The idea that the self is inextricably intertwined with the rest of the world—the “oneness hypothesis”—can be found in many of the world’s philosophical and religious traditions. Oneness provides ways to imagine and achieve a more expansive conception of the self as fundamentally connected with other people, creatures, and things. Such views present profound challenges to Western hyperindividualism and its excessive concern with self-interest and tendency toward self-centered behavior. This anthology presents a wide-ranging, interdisciplinary exploration of the nature and implications (...) of the oneness hypothesis. While fundamentally inspired by East and South Asian traditions, in which such a view often is critical to philosophical approach, this collection draws upon religion, psychology, and Western philosophy, as well as sociology, evolutionary theory, and cognitive neuroscience. Contributors trace the oneness hypothesis through the works of East Asian and Western thinkers and traditions, including Confucianism. Mohism, Daoism, Buddhism, Platonism, Zhuangzi, Kant, James, and Dewey. They intervene in debates over ethics, cultural difference, identity, group solidarity, and the positive and negative implications of metaphors of organic unity. Challenging dominant traditional views that presume the proper scope of the mind stops at the boundaries of the skin and skull, The Oneness Hypothesis shows that a more relational conception of the self is not only consistent with contemporary science but has the potential to lead to greater happiness and well-being for both individuals and the larger wholes of which they are parts. (shrink)

Foundation models such as GPT-4 are fine-tuned to avoid unsafe or otherwise problematic behavior, so that, for example, they refuse to comply with requests for help with committing crimes or with producing racist text. One approach to fine-tuning, called reinforcement learning from human feedback, learns from humans' expressed preferences over multiple outputs. Another approach is constitutional AI, in which the input from humans is a list of high-level principles. But how do we deal with potentially diverging input from humans? How (...) can we aggregate the input into consistent data about "collective" preferences or otherwise use it to make collective choices about model behavior? In this paper, we argue that the field of social choice is well positioned to address these questions, and we discuss ways forward for this agenda, drawing on discussions in a recent workshop on Social Choice for AI Ethics and Safety held in Berkeley, CA, USA in December 2023. (shrink)

In this astonishingly rich volume, experts in ethics, epistemology, philosophy of mind, political theory, aesthetics, history, critical theory, and hermeneutics bring to light the best philosophical scholarship on what is arguably Nietzsche's most rewarding but most challenging text. Including essays that were commissioned specifically for the volume as well as essays revised and edited by their authors, this collection showcases definitive works that have shaped Nietzsche studies alongside new works of interest to students and experts alike. A lengthy introduction, annotated (...) bibliography, and index make this an extremely useful guide for the classroom and advanced research. (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 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)

Owens (1993) argues that a tension exists between our commonsense view of mental states and the scientific view that psychological explanations not contradict supervenience. He suggests that one cannot accept the anti-individualistic conclusions of Twin-Earth thought experiments and continue to use folk psychological states to explain behavior. I argue that his conclusions are based on individuating content widely and causal powers narrowly, and that such individuation violates consistency assumptions about the terms of his discussion. Thus, I argue, the tension he (...) points to evaporates when we adopt either a consistently wide view or a consistently narrow view. (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)

Traditional philosophical discussions of knowledge have focused on the epistemic status of full beliefs. In this book, Moss argues that in addition to full beliefs, credences can constitute knowledge. For instance, your .4 credence that it is raining outside can constitute knowledge, in just the same way that your full beliefs can. In addition, you can know that it might be raining, and that if it is raining then it is probably cloudy, where this knowledge is not knowledge of (...) propositions, but of probabilistic contents. -/- The notion of probabilistic content introduced in this book plays a central role not only in epistemology, but in the philosophy of mind and language as well. Just as tradition holds that you believe and assert propositions, you can believe and assert probabilistic contents. Accepting that we can believe, assert, and know probabilistic contents has significant consequences for many philosophical debates, including debates about the relationship between full belief and credence, the semantics of epistemic modals and conditionals, the contents of perceptual experience, peer disagreement, pragmatic encroachment, perceptual dogmatism, and transformative experience. In addition, accepting probabilistic knowledge can help us discredit negative evaluations of female speech, explain why merely statistical evidence is insufficient for legal proof, and identify epistemic norms violated by acts of racial profiling. Hence the central theses of this book not only help us better understand the nature of our own mental states, but also help us better understand the nature of our responsibilities to each other. (shrink)

This paper develops a precise understanding of the thesis of moral encroachment, which states that the epistemic status of an opinion can depend on its moral features. In addition, I raise objections to existing accounts of moral encroachment. For instance, many accounts fail to give sufficient attention to moral encroachment on credences. Also, many accounts focus on moral features that fail to support standard analogies between pragmatic and moral encroachment. Throughout the paper, I discuss racial profiling as a case study, (...) arguing that moral encroachment can help us identify one respect in which racial profiling is epistemically problematic. (shrink)

This paper examines the distinction between self-love and self-conceit in Kant's moral psychology. It motivates an alternative account of the origin of self-conceit by drawing a parallel to what Kant calls transcendental illusion.

It is often assumed that Fichte's aim in Part I of the System of Ethics is to provide a deduction of the moral law, the very thing that Kant – after years of unsuccessful attempts – deemed impossible. On this familiar reading, what Kant eventually viewed as an underivable 'fact' (Factum), the authority of the moral law, is what Fichte traces to its highest ground in what he calls the principle of the 'I'. However, scholars have largely overlooked a passage (...) in the System of Ethics where Fichte explicitly invokes Kant's doctrine of the fact of reason with approval, claiming that consciousness of the moral law grounds our belief in freedom (GA I/5:65). On the reading I defend, Fichte's invocation of the Factum is consistent with the structure of Part I when we distinguish (a) the feeling of moral compulsion from (b) the moral law itself. (shrink)

Just as humans can draw conclusions responsibly or irresponsibly, so too can computers. Machine learning systems that have been trained on data sets that include irresponsible judgments are likely to yield irresponsible predictions as outputs. In this paper I focus on a particular kind of inference a computer system might make: identification of the intentions with which a person acted on the basis of photographic evidence. Such inferences are liable to be morally objectionable, because of a way in which they (...) are presumptuous. After elaborating this moral concern, I explore the possibility that carefully procuring the training data for image recognition systems could ensure that the systems avoid the problem. The lesson of this paper extends beyond just the particular case of image recognition systems and the challenge of responsibly identifying a person’s intentions. Reflection on this particular case demonstrates the importance (as well as the difficulty) of evaluating machine learning systems and their training data from the standpoint of moral considerations that are not encompassed by ordinary assessments of predictive accuracy. (shrink)

Traditional procedures for rational updating fail when it comes to self-locating opinions, such as your credences about where you are and what time it is. This paper develops an updating procedure for rational agents with self-locating beliefs. In short, I argue that rational updating can be factored into two steps. The first step uses information you recall from your previous self to form a hypothetical credence distribution, and the second step changes this hypothetical distribution to reflect information you have genuinely (...) learned as time has passed. While the second step resembles traditional procedures of updating by conditionalization, the first is best understood by analogy to traditional models of how agents transmit self-locating opinions through ordinary interpersonal communication. (shrink)

Here I consider the two most venerated arguments about the existence of God: the Ontological Argument and the Argument from Evil. The Ontological Argument purports to show that God’s nature guarantees that God exists. The Argument from Evil purports to show that God’s nature, combined with some plausible facts about the way the world is, guarantees (or is very compelling grounds for thinking) that God does not exist. Obviously, both arguments cannot be sound. But I argue here that they are (...) both unsound for the very same reason. (shrink)

This Element introduces the philosophical literature on models, with an emphasis on normative considerations relevant to models for decision-making. Chapter 1 gives an overview of core questions in the philosophy of modeling. Chapter 2 examines the concept of model adequacy for purpose, using three examples of models from the atmospheric sciences to describe how this sort of adequacy is determined in practice. Chapter 3 explores the significance of using models that are not adequate for purpose, including the purpose of informing (...) public decisions. Chapter 4 provides a basic framework for values in modelling, using a case study to highlight the ethical challenges in building models for decision making. It concludes by establishing the need for strategies to manage value judgments in modelling, including the potential for public participation in the process. (shrink)

This article provides an analysis of bioprinting personalised medical device technology and its ethical challenges to regulation and research ethics. I argue the inclusion of bioprinting applications within existing regulatory frameworks does not adequately address the technologies disruption to the traditionally siloed activities of research and treatment. Using the conceptual framework of liminality, I offer a meaningful way to engage with this technology and address some identified concerns with how it will be categorised and the appropriate recognition of its evidentiary (...) thresholds. I demonstrate these concerns through the exploration of limited conventional research methodologies tasked with the production of generalisable knowledge, specifically population-based evidence that is derived from Randomised Clinical Trials. I use Australian regulatory amendments introduced in 2021 as an example of current regulatory trajectories and highlight why I believe this approach to be insufficient. The significance of this argument will be to demonstrate the disruption of bioprinting applications to current approaches in medical policy, and how various jurisdictions are enacting regulation that is not fit for purpose. (shrink)

We review and present a new meta‐analysis of research suggesting that ethicists in the United States appear to behave no morally better overall than do non‐ethicist professors. Measures include: returning library books, peer evaluation of overall moral behavior, voting participation, courteous and discourteous behavior at conferences, replying to student emails, paying conference registration fees and disciplinary society dues, staying in touch with one's mother, charitable giving, organ and blood donation, vegetarianism, and honesty in responding to survey questions. One multi‐measure study (...) found ethicists tending to embrace more stringent moral views, especially about meat eating and charitable donation. The same multi‐measure study found ethicists and other professors to show similarly small‐to‐medium correlations between their expressed normative attitudes and their self‐reported or directly measured behavior. (shrink)

There are many alleged problems with trusting another person’s moral testimony, perhaps the most prominent of which is that it fails to deliver moral understanding. Without moral understanding, one cannot do the right thing for the right reason, and so acting on trusted moral testimony lacks moral worth. This chapter, however, argues that moral advice differs from moral testimony, differs from it in a way that enables a defender of moral advice to parry this worry about moral worth. The basic (...) idea is that an advisor and an advisee can together constitute a joint agent, and that this joint agent’s action can indeed have moral worth. So while the advisee himself might not do the right thing for the right reason (this because all alone he lacks the right reason), and while the advisor herself might not do the right thing for the right reason (this because all alone she does not do the right thing), they together do the right for the right reason. (shrink)

I propose a construal of aesthetic value that gives us reason to emphasize some aesthetic practices over others. This construal rests on the existence of a central aesthetic value, namely apprehension-testing intricacy within an appropriate domain. I address three objections: the objection that asks how an aesthetic value based on intricacy can account for the value of minimalism; the objection that asks about the difference between intricacy within a medium and intricacy between media; and the objection that asks about the (...) danger of a regress. I then say that, although this central aesthetic value can in principle allow us to adjudicate between aesthetic practices, we have epistemic limits (about the potential of certain artistic domains to allow for apprehension-testing intricacy) that prevent adjudication in some cases. Even if there is a difference between the vastness of the potential-intricacy-fields somewhere down the line, it is too far for us to see. (shrink)

In biomedicine, practitioners often treat risk of disease as an illness in itself—suitable for monitoring and intervention. In some cases, increased diagnostics improve health outcomes by detecting problems early. Recently, however, science and technology studies scholars and medical practitioners have noted that the treatment of risk can also lead to unnecessary intervention and possible harm. Despite these findings, it is often hard to see changes in practice. Childbirth serves as an illuminating case because two models of health risk operate simultaneously—in (...) addition to the model valuing frequent intervention, there is another that seeks to mitigate risk by refusing medical surveillance. Based on interviews with birth providers and an analysis of professional documents, this article uses the case of fetal heart rate monitoring in American childbirth to demonstrate how some health providers are framing “intentional non-knowing” as a moral imperative to reduce medical risk. Studying the success and limitations of this “risk counterculture” illuminates how risk societies are changing in response to data suggesting that more information can have hurtful effects. This case integrates well-developed theories of knowledge production with less-developed theories of knowledge nonproduction, leading to a more fruitful discussion of the boundaries of responsible knowledge in risk management. (shrink)

Kant is well known for claiming that we can never really know our true moral disposition. He is less well known for claiming that the injunction "Know Yourself" is the basis of all self-regarding duties. Taken together, these two claims seem contradictory. My aim in this paper is to show how they can be reconciled. I first address the question of whether the duty of self-knowledge is logically coherent (§1). I then examine some of the practical problems surrounding the duty, (...) notably, self-deception (§2). Finding none of Kant's solutions to the problem of self-deception satisfactory, I conclude by defending a Kantian account of self-knowledge based on his theory of conscience (§3). (shrink)

In 1970 a coalition of student activists opposing the Vietnam War circulated documents revealing the involvement of several prominent social scientists in U.S. counterinsurgency activities in Thailand--activities that could cause harm to the people who were the subject of the scholars' research. The disclosure of these materials, which detailed meetings with the Agency for International Development and the Defense Department, prompted two members of the Ethics Committee of the American Anthropological Association to issue an unauthorized rebuke of the accused. Over (...) the next two years, the AAA agonized over the allegations and the appropriate response to them. Within an academic community already polarized by the war, political and professional acrimony reached unprecedented levels. Although the association ultimately passed a code of ethics, the key issues raised in the process were never fully resolved. Now back in print, Eric Wakin's Anthropology Goes to War is the first comprehensive study of what became known as the Thailand Controversy--and a timely reminder of a debate whose echoes may be heard in our own time. (shrink)

The ethical and political dilemmas raised byInformation and Communication Technology (ICT)have only just begun to be understood. Theimpact of centralised data collection, masscommunication technologies or the centrality ofcomputer technology as a means of accessingimportant social institutions, all poseimportant ethical and political questions. As away of capturing some of these effects I willcharacterise them in terms of the type of powerand, more particularly, the ‘Power-over’ peoplethat they exercise. My choice of thisparticular nomenclature is that it allows us todescribe, firstly, how specific (...) technologiesoperate and second, exactly what sorts ofconstraints they impose on people. The reasonfor this focus has to do with a further aim ofthe essay, which is to intervene in aparticular type of debate that is often hadaround the appropriate use and scope oftheories of power that are employed in thinkingabout ICT, especially those theories associatedwith the work of Michel Foucault. There isconsiderable use of his work in computerethics, but my claim will be that despite theproductive uses of his work in the areas ofsurveillance, for instance, it does not exhaustthe larger potential of his work on power and,in part, `government.' I will argue that inorder to properly understand the politicalimpact of some aspects of ICT, especially thedigital divide, one needs an account of howpower operates that includes more traditionaltypes of power-over. To the extent that I willdeal with these concerns, the paper is both acontribution to debates about the nature andscope of Foucault's theory of power and to theissue of the effects of the digital divide. (shrink)

This paper argues that under some conditions, when one person acts on the direction of another person, the two of them thereby act together, and that this explains why both the director and the directee can be responsible for what is done. In other words, a director and a directee can be a joint agent, one whose members are responsible for what they together do. This is most clearly so when the directive is a command. But it is also sometimes (...) so when the directive is a bit of advice. (shrink)

INTRODUCTION There may be times when what is most needed is, not so much a new discovery or a new idea as a different 'slant'; I mean a comparatively slight ...

Kant’s doctrine of the Fact of Reason is one of the most perplexing aspects of his moral philosophy. The aim of this paper is to defend Kant’s doctrine from the common charge of dogmatism. My defense turns on a previously unexplored analogy to the notion of ‘matters of fact’ popularized by members of the Royal Society in the seventeenth century. In their work, ‘facts’ were beyond doubt, often referring to experimental effects one could witness first hand. While Kant uses the (...) German equivalent in different contexts, I argue that the scientific analogy opens up a new framework for interpreting his strategy of justification in the Critique of Practical Reason. In the final section, I address a few possible objections to my reading, one of which I anticipate coming from Dieter Henrich and Ian Proops, who have argued that Kant’s Fact of Reason is best understood under a legal analogy. (shrink)

In his work on Wu wei, Edward Slingerland argues that the classical Chinese ideal is an inherently paradoxical concept that is first and foremost spiritual and political only secondarily. Through a close reading of the Dao de Jing, the first major classical text to substantially deploy and develop the concept, I argue that Wu wei isn’t inherently paradoxical and that this is seen precisely when it is viewed in terms of its political primacy. On my reading, the emergence of Wu (...) wei in the Daoist canon is an equilibrating moment of political mediation between the highly intentionalized sphere of human pursuits and the purposeless fluidity and boundless flux of the natural world. Wu wei here takes on a different aspect—mystery rather than paradox—when considered within a form of political collectivity in which the intentional and the innate, purposive and natural are constantly juxtaposed and contending with one another. (shrink)

Consciousness emerges as the key topic in this second edition of Owen Flanagan's popular introduction to cognitive science and the philosophy of psychology....

Human beings have the unique ability to consciously reflect on the nature of the self. But reflection has its costs. We can ask what the self is, but as David Hume pointed out, the self, once reflected upon, may be nowhere to be found. The favored view is that we are material beings living in the material world. But if so, a host of destabilizing questions surface. If persons are just a sophisticated sort of animal, then what sense is there (...) to the idea that we are free agents who control our own destinies? What makes the life of any animal, even one as sophisticated as Homo sapiens, worth anything? What place is there in a material world for God? And if there is no place for a God, then what hold can morality possibly have on us--why isn't everything allowed? Flanagan's collection of essays takes on these questions and more. He continues the old philosophical project of reconciling a scientific view of ourselves with a view of ourselves as agents of free will and meaning-makers. But to this project he brings the latest insights of neuroscience, cognitive science, and psychiatry, exploring topics such as whether the conscious mind can be explained scientifically, whether dreams are self-expressive or just noise, the moral socialization of children, and the nature of psychological phenomena such as multiple personality disorder and false memory syndrome. What emerges from these explorations is a liberating vision which can make sense of the self, agency, character transformation, and the value and worth of human life. Flanagan concludes that nothing about a scientific view of persons must lead to nihilism. (shrink)

Providing a theory of moral practice for a contemporary sociological audience, Owen Abbott shows that morality is a relational practice achieved by people in their everyday lives. He moves beyond old dualisms—society versus the individual, social structure versus agency, body versus mind—to offer a sociologically rigorous and coherent theory of the relational constitution of the self and moral practice, which is both shared and yet enacted from an individualized perspective. In so doing, The Self, Relational Sociology, and Morality in (...) Practice not only offers an urgently needed account of moral practice and its integral role in the emergence of the self, but also examines morality itself within and through social relations and practices. Abbott’s conclusions will be of interest to social scientists and philosophers of morality, those working with pragmatic and interactionist approaches, and those involved with relational sociology and social theory. (shrink)

Owen Flanagan argues that we are on the way to understanding consciousness and its place in the natural order.