Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.

A provocative argument that environmental thinking would be better off if it dropped the concept of “nature” altogether and spoke instead of the built environment. -/- Environmentalism, in theory and practice, is concerned with protecting nature. But if we have now reached “the end of nature,” as Bill McKibben and other environmental thinkers have declared, what is there left to protect? In Thinking like a Mall, Steven Vogel argues that environmental thinking would be better off if it dropped the (...) concept of “nature” altogether and spoke instead of the “environment”—that is, the world that actually surrounds us, which is always a built world, the only one that we inhabit. We need to think not so much like a mountain (as Aldo Leopold urged) as like a mall. Shopping malls, too, are part of the environment and deserve as much serious consideration from environmental thinkers as do mountains. -/- Vogel argues provocatively that environmental philosophy, in its ethics, should no longer draw a distinction between the natural and the artificial and, in its politics, should abandon the idea that something beyond human practices (such as “nature”) can serve as a standard determining what those practices ought to be. The appeal to nature distinct from the built environment, he contends, may be not merely unhelpful to environmental thinking but in itself harmful to that thinking. The question for environmental philosophy is not “how can we save nature?” but rather “what environment should we inhabit, and what practices should we engage in to help build it?”. (shrink)

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

For decades, worries about undue inducement have Pervaded clinical research, and are especially common when research is accompanied by payment or conducted in developing countries. Few ethical judgments carry as much moral opprobrium or are thought to undermine the ethical soundness of a clinical trial as thoroughly as undue inducement. Indeed, the admonition to prevent undue inducement is one of the few explicit instructions in the Common Rules requirements for informed consent.Despite their long history and pervasiveness, charges of undue inducement (...) in clinical research are almost always mistaken. Indeed, I will advance an even more radical claim: Aresearch trial that otherwise fulfills the fundamental ethical requirements for human subjects research inherently cannot create the possibility of undue inducement because substantial risk of serious harm isprecluded. Charges of undue inducement tend to express displaced and mislabeled ethical concerns about other aspects of human subjects research. Consequently, claims of undue inducement should rarely be made, and when they are advanced should be treated with skepticism, placing a heavy burden of proofon those advancing such charges. (shrink)

For decades, worries about undue inducement have Pervaded clinical research, and are especially common when research is accompanied by payment or conducted in developing countries. Few ethical judgments carry as much moral opprobrium or are thought to undermine the ethical soundness of a clinical trial as thoroughly as undue inducement. Indeed, the admonition to prevent undue inducement is one of the few explicit instructions in the Common Rules requirements for informed consent.Despite their long history and pervasiveness, charges of undue inducement (...) in clinical research are almost always mistaken. Indeed, I will advance an even more radical claim: Aresearch trial that otherwise fulfills the fundamental ethical requirements for human subjects research inherently cannot create the possibility of undue inducement because substantial risk of serious harm isprecluded. Charges of undue inducement tend to express displaced and mislabeled ethical concerns about other aspects of human subjects research. Consequently, claims of undue inducement should rarely be made, and when they are advanced should be treated with skepticism, placing a heavy burden of proofon those advancing such charges. (shrink)

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, such as tirzepatide, have been found to be effective for treating obesity and diabetes, significantly reducing weight and the risk or predicted risk of adverse cardiovascular events. There is a global shortage of these medications that could last several years and raises questions about how limited supplies should be allocated. We propose a fair-allocation framework that enables evaluation of the ethics of current (...) practices and could guide governments, professional societies, and physicians in allocation decisions. (shrink)

All investigators funded by the National Institutes of Health are now required to receive training about the ethics of clinical research. Based on a course taught by the editors at NIH, Ethical and Regulatory Aspects of Clinical Research is the first book designed to help investigators meet this new requirement. The book begins with the history of human subjects research and guidelines instituted since World War II. It then covers various stages and components of the clinical trial process: designing the (...) trial, recruiting participants, ensuring informed consent, studying special populations, and conducting international research. Concluding chapters address conflicts of interest, scientific misconduct, and challenges to the IRB system. The appendix provides sample informed consent forms. This book will be used in undergraduate courses on research ethics and in schools of medicine and public health by students who are or will be carrying out clinical research. Professionals in need of such training and bioethicists also will be interested. (shrink)

The standard Kratzerian analysis of modal auxiliaries, such as ‘may’ and ‘can’, takes them to be univocal and context-sensitive. Our first aim is to argue for an alternative view, on which such expressions are polysemous. Our second aim is to thereby shed light on the distinction between semantic context-sensitivity and polysemy. To achieve these aims, we examine the mechanisms of polysemy and context-sensitivity and provide criteria with which they can be held apart. We apply the criteria to modal auxiliaries and (...) show that the default hypothesis should be that they are polysemous, and not merely context-sensitive. We then respond to arguments against modal ambiguity. Finally, we show why modal polysemy has significant philosophical implications. (shrink)

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and (...) disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

The understanding of appropriate ethical protections for participants of biomedical research has not been static. It has evolved over time, with the evolution of biomedical research as well as social values. Since World War II, there have been four major paradigms of research and research oversight operative in the United States. These paradigms incorporate different values and provide different approaches to research oversight and the protection of research participants.

For some time, it seemed that one had to choose between two sharply different theories of epistemic justification, foundationalism and coherentism. Foundationalists typically held that some beliefs were certain, and, hence, basic. Basic beliefs could impart justification to other, non-basic beliefs, but needed no such support themselves. Coherentists denied that there are any basic beliefs; on their view, all justified beliefs require support from other beliefs. The divide between foundationalism and coherentism has narrowed lately, and Susan Haack attempts to synthesize (...) these competing accounts into a view she calls "foundherentism.". (shrink)

We argue that charging people to participate in research is likely to undermine the fundamental ethical bases of clinical research, especially the principles of social value, scientific validity, and fair subject selection.

The debate about justice and health care has occurred largely at a remove from the institutions it concerns; it has been about our most general moral principles, and about what things we value. This debate has foundered. But if the debate is turned in another direction, toward some moral principles that are widely accepted within those institutions, and toward principles that have to do with control over allocation decisions rather than with actually how to make those decisions, agreement may be (...) nearer at hand. (shrink)

Global health is at a crossroads. The 2030 Agenda for Sustainable Development has come with ambitious targets for health and health services worldwide. To reach these targets, many more billions of dollars need to be spent on health. However, development assistance for health has plateaued and domestic funding on health in most countries is growing at rates too low to close the financing gap. National and international decision-makers face tough choices about how scarce health care resources should be spent. Should (...) additional funds be spent on primary prevention of stroke, treating childhood cancer, or expanding treatment for HIV/AIDS? Should health coverage decisions take into account the effects of illness on productivity, household finances, and children's educational attainment, or just focus on health outcomes? Does age matter for priority setting or should it be ignored? Are health gains far in the future less important than gains in the present? Should higher priority be given to people who are sicker or poorer? Global Health Priority-Setting provides a framework for how to think about evidence-based priority-setting in health. Over 18 chapters, ethicists, philosophers, economists, policy-makers, and clinicians from around the world assess the state of current practice in national and global priority setting, describe new tools and methodologies to address establishing global health priorities, and tackle the most important ethical questions that decision-makers must consider in allocating health resources. (shrink)

Emanuel Copilaș ABSTRACT: The present article aims to offer a synoptic picture of communist Romania’s relations with Third World countries during the Ceaușescu regime. Within these relations, economic and geopolitical motivations coexisted along with ideological ones, thus making the topic one of the most interesting and relevant key for understanding RSR’s complex and cunning international...

According to the subjective view of lying, speakers can lie by asserting a true proposition, as long as they believe this proposition to be false. This view contrasts with the objective view, according to which lying requires the actual falsity of the proposition asserted. The aim of this paper is to draw attention to pairs of assertions that differ only in intuitively redundant content and to show that such pairs of assertions are a reason to favour the subjective view of (...) lying over the objective one. (shrink)

In this article, we explore whether cross-linguistic differences in grammatical aspect encoding may give rise to differences in memory and cognition. We compared native speakers of two languages that encode aspect differently (English and Swedish) in four tasks that examined verbal descriptions of stimuli, online triads matching, and memory-based triads matching with and without verbal interference. Results showed between-group differences in verbal descriptions and in memory-based triads matching. However, no differences were found in online triads matching and in memory-based triads (...) matching with verbal interference. These findings need to be interpreted in the context of the overall pattern of performance, which indicated that both groups based their similarity judgments on common perceptual characteristics of motion events. These results show for the first time a cross-linguistic difference in memory as a function of differences in grammatical aspect encoding, but they also contribute to the emerging view that language fine tunes rather than shapes perceptual processes that are likely to be universal and unchanging. (shrink)

To guide treatment decisions for incompetent patients who have no advance directives, health care institutions should look to the preferences of their own communities of patients. That is the best way to ensure that incompetent patients' wishes will be followed.

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be (...) preserved, reproduced, and made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Our Viewpoint argues that expanding access to less effective or more toxic treatments is supported not only by utilitarian ethical reasoning but also by two other ethical frameworks: those that emphasise equality and those that emphasise giving priority to the patients who are worst off. The inadequate resources available for global health reflect not only natural constraints but also unwise social and political choices. However, pitting efforts to reduce inequality and better fund global health against efforts to put available resources (...) to their best use mistakes complementary objectives for conflicting ones. (shrink)

I explore and develop the idea that (NA) knowledge is non-accidentally true belief. The applicable notion of non-accidentality differs from that of ‘epistemic luck’ discussed by Pritchard. Safety theories may be seen as a refinement of, or substitute for, NA but they are subject to a fundamental difficulty. At the same time, NA needs to be adjusted in order to cope with two counterexamples. The Light Switch Case turns on the ‘directionof-fit’ between a belief and the facts, while the Meson (...) Case concerns knowledge of nomological necessities. A proposed revision to NA is: (ENA) S knows that P when S’s belief that P is non-accidentally true because (i) it is based on good evidence, and (ii) in and of themselves, beliefs based on good evidence tend to be true. ‘knowledge-as-credit’ accounts have been offered as an alternative way of sharpening NA. I argue that such accounts face serious objections that don’t apply to ENA. Finally, I take up Lackey’s worry that the credit-based approach mishandles knowledge via testimony. ENA faces no difficulty on that score, which counts in its favor. (shrink)

We present a conceptual framework on the experience of time and provide a coherent basis on which to base further inquiries into qualitative approaches concerning time experience. We propose two Time-Layers and two Time-Formats forming four Time-Domains. Micro-Flow and Micro-Structure represent the implicit phenomenal basis, from which the explicit experiences of Macro-Flow and Macro-Structure emerge. Complementary to this theoretical proposal, we present empirical results from qualitative content analysis obtained from 25 healthy participants. The data essentially corroborate the theoretical proposal. With (...) respect to Flow, the phenomenally accessible time experience appeared as a continuous passage reaching from the past through the present into the future. With respect to Structure, the individual present was embedded in the individual biography, emerging from past experiences and comprising individual plans and goals. New or changing plans and goals were being integrated into the existing present, thus forming a new present. The future appeared as changeable within the present, by means from the past, and therefore as a space of potential opportunities. Exemplarily, we discuss these results in relation to previous empirical findings on deviant experiences of time in Autism Spectrum Disorder that is presumably characterized by a breakdown of Flow and concomitant compensatory repetition resulting in an overly structured time. Finally, we speculate about possible implications of these findings both for psychopathological and neuroscientific research. (shrink)

This book presents a collection of original essays by leading thinkers in political theory, philosophy, and bioethics on key issues concerning global justice and bioethics. It is the first collection to comprehensively address these pressing theoretical and practical questions about international distributive justice, humans rights, health care and medical research.

In a pluralistic society, the “best interests” standard is an inadequate criterion for determining what level of medical care to provide incompetent patients. Instead, the standard of care should be derived from the deliberations of particular communities. A “community‐federated” plan would enhance individual choice and diminish family and physician uncertainty.

The current prevailing view is that participation in biomedical research is above and beyond the call of duty. While some commentators have offered reasons against this, we propose a novel public goods argument for an obligation to participate in biomedical research. Biomedical knowledge is a public good, available to any individual even if that individual does not contribute to it. Participation in research is a critical way to support an important public good. Consequently, all have a duty to participate. The (...) current social norm is that individuals participate only if they have a good reason to do so. The public goods argument implies that individuals should participate unless they have a good reason not to. Such a shift would be of great aid to the progress of biomedical research, eventually making society significantly healthier and longer lived. (shrink)

Hans Jonas accuses Heidegger of “never bring[ing] his question about Being into correlation with the testimony of our physical and biological evolution.” Neither the early nor later Heidegger has a “philosophy of nature,” Jonas charges, because Naturphilosophie demands a new concept of matter, a monistic account of cosmogony and evolution, and the grounding of ethical responsibility for future generations in an ontological “first principle.” Jonas’s ontological rethinking of Darwinism allows him to overcome the nihilism that a mechanistic interpretation of evolution (...) forces upon us: a nihilism allegedly shared by Heidegger. I imagine a Heideggerian response to Jonas, and ask whether the dream of recovering a synthesis between cosmogony and moral insight has been irrecoverably shattered by modern natural science. (shrink)

Matthias Vogel challenges the belief, dominant in contemporary philosophy, that reason is determined solely by our discursive, linguistic abilities as communicative beings. In his view, the medium of language is not the only force of reason. Music, art, and other nonlinguistic forms of communication and understanding are also significant. Introducing an expansive theory of mind that accounts for highly sophisticated, penetrative media, Vogel advances a novel conception of rationality while freeing philosophy from its exclusive attachment to linguistics. (...) class='Hi'>Vogel's media of reason treats all kinds of understanding and thought, propositional and nonpropositional, as important to the processes and production of knowledge and thinking. By developing an account of rationality grounded in a new conception of media, he raises the profile of the prelinguistic and nonlinguistic dimensions of rationality and advances the Enlightenment project, buffering it against the postmodern critique that the movement fails to appreciate aesthetic experience. Guided by the work of Jürgen Habermas, Donald Davidson, and a range of media theorists, including Marshall McLuhan, Vogel rebuilds, if he does not remake, the relationship among various forms of media--books, movies, newspapers, the Internet, and television--while offering an original and exciting contribution to media theory. (shrink)

Alfred Schutz is, without a doubt, one of the phenomenologists that contributed the most to the reflection on how to apply insights from phenomenological philosophy to the, empirical and theoretical, human and social sciences. However, his work tends to be neglected by many of the current advocates of phenomenology within these disciplines. In the present paper, I intend to remedy this situation. In order to do so, I will systematically revisit his mundane and social-scientifically oriented account of phenomenology, which, as (...) I shall show, emerges from a theoretical confrontation with the Husserlian distinction between transcendental phenomenology and phenomenological psychology. (shrink)

The method of Conceptual Analysis makes use of natural language speaker intuitions about the meanings of expressions, and relies on an externalist assumption about meanings—namely, that they can be given in terms of referential relations and truth. This article argues that this widely used methodology in metaphysics is troubled, because the assumed externalist hypothesis about natural language meanings is beset with trenchant obstacles in explaining linguistic phenomena. It argues that the use of Conceptual Analysis in metaphysical investigation inherits the difficulties (...) for the externalist hypothesis generally assumed by metaphysical inquiry. It explores two cases of such investigation that serve to exemplify the breadth of topics susceptible to troubles with the externalist hypothesis regarding natural language meanings: the extended mind hypothesis and the metaphysics of causation. (shrink)