Under the label of scientific metaphysics, many naturalist metaphysicians are moving away from a priori conceptual analysis and instead seek scientific explanations that will help bring forward a unified understanding of the world. This paper first reviews how our classical assumptions about ordinary objects fail to be true in light of quantum mechanics. The paper then explores how our experiences of ordinary objects arise by reflecting on how our neural system operates algorithmically. Contemporary models and simulations in computational neuroscience are (...) shown to provide a theoretical framework that does not conflict with existing fundamental physical theories, and nonetheless helps us make sense of the manifest image. It is argued that we must largely explain how the manifest image arises in algorithmic terms, so that we can pursue a metaphysics about ordinary objects that is scientifically well founded. (shrink)

A correction to this paper has been published: https://doi.org/10.1007/s10912-021-09698-y.

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

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

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

"More than any thing else technology creates our world. It creates our wealth, our economy, our very way of being," says W. Brian Arthur. Yet, until now the major questions of technology have gone unanswered. Where do new technologies come from -- how exactly does invention work? What constitutes innovation, and how is it achieved? Why are certain regions -- Cambridge, England, in the 1920s and Silicon Valley today -- hotbeds of innovation, while others languish? Does technology, like biological (...) life, evolve? How do new industries, and the economy itself, emerge from technologies? In this groundbreaking work, pioneering technology thinker and economist W. Brian Arthur sets forth a boldly original way of thinking about technology that gives answers to these questions. The Nature of Technology is an elegant and powerful theory of technology's origins and evolution. It achieves for the progress of technology what Thomas Kuhn's The Structure of Scientific Revolutions did for scientific progress. Arthur explains how transformative new technologies arise and how innovation really works. Conventional thinking ascribes the invention of technologies to "thinking outside the box," or vaguely to genius or creativity, but Arthur shows that such explanations are inadequate. Rather, technologies are put together from pieces -- themselves technologies -- that already exist. Technologies therefore share common ancestries and combine, morph, and combine again to create further technologies. Technology evolves much as a coral reef builds itself from activities of small organisms -- it creates itself from itself; all technologies are descended from earlier technologies. Drawing on a wealth of examples, from historical inventions to the high-tech wonders of today, and writing in wonder fully engaging and clear prose, Arthur takes us on a mind-opening journey that will change the way we think about technology and how it structures our lives. (shrink)

Contemporary health care often lacks generosity of spirit, even when treatment is most efficient. Too many patients are left unhappy with how they are treated, and too many medical professionals feel estranged from the calling that drew them to medicine. Arthur W. Frank tells the stories of ill people, doctors, and nurses who are restoring generosity to medicine--generosity toward others and to themselves. The Renewal of Generosity evokes medicine as the face-to-face encounter that comes before and after diagnostics, pharmaceuticals, (...) and surgeries. Frank calls upon the Roman emperor Marcus Aurelius, philosopher Emmanuel Levinas, and literary critic Mikhail Bakhtin to reflect on stories of ill people, doctors, and nurses who transform demoralized medicine into caring relationships. He presents their stories as a source of consolation for both ill and professional alike and as an impetus to changing medical systems. Frank shows how generosity is being renewed through dialogue that is more than the exchange of information. Dialogue is an ethic and an ideal for people on both sides of the medical encounter who want to offer more to those they meet and who want their own lives enriched in the process. The Renewal of Generosity views illness and medical work with grace and compassion, making an invaluable contribution to expanding our vision of suffering and healing. (shrink)

In At the Will of the Body , Arthur Frank told the story of his own illnesses, heart attack and cancer. That book ended by describing the existence of a "remission society," whose members all live with some form of illness or disability. The Wounded Storyteller is their collective portrait. Ill people are more than victims of disease or patients of medicine they are wounded storytellers. People tell stories to make sense of their suffering when they turn their diseases (...) into stories, they find healing. Drawing on the work of authors such as Oliver Sacks, Anatole Broyard, Norman Cousins, and Audre Lorde, as well as from people he met during the years he spent among different illness groups, Frank recounts a stirring collection of illness stories, ranging from the well-known--Gilda Radner's battle with ovarian cancer--to the private testimonials of people with cancer, chronic fatigue syndrome, and disabilties. Their stories are more than accounts of personal suffering: they abound with moral choices and point to a social ethic. Frank identifies three basic narratives of illness in restitution, chaos, and quest. Restitution narratives anticipate getting well again and give prominence to the technology of cure. In chaos narratives, illness seems to stretch on forever, with no respite or redeeming insights. Quest narratives are about finding that insight as illness is transformed into a means for the ill person to become someone new. (shrink)

The lectures have afforded me an opportunity of developing more fully than in my earlier books the principles of philosophic thought associated with the modern advances of physical science. It is often said that there is no "philosophy of ...

This is the text of The Lindley Lecture for 1962, given by Arthur N. Prior (1914-1969).

In this acclaimed work, first published in 1986, world-renowned scholar Arthur C. Danto explored the inextricably linked but often misunderstood relationship between art and philosophy. In light of the book's impact--especially the essay "The End of Art," which dramatically announced that art ended in the 1960s--this enhanced edition includes a foreword by Jonathan Gilmore that discusses how scholarship has changed in response to it. Complete with a new bibliography of work on and influenced by Danto's ideas, _The Philosophical Disenfranchisement (...) of Art_ continues to be of interest to anyone who thinks seriously about art, as well as to philosophers, aestheticians, and art historians. (shrink)

The concept of natural otherness can be found throughout the environmental ethics literature. Drawing on this concept, this article pursues two aims. For one, it argues for an account of individual natural otherness as stable difference as opposed to accounts of natural otherness that put more emphasis on independence for the purpose of differentiating individual natural otherness from the concept of wildness. Secondly, this account of natural otherness is engaged to argue for a particular way of theorising the moral standing (...) of individual nonhuman entities. While individual natural otherness in itself does not provide an account of whether an entity matters morally in itself (that is, whether it is morally considerable); it points to an account of incommensurable moral significance for all entities which are attributed moral considerability. That is an often-overlooked alternative to egalitarian or hierarchical accounts or moral significance. Individual natural otherness understood in this way in turn provides another explanatory story for why relational accounts of environmental ethics that strongly emphasise the importance of concepts such as wildness are particularly salient. (shrink)

Arthur I. Miller is a historian of science whose approach has been strongly influenced by current work in cognitive science, and in this book he shows how the two fields might be fruitfully linked to yield new insights into the creative process.

I am grateful to Donald Ainslie, Lisa Austin, Michael Blake, Abraham Drassinower, David Dyzenhaus, George Fletcher, Robert Gibbs, Louis-Philippe Hodgson, Sari Kisilevsky, Dennis Klimchuk, Christopher Morris, Scott Shapiro, Horacio Spector, Sergio Tenenbaum, Malcolm Thorburn, Ernest Weinrib, Karen Weisman, and the Editors of Philosophy & Public Affairs for comments, and audiences in the UCLA Philosophy Department and Columbia Law School for their questions.

Schopenhauer argues, in uniquely powerful prose, that self-consciousness gives the illusion of freedom and that human actions are determined, but that we rightly feel guilt because our actions issue from our essential individual character. He locates moral value in the virtues of loving kindness and voluntary justice that spring from the fundamental incentive of compassion. Morality's basis is ultimately metaphysical, resting on an intuitive identification of the self with all other striving and suffering beings. The Introduction by leading Schopenhauer scholar (...) Christopher Janaway gives a clear summary of the argument of the essays in the context of Schopenhauer's life and works and the history of ethics in the modern period. --from publisher description. (shrink)

Twentieth-century developments in quantum physics, together with an emerging science of consciousness, have created the need for a new cosmology, or model of the universe. The theory of process contained in THE REFLEXIVE UNIVERSE places consciousness within the context of contemporary science. One of the central themes of this extraordinary work is that each successive organization of matter, from fundamental particles in physics to living organisms, expresses a particular stage in the evolution of mind. Starting with the photon, the basic (...) unit of light, and moving through atomic physics, molecular chemistry, the morphology of plants and animals and finally to levels of human evolution, Young develops his theory in vivid step-by-step detail. Consciousness, in his point of view, is not isolated from the material universe. It exists in a continuum, one in which physical and nonphysical realms can be linked and the teachings of mythology and religion can be integrated. To order: FAX: 415-883-9280; e-mail: [email protected]; or write: Anodos Foundation, c/o Publishers Services, P.O. Box 2510, Novato, CA 94948. Visa and MasterCard only. Trade STOP orders 40% plus postage. (shrink)

Few philosophers are as widely read or as widely misunderstood as Friedrich Nietzsche. When Danto's classic study was first published in 1965, many regarded Nietzsche as a brilliant but somewhat erratic thinker. Danto, however, presented a radically different picture, arguing that Nietzsche offered a systematic and coherent philosophy that anticipated many of the questions that define contemporary philosophy. Danto's clear and insightful commentaries helped canonize Nietzsche as a philosopher and continue to illuminate subtleties in Nietzsche's work as well as his (...) immense contributions to the philosophies of science, language, and logic. This new edition, which includes five additional essays, not only further enhances our understanding of Nietzsche's philosophy; it responds to the misunderstandings that continue to muddy his intellectual reputation. Even today, Nietzsche is seen as everything from a precursor of feminism and deconstruction to a prophetic writer and spokesperson for disgruntled teenage boys. As Danto points out in his preface, Nietzsche's writings have purportedly inspired recent acts of violence and school shootings. Danto counters these misreadings by elaborating an anti-Nietzschian philosophy from within Nietzsche's own philosophy "in the hope of disarming the rabid Nietzsche and neutralizing the vivid frightening images that have inspired sociopaths for over a century." The essays also consider specific works by Nietzsche, including _Human, All Too Human_ and _The Genealogy of Morals_, as well as the philosopher's artistic metaphysics and semantical nihilism. (shrink)

Our study considers the governance, ethics and operational challenges associated with the acquisition, manipulation and commodification of ‘big data’ in the financial services sector. To the best of our knowledge, there are no published studies describing empirical research undertaken within companies in this sector to understand how they are responding to such challenges: our field-based research is a significant initial contribution in this respect. We describe the results of a micro-ethnographic study undertaken in a small-to-medium-sized company developing disruptive, technology-related platforms (...) and services in the banking and retail sectors based on big data and associated analytics: these are used to derive commercially valuable insights from personal customer data in exchange for cash back and targeted rewards. The company was found to employ a multi-level innovation governance approach, underpinned by an ethical strategy based on a principle of mutual benefit. Opt-in and informed consent for using data for specific purposes was supported by principles of data minimisation and anonymisation, with unrestricted use of secondary, anonymised and aggregated data to develop insights. Governance, which included contextual data protection legislation, payment-card industry data usage standards and internal corporate controls, presented as bespoke organisational practices relating to data security and privacy. These in total set the governance and ethics frame for big data innovation at the company within which it has had to be both adaptive and responsive under conditions of normative and regulatory uncertainty. (shrink)

A sympathetic and systematic reconstruction of Sartre's philosophy, explaining its relation to other major philosophical theories. Among the themes elucidated are the relation between reality and our representation of it; the parities between language and consciousness; the relationship between the world as it may be and as we structure it in our interventions as engaged beings; the conceptual interdependence of the self and others; and the connections between factual beliefs and systems of value.--Adapted from book jacket.

This paper consists in an exposition of a proof Newton gave in 1666 of the parallelogram law for compounding velocities, and an examination of its implications for understanding his treatment of motion resulting from a continuously acting force in the Principia. I argue that the “moments” invoked in the fluxional proof of the vector resolution and composition of velocities are “virtual times”, a device allowing Newton to represent motions by the linear displacements produced in such a time; the ratio of (...) velocities at an instant can then be represented by assuming the velocities continue for such a virtual time. By the Method of First and Ultimate Ratios, the first ratio of the velocities is then given by the ratio of such lines, under the presupposition that in the limit they will shrink to zero magnitude. I then argue that the same device is implicit in Newton’s appeal to “moments” or “particles of time” in his proof of Kepler’s Area Law in the “Locke Paper” and in Proposition 1 of Book 1 of the Principia, and that the limiting process involved there is therefore the same as that implicit in the Method of First and Ultimate Ratios. (shrink)

But Findlay's remark, like so much that has been written on the subject of time in the present century, was provoked in the first place by McTaggart's ...

" The essays also consider specific works by Nietzsche, including Human, All Too Humanand The Genealogy of Morals, as well as the philosopher's artistic metaphysics and semantical nihilism.

The identity of indiscernibles states that indiscernible objects must be identical. Many philosophers have held that the PII turns out to be either true but trivial, or non-trivial but false, depending on how the notion of discernibility is spelled out. In this paper, I propose and defend an account of this notion which aims to yield a minimally non-trivial and yet plausible version of the PII. I argue moreover that this version of the principle is immune to a number of (...) well-known and recent objections to the PII. (shrink)

Surveys and extens work that has been done in the past two years on 'tense logic' and is a sequel to the author's book, Time and Modality.

The standard view of ignorance is that it consists in the mere lack of knowledge or true belief. Duncan Pritchard has recently argued, against the standard view, that ignorance is the lack of knowledge/true belief that is due to an improper inquiry. I shall call, Pritchard’s alternative account the Normative Account. The purpose of this article is to strengthen the Normative Account by providing an independent vargument supporting it.

1. Bd. Vier Bücher, nebst einem Anhange, der die Kritik der kantischen Philosophie enthält -- 2. Bd. Welcher die Ergänzungen zu die den vier Büchern des ersten Bandes enthält.

Written in 1839 and chosen as the winning entry in a competition held by the Royal Norwegian Society of Sciences, Schopenhauer's Prize Essay on the Freedom of the Will marked the beginning of its author's public recognition and is widely regarded as one of the most brilliant and elegant treatments of free will and determinism. Schopenhauer distinguishes the freedom of acting from the freedom of willing, affirming the former while denying the latter. He portrays human action as thoroughly determined but (...) also argues that the freedom which cannot be established in the sphere of human action is preserved at the level of our innermost being as individuated will, whose reality transcends all dependency on outside factors. This volume offers the text in a previously unpublished translation by Eric F. J. Payne, the leading twentieth-century translator of Schopenhauer into English, together with a historical and philosophical introduction by Günter Zöller. (shrink)

Divided into two parts, the first concentrates on the logical properties of propositions, their relation to facts and sentences, and the parallel objects of commands and questions. The second part examines theories of intentionality and discusses the relationship between different theories of naming and different accounts of belief.

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

This book takes its point of departure from the work of the French sociologist Pierre Bourdieu, whose book 'Distinction' is considered a classic work of sociological analysis. The topics dealt with are shown in the table of contents below. The book is distinctive in that it offers discussions of four methodologies/theories used in discussing taste: semiotics, psychoanalytic theory, sociological theory and Marxist theory and then applies these theories in the second part of the book to a variety of topics involving (...) taste, such as yogurt, dogs, the singer Celine Dion, ocean cruises, brands, smartphones, men's facial hair, and so on. Readers of the book will learn four methodologies they can use in analyzing taste and see how these methodologies were applied. (shrink)

Mr. Danto argues that recent developments in the artworld, in particular the production of works of art that cannot be told from ordinary things, make urgent the need for a new theory of art and make plain the factors such a theory can and cannot involve. In the course of constructing such a theory, he seeks to demonstrate the relationship between philosophy and art, as well as the connections that hold between art and social institutions and art history. The book (...) distinguishes what belongs to artistic theory from what has traditionally been confused with it, namely aesthetic theory and offers as well a systematic account of metaphor, expression, and style, together with an original account 0f artistic representation. A wealth of examples, drawn especially from recent and contemporary art, illuminate the argument. (shrink)

In Danto's view, Andy Warhol's Brillo Box was not only a radical attack on traditional definitions of the art work; it brought the history of Western art to a close. In this collection of interconnected essays, he grapples with this and many more of the most challenging issues in art today, from the problems of contemporary pluralism to the dilemmas of censorship and state support for artists.

Persuasive and humane, this classic of philosophy offers Schopenhauer's fullest examination of ethical themes, articulating a descriptive form of ethics that contradicts the rationally based prescriptive theories. Starting with his polemic against Kant's ethics of duty, Schopenhauer argues that compassion forms the basis of morality, and he outlines a perspective on ethics in which passion and desire correspond to different moral characters, behaviors, and worldviews. He further defines his metaphysics of morals, employing Kant’s transcendental idealism to illustrate both the interconnectiveness (...) of being and the affinity of his ethics to Eastern thought. (shrink)

A new, comprehensive English anthology What is the meaning of life? How should I live? Is there any purpose to the universe? Generations have turned to the great German philosopher Arthur Schopenhauer for answers to such essential questions of existence. His influence has extended not only to later philosophers—Nietzsche, Freud, and Wittgenstein among them—but also to musicians, artists, and important novelists such as Tolstoy, Thomas Mann, and Proust. The Essential Schopenhauer, the most comprehensive English anthology now available of this (...) seminal thinker’s writings, will open English readers to Schopenhauer’s profound ideas. Selected by Wolfgang Schirmacher, president of the International Schopenhauer Association, The Essential Schopenhauer is an invaluable and accessible introduction to Schopenhauer’s powerful body of work. (shrink)

"The Wisdom of Life and Counsels and Maxims," by philosopher Arthur Schopenhauer, offers a more accurate and realistic outlook on life than his student, Friedrich Nietzsche. While many disagree with Schopenhauer's renunciation of life, there is much to agree with in this book. Schopenhauer doesn't see a whole lot to celebrate in this vale of tears. His general view in "The Wisdom of Life and Counsels and Maxims" is summed up thus: Life is hell. Try to find a room (...) furthest from the flames. If you tend towards a sunnier view of things then you're very likely to find this book by the grandmaster of philosophical pessimism unduly cynical. But if you've pretty much had it with the world and seldom meet a man (or woman) you wouldn't rather see the back of, you'll be delighted to find a fellow traveler and find wit and solace in Schopenhauer's acidic view of this "wonderful gift of life." Though riddled with hard-nosed realism and misanthropy, "The Wisdom of Life and Counsels and Maxims" is positively entertaining and enjoyable. Schopenhauer's style is fluid, prosaic, and imaginative, unlike most German philosophy. In lieu of modern world events, it is probably more relevant a work today than ever before. Schopenhauer discusses an array of subjects, such as the emptiness of those things commonly pursued by the masses (money, status/position, vanity, sensual pleasure, etc.), and those most commonly ignored by most (temperance, good health, character, individuality, and developing one's mind). Small, fleeting pleasures notwithstanding, Schopenhauer casts an unflinchingly jaundiced eye on the experience of human life and doesn't sweeten the pill. For its bracing honesty alone, this book deserves its reputation as one of the greatest philosophical manuals of how to best live our lives ever written. (shrink)

Few philosophers are as widely read or as widely misunderstood as Friedrich Nietzsche. When Danto's classic study was first published in 1965, many regarded Nietzsche as a brilliant but somewhat erratic thinker. Danto, however, presented a radically different picture, arguing that Nietzsche offered a systematic and coherent philosophy that anticipated many of the questions that define contemporary philosophy. Danto's clear and insightful commentaries helped canonize Nietzsche as a philosopher and continue to illuminate subtleties in Nietzsche's work as well as his (...) immense contributions to the philosophies of science, language, and logic. This new edition, which includes five additional essays, not only further enhances our understanding of Nietzsche's philosophy; it responds to the misunderstandings that continue to muddy his intellectual reputation. Even today, Nietzsche is seen as everything from a precursor of feminism and deconstruction to a prophetic writer and spokesperson for disgruntled teenage boys. As Danto points out in his preface, Nietzsche's writings have purportedly inspired recent acts of violence and school shootings. Danto counters these misreadings by elaborating an anti-Nietzschian philosophy from within Nietzsche's own philosophy "in the hope of disarming the rabid Nietzsche and neutralizing the vivid frightening images that have inspired sociopaths for over a century." The essays also consider specific works by Nietzsche, including _Human, All Too Human_ and _The Genealogy of Morals_, as well as the philosopher's artistic metaphysics and semantical nihilism. (shrink)

The author examines recent developments in parapsychological research and explains their implications for physicists.