The National Institute for Health and Care Excellence, the UK’s main healthcare priority-setting body, recently reaffirmed a longstanding claim that in recommending technologies to the National Health Service it cannot apply the ‘rule of rescue’. This paper explores this claim by identifying key characteristics of the rule and establishing to what extent these are also features of NICE’s approach to evaluating ultra-orphan drugs through its highly specialised technologies programme. It argues that although NICE in all likelihood does not act because (...) of the rule in prioritising these drugs, its actions in relation to HSTs are nevertheless in accordance with the rule and are not explained by the full articulation of any alternative set of rationales. That is, though NICE implies that its approach to HSTs is not motivated by the rule of rescue, it is not explicit about what else might justify this approach given NICE’s general concern with overall population need and value for money. As such, given NICE’s reliance on notions of procedural justice and its commitment to making the reasons for its priority-setting decisions public, the paper concludes that NICE’s claim to reject the rule is unhelpful and that NICE does not currently meet its own definition of a fair and transparent decision-maker. (shrink)

One rationale policy-makers sometimes give for declining to fund a service or intervention is on the grounds that it would be ‘unaffordable’, which is to say, that the total cost of providing the service or intervention for all eligible recipients would exceed the budget limit. But does the mere fact that a service or intervention is unaffordable present a reason not to fund it? Thus far, the philosophical literature has remained largely silent on this issue. However, in this article, we (...) consider this kind of thinking in depth. Albeit with certain important caveats, we argue that the use of affordability criteria in matters of public financing commits what Parfit might have called a ‘mistake in moral mathematics’. First, it fails to abide by what we term a principle of ‘non-perfectionism’ in moral action: the mere fact that it is practically impossible for you to do all the good that you have reason to do does not present a reason not to do whatever good you can do. And second, when used as a means of arbitrating between which services to fund, affordability criteria can lead to a kind of ‘numerical discrimination’. Various attendant issues around fairness and lotteries are also discussed. (shrink)

The UK’s National Institute for Health and Care Excellence is responsible for conducting health technology assessment on behalf of the National Health Service. In seeking to justify its recommendations to the NHS about which technologies to fund, NICE claims to adopt two complementary ethical frameworks, one procedural—accountability for reasonableness —and one substantive—an ‘ethics of opportunity costs’ that rests primarily on the notion of allocative efficiency. This study is the first to empirically examine normative changes to NICE’s approach and to analyse (...) whether these enhance or diminish the fairness of its decision-making, as judged against these frameworks. It finds that increasing formalisation of NICE’s approach and a weakening of the burden of proof laid on technologies undergoing HTA have together undermined its commitment to EOC. This implies a loss of allocative efficiency and a shift in the balance of how the interests of different NHS users are served, in favour of those who benefit directly from NICE’s recommendations. These changes also weaken NICE’s commitment to AfR by diminishing the publicity of its decision-making and by encouraging the adoption of rationales that cannot easily be shown to meet the relevance condition. This signals a need for either substantial reform of NICE’s approach, or more accurate communication of the ethical reasoning on which it is based. The study also highlights the need for further empirical work to explore the impact of these policy changes on NICE’s practice of HTA and to better understand how and why they have come about. (shrink)

Healthcare priority-setting institutions have good reason to want to demonstrate that their decisions are morally justified—and those who contribute to and use the health service have good reason to hope for the same. However, finding a moral basis on which to evaluate healthcare priority-setting is difficult. Substantive approaches are vulnerable to reasonable disagreement about the appropriate grounds for allocating resources, while procedural approaches may be indeterminate and insufficient to ensure a just distribution. In this paper, we set out a complementary, (...) coherence-based approach to the evaluation of healthcare priority-setting. Drawing on Rawls, we argue that an institutional priority-setter’s claim to moral justification can be assessed, in part, based on the extent to which its many normative commitments are mutually supportive and free from dissonance; that is, on the ability to establish narrow reflective equilibrium across the normative content of a priority-setter’s policy and practice. While we do not suggest that the establishment of such equilibrium is sufficient for moral justification, we argue that failure to do so might—like the proverbial canary in the coalmine—act as a generalised warning that something is awry. We offer a theoretical argument in support of this view and briefly outline a practical method for systematically examining coherence across priority-setting policy and practice. (shrink)

The National Institute for Health and Care Excellence (NICE) is the UK’s primary healthcare priority-setting body, responsible for advising the National Health Service in England on which technologies to fund and which to reject. Until recently, the normative approach underlying this advice was described in a 2008 document entitled ‘Social value judgements: Principles for the development of NICE guidance’ (SVJ). In January 2020, however, NICE replaced SVJ with a new articulation of its guiding principles. Given the significant evolution of NICE’s (...) methods between 2008 and 2020, this study examines whether this new document (‘Principles’) offers a transparent account of NICE’s current normative approach. It finds that it does not, deriving much of its content directly from SVJ and failing to fully acknowledge or explain how and why NICE’s approach has since changed. In particular, Principles is found to offer a largely procedural account of NICE decision-making, despite evidence of the increasing reliance of NICE’s methods on substantive decision-rules and ‘modifiers’ that cannot be justified in purely procedural terms. Thus, while Principles tells NICE’s stakeholders much about how the organisation goes about the process of decision-making, it tells them little about the substantive grounds on which its decisions are now based. It is therefore argued that Principles does not offer a transparent account of NICE’s normative approach (either alone, or alongside other documents) and that, given NICE’s reliance on transparency as a requirement of procedural justice, NICE does not in this respect satisfy its own specification of a just decision-maker. (shrink)

Background As the UK’s main healthcare priority-setter, the National Institute for Health and Care Excellence (NICE) has good reason to want to demonstrate that its decisions are morally justified. In doing so, it has tended to rely on the moral plausibility of its principle of cost-effectiveness and the assertion that it has adopted a fair procedure. But neither approach provides wholly satisfactory grounds for morally defending NICE’s decisions. In this study we adopt a complementary approach, based on the proposition that (...) a priority-setter's claim to moral justification can be assessed, in part, based on the coherence of its approach and that the reliability of any such claim is undermined by the presence of dissonance within its moral system. This study is the first to empirically assess the coherence of NICE’s formal approach and in doing so to generate evidence-based conclusions about the extent to which this approach is morally justified. Methods The study is grounded in the theory, methods and standards of empirical bioethics. Twenty NICE policy documents were coded to identify and classify the normative commitments contained within NICE technology appraisal policy as of 31 December 2021. Coherence was systematically assessed by attempting to bring these commitments into narrow reflective equilibrium (NRE) and by identifying sources of dissonance. Findings Much of NICE policy rests on coherent values that provide a strong foundation for morally justified decision-making. However, NICE’s formal approach also contains several instances of dissonance which undermine coherence and prevent NRE from being fully established. Dissonance arises primarily from four sources: i) NICE’s specification of the principle of cost-effectiveness; ii) its approach to prioritising the needs of particular groups; iii) its conception of reasonableness in the context of uncertainty, and iv) its concern for innovation as an independent value. Conclusion At the time of analysis, the level of coherence across NICE policy provides reason to question the extent to which its formal approach to technology appraisal is morally justified. Some thoughts are offered on why, given these findings, NICE has been able to maintain its legitimacy as a healthcare priority-setter and on what could be done to enhance coherence. (shrink)

This chapter contains sections titled: Why? Justifying Climbing Costs of Climbing Benefits of Climbing The Balance Conclusion Notes.

Contains contributions from some of the most prominent thinkers and experts in philosophy-driven methods, such as phenomenology, hermeneutics, and semiotics. This international body of scholars discuss the issue of method itself, as well as bring those methods to bear on some of the most prominent issues of our time in the areas of media, culture and criticism.

Dr. Floyd-Thomas’s paper brings nuance to the discussion of pride and the hubris brought by the Westernized Enlightenment across disciplines. As much as I have the impulse to throttle others or shout or spit with the onslaught of mis-truths and ‘alternative facts’, this would not be a wise moment to conclude inquiry as an oral historian, or a Christian ethicist. I ask, can we decolonize ourselves, our syllabi, the canon, and thus our students with grace, understanding, even forgiveness so as (...) not to repeat the trespasses? (shrink)

A study of the relation of metaphysics to grammar, placing the central topics of philosophy in an entirely new light.

We call systematic disputes that are particularly hard to resolve deep disagreements. We can divide most theories of deep disagreements in analytic epistemology into two camps: the Wittgensteinian view and the fundamental epistemic principles view. This essay analyzes how both views deal with two of the most pressing issues a theory of deep disagreement must address: their source and their resolution. After concluding that the paradigmatic theory of each camp struggles on both fronts, the essay proceeds to show that, despite (...) their differences, these theories share some core assumptions and think of deep disagreements similarly: as grounded in fundamental epistemic differences between the parties. This underlying conception of deep disagreements the author calls “the fundamental model.” The essay provides reasons to be wary of this conception, and hence, mainstream epistemologists’ treatment of the issue. (shrink)

The introduction to the topic of this issue is an overview of the research articles authored by Russian, Lithuanian, and Indian scholars on various problems of Mahayana Buddhist philosophy. While explaining the status of the terms “Mahāyāna” and “Hīnayāna,” the author emphasizes that since they are represent the apologetic conceptualizations of Mahayanists, the appellation “Hīnayāna” (“Lesser Vehicle”, etc.) is not recognized either by those Buddhists who are supposed to be characterized by it, or by scholars striving for a neutral appellation. (...) This creates difficulties, including the need for a generally accepted designation for this Buddhist tradition. However, despite the apologetic nature of the Mahāyāna - Hīnayāna opposition, the difference between the two is captured very plausibly. The first one teaches about the individual way of achieving liberation from the cycle of endless rebirths (saṃsāra) through a personal, individual self-perfection (the path of the arhat) leading to enlightenment (bodhi) and nirvāṇa (extinction of passions). The second one develops a full-fledged religion with its own pantheon and rituals, in which nirvāṇa and individual liberation, while remaining, more or less theoretically, the ultimate goal, are pushed to a distant plane. At the same time, the idea of compassion and the ideal of bodhisattva who, having taken a vow to help all living beings to get rid of sufferings, continues to remain in saṃsāra, is put forward in the center. However, despite this major difference a Buddhist discipline known as Abhidharma which consists in analysis and classification of discrete states of consciousness (dharmas), identified in meditation, remains a reference point in both traditions. Three authors touch upon it (Helen Ostrovskaya, Pradeep Gokhale, and Vladimir Korobov). Two of them (Ostrovskaya and Gokhale) focus on the problems of murder and death, and the third one (Korobov) dwells on the methodology of Abhidharma. Vladimir Ivanov offers a new interpretation of the structure of Śāntarakṣita’s treatise “Tattva-saṃgraha” with Kamalaśīla’s “Pañjikā” commentary. Yangutov and Lepekhov explore the specificity of Buddhism reception in China, Tibet, Mongolia, and Russia. Nesterkin publishes for the first time B. Baradiin’s theses for Agvan Dordjiev’s lecture, which exemplifies the Buryat Buddhist Renovationists’ interpretation of Buddhism. Burmistrov analyzes the views of Indian historians of philosophy on the history of Buddhism, Volkova - the concepts of Buddhist ethics in contemporary analytical philosophy. (shrink)

This book selectively examines a range of ideas and arguments drawn from the philosophical traditions of South and East Asia, focusing on those that are especially relevant to the philosophy of religion. The book introduces key debates about the self and the nature of reality that unite the otherwise highly diverse philosophies of Indian and Chinese Buddhism, Hinduism, and Jainism. The emphasis of the book is analytical rather than historical. Key issues are explained in a clear, precise, accessible manner, and (...) with a view to their relevance to contemporary philosophical debates. (shrink)

An urgent call for everyone to find inventive ways to question the ethics of sexuality.

Does the Internet provide an environment in which rational individuals can initiate and maintain relationships of interpersonal trust? This paper argues that it does. It begins by examining distinctive challenges facing would-be trusters on the net, concluding that, however distinctive, such challenges are not unique to the Internet, so cannot be cited as grounds for disparaging the rationality of Internet trust. Nevertheless, these challenges point up the importance of developing mature capacities for trust, since immature trusters are particularly vulnerable to (...) the liabilities of Internet trust. This suggests that Internet trust can only be rational for those who have developed mature capacities for trust. But that suggestion ignores how trust on the Internet may also facilitate the development of such capacities. (shrink)

The figure of the mistress is undoubtedly controversial provoking intense reactions, ranging from fear, to disgust and revulsion, to excitement and titillation, to sadness and perhaps to some, love. The mistress is conventionally depicted as a threat to moral living and someone whose sexuality is 'defective' and 'toxic'. Of course, she is a woman that you would not have as your friend, and certainly not your wife, since her 'ethical sense', if she even has one, is dubious at best. This (...) book subverts these traditional judgements offering an unflinching look at the lived experience of the mistress and recasts her as a potentially loving, free, intimate 'other' woman. Drawing upon feminist philosophy, contemporary sexual ethics and the current cultural moment of #MeToo, Mistress Morality moves beyond a narrative of 'infidelity', conventional judgment, the safeguarding of monogamy and conventional heterosex that permeates our society. It asks what happens when we let go of our insecurities, judgments and moralistic relationship philosophies and opt, instead, for an ethics of kindness. A kindness underpinned by engaging with those deemed 'other' and learning from mistresses, both straight and queer, new ways of thinking about ethics and sex, meaning we have better sex, and can be better to each other. (shrink)

An interdisciplanary collection of essays focused on Kant's work on the concept of community.

Victoria Camps analiza en estas páginas la fragilidad de una ética que nace y se desarrolla con el triunfo del pensamiento liberal. La defensa de las libertades individuales, de donde emanan los derechos humanos, potencia los intereses privados frente al interés público. Desde esta perspectiva, una ética liberal es tolerante y laica, carece de dogmas, se nutre de principios abstractos, aceptados en teoría, pero con escasa incidencia en la práctica, como lo muestran la impotencia frente a la corrupción y (...) las dificultades para educar cívicamente y construir una moralidad pública. Como es habitual en otras publicaciones de la autora, su interés parte de las teorías filosóficas que han estructurado el pensamiento moral contemporáneo pero no se limita a elaborar un discurso circunscrito al debate académico. Le importa mostrar la relevancia de la filosofía para abordar las debilidades ético-políticas de nuestro tiempo. (shrink)

En este capítulo, analizo a qué se refiere Kuhn cuando habla de metáfora en las Conferencias Notre Dame, pero sobre todo a explorar a qué no se refiere. En la primera sección, analizo por qué Kuhn usa el término “metáfora” para referirse al proceso de aprendizaje de lenguaje científico, en particular, los paralelismos que encuentra entre ambos fenómenos. En la segunda sección, se presentan algunos aspectos centrales de dos teorías influyentes sobre la metáfora: la teoría del mapeo estructural y la (...) teoría de las metáforas conceptuales. Luego, en la sección III, vuelvo a Kuhn para ver las diferencias cruciales que encontramos entre los procesos metafóricos y el proceso de ostensión del que habla el autor. Finalmente, presento una noción del segundo Wittgenstein, la idea de figura, para ofrecer una nueva forma de interpretar la idea de que el cambio revolucionario involucra un cambio en la metáfora central. (shrink)

There has recently been a resurgence of philosophical and scientific interest in the foundations of self-consciousness, with particular focus on its altered, anomalous forms. This paper looks at the altered forms of self-awareness in Depersonalization Disorder (DPD), a condition in which people feel detached from their self, their body and the world (Derealisation). Building upon the phenomenological distinction between reflective and pre-reflective self-consciousness, we argue that DPD may alter thetransparencyof basic embodied forms of pre-reflective self-consciousness, as well as the capacity (...) to flexibly modulate and switch between the reflective and pre-reflective facets of self-awareness. Empirical evidence will be invoked in support of the idea that impaired processing of bodily signals is characteristic of the condition. We provide first-hand subjective reports describing the experience of self-detachment or fracture between an observing and an observed self. This split is compared with similar self-detachment phenomena reported in certain Buddhist-derived meditative practices. We suggest that these alterations and changes may reveal the underlying and tacit transparency that characterises the embodied and basic pre-reflective forms of self-consciousness, in the same way that a crack in a transparent glass may indicate the presence of an unnoticed window. (shrink)

Over three decades, Gillian Howie wrote at the forefront of philosophy and critical theory, before her untimely death in 2013. This interdisciplinary collection uses her writings to explore the productive, yet often resistant, interrelationship between feminism and critical theory, examining the potential of Howie's particular form of materialism. The contributors also bring to this debate a serious engagement with Howie's late turn towards philosophies of mortality, therapy and 'living with dying'. The volume considers how differently embodied subjects are positioned within (...) public institutions, discourses and spaces, and the role of philosophy, art, film, photography, and literature, in facing situations such as sexual oppression and life-limiting illness. (shrink)

Where does theory come from in educational research - and how is it operationalized in diverse, interdisciplinary contexts and professional settings? This volume examines the places and spaces of theory in the work of nine pre- to post-doctoral scholars, whose narratives transport us across a wide range of interdisciplinary themes and fields of inquiry from Irigaray on mothering in higher education to Jamison among Danish engineering undergraduates; from Te Whariki in a New Zealand kindergarten to ren wen in contemporary China. (...) Drawing on a range of theorists such as Butler, Bhabah, Bourdieu, Freire, Foucault, Levi-Strauss and Žižek, the book provides numerous opportunities for debate and discussion on theory and the doctoral thesis and their interrelations with pedagogy and methodology in times of great insecurity across the globe. In doing so it develops new possibilities for pedagogies of change in and beyond our current educational systems and structures. (shrink)

This paper is divided into two parts. In Section 1, I explore and defend a “regulative view” of folk-psychology as against the “standard view”. On the regulative view, folk-psychology is conceptualized in fundamentally interpersonal terms as a “mind-making” practice through which we come to form and regulate our minds in accordance with a rich array of socially shared and socially maintained sense-making norms. It is not, as the standard view maintains, simply an epistemic capacity for coming to know about the (...) mental states and dispositions already there. Importantly, the regulative view can meet and beat the standard at its own epistemic game. But it also does more. In Section 2, I show how the regulative view makes progress on two other problems that remain puzzling on the standard view: the problem of “first-person authority” – accounting for the special features of self-knowledge; and the problem of “reactive.. (shrink)

The medicalisation of pregnancy and childbirth has been encouraged by the continuing growth of technology that can be applied to the reproductive journey. Technology now has the potential to fully separate reproduction from the human body with the prospect of ectogenesis—the gestation of a fetus outside of the human body. This paper considers the issues that have been caused by the general medicalisation of pregnancy and childbirth and the impact that ectogenesis may have on these existing issues. The medicalisation of (...) pregnancy and childbirth is criticised for its impact on the relationship between doctors and pregnant women and the way in which doctors treat fetuses. It is argued that ectogenesis may cause more imbalance in the doctor and intended parent relationship and may result in an increased lack of clarity regarding a doctor’s duty to the fetus. This paper finds that extensive guidance and revised legislation will be necessary to minimise the impact of ectogenesis on the existing issues caused by the medicalisation of reproduction. (shrink)

This paper examines the methodological claim made famous by P.F. Strawson: that we understand what features are required for responsible agency by exploring our attitudes and practices of holding responsible. What is the presumed metaphysical connection between holding responsible and being fit to be held responsible that makes this claim credible? I propose a non-standard answer to this question, arguing for a view of responsible agency that is neither anti-realist (i.e. purely 'conventionalist') nor straightforwardly realist. It is instead ‘constructivist’. On (...) the ‘Scaffolding View’ I defend, reactive attitudes play an essential role in developing, supporting, and thereby maintaining the capacities that make for responsible agency. While this view has relatively novel implications for a metaphysical understanding of capacities, its chief virtue, in contrast with more standard views, is providing a plausibly defensible account of how so-called responsible agents genuinely deserve to be treated as such. (shrink)

Philosophers and social scientists have focussed a great deal of attention on our human capacity to trust, but relatively little on the capacity to hope. This is a significant oversight, as hope and trust are importantly interconnected. This paper argues that, even though trust can and does feed our hopes, it is our empowering capacity to hope that significantly underwrites—and makes rational—our capacity to trust.