The Harm Threshold (HT) holds that the state may interfere in medical decisions parents make on their children’s behalf only when those decisions are likely to cause serious harm to the child. Such a high bar for intervention seems incompatible with both parental obligations and the state’s role in protecting children’s well-being. In this paper, I assess the theoretical underpinnings for the HT, focusing on John Stuart Mill’s Harm Principle as its most plausible conceptual foundation. I offer (i) a novel, (...) text-based argument showing that Mill’s Harm Principle does not give justificatory force to the HT; and (ii) a positive account of some considerations which, beyond significant harm, would comprise an intervention principle normatively grounded in Mill’s ethical theory. I find that substantive recommendations derived from Mill’s socio-political texts are less _laissez-faire_ than they have been interpreted by HT proponents. Justification for state intervention owes not to the severity of a harm, but to whether that harm arises from the failure to satisfy one’s duty. Thus, a pediatric intervention principle derived from Mill ought not to be oriented around the _degree_ of harm caused by a parent’s healthcare decision, but rather, the _kind_ of harm—specifically, whether the harm arises from violation of parental obligation. These findings challenge the interpretation of Mill adopted by HT proponents, eliminating a critical source of justification for a protected domain of parental liberty and reorienting the debate to focus on parental duties. (shrink)

Children are presumptively regarded as incompetent to make their own medical decisions, and the responsibility for making such decisions typically falls to parents. Parental authority is not unlimited, however, and ethical guidelines identifying appropriate bounds on this authority are needed. One proposal currently gaining support is the Harm Threshold (HT), which asserts that the state may only legitimately intervene in parental decision-making when serious and preventable harm to children is likely. This paper considers two questions: in virtue of what underlying (...) principle or property does the HT gain its purported justification?; and does this underlying principle or property ground the HT as its proponents conceive of it? I identify two separate grounds represented in the literature: (i) J.S. Mill’s Harm Principle; and (ii) the liberty interests of parents. I find that the HT is not sufficiently grounded in either of these, revealing a substantial conceptual difficulty for its advocates. (shrink)

This paper advances a novel conception of the child’s best interest in regard to pediatric surgeries that do not promote the preventive or therapeutic health needs of children, or elective pediatric surgeries (EPS). First, children’s capacity for decision-making is examined, and the best decision-making model for EPS is identified as the Best Interest Standard. What follows is a discussion of the interests of children in the context of EPS, the correlation of fundamental interests to rights, and guidelines for weighing children’s (...) competing interests. Next, the rights and duties of parents as proxy decision makers are considered. Finally, a reinterpretation of the Best Interest Standard is proposed, identifying as paramount a child’s ability to make elective medical decisions for herself when she reaches maturity. (shrink)

This quarter’s issue of the Kennedy Institute of Ethics Journal dives deeply into questions concerning who is the proper target of medical interventions, and under what circumstances. Mary Jean Walker and James Franklin’s article, “An Argument Against Drug Testing Welfare Recipients,” and Maggie Taylor’s “Too Close to the Knives: Children’s Rights, Parental Authority, and Best Interests in the Context of Elective Pediatric Surgeries” both ask hard questions about when medical interventions can be imposed without consent, purportedly in order (...) to secure non-medical, social benefits for their recipients. Lauren Freeman and Saray Ayala López’s “Sex Categorization in Medical Contexts: A Cautionary Tale,” questions who... (shrink)

Equilibrium explanations use an equilibrium to represent and explain a system’s dynamic behavior. They provide a system with the property of global stability: a system will converge towards and remain in equilibrium regardless of its initial conditions and dynamic process. Thus, equilibrium explanations are generally treated as non-causal explanations. There are two claims subsumed under that comprehensive thesis. The first claim is that equilibrium explanations do not identify any causes because a system with global stability resists manipulation. The second claim (...) is that even if equilibrium explanations do identify causes by manipulation, those causes are embedded in a system’s deeper, underlying structural relationships, and those causes are irrelevant to explaining a system’s behavior. Only the system’s structural relationships are relevant. But equilibrium explanations are not monolithic. I compare dynamic systems with multiple, competing equilibria to systems with a globally stable equilibrium. Equilibrium explanations of the former use intervention on a system’s initial conditions and dynamic process to manipulate equilibria, which identifies causes. Furthermore, a system’s initial conditions and dynamic process are relevant to explaining why one equilibrium is selected instead of another. I then apply these lessons to systems with a globally stable equilibrium and discuss when their corresponding equilibrium explanations have a proper role in the parent sciences. (shrink)

One of the most influential philosophers in the English-speaking world, Charles Taylor is internationally renowned for his contributions to political and moral theory, particularly to debates about identity formation, multiculturalism, secularism, and modernity. In _Modern Social Imaginaries,_ Taylor continues his recent reflections on the theme of multiple modernities. To account for the differences among modernities, Taylor sets out his idea of the social imaginary, a broad understanding of the way a given people imagine their collective social life. (...) Retelling the history of Western modernity, Taylor traces the development of a distinct social imaginary. Animated by the idea of a moral order based on the mutual benefit of equal participants, the Western social imaginary is characterized by three key cultural forms—the economy, the public sphere, and self-governance. Taylor’s account of these cultural formations provides a fresh perspective on how to read the specifics of Western modernity: how we came to imagine society primarily as an economy for exchanging goods and services to promote mutual prosperity, how we began to imagine the public sphere as a metaphorical place for deliberation and discussion among strangers on issues of mutual concern, and how we invented the idea of a self-governing people capable of secular “founding” acts without recourse to transcendent principles. Accessible in length and style, _Modern Social Imaginaries_ offers a clear and concise framework for understanding the structure of modern life in the West and the different forms modernity has taken around the world. (shrink)

Spirituality and Dialectics is a passionate and rigorous argument against nihilism and a manifesto for the party of meaning and hope. It demonstrates how we can ground principles of meaning and value, against the aesthetic and intellectual hegemony of the enlightenment—culminating most currently through postmodernity, as a basis for the critique of all present injustice. What emerges is a vision of a new social order that permits the full development of human social capacities.

This is the first volume in which an account of personal autonomy is developed that both captures the contours of this concept as it is used in social philosophy and bioethics, and is theoretically grounded in, and a part of, contemporary autonomy theory. James Stacey Taylor’s account is unique as it is explicitly a political one, recognizing that the attribution of autonomy to agents is dependent in part on their relationships with others and not merely upon their own mental (...) states. The volume is distinctive in its examples, which touch on the ethics of using inducements to encourage persons to participate in medical research, the ethical issues associated with the use of antibiotics, and the ethical basis for both patient confidentiality and informed consent. (shrink)

Introduction to Hegel's thought for the student and general reader, emphasizing in particular his social and political thought and his continuing relevance to contemporary problems.

_ Exemplarist Moral Theory _ By ZagzebskiLinda TrinkausOxford University Press, 2017. xiv + 274 pp. £41.99.

Philosophy and Phenomenological Research, EarlyView.

The lexical priority of fair equality of opportunity in John Rawls’s justice as fairness, which has been sharply criticized by Larry Alexander and Richard Arneson among others, is left almost entirely undefended in Rawls’s works. I argue here that this priority rule can be successfully defended against its critics despite Rawls’s own doubts about it. Using the few textual clues he provides, I speculatively reconstruct his defense of this rule, showing that it can be grounded on our interest in self-realization (...) through work. This reconstructed defense makes liberal use of concepts already present in A Theory of Justice , including the Aristotelian Principle (which motivates the achievement of increasing virtuosity) and the Humboldtian concept of social union (which provides the context for the development of such virtuosity). I also show that this commitment to self-realization, far from violating the priority of right in Rawls’s theory, stems directly from his underlying commitment to autonomy, which is the very foundation of the moral law in his doctrine of right. The reconstituted defense of this priority rule not only strengthens the case for justice as fairness but also has important and controversial implications for public policy. (shrink)

This essay argues that deflationism is incompatible with the phenomenon of referential indeterminacy. This puts the deflationist in the difficult position of having to deny the possibility of what otherwise seems like a manifest and theoretically important phenomenon. Section 1 provides background on deflationism. Section 2 considers an intuitive argument by Stephen Leeds to the effect that deflationism precludes RI; the essay argues that this argument does not succeed. The rest of the essay presents its own, distinct argument for the (...) incompatibility of deflationism and RI. Section 3 argues that direct RI—RI that is not simply a derivative of some other, nonreferential instance of indeterminacy—is strictly incompatible with deflationism. Section 4 considers a couple of different ways the deflationist might try to achieve indirect RI—via indeterminate identity and indeterminate synonymy—and argues that each is unsatisfactory. (shrink)

The number and the scale of transboundary public health concerns are increasing. Infectious and non-communicable diseases, international trade in tobacco, alcohol, and other dangerous products as well as the control of the safety of health services, pharmaceuticals, and food are merely a few examples of contemporary transnationalization of health concerns. The rapid development and diffusion of scientific and technological developments across national borders are creating new realms of international health concern, such as aspects of biomedical science, including human reproductive cloning, (...) germ-line therapy, and xenotransplantation, as well as environmental health problems, including climate change, biodiversity loss, and depletion of the ozone layer. Growth in international trade and travel, in combination with population growth, has served to increase the frequency and intensity of health concerns bypassing or spilling over sovereign boundaries.Although health has traditionally been seen an area of limited multilateral cooperation, there is growing awareness that contemporary globalization has led to the proliferation of cross border determinants of health status and is undermining the capacity of nation states to protect health through domestic action alone. (shrink)

This essay makes a case for the relevance of Foucault’s critique of modern Western subjectivity for feminist efforts toward countering sexual violence against women. In his last four Collège de France courses, Foucault shows that subjectivity produces a normalizing relation of the self to itself, the effects of which extend beyond the self in equally harmful ways. As I see it, this harm is especially damaging to women who have experienced sexual violence; moreover, it inhibits effective feminist resistance to such (...) violence. Through analyzing a particular instance of feminist activism, I argue for the anti-normalizing potential of a contemporary mode of self-relation that functions in a way analogous to that fostered by the ancient practice of parrhēsia. (shrink)

We present a new partial order for directly forcing morasses to exist that enjoys a significant homogeneity property. We then use this forcing in a reverse Easton iteration to obtain an extension universe with morasses at every regular uncountable cardinal, while preserving all n-superstrong , hyperstrong and 1-extendible cardinals. In the latter case, a preliminary forcing to make the GCH hold is required. Our forcing yields morasses that satisfy an extra property related to the homogeneity of the partial order; we (...) refer to them as mangroves and prove that their existence is equivalent to the existence of morasses. Finally, we exhibit a partial order that forces universal morasses to exist at every regular uncountable cardinal, and use this to show that universal morasses are consistent with n-superstrong, hyperstrong, and 1-extendible cardinals. This all contributes to the second author’s outer model programme, the aim of which is to show that L-like principles can hold in outer models which nevertheless contain large cardinals. (shrink)

This paper considers the morally relevant ways in which population-based research is a distinct type of human subjects research that have unique moral considerations relevant for public health practitioners and researchers. By defining population-based research, the authors distinguish it from public health practice and then consider, in more detail, the ways in which population-based research differs from clinical human subjects research. Based upon the distinctions between these types of research and practice, they identify five important issues that arise in the (...) design and conduct of certain kinds of population-based research. The authors hope that public health practitioners find these distinctions useful in determining when their work may actually be population-based research and that public health researchers use them to identify the areas where ethical issues in their research may arise. (shrink)

The challenge of convincing people to change their eating habits towards more environmentally sustainable food consumption (ESFC) patterns is becoming increasingly pressing. Food preferences, choices and eating habits are notoriously hard to change as they are a central aspect of people’s lifestyles and their socio-cultural environment. Many people already hold positive attitudes towards sustainable food, but the notable gap between favorable attitudes and actual purchase and consumption of more sustainable food products remains to be bridged. The current work aims to (...) 1) present a comprehensive theoretical framework for future research on ESFC, and 2) highlight behavioral solutions for environmental challenges in the food domain from an interdisciplinary perspective. First, starting from the premise that food consumption is deliberately or unintentionally directed at attaining goals, a goal-directed framework for understanding and influencing ESFC is built. To engage in goal-directed behavior, people typically go through a series of sequential steps. The proposed theoretical framework makes explicit the sequential steps or hurdles that need to be taken for consumers to engage in ESFC. Consumers need to positively value the environment, discern a discrepancy between the desired versus the actual state of the environment, opt for action to reduce the experienced discrepancy, intend to engage in behavior that is expected to bring them closer to the desired end state, and act in accordance with their intention. Second, a critical review of the literature on mechanisms that underlie and explain ESFC (or the lack thereof) in high-income countries is presented and integrated into the goal-directed framework. This contribution thus combines a top-down conceptualization with a bottom-up literature review; it identifies and discusses factors that might hold people back from ESFC and interventions that might promote ESFC; and it reveals knowledge gaps as well as insights on how to encourage both short- and long-term ESFC by confronting extant literature with the theoretical framework. Altogether, the analysis yields a set of 33 future research questions in the interdisciplinary food domain that deserve to be addressed with the aim of fostering ESFC in the short and long term. (shrink)

The main question that Firestone & Scholl (F&S) pose is whether “what and how we see is functionally independent from what and how we think, know, desire, act, and so forth” (sect. 2, para. 1). We synthesize a collection of concerns from an interdisciplinary set of coauthors regarding F&S's assumptions and appeals to intuition, resulting in their treatment of visual perception as context-free.

Normative case studies represent empirically grounded phenomena that raise normative philosophical questions. Growth in the popularity of case-based inquiry in philosophy reflects a recent trend in the field not to shy away from engaging with empirical realities, but instead to advance philosophical projects that recognize and speak directly to these realities, including social inequities endemic to our societies. Yet, as the use of case studies and other empirically engaged philosophical approaches has grown, concerns have been raised about whether these methods (...) risk reducing philosophy to social science and, in turn, burdening philosophy with the constraints of social science research. Responding to these concerns calls for more attention to the methodological dimensions of case-based inquiry in philosophy. In this article, Rebecca Taylor offers reflections on two core clarifying questions: (1) What makes normative case studies distinct from other related tools for inquiry — in particular, philosophical thought experiments and qualitative case studies? (2) What quality criteria should guide the development of normative case studies? (shrink)

According to policy makers, telemedicine offers “huge opportunities to improve the quality and accessibility of health services.” It is defined as diagnosis, treatment, and monitoring, with doctors and patients separated by space but mediated through information and communication technologies. This mediation is explored through an ethnography of a U.K. teledermatology clinic. Diagnostic image transfer enables medicine at a distance, as patients are removed from knowledge generation by concentrating their identities into images. Yet that form of identity allows images and the (...) expert gaze to be brought into potentially lifesaving proximity. Following Latour’s thread, images must be captured and then mobilized to the knowledge base, where they must be stabilized into standard diagnoses, then combined with different images, waiting lists, skin lesions, dermatologists, paper records, and beds, so that ultimately, outcomes are produced. This huge task requires new knowledges and a widening of agency that, if unacknowledged, may see telemedicine projects continue to founder. (shrink)

_A leading thinker asks why “faster” is synonymous with “better” in our hurried world and suggests how to take control of our runaway lives_ We live in an ever-accelerating world: faster computers, markets, food, fashion, product cycles, minds, bodies, kids, lives. When did everything start moving so fast? Why does speed seem so inevitable? Is faster always better? Drawing together developments in religion, philosophy, art, technology, fashion, and finance, Mark C. Taylor presents an original and rich account of a (...) great paradox of our times: how the very forces and technologies that were supposed to free us by saving time and labor now trap us in a race we can never win. The faster we go, the less time we have, and the more we try to catch up, the farther behind we fall. Connecting our speed-obsession with today’s global capitalism, he composes a grand narrative showing how commitments to economic growth and extreme competition, combined with accelerating technological innovation, have brought us close to disaster. Psychologically, environmentally, economically, and culturally, speed is taking a profound toll on our lives. By showing how the phenomenon of speed has emerged, Taylor offers us a chance to see our pace of life as the product of specific ideas, practices, and policies. It’s not inevitable or irreversible. He courageously and movingly invites us to imagine how we might patiently work towards a more deliberative life and sustainable world. (shrink)

Foucault's influence has waned little over recent years and the once avant-garde theorist is now mainstream for countless subjects in the humanities and social sciences. He continues to out-sell his contemporaries and there remains strong demand for books that offer readers fresh exegesis of his work.

More than simply a listing and abstract discussion of ideas, the book presents a searching analysis of Aristotle's thought, both in terms of its historical...

This paper problematizes the claim that Michel Foucault's work is normatively lacking and therefore possesses only limited political relevance. While Foucault does not articulate a traditional normative framework for political activity, I argue that his work nonetheless reflects certain normative commitments to, for example, practicing freedom and improving the state of the world. I elucidate these commitments by sketching out Foucault's notion of critique as a mode of existence characterized by practices of the self, arguing that such practices possess political (...) significance within the context of what Foucault refers to as a way of life, and analyzing points of intersection and departure between Kant's and Foucault's respective responses to the question `What is Enlightenment?' in order to clarify the connection Foucault makes between self-practices and freedom. Through this analysis I also show that Foucault reconceptualizes normative concepts such as obligation, freedom, autonomy and publicity in non-normalizing, politically compelling ways, and argue that his work opens onto a similar reconceptualization of the notion of political unity. I conclude with a preliminary investigation into the political efficacy of Foucault's ethos by discussing its relevance specifically for feminist politics. (shrink)

In this paper I argue that the free-market provision of health care is both practical and morally sound, and is superior in both respects to its provision by the State. The State provision of health care will be inefficient compared to its free-market alternative. It will thus provide less health care to persons for the same amount of expenditure, and so save fewer lives and alleviate less suffering for two reasons: state actors have no incentive to husband their resources effectively, (...) and that in a non-market setting, special interest groups can capture resources through lobbying, perverting them away from their efficient allocation. Given these considerations of efficiency a utilitarian should morally prefer the free-market provision of health care to its State-based rival. Furthermore, even if one is not a utilitarian, the free-market provision of health care will be more morally sound than its State-based alternative because it will likely better respect the autonomy of persons, and will better refrain from imposing values upon persons. With these points in hand, I address two prominent objections to a free market system of health care. (shrink)

The lack of medical availability of effective pain medication is an enduring and expanding global health calamity. Despite important medical advances, pain remains severely under-treated worldwide, particularly in developing countries. This article contributes to the discussion of this global health crisis by considering international legal and institutional mechanisms to promote wider accessibility to critical narcotic drugs for pain relief.

Friedrich Nietzsche has emerged as one of the most important and influential modern philosophers. For several decades, the book series Monographien und Texte zur Nietzsche-Forschung (MTNF) has set the agenda in a rapidly growing and changing field of Nietzsche scholarship. The scope of the series is interdisciplinary and international in orientation reflects the entire spectrum of research on Nietzsche, from philosophy to literary studies and political theory. The series publishes monographs and edited volumes that undergo a strict peer-review process. The (...) book series is led by an international team of editors, whose work represents the full range of current Nietzsche scholarship. (shrink)