reliable indicator at the semantics/pragmatics interface.

The concepts of health and disease play pivotal roles in medicine and the health professions This volume brings together the requisite literature for understanding current discussions and debates these concepts. The selections in the volume attempt to present a wide range of views concerning the nature of the concepts of health and issues using both historical and contemporary sources -- Back cover.

Two principles of locality used in discussions about quantum mechanics are distinguished. The intuitive no-action-at-a distance requirement is called physical locality. There is also a mathematical requirement of a kind of factorizability which is referred to as "locality". It is argued in this paper that factorizability is not necessary for physical locality. Ways of producing models that are physically local although not factorizable which are concerned with correlations between the behavior of pairs of particles are suggested. These models can account (...) for all the quantum mechanical single and joint probabilities. (shrink)

Cannabis use in some individuals can meaningfully introduce de novo risk for the initiation of opioid use and development of opioid use disorder. These risks may be particularly high during adolescence when cannabis use may disrupt critical periods of neurodevelopment. Current research studying the combination of genetic and environmental factors involved in substance use disorders is poorly understood. More research is needed, particularly to identify which adolescents are most at risk and to develop effective interventions addressing contributing factors such as (...) trauma and psychiatric comorbidity. (shrink)

In the May 15, 1935 issue of Physical Review Albert Einstein co-authored a paper with his two postdoctoral research associates at the Institute for Advanced Study, Boris Podolsky and Nathan Rosen. The article was entitled “Can Quantum Mechanical Description of Physical Reality Be Considered Complete?” (Einstein et al. 1935). Generally referred to as “EPR”, this paper quickly became a centerpiece in the debate over the interpretation of the quantum theory, a debate that continues today. The paper features a striking case (...) where two quantum systems interact in such a way as to link both their spatial coordinates in a certain direction and also their linear momenta (in the same direction). As a result of this “entanglement”, determining either position or momentum for one system would fix (respectively) the position or the momentum of the other. EPR use this case to argue that one cannot maintain both an intuitive condition of local action and the completeness of the quantum description by means of the wave function. This entry describes the argument of that 1935 paper, considers several different versions and reactions, and explores the ongoing significance of the issues they raise. (shrink)

The movement to try to close the ever-widening gap between demand and supply of organs has recently arrived at the prison gate. While there is enthusiasm for using executed prisoners as sources of organs, there are both practical barriers and moral concerns that make it unlikely that proposals to use prisoners will or should gain traction. Prisoners are generally not healthy enough to be a safe source of organs, execution makes the procurement of viable organs difficult, and organ donation post-execution (...) ties the medical profession too closely to the act of execution. (shrink)