Accelerated approval of aducanumab for mild Alzheimer's by the U.S. Food and Drug Administration on June 7, 2021, has generated substantial medical, scientific, and ethical controversy. That approval was contrary to the nearly unanimous judgment of the FDA's Advisory Committee that little reliable evidence existed of significant benefit, even though the drug did reduce β‐amyloid. Three major ethical problems were created by this approval: (1) Medicare resources would be unjustly squandered, given the drug's $56,000 annual price and the 3.1 million (...) older potential American patients needing the drug; (2) physicians will feel ethically compelled to provide the drug to desperate, insistent patients, given FDA approval and in spite of side effects of brain bleeds and brain swelling; (3) and false hopes are generated for patients. A needed corrective by the federal government would reduce reimbursement to the bare cost of producing the drug (plus only a modest profit) until a phase IV trial has been successfully completed. (shrink)

The annual cost of healthcare in the United States reached $2.5 trillion in 2009 (about 17.6% of GDP) with projections to 2019 of about $4.5 trillion (about 20% of likely GDP).

Einfühlung wird ideengeschichtlich an das Konzept der Selbstperfektionierung geknüpft und insofern im Modus der Defizienz verhandelt. Dabei fungieren antike und mittelalterliche Diskurse um Gotteserkenntnis als historisch-konzeptionelle Vorläufer neuzeitlichmoderner Erklärungsfolien zwischenmenschlicher Alterität, mithin als semantische Vorform der zeitgenössischen Einfühlungs-Idee. In diesem Kontext ist eine ethisch-epistemologische Asymmetrie zu konstatieren, die Gott einerseits als den All-Empathischen beschreibt und zugleich die Erkenntnisbemühungen des Menschen als unabgeschlossen und prozessual vorstellt. Einfühlung produziert sich als regulative Idee im doppelten Sinne: Während Gott als empathische Transzendenz erscheint, bedarf (...) es unendlicher Annäherungsbewegungen, damit der Mensch sich in einem Akt transzendenter Empathie in Gott einfühlen kann. Durch die Etablierung dieser Vorstellungsverbindung hat das Innenleben des Anderen eine transzendente Aufladung erfahren. Das Fremdpsychische wurde zum modernen Mysterium. (shrink)

Secondary education around the world has been significantly disrupted by covid-19. Students have been forced into new ways of independent learning, often using remote technologies, but without the social nuances and direct teacher interactions of a normal classroom environment. Using data from the School Attitudes Survey—which surveys students regarding the perceived level of difficulty, anxiety level, self-efficacy, enjoyability, subject relevance, and opportunities for creativity with regards to each of their school subjects—this study examines students' responses to this disruption from two (...) very different schools with two very different experiences of the pandemic. This paper reports on the composite attitudinal profiles of students in the senior secondary levels at each school. The findings challenged our expectation that the increased difficulty and anxiety caused by the disruption would reduce perceived opportunities for creativity. Indeed, our analyses showed that the students at both schools demonstrated generally positive attitudes toward their learning and strongly associated opportunities for creativity with other attitudinal constructs including enjoyability, subject relevance, and self-efficacy. These complex associations made by the students appear to have buffered the impacts of the disruption, and they may even have supported creative resilience. (shrink)

Abstract:The American College of Physicians in its ethics manual endorsed the idea that physicians ought to improve their ability to provide care to their patients more parsimoniously. This elicited a critical backlash; critics essentially claimed that what was being endorsed was a renamed form of rationing. In a recent article, Tilburt and Cassel argued that parsimonious care and rationing are ethically distinct practices. In this essay I critically assess that claim. I argue that in practice there is considerable overlap between (...) what they term parsimonious care and what they define as rationing. The same is true of the Choosing Wisely campaign endorsed by the American Board of Internal Medicine. In both cases, if the goal is to control healthcare costs by reducing the use of marginally beneficial care that is not cost effective, then a public conversation about the justness of specific choices is essential. (shrink)

This paper compares the ethical standards reported by consumers and managers with different attachment styles (secure, preoccupied, fearful, or dismissing). We conducted two studies of consumer ethical beliefs and a third managerial survey. In Study 1, we used a questionnaire that we constructed, and in Study 2, we used the Muncy–Vitell Consumer Ethics Scale. The results in both the studies were consistent and showed that men reported a greater indifference to ethical transgressions than women. Based on the two studies, the (...) results indicate that␣among male consumers, the dismissing participants reported the greatest overall indifference to ethical transgressions and the secure participants expressed the most ethical beliefs. The two intermediate groups did not differ significantly from each other. In Study 1, none of the women consumers reported a dismissing attachment style. Women with a secure style reported more ethical beliefs than those in the other two groups. However, the sample in Study 2 included dismissing women. The dismissing women reported the greatest overall indifference to ethical transgressions and the secure women expressed the most ethical beliefs. The illegal profit subscale described the most severe ethical transgressions, and for both men and women, the secure participants were less apt than the other participants to report a willingness to transgress. In Study 3, the Newstrom and Ruch (1975, MSU Business Topics, Winter, 31) Questionnaire was administered to 227 managers. All four attachment patterns were represented among the participants of both genders. In all cases, the participants with a dismissing attachment style showed the greatest readiness to transgress. (shrink)

I agree with Professor ter Meulen that there is no need to make a forced choice between “justice” and “solidarity” when it comes to determining what should count as fair access to needed health care. But he also asserts that solidarity is more fundamental than justice. That claim needs critical assessment. Ter Meulen recognizes that the concept of solidarity has been criticized for being excessively vague. He addresses this criticism by introducing the more precise notion of “humanitarian solidarity.” However, I (...) argue that these notions are still not precise enough and are in need of behavioral translation, especially in relation to the problem of fair health care rationing. More specifically, I argue that translation ought to take the form of a well-ordered process of rational democratic deliberation, which I describe and defend in this essay. Such a process is what is required to construct a working model of just solidarity as opposed to a merely abstract idealization of just solidarity. (shrink)

At the turn of the last century, paleontologists wagered that they could find the missing link between lobe-finned fish and early terrestrial vertebrates. Given how these evolutionary relatives are distributed in the fossil record, Daeschler et al. predicted that some transitional form awaited discovery in late Devonian outcrops of the Canadian Arctic. It was there that they won their bet: the team soon found Tiktaalik roseae, a “fishopod” with a mix of aquatic and terrestrial traits. Tiktaalik’s discovery now stands as (...) paleontologists’ textbook case of scientific reasoning done right. (shrink)

Organisms leave a variety of traces in the fossil record. Among these traces, vertebrate and invertebrate paleontologists conventionally recognize a distinction between the remains of an organism’s phenotype and the remains of an organism’s life activities. The same convention recognizes body fossils as biological structures and trace fossils as geological objects. This convention explains some curious practices in the classification, as with the distinction between taxa for trace fossils and for tracemakers. I consider the distinction between “parallel taxonomies,” or parataxonomies, (...) which privileges some kinds of fossil taxa as “natural” and others as “artificial.” The motivations for and consequences of this practice are inconsistent. By comparison, I examine an alternative system of classification used by paleobotanists that regards all fossil taxa as “artificially” split. While this system has the potential to inflate the number of taxa with which paleontologists work, the system offers greater consistency than conventional practices. Weighing the strengths and weaknesses of each system, I recommend that paleontologists should adopt the paleobotanical system more broadly. (shrink)

Developments in genetic engineering may soon allow biologists to clone organisms from extinct species. The process, dubbed “de-extinction,” has been publicized as a means to bring extinct species back to life. For theorists and philosophers of biology, the process also suggests a thought experiment for the ongoing “species problem”: given a species concept, would a clone be classified in the extinct species? Previous analyses have answered this question in the context of specific de-extinction technologies or particular species concepts. The thought (...) experiment is given more comprehensive treatment here. Given the products of three de-extinction technologies, twenty-two species concepts are “tested” to see which are consistent with the idea that species may be resurrected. The ensuing discussion considers whether or not de-extinction is a conceptually coherent research program and, if so, whether or not its development may contribute to a resolution of the species problem. Ultimately, theorists must face a choice: they may revise their commitments to species concepts or they may recognize de-extinction as a means to make progress in the species problem. (shrink)

Building on recent formal work by Aleks Knoks, we explore how the idea that certain epistemic norms may be indeterminate could be implemented in a default logic.

This article probes the relationship among constitutionalism, extra-legal prerogative power, and citizen judgment. While much has been written about the nature of Lockean prerogative, and while his theory serves as a direct inspiration for contemporary "normative extra-legalists," key participants in the debate over emergency powers, less attention has been paid to how the people judge prerogative. Attention to this issue is useful because an examination of the process of political judgment of extra-legalism in Locke leads to a complication of the (...) current extra-legalist vision of democratic mechanisms of accountability. The author argues that the extra-legal approach is right to consider the role of democratic publics in potentially constraining the exercise of emergency powers but wrong to formulate that role as one extra-constitutional power checking another extra-constitutional power. The author situates both prerogative power and citizen judgment of it at the threshold of the constitutional order. (shrink)

We consider a proportional-prize contest to forecast future events, and show that, in equilibrium, this mechanism possesses perfect forecasting ability for any group size when the contestants share common knowledge about the probabilities by which future events realize. Data gathered in a laboratory experiment confirm the performance invariance to group size. By contrast, when realization probabilities are not common knowledge, there are some differences across group sizes. The mechanism operates marginally better with three or four compared to two players. However, (...) this effect is mainly driven by players’ behavior rather than by differences in the beliefs they form about the realization probabilities. (shrink)

If we accept the premise that some sort of rationing of access to health care resources is necessary to contain escalating health care costs effectively, then we need to ask how that rationing might be accomplished most fairly. Calabresi and Bobbitt have argued in their book Tragic Choices that there is no 'perfectly fair' or even 'reasonably fair' way to bring this about.

Eleonore Stump has recently argued that the Aristotelian foundations of Aquinas’s virtue theory have not only been exaggerated but are mistaken. She does not dispute Aquinas’s familiarity with and dependence on Aristotle’s moral theory. Instead, she argues that Aquinas’s ethics must be seen as essentially second-personal, where the central relationship is between the moral agent and the Holy Spirit, specifically the gifts of the Holy Spirit and the theological virtues. Her argument for displacing Aristotle, however, advances on at least two (...) questionable fronts. On the one hand, she claims that the acquired, Aristotelian moral virtues are, for Aquinas, not real virtues at all. Only the infused moral virtues are real. On the other hand, she argues that the pro-Aristotelian character of many descriptions of Aquinas’s moral theory over-emphasizes the role of reason in Aquinas’s ethics. Against this prevailing view, Stump contends that Aquinas is, in a limited way, closer to Hume in privileging the passions over reason. I challenge Stump’s attempted displacement of Aristotle by questioning her on both of these fronts. (shrink)

This essay challenges a growing consensus among Aquinas scholars who attribute to him a pro-passion attitude, linking his virtue theory to accounts of emotion that see the emotions in a primarily positive light. There are good reasons for thinking Aquinas far more skeptical of the role to be played by emotion in the virtuous life—indeed, one can safely argue, in agreement with Aquinas, that the emotions are often threats to and so in need of control by the virtues. I focus (...) on the ideal of reason’s control over the emotions in the essay in contrast with the work of Robert Miner whose understanding of Aquinas on the passions and virtues tends to downplay the dominating role that reason plays in the moral theory of Aquinas. For Aquinas IRC is central to the normativity of the virtues that relate to the emotions. In contrast, Miner appears to minimize the need for the emotions to be controlled, which entails a certain elevation of the emotions to a nearly co-equal status with reason in Aquinas’s moral theory. Miner adopts two argumentative strategies to achieve this valorization of emotion in Aquinas, but I find both exegetically inaccurate and experientially deficient. (shrink)

I have never doubted that the problem of inequalities in health status and access to needed care is a difficult ethical and political challenge. After reading the essays in Understanding Health Inequalities and Justice: New Conversations across the Disciplines, edited by Mara Buchbinder, Michele Rivkin-Fish, and Rebecca Walker, I concluded that despair was the only suitable response in the face of daunting ethical and political complexity. The editors of this volume have three questions in mind that they asked contributors to (...) address. How do scholars from various disciplines approach relations between health inequalities and ideals of justice? Social scientists want to offer empirical descriptions of inequalities in health status across a range of social groups, but there are numerous ways of offering such descriptions. Are they all “correct”? Philosophers and medical ethicists want to make normative judgments regarding which inequalities matter, ethically speaking. So do we need to know when considerations of justice are relevant to assessing health inequalities and which considerations of justice are most relevant in specific contexts? Ultimately, the question is which of these scholarly approaches is most useful for improving health policy. (shrink)

What does it mean to be a “just” and “caring” society in meeting the health care needs of the terminally ill when we have only limited resources to meet virtually unlimited health care needs? This is the question that will be the focus of this essay. Another way of asking our question would be the following: Relative to all the other health care needs in our society, especially the need for lifesaving or life-prolonging health care, how high a priority ought (...) the health care needs of persons who are terminally ill have? Should any of the health care needs of the terminally ill be assigned very low priority? Or should all their health care needs be assigned the highest priority? If we reflect a bit, we will find ourselves greatly internally conflicted. On the one hand, the “caring” side of our moral self might see terminally ill individuals as being among the “medically least well off,” and therefore, deserving virtually any medical resources that will yield any degree of good for them. (shrink)

This personal narrative tugs at the heart strings. However, personal narratives are not sufficient to justify public funding for any screening policy. We have to take seriously the ‘just caring’ problem. We have only limited resources to meet virtually unlimited health care needs. No doubt, screening tests often save lives. The author wants public funding for prostate-specific antigen screening for prostate cancer. However, why only prostate cancer? Numerous cancers at various stages can be screened for. Are all of them equally (...) deserving of public funding? What about screening for a very long list of other life-threatening medical disorders? There is nothing ethically special about cancer. Where does the money come from to pay for all these screening tests? Do we reduce expensive life-prolonging care for patients in late-stage diseases? Ultimately, a balance must be struck between saving statistical lives through screening and saving identifiable lives in the intensive care unit. Achieving a just balance requires rational democratic deliberation as justification for these choices, not personal narratives. (shrink)

Warwick Heale has recently defended the notion of individualized and personalized Quality-Adjusted Life Years in connection with health care resource allocation decisions. Ordinarily, QALYs are used to make allocation decisions at the population level. If a health care intervention costs £100,000 and generally yields only two years of survival, the cost per QALY gained will be £50,000, far in excess of the £30,000 limit per QALY judged an acceptable use of resources within the National Health Service in the United Kingdom. (...) However, if we know with medical certainty that a patient will gain four extra years of life from that intervention, the cost per QALY will be £25,000. Heale argues fairness and social utility require such a patient to receive that treatment, even though all others in the cohort of that patient might be denied that treatment. Likewise, Heale argues that personal commitments of an individual, that determine how they value a life-year with some medical intervention, ought to be used to determine the value of a QALY for them. I argue that if Heale’s proposals were put into practice, the result would often be greater injustice. In brief, requirements for the just allocation of health care resources are more complex than pure cost-effectiveness analysis would allow. (shrink)

In this essay, I examine Derrida’s deconstruction (or critique) of the death penalty in his first set of lectures (The Death Penalty, Volume 1). The essay has two parts. First, I reconstruct this deconstruction. I show that the deconstruction depends on the difference between the calculable instant and the incalculable instant. Then, in the second part I show how this difference is based on the deconstruction of temporalization Derrida produced in his 1967 Voice and Phenomenon. The deconstruction of temporalization shows (...) that the calculated instant is impossible, and the future, including the instant of my death, remains incalculable. In the essay’s conclusion, I show that the pardon from the death penalty is only a gift of time, only more time or extra time. The pardon can pardon someone from the condemnation to death, but it cannot pardon anyone from the condemnation to die. The pardon can give only a finite survival. (shrink)