I introduce and argue for a Priority Principle, according to which we exemplify certain of our mental properties in the primary or non-derivative sense. I then apply this principle to several debates in the metaphysics and philosophy of mind.

In a famous passage (A68/B93), Kant writes that “the understanding can make no other use of […] concepts than that of judging by means of them.” Kant's thought is often called the thesis of the priority of judgments over concepts. We find a similar sounding priority thesis in Frege: “it is one of the most important differences between my mode of interpretation and the Boolean mode […] that I do not proceed from concepts, but from judgments.” Many interpreters (...) have thought that Frege's priority principle is close to (or at least derivable from) Kant's. I argue that it is not. Nevertheless, there was a gradual historical development that began with Kant's priority thesis and culminated in Frege's new logic. (shrink)

According to Jeffrey Brower’s hylomorphic account of material substances, prime matter and substantial forms together compose material substances, and material substances and accidental forms together compose accidental unities. In a recent article, Andrew Bailey has argued that Brower’s account has the counter-intuitive implication that no human person is ever the primary possessor, the primary thinker, of her own thoughts. In this paper, I consider various ways in which Brower might reply to this objection. I first consider several “invariant strategies”, solutions (...) that do not require any significant alteration to Brower’s account. I argue that these strategies are unsuccessful. I then introduce two ways of modifying Brower’s hylomorphic account of material substances so as to avoid Bailey’s objection. I argue that these “variant strategies” are successful, but they require that Brower significantly alter one or more of the main features of his account. (shrink)

Background: Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. Objective: The objective of this article is to examine how significant others may affect the principle of justice in the medical treatment and nursing care of intensive care patients. Method: Field observations and in-depth interviews with physicians and nurses in intensive care (...) units (ICU). Emphasis was placed on eliciting the underlying rationale for prioritisations in clinical intensive care with particular focus on clinicians’ considerations when limiting ICU treatment. Results: Significant others could induce an unintentional discrimination of ICU patients. Family members who were demanding received more time and attention for both the patient and themselves. Patients’ and families’ status and position and/or an interesting medical diagnosis seemed to govern the clinicians’ priorities of patients and families—consciously as well as unconsciously. The clinicians emphasised that patient information given through families was important. However, patients’ preferences and values conveyed to clinicians through their families were not always taken seriously. This even applied in cases with very serious prognoses and an explicit patient wish to forego life-prolonging treatment. Conclusion: The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers’ professional and personal values, attitudes and interests. (shrink)

How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems (...) unreasonable that public values would straightforwardly decide the ethical question of how resources should be distributed. On the other hand, in a democratic society, it seems equally unreasonable that they would be considered irrelevant for this question. In this paper we draw on the notion of reflective equilibrium and discuss the relevance and roles that empirical studies may plausibly have for justification in priority setting ethics. We develop a framework for analysing how different kinds of empirical results may have different kinds of implications for justification. (shrink)

Background Standard interpretations of the ethical principle of respect for persons have not incorporated the views and values of patients, especially patients from groups underrepresented in research. This limits the ability of research ethics scholarship, guidance, and oversight to support inclusive, patient-centered research. This study aimed to identify the practical approaches that patients in community-based settings value most for conveying respect in genomics research. Methods We conducted a 3-round, web-based survey using the modified Delphi technique to identify areas of (...) agreement among English-speaking patients at primary care clinics in Washington State and Idaho who had a personal or family history of cancer. In Round 1, respondents rated the importance of 17 items, identified in prior qualitative work, for feeling respected. In Round 2, respondents re-rated each item after reviewing overall group ratings. In Round 3, respondents ranked a subset of the 8 most highly rated items. We calculated each item’s mean and median rankings in Round 3 to identify which approaches were most important for feeling respected in research. Results Forty-one patients consented to the survey, 21 (51%) completed Round 1, and 18 (86% of Round 1) completed each of Rounds 2 and 3. Two sets of rankings were excluded from analysis as speed of response suggested they had not completed the Round 3 ranking task. Respondents prioritized provision of study information to support decision-making (mean ranking 2.6 out of 8; median ranking 1.5) and interactions with research staff characterized by kindness, patience, and a lack of judgment (mean ranking 2.8; median ranking 2) as the most important approaches for conveying respect. Conclusions Informed consent and interpersonal interactions are key ways that research participants experience respect. These can be supported by other approaches to respecting participants, especially when consent and/or direct interactions are infeasible. Future work should continue to engage with patients in community-based settings to identify best practices for research without consent and examine unique perspectives across clinical and demographic groups in different types of research. (shrink)

Descartes’ version of the Cosmological Argument in the Third Meditation is usually considered a failure, not because its conclusion doesn't follow from its premises, but because the truth of two of its premises is doubtful. One of these premises is that the objective reality of an idea is derived from a cause in which there is at least as much formal reality; the other, that only a being that possesses the qualities normally attributed to God could be responsible for the (...) idea of God. Typically there are two objections made in response to the first of these premises. First, we don't understand the concepts of formal and objective reality well enough to know whether or not the premise commands our assent. (shrink)

Most public and non-profit organisations that fund health research provide the majority of their funding in the form of grants. The calls for grant applications are often untargeted, such that a wide variety of applications may compete for the same funding. The grant review process therefore plays a critical role in determining how limited research resources are allocated. Despite this, little attention has been paid to whether grant review criteria align with widely endorsed ethical criteria for allocating health research resources. (...) Here, we analyse the criteria and processes that ten of the largest public and non-profit research funders use to choose between competing grant applications. Our data suggest that research funders rarely instruct reviewers to consider disease burden or to prioritise research for sicker or more disadvantaged populations, and typically only include scientists in the review processes. This is liable to undermine efforts to link research funding to health needs. (shrink)

This paper highlights a feature common to many ethical guidelines—namely, the idea that the interests of the individual shall always prevail over the interests of science and society. The paper presents how some major ethical guidelines treat the balancing of research interests against those of research subjects and spells out the difficulties in interpreting the principle of the primacy of the individual in a way that can be action-guiding. It suggests various alternative interpretations of the primacy of the individual (...) and argues that they do not hold. Finally, the implications of this analysis for ethical guidelines are discussed. (shrink)

In recent years there has been a good deal of discussion of equality’s place in the best account of distribution or distributive justice. One central question has been whether egalitarianism should give way to a principle requiring us to give priority to the worse off. In this article, I shall begin by arguing that the grounding of equality is indeed insecure and that the priority principle appears to have certain advantages over egalitarianism. But I shall then (...) claim that the priority principle itself is ungrounded and that the priority principle should itself give way to a sufficiency principle based — indirectly, via the notion of an impartial spectator — on compassion for those who are badly off. (shrink)

Advancement of modern agricultural biotechnology has brought various potential benefits to humankind, but at the same time ethical concerns regarding some applications such as genetically modified foods have been raised among the public. Several questions are being posed; should they utilize such applications to improve quality of their life, or should they refrain in order to save themselves from any associated risk? What are the ethical principles that can be applied to assess these applications? By using GMF as a case (...) study, this paper discusses possible answers to these questions from Islamic perspective. Such answers are based on the understanding of the Islamic concept of maslahah and mafsadah as well as the Islamic principles of priority. There is no specific GMF that has been declared as unlawful by Muslim scholars thus far. Nevertheless, they generally state that any GMF that contains unlawful substance is prohibited in Islam. Such statement can be understood since Islam puts highest priority to preserve shari’ah which prescribes the lawful and unlawful things in human life. Priorities have also been given to preserve human health and environment therefore any GMF that may inflict harm on both entities is also considered as unlawful. (shrink)

According to the priority view, or prioritarianism, it matters more to benefit people the worse off they are. But how exactly should the priority view be defined? This article argues for a highly general characterization which essentially involves risk, but makes no use of evaluative measurements or the expected utility axioms. A representation theorem is provided, and when further assumptions are added, common accounts of the priority view are recovered. A defense of the key idea behind the (...) priority view, the priority principle, is provided. But it is argued that the priority view fails on both ethical and conceptual grounds. (shrink)

Thomas Weiss oversimplifies when he identifies the International Committee of the Red Cross with the classicist position of nonconfrontation.

Priority monism is roughly the view that the universe is the only fundamental object, that is, a concrete object that does not depend on any other concrete object. Schaffer, the main advocate of PM, claims that PM is compatible with dependence having two different directions: from parts to wholes for subcosmic wholes, and from whole to parts for the cosmic whole. Recently it has been argued that this position is untenable. Given plausible assumptions about dependence, PM entails that dependence (...) has only one direction, it always goes from wholes to parts. One such plausible assumption is a principle of Isolation. I argue that, given all extant accounts of dependence on the market, PM entails No Isolation. The argument depends upon a particular feature of the dependence relation, namely, necessitation and its direction. In the light of this, I contend that the argument is important, insofar as it suggests that we should distinguish dependence from other cognate notions, e.g. grounding. Once this distinction is made, I suggest we should also distinguish between two different notions of fundamentality that might turn out to be not-coextensive. (shrink)

The development of some COVID-19 vaccines by private companies like Moderna and Sanofi-GSK has been substantially funded by various governments. While the Sanofi CEO has previously suggested that countries that fund this development ought to be given some priority, this suggestion has not been taken seriously in the literature. Considerations of nationalism, sustainability, need, and equitability have been more extensively discussed with respect to whether and how much a country is entitled to advance purchase orders of the vaccine under (...) conditions of absolute scarcity. Yet, little attention has been paid to whether prior investment into developing a vaccine entitles a country to some priority with respect to these orders. Moreover, while not a majority view, some survey results show that a significant minority of the populace does endorse some view like this. This article argues that the minority have a point: recognizing funder countries some priority is justified by the weak Lockean claim (WLC). According to the WLC, the fact that someone has contributed to the development of something gives them some entitlement to the resultant product. This article will defend the WLC, and address objections to the argument, including those pertaining to questions of historical injustice and medical need. This argument does not imply an unconstrained entitlement. Rather, contribution to development is one morally relevant factor that must be tempered by and weighed against potentially more substantial claims to priority based on need, equity, and other considerations. (shrink)

Epistemic burdens – the nature and extent of our ignorance (that and how) with respect to various courses of action – serve to determine our incentive structures. Courses of action that seem to bear impossibly heavy epistemic burdens are typically not counted as options in an actor’s menu, while courses of action that seem to bear comparatively heavy epistemic burdens are systematically discounted in an actor’s menu relative to options that appear less epistemically burdensome. That ignorance serves to determine what (...) counts as an option means that epistemic considerations are logically prior to moral, prudential, and economic considerations: in order to have moral, prudential, or economic obligations, one must have options, and epistemic burdens serve to determine our options. One cannot have obligations without doing some epistemic work. We defend this claim on introspective grounds. We also consider how epistemic burdens distort surrogate decision-making. The unique epistemology of surrogate cases makes the priority of the epistemic readily apparent. We then argue that anyone who accepts a principle similar to ought implies can is committed to the logical priority of the epistemic. We also consider and reject several possible counterarguments. -/- . (shrink)

Steinberg has recently proposed an argument against Schaffer’s priority monism. The argument assumes the principle of Necessity of Monism, which states that if priority monism is true, then it is necessarily true. In this paper, I argue that Steinberg’s objection can be eluded by giving up Necessity of Monism for an alternative principle, that I call Essentiality of Fundamentality, and that such a principle is to be preferred to Necessity of Monism on other grounds as (...) well. (shrink)

In this article I analyse and discuss guidelines for priority setting in crisis management at a regional level in Sweden. The guidelines concern three types of crises: pandemics, large losses of electric power and interruptions in water supply. Pandemics are typical public health issues. Large losses of electric power and interruptions in water supply are in themselves not, but may have serious public health consequences. These guidelines are compared with guidelines for priority setting in health care. This is (...) done because of the central position of health care in the management of many different types of crises. The comparison shows clear differences. In the analysis, I use a distinction between substantive principles of priority setting and process-oriented principles. Regarding substantive principles, I have found that the guidelines point in different directions. This seems acceptable, however, since they focus on different problems. Moreover, it seems possible to integrate the various context-dependent principles by relating them to higher order principles. Regarding process-oriented principles, I have found that how and to what extent these principles are applied in the guidelines vary. If we want to apply these principles in a more satisfying way, this would require a more systematic approach. (shrink)

Background Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses’ prioritizations in their work to achieve well-being and health for nursing home residents. Aim The aim of this study was to explore nursing home nurses’ priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic. Research design, participants, and research context We conducted (...) a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis. Ethical considerations Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649). Findings We identified an overarching theme—nursing home nurses struggling on multiple fronts, “just do it”—and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives’ expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing. Conclusions Nurses’ priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses’ priorities. Nursing home nurses need organizational and managerial support to prioritize. (shrink)

As the demand for healthcare rises, so does the need for priority setting in healthcare. In this paper, I consider a prominent priority-setting principle: proportional shortfall. My purpose is to argue that proportional shortfall, as a principle, should not be adopted. My key criticism is that proportional shortfall fails to consider past health.Proportional shortfall is justified as it supposedly balances concern for prospective health while still accounting for lifetime health, even though past health is deemed irrelevant. (...) Accounting for this lifetime perspective means that the principle may indirectly consider past health by accounting for how far an individual is from achieving a complete, healthy life. I argue that proportional shortfall does not account for this lifetime perspective as it fails to incorporate the fair innings argument as originally claimed, undermining its purported justification.I go on to demonstrate that the case for ignoring past health is weak, and argue that past health is at least sometimes relevant for priority-setting decisions. Specifically, when an individual’s past health has a direct impact on current or future health, and when one individual has enjoyed significantly more healthy life years than another.Finally, I demonstrate that by ignoring past illnesses, even those entirely unrelated to their current illness, proportional shortfall can lead to instances of double jeopardy, a highly problematic implication. These arguments give us reason to reject proportional shortfall. (shrink)

The development of some COVID-19 vaccines by private companies like Moderna and Sanofi-GSK has been substantially funded by various governments. While the Sanofi CEO has previously suggested that countries that fund this development ought to be given some priority, this suggestion has not been taken seriously in the literature. Considerations of nationalism, sustainability, need, and equitability have been more extensively discussed with respect to whether and how much a country is entitled to advance purchase orders of the vaccine under (...) conditions of absolute scarcity. Yet, little attention has been paid to whether prior investment into developing a vaccine entitles a country to some priority with respect to these orders. Moreover, while not a majority view, some survey results show that a significant minority of the populace does endorse some view like this. This article argues that the minority have a point: recognizing funder countries some priority is justified by the weak Lockean claim (WLC). According to the WLC, the fact that someone has contributed to the development of something gives them some entitlement to the resultant product. This article will defend the WLC, and address objections to the argument, including those pertaining to questions of historical injustice and medical need. This argument does not imply an unconstrained entitlement. Rather, contribution to development is one morally relevant factor that must be tempered by and weighed against potentially more substantial claims to priority based on need, equity, and other considerations. (shrink)

This paper aims to illuminate some issues in the equality, priority, or what debate. I characterize egalitarianism and prioritarianism, respond to the view that we should care about sufficiency or compassion rather than equality or priority, discuss the levelling down objection, and illustrate the significance of the distinction between prioritarianism and egalitarianism, establishing that the former is no substitute for the latter. In addition, I respond to Bertil Tungodden's views regarding the Slogan, the levelling down objection, the Pareto (...) Principle, leximin, the principle of personal good, strict moderate egalitarianism, the Hammond Equity Condition, the intersection approach, and non-aggregative reasoning. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order (...) to ensure that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities. We review explicit priority setting efforts in Norway, Sweden, Israel, the Netherlands, Denmark, New Zealand, the United Kingdom and (...) the state of Oregon in the US. The approaches used can be divided into those centered on outlining principles versus those that define practices. In order to establish the main lessons from their experiences we consider the process each country used, criteria to judge the success of these efforts, which approaches seem to have met these criteria, and using their successes and failures as a guide, how to proceed in setting priorities. We demonstrate that there is little evidence that establishment of a values framework for priority setting has had any effect on health policy, nor is there evidence that priority setting exercises have led to the envisaged ideal of an open and participatory public involvement in decision making. (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal access may (...) compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

The moral principle of giving greater priority to benefiting people, the less well off they are, has been thought by some to share the plausibility of egalitarianism whilst avoiding the less plausible implications of the latter. This paper argues that the 'priority' principle does have an authentic place in our moral thinking, and that it is distinct from the idea of ‘equality’, but that the latter also has an indispensible role to play. The idea of ‘ (...) class='Hi'>priority’has its place as the expression of the moral standpoint of benevolent and sympathetic concern. ‘Equality’, in contrast, functions as a conception of social justice, from which it cannot be displaced by the idea of ‘priority’. (shrink)

On a Molinist account of creation and providence, not only is there is a complete set of truths about what every possible person would freely do in any possible set of circumstances, but these conditional truths are part of the very explanation of our existence. Robert Adams has recently argued that the explanatory priority of these conditionals undermines libertarian freedom. In the present essay, I take at close look at Adams’ argument and at the Molinist response of Thomas Flint. (...) After showing that Flint’s response is inadequate, I develop what I believe to be a more successful Molinist response to Adams’ argument. Along the way, I seek to provide some insight into the nature of libertarian freedom and the proper interpretation of the much discussed “principle of alternate possibilities.”. (shrink)

Recently, Jonathan Tallant has argued that we should reject priority views, which hold that some objects are fundamental and others are dependent. Tallant’s argument relies on two proposed mereological possibilities: a gunky world, where everything has a proper part, and a junky world, where everything is a proper part. In this paper, I criticise Tallant’s argument and argue that neither of these possibilities threaten priority views per se; at most, they threaten only particular forms of priority views (...) that contain a certain independently controversial assumption. First, I defend priority pluralism against the gunk argument: the genuine conceivability of gunk can be plausibly doubted on the basis of a certain principle concerning metaphysical possibility, and even if this principle is false, the possibility of a gunky world poses no devastative problem for pluralism per se because it can be considered to be consistent with nonatomism. Second, I defend priority monism against the junk argument: the possibility of a junky world poses no devastative problem for monism per se because it can be considered to be consistent with nonholism in a twofold sense. Finally, I show that even monism as defined as genuinely holistic can be plausibly defended against the junk argument once the claim of the possible nonexistence of the maximal whole is reinterpreted based on the priority-based conception of existence. (shrink)

Germany has just started a public debate on priority-setting, rationing and cost-effectiveness due to the cost explosion within the German health care system. To date, the costs for German health care run at 11,6 % of its Gross Domestic Product (GDP, 278,3 billion €) that represents a significant increase from the 5,9 % levels present in 1970. In response, the German Parliament has enacted several major and minor legal reforms over the last three decades for the sake of cost (...) containment and maintaining stability of the health care system. The Statutory Health Insurance—SHI (Gesetzliche Krankenversicherung—GKV) is based on the fundamental principle of solidarity and provides an ethical and legal framework for implementing equity, comprehensiveness and setting the principles and rules for financing and providing health care services and benefits. Within the SHI system, several major actors can be identified: the Federal Ministry of Health, the 16 state ministries of health, the Federal Joint Committee (G-BA), the physicians (with their associations) and the hospitals (with their organizations) on the provider side, and the sickness funds with their associations on the purchasers’ side. This article reviews the structure and complexities of the German health care system with its major players and participants. The focus will be put on relevant ethical, legal and economic aspects for prioritization, rationalization, rationing and cost-effectiveness of medical benefits and services. In conclusion, this article pleads for open discussion on the challenging subject of priority-setting instead of accepting the implicit and non-transparent rationing of medical services that currently occurs at many different levels within the health care system, as it stands today. (shrink)

The moral principle of giving greater priority to benefiting people, the less well off they are, has been thought by some to share the plausibility of egalitarianism whilst avoiding the less plausible implications of the latter. This paper argues that the 'priority' principle does have an authentic place in our moral thinking, and that it is distinct from the idea of ‘equality’, but that the latter also has an indispensible role to play. The idea of ‘ (...) class='Hi'>priority’has its place as the expression of the moral standpoint of benevolent and sympathetic concern. ‘Equality’, in contrast, functions as a conception of social justice, from which it cannot be displaced by the idea of ‘priority’. (shrink)

Recently theorists have demonstrated a growing interest in the ethical aspects of resource allocation in international non-governmental humanitarian, development and human rights organizations (INGOs). This article provides an analysis of Thomas Pogge's proposal for how international human rights organizations ought to choose which projects to fund. Pogge's allocation principle states that an INGO should govern its decision making about candidate projects by such rules and procedures as are expected to maximize its long-run cost-effectiveness, defined as the expected aggregate moral (...) value of the projects it undertakes divided by the expected aggregate cost of these projects? I critique Pogge's argument on two fronts: (1) I demonstrate that his view is problematic on his own terms, even if we accept the cost-effectiveness framework he employs. (2) I take issue with his overall approach because it generates results which can undermine the integrity of INGOs. Further, his approach mis-characterizes the nature of INGOs, and this mistake is at the root of his problematic view of INGO priority-setting. Ultimately, I argue for a conception of INGOs in which they are understood as ?organizations of principle?, in the sense that they are independent moral agents and so should be permitted a fairly wide sphere of autonomy within reasonable moral constraints. (shrink)

It has often been proposed to restrict access to postmortal organs to registered donors, or at least to give them priority on the waiting list. Such proposals are motivated by considerations of fairness: everyone benefits from the existence of a pool of available organs and of an organised system of distributing them and it is unfair that people who are prepared to contribute to this public good are duped by people who are not. This paper spells out this rationale (...) and goes on to discuss the main principled objections that have been brought forward to such proposals. The most fundamental objection is that healthcare resources should be allocated in accordance with need, not with merit. The reply to this objection is that the principle of allocation according to need only holds in cases in which the provision of such resources and the fair distribution of the burdens of contribution are independently secured, as they are in an obligatory insurance system. (shrink)

Throughout the critical period Kant enigmatically insists that reason is a ‘unity’, thereby suggesting that both our theoretical and practical endeavors are grounded in one and the same rational capacity. How Kant's unity thesis ought to be interpreted and whether it can be substantiated remain sources of controversy in the literature. According to the strong reading of this claim, reason is a ‘unity’ because all our reasoning, including our theoretical reasoning, functions practically. Although several prominent commentators endorse this view, it (...) is widely thought to lack exegetical support. This paper seeks to strengthen the case for this reading by showing how theoretical reason's positive function, as Kant presents it in the Appendix to the Transcendental Dialectic, may be construed as fundamentally practical. I argue that reason's supreme regulative principle ought to be understood as a categorical practical imperative. This interpretation, I suggest, resolves the apparent inconsistencies that blight Kant's account of the principle in the Appendix, while bringing greater overall coherence to his account of theoretical reason's regulative function. (shrink)

The growing gap between demands and resources is putting immense pressure on all government spending in Sweden. The gap is especially apparent in care and services for elderly people in light of the rapid aging of the population. The article considers the decisions and priorities concerning resource allocation in the welfare sector in general and in elderly care in particular. The aim is to describe the political and administrative setting and to provide a conceptual structure that outlines the nature of (...) the problem. Various levels of decision making are identified and discussed in the context of political accountability. Current transitions in elderly care are described with respect to service provision, marketisation, coverage rates, and eligibility standards. Basic principles of distribution are highlighted in order to clarify some central concepts of efficiency and justice, and a number of strategies for actual prioritising are identified. The article concludes with an endorsement of more conscious decisions in resource allocation. Existing knowledge and information concerning the effects of various strategies must be utilised, and the values and assumptions used for setting priorities must be made explicit. (shrink)

Some of us believe in giving priority to people who are badly off in designing social policies and in acting ourselves to help others. As Thomas Nagel puts it, the badly off should be first in the queue when benefits are distributed. This idea is one way of explaining moral views that are called ‘egalitarian.’ Egalitarian moral views can depend either on the idea of valuing equality itself or on the idea of giving priority to the interests of (...) the badly off. This paper is concerned with the second kind of egalitarianism.The purest form of the idea explains the priority in this way: a benefit for someone badly off can be more important morally, or can have more value, than a benefit of the same size for someone better off. This is to suppose that the priority in question cannot be explained by thinking in utilitarian terms and accepting the principle of diminishing marginal utility. (shrink)

This paper develops an account of the normative basis of priority setting in health care as combining the values which a given society holds for the common good of its members, with the universal provided by a principle of common humanity. We discuss national differences in health basket in Europe and argue that health care decision-making in complex social and moral frameworks is best thought of as anchored in such a principle by drawing on the philosophy of (...) need. We show that health care needs are ethically ‘thick’ needs whose psychological and social construction can best be understood in terms of David Wiggins’s notion of vital need: a person’s need is vital when failure to meet it leads to their harm and suffering. The moral dimension of priority setting which operates across different societies’ health care systems is located in the demands both of and on any society to avoid harm to its members. (shrink)

In various texts, Aristotle assigns priority to form, in its role as a principle and cause, over matter and the matter-form compound. Given the central role played by this claim in Aristotle's search for primary substance in the Metaphysics, it is important to understand what motivates him in locating the primary causal responsibility for a thing's being what it is with the form, rather than the matter. According to Met. Theta.8, actuality [ energeia / entelecheia ] in general (...) is prior to potentiality [ dunamis ] in three ways, viz., in definition, time and substance. I propose an explicitly causal reading of this general priority claim, as it pertains to the matter-form relationship. The priority of form over matter in definition, time and substance, in my view, is best explained by appeal to the role of form as the formal, efficient and final cause of the matter-form compound, respectively, while the posteriority of matter to form according to all three notions of priority is most plausibly accounted for by the fact that the causal contribution of matter is limited to its role as material cause. When approached from this angle, the work of Met. Theta.8 can be seen to lend direct support to the more specific and explicitly causal priority claim we encounter in Met. Z.17, viz., that form is prior to matter in its role as the principle and primary cause of a matter-form compound's being what it is. (shrink)

This monograph details a new solution to an old problem of metaphysics. It presents an improved version of Ostrich Nominalism to solve the Problem of Universals. This innovative approach allows one to resolve the different formulations of the Problem, which represents an important meta-metaphysical achievement. In order to accomplish this ambitious task, the author appeals to the notion and logic of ontological grounding. Instead of defending Quine’s original principle of ontological commitment, he proposes the principle of grounded ontological (...) commitment. This represents an entirely new application of grounding. Some metaphysicians regard Ostrich Nominalism as a rejection of the problem rather than a proper solution to it. To counter this, the author presents solutions for each of the formulations. These include: the problem of predication, the problem of abstract reference, and the One Over Many as well as the Many Over One and the Similar but Different variants. This book will appeal to anyone interested in contemporary metaphysics. It will also serve as an ideal resource to scholars working on the history of philosophy. Many will recognize in the solution insights resembling those of traditional philosophers, especially of the Middle Ages. (shrink)

In this paper I argue against rationalist readings of Aristotle's epistemology, on which our scientific understanding is justified on the basis of certain demonstrative first principles that are themselves justified only by some brute form of rational intuition. I then investigate the relationship between our intuition of principles and the broadly perceptual knowledge from which it derives. I argue that, for Aristotle, perceptual knowledge helps justify our intuition of principles, and also serves as an authority against which these principles and (...) their consequences must be assessed. I end by considering how we should understand the justificatory role played by perception, and sketching the nuanced, empirically-minded sort of foundationalism I take Aristotle to endorse. (shrink)

In this paper, I try to decipher the role of internal symmetries in the ontological maze of particle physics. The relationship between internal symmetries and laws of nature is discussed within the framework of “Platonic realism.” The notion of physical “structure” is introduced as representing a deeper ontological layer behind the observable world. I argue that an internal symmetry is a structure encompassing laws of nature. The application of internal symmetry groups to particle physics came about in two revolutionary steps. (...) The first was the introduction of the internal symmetries of hadrons in the early 1960s. These global and approximate symmetries served as means of bypassing the dynamics. I argue that the realist could interpret these symmetries as ontologically prior to the hadrons. The second step was the gauge revolution in the 1970s, where symmetries became local and exact and were integrated with the dynamics. I argue that the symmetries of the second generation are fundamental in the following two respects: According to the so-called “gauge argument,” gauge symmetry dictates the existence of gauge bosons, which determine the nature of the forces. This view, which has been recently criticized by some philosophers, is widely accepted in particle physics at least as a heuristic principle. In view of grand unified theories, the new symmetries can be interpreted as ontologically prior to baryon matter. (shrink)

What are the criteria for reasonable clinical judgements? The reasonableness of macro-level decision-making has been much discussed, but little attention has been paid to the reasonableness of applying guidelines generated at a macro-level to individual cases. This paper considers a framework for reasonable clinical decision-making that will capture cases where relevant guidelines cannot reasonably be followed. There are three main sections. (1) Individual claims on healthcare from the point of view of concerns about equity are analysed. (2) The demands of (...) responsibility and equity on professional clinical performance are discussed, and how the combination of these demands emerges into seven requirements that constitute the framework is explored. Since this framework is developed to assist in reasonable clinical decision-making, practical implications of all these requirements are also suggested. (3) Challenges concerning the framework are discussed. First, a crucial presumption that the framework relies upon is considered—namely, clinicians’ willingness to justify their decisions as requested. Then how public deliberation may influence clinical decision-making is discussed. Next is a consideration of how clinicians’ need to have confidence in their own judgements in order to perform in a manner worthy of trust would be compatible with adherence to the framework supported by public deliberation. It is concluded that fair distribution in the interplay between macro- and micro-level considerations can be secured by legitimising procedures on each level, by ensuring well-organised and continuing public debate and by basing individual clinical judgements upon well-justified and principled normative bases. (shrink)

Positional goods are goods whose relative amount determines their absolute value. Many goods appear to have positional aspects. For example, one’s relative standing in the distribution of education and wealth may determine one’s absolute condition with respect to goods like employment opportunities, self-respect, and social inclusion. Positional goods feature in recent arguments from T.M. Scanlon, Brian Barry, and Harry Brighouse and Adam Swift that assert that we should favor egalitarian distributions of positional goods even if we reject equality as a (...) fundamental principle of distributive justice. With respect to positional goods, worsening the better off is required to better the worse off. Thus, we have reason to “level down” goods such as education and wealth in order to benefit those worse off with respect to the value of those goods. I argue that the allegedly positional aspects of the goods in question are not actually positional. Moreover, leveling down these goods risks self-defeat: it may produce a net decrease in the value of the shares of individuals with less of such goods. If so, leveling down measures would fail on their own terms. (shrink)