Vaccine refusal occurs for a variety of reasons. In this article we examine vaccine refusals that are made on conscientious grounds; that is, for religious, moral, or philosophical reasons. We focus on two questions: first, whether people should be entitled to conscientiously object to vaccination against contagious diseases ; second, if so, to what constraints or requirements should conscientious objection to vaccination be subject. To address these questions, we consider an analogy between CO to vaccination and CO to military service. (...) We argue that conscientious objectors to vaccination should make an appropriate contribution to society in lieu of being vaccinated. The contribution to be made will depend on the severity of the relevant disease, its morbidity, and also the likelihood that vaccine refusal will lead to harm. In particular, the contribution required will depend on whether the rate of CO in a given population threatens herd immunity to the disease in question: for severe or highly contagious diseases, if the population rate of CO becomes high enough to threaten herd immunity, the requirements for CO could become so onerous that CO, though in principle permissible, would be de facto impermissible. (shrink)

Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for—and demands on—these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunity to try interventions that are not yet approved by standard regulatory processes. But while they signal that health care systems can and will respond to individual suffering, SAPs have several disadvantages, including (...) the potential to undermine regulatory and knowledge-generation structures that constitute significant public goods. The “balance” between these considerations depends in part on how broadly SAPs are used, but also on whether SAPs can be made to contribute to the generation of knowledge about the effects of health interventions. We argue that patients should usually be required to contribute outcome data while using SAPs. (shrink)

This paper is predicated on the understanding that clinical encounters between clinicians and patients should be seen primarily as inter-relations among persons and, as such, are necessarily moral encounters. It aims to relocate the discussion to be had in challenging medical decision-making situations, including, for example, as the end of life comes into view, onto a more robust moral philosophical footing than is currently commonplace. In our contemporary era, those making moral decisions must be cognizant of the existence of perspectives (...) other than their own, and be attuned to the demands of inter-subjectivity. Applicable to clinical practice, we propose and justify a Habermasian approach as one useful means of achieving what can be described as dialogic consensus. The Habermasian approach builds around, first, his discourse theory of morality as universalizable to all and, second, communicative action as a cooperative search for truth. It is a concrete way to ground the discourse which must be held in complex medical decision-making situations, in its actual reality. Considerations about the theoretical underpinnings of the application of dialogic consensus to clinical practice, and potential difficulties, are explored. (shrink)

The historical emphasis of medical ethics, based on substantive frameworks and principles derived from them, is no longer seen as sufficiently sensitive to the moral pluralism characteristic of our current era. We argue that moral decision-making in clinical situations is more properly derived from a process of dialogic consensus. This process entails an inclusive, noncoercive, and self-reflective dialogue within the community affected. In order to justify this approach, we make two claims—the first epistemic, and the second normative. The epistemic claim (...) follows from Habermas’ “ways” of knowing. We argue that the dialogue emanating from this episteme focuses on the relevant facts about the patient, as well as on the values attached to these facts, thus allowing facts and their meanings to serve as the basis for reflective action appropriate to the circumstances. The normative claim follows from Habermas’ discourse theory of morality and communicative action. It determines that clinical decision-making should be approached from the perspective of the actual reality of people in their situation of illness, set in their socio-cultural background, and hence be grounded in the second-person perspective. Relocating ethical decision-making from a monological space into one characterized by dialogue is especially appropriate to the clinical encounter. (shrink)

Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...) that ‘disease’ should be considered a vague concept with a non-classical structure. On this view, overdiagnosed cases are ‘borderline’ cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a pre ́cising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

Following Wittgenstein’s lead, Crispin Wright and others have argued that hinge propositions are immune from skeptical doubt. In particular, the entitlement strategy, as we shall refer to it, says that hinge propositions have a special type of justification because of their role in our cognitive lives. Two major criticisms are raised here against the entitlement strategy when used in attempts to justify belief in the external world. First, the hinge strategy is not sufficient to thwart underdetermination skepticism, since underdetermination considerations (...) lead to a much stronger form of skepticism than is commonly realized. Second, the claim that hinge propositions are necessary to trust perception is false. There is an alternative to endorsing a particular hinge proposition about the external world, external world disjunctivism, which permits us to trust perception, while skirting the difficulties raised by skepticism. (shrink)

Personalised medicine has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells so as to make individualised treatment predictions. We compare this strategy to two main PM strategies—stratified medicine and (...) computational models. Drawing on epistemological work in the philosophy of medicine, we explain why these two methods, while powerful, are neither truly personalised nor, epistemologically speaking, novel strategies. Both are forms of correlational black box. We then argue that the iPSC models would count as a new kind of black box. They would not rely entirely on mechanistic knowledge, and they would utilise correlational evidence in a different way from other strategies—a way that would enable personalised predictions. In arguing that the iPSC models would present a novel method of gaining evidence for clinical practice, we provide an epistemic analysis that can help to inform the practical, regulatory, and ethical challenges of developing an iPSC system. (shrink)

While we often talk about time using spatial terms, experimental investigation of space-time associations has focused primarily on the space in front of the participant. This has had two consequences: the disregard of the space behind the participant and the creation of potential task demands produced by spatialized manual button-presses. We introduce and test a new paradigm that uses auditory stimuli and vocal responses to address these issues. Participants made temporal judgments about deictic or sequential relationships presented auditorily along a (...) body-centered sagittal or transversal axis. Results involving the transversal axis replicated previous work while sagittal axis results were surprising. Deictic judgments did not use the sagittal axis but sequential judgments did, in a previously undocumented way. Participants associated earlier judgments with the space in front of them and later judgments with the space behind them. These findings, using a new approach, p.. (shrink)

This empirical study advances the understanding of the theory of investment in human capital by outlining limitations to its applicability in the context of return to education. The study uses the concept of moral hazard to examine circumstances when financial support for education purpose generates less desirable post-graduation incomes. This study explores the relationship between financial support and post-graduation incomes using data from the Survey of Income and Program Participation that is designed to measure the economic situation of individuals. Results (...) suggest that students are less likely to engage in moral hazardous behavior to the degree to which they are older and to the degree to which they receive costlier financial assistance. (shrink)

An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve (...) ‘mismatches’ between one’s beliefs about one’s health status on the one hand, and bodily sensations or past experience on the other. Patients’ attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in self-understanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety. (shrink)

The ability to represent same-different relations is an important condition for abstract thought. However, there is mixed evidence for when this ability develops, both ontogenetically and phylogenetically. Apparent success in relational reasoning may be evidence for genuine conceptual understanding or may be the result of low-level, perceptual strategies. We introduce a method to discriminate these possibilities by pitting two conditions that are perceptually matched but conceptually different: in a "fused" condition, same and different objects are joined, creating single objects that (...) have the same perceptual features as the two object pairs in the "relational" condition. However, the "fused" objects do not provide evidence for the relation 'same.' Using this method with human toddlers in a causal relational reasoning task provides evidence for genuine conceptual understanding. This novel technique offers a simple manipulation that may be applied to a variety of existing match-to-sample procedures used to assess same-different reasoning to include in future research with non-human animals across species, as well as human infants. (shrink)

In an age where previous frames of reference lose their certainty nurses are finding themselves rethinking their relations to the ‘real’. In this paper I interrogate an empirical ‘text’ of a local nursing cultural practice through a poststructural critique of the ways in which language, discourses, representation and experience intersect to construct ‘reality’ for us with specific consequences. I do this in an attempt to disclose the micro‐politics at work in the processes of signifying and thus representing nursing to a (...) world of potential students. The discourses of science and caring find themselves exposed in particular representational technologies and practices that mark nursing's collusion with the ‘truths’ of science at the expense of those we loosely name ‘caring’. This cultural theoretical work constitutes a provisional and historical fragment of analysis designed to trouble the relations we often unwittingly sustain with dominant ‘regimes of truth’. (shrink)

In this paper I challenge the orthodox view of the significance of Platonic value problems. According to this view, such problems are among the central questions of epistemology, and answering them is essential for justifying the status of epistemology as a major branch of philosophical enquiry. I challenge this view by identifying an assumption on which Platonic value problems are based – the value assumption – and considering how this assumption might be resisted. After articulating a line of thought that (...) supports the assumption, I highlight one way of undermining it, which is to deny that we desire knowledge and not just true belief because we prefer knowledge to true belief. I then consider an attempt to undermine the value assumption in this way, inspired by Bernard Williams. I contend that Williams's argument fails, but also that seeing why it fails is instructive for future attempts to resist the value assumption. (shrink)

Unlike topics such as criminal responsibility, dangerousness has only recently begun to interest philosophically minded penologists. The most likely explanation is that until the middle of this century the periods for which people who had done serious harm to others were incarcerated in the UK so long that when they were released their age or condition or circumstances made them unlikely to repeat their crimes. It was only when pressure of resources—in plain terms overcrowded prisons and mental hospitals—forced the shortening (...) of these periods that it became politically necessary to worry about the possible dangerousness of really substantial numbers of prisoners and patients who became eligible for release. The problem was not entirely new. A few lifers, for example, had been set free each year, under licences which lasted for the rest of their lives; and the Special Hospitals which housed the violent insane had discharged carefully selected inmates, also under supervision. But by the late 1960s the introduction of parole, the Mental Health Act and the abolition of capital punishment had greatly increased the number of cases in which the problem of dangerousness had to be faced, and difficult decisions had to be taken. (shrink)

Imprisonment may sometimes be a justified form of punishment. Yet the U.S. carceral system suffers from appalling problems of justice—in who is put into prisons, in how imprisoned people are treated, and in downstream personal and community health impacts. Medical personnel working in prisons and jails take on risky work for highly vulnerable and underserved patients. They are to be lauded for their professional commitments. Yet at the same time, prison care undercuts the ability of medical personnel to uphold their (...) own professional standards and sometimes fails in even basic health protection. Doctors in prisons are stuck between their commitment to vulnerable patients and complicity in a system that requires their participation to uphold its constitutionality. Medical ethics is frayed in prisons, and the problem deserves our attention. (shrink)

At the end of the sixteenth century, Friar Juan de Torquemada watched the game of volador on the central plaza in Mexico. At the top of a pole some twenty meters high there was a small pivoting platform. Four ropes were wound around the top of the pole and held in place by a wooden frame. Five men dressed in feathery costumes making them look like birds climbed up the shaft. One of them reached the narrow platform and began to (...) dance. Then the other four bird-men tied themselves to the ends of the ropes and plunged into space, head down, held by the ropes around their waists. This initiated a spectacular circular flight in ever widening rings as the cords unwound. They straightened up only at the last moment, just in time to put their feet on the ground, dizzy and staggering. But on that particular day, one of the dancers was not to straighten himself up. The rope had been badly attached and broke, dropping the man like a heavy mass to the ground, lifeless. The Franciscan at once used this as an argument to demand that the Viceroy prohibit this game. But the civil authorities refused to do so, to the monk's great consternation. (shrink)

We argue that many of the benefits theorists have attributed to the ability to forget should instead be attributed to what psychologists call the “fading affect bias,” namely the tendency for the negative emotions associated with past events to fade more substantially than the positive emotions associated with those events. Our principal contention is that the disposition to display the fading affect bias is normatively good. Those who possess it tend to lead better lives and more effectively improve their societies. (...) Secondarily, we note that if Julia Driver’s moral theory is correct, then the disposition to display the fading affect bias is a moral virtue. (shrink)

“States have no morality, they have interests,” remarked an overzealous diplomat. And in this same manner we sometimes see that reasons of state take priority over moral rules. A sweet young thing testifying before a committee of the United State Congress said “sometimes you have to put yourself above the law,” no doubt repeating something that had been said to her. At a time when unrestrained application of the reasons of state can only lead to violence that can no longer (...) be sustained, we can judge to what extent such remarks are without foundation. (shrink)

Encounters with Alphonso Lingis is the first extensive study of this American philosopher who is gaining an international reputation to augment his national one. The distinguished contributors to this volume address most of the central themes found in Lingis's writings—including singularity and otherness, death and eroticism, emotions and rationality, embodiment and the face, excess and the sacred. The book closes with a new essay by Lingis himself.

Although many organizations around the world have engaged in corporate social responsibility programing, there is little evidence of social impact. This is a problematic omission since many programs carry the stigma of marketing ploys used to bolster organizational image or reduce consumer skepticism. To address this issue and build on existing scholarship, the purpose of this study was to evaluate a socially responsible youth employability program in the United Kingdom. The program was developed through the foundation of a professional British (...) soccer team to bolster employability and life skills for marginalized London youth. Program funding was provided by a large multinational bank as part of their CSR agenda. This evaluation was undertaken to understand the beneficiary impacts associated with program deployment. Results from the pre-intervention/post-intervention, sequential mixed-method evaluation show statistically significant differences among several “soft” beneficiary outcomes. However, results are mixed regarding whether the “hard” outcome of employment was achieved by program participants. Qualitative findings buttress these results, indicating a high level of motivation for work, attitude enhancement, and satisfaction with program delivery. (shrink)

Sport is viewed as an arena for positive life skill development, including leadership development. In 2015, the NFHS launched an online Captain’s Leadership Training Course. The main purpose of this study was to examine the effectiveness of the course in improving leadership knowledge and ability. An electronic survey was sent to a sample of athletes, ages 13–19 in eight United States states who had completed the NFHS course within the last 3–18 months. Most athletes completed the course based upon their (...) coach’s recommendation. The course was viewed to be moderately to very useful in helping them in preparing to be a team captain. Participants believed the course to be very to extremely effective in building their knowledge on motivation, communication, decision making, peer modeling, team cohesion and problem solving strategies. Canonical correlation analyses showed that athletes who felt they were more reflective tended to rate the effectiveness of the course lower than their peers. Additionally, analyses did not show any clear demographic characteristics that distinguished between perceptions of the effectiveness of the course, showing the value found in the course was high with all types of scholastic athletes. Athletes felt the course could be improved most in the area of learning how to manage conflict with their peers and coaches. Future research in scholastic leadership should seek to understand the impact of the course prospectively across a high school sport season. (shrink)

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 1-2, Page 219-244, June 2022.

This chapter examines some of the social science data concerning the relationship between happiness and achievement. The chapter explores further the idea that there are causal links between happiness and achievement, focusing on what common sense has to say about these matters. Reflective common sense supports a bidirectional model of causation: good moods often cause achievement and achievement often causes good moods. Before looking at the studies in support of the claim that happiness promotes achievement, the chapter considers the notion (...) of ‘effect size’. The question of whether positive affect causes achievement can be addressed by two sorts of studies. One type is longitudinal studies; the other is laboratory studies. Correlation, longitudinal, and experimental studies converge to show that positive moods and emotions cause achievement. Social science research suggests that those who are happier than average will be doubly blessed: they are happier and, on average, they will achieve more. (shrink)

We describe herein an introductory STS course, designed for large numbers of students, which uses a large number of faculty instructors. Its content and style has evolved continuously for 20 years in a major research university and been adapted for use in small two-year and four-year campuses.

Psychological altruism (being motivated by the needs of others) has a tendency to produce behaviour that is costly in evolutionary terms. How, then, could the capacity for psychological altruism evolve? One suggestion is that it is the result of sexual selection. There are, however, two problems that face such an account: first, it is not clear that the resulting behaviour would be altruistic in the relevant sense, and second, it does not seem to fit with key features of our actual (...) helping behaviour. I will argue that both of these problems can be avoided if we adopt a modular account of desire formation. (shrink)

Colleen Murphy’s impressive book presents a unified theory of transitional justice as a single, novel, distinct kind of justice, intended to guide normative evaluation of the choices transitional societies make in dealing with the past. I raise three central challenges to Murphy’s theory. First, how do we know that transitional justice is fundamentally a single special kind of justice that permits a grand unified theory? Second, is it plausible to hold, as Murphy claims, that societal transformation is the overarching aim (...) or objective of transitional justice? Third, is transitional justice convincingly explained as pursuing societal transformation ‘through’ or ‘by’ dealing with past wrongdoing? I argue that Murphy’s ambitious and finely detailed account does not fully reckon with dissensus about transitional justice in the field and does not adequately defend the central claim that transitional justice aims at societal transformation to be pursued by responding to past wrongs. (shrink)

Typical modes of reasoning in the Chinese tradition have often been described by Western thinkers as ‘correlative’ or ‘analogical’ in contrast with the supposedly rational, Western mode of reasonin...

This book review essay discusses Principles of Animal Research Ethics (2020), by Tom L. Beauchamp and David DeGrazia.