Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine and (...) life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on ‘objective medical knowledge’. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance. (shrink)

We respond to recent comments on our proposal to improve justice in ventilator triage, in which we used as an example New Jersey’s publicly available and legally binding Directive Number 2020-03. We agree with Bernard Lo and Doug White that equity implications of triage frameworks should be continually reassessed, which is why we offered six concrete options for improvement, and called for monitoring the consequences of adopted triage models. We disagree with their assessment that we mis-characterised their Model Guidance, as (...) included in the NJ Directive, in ways that undermine our conclusions. They suggest we erroneously described their model as a two-criterion allocation framework; that recognising other operant criterion reveals it ‘likely mitigate[s] rather than exacerbate[s] racial disparities during triage’, and allege that concerns about inequitable outcomes are ‘without evidence’. We highlight two major studies robustly demonstrating why concerns about disparate outcomes are justified. We also show that White and Lo seek to retrospectively—and counterfactually—correct the version of the Model Guideline included in the NJ Directive. However, as our facsimile reproductions show, neither the alleged four-criteria form, nor other key changes, such as dropping the Sequential Organ Failure Assessment score, are found in the Directive. These points matter because our conclusions hence stand, because the public version of the Model Guidance had not been updated to reduce the risk of inequitable outcomes until June 2021 and NJ’s Directive still does not reflect these revisions, and, hence, represents a less equitable version, as acknowledged by its authors. We comment on broader policy implications and call for ways of ensuring accurate, transparent and timely updates for users of high-stakes guidelines. (shrink)

Husserl und die transzendentale Intersubjektivität analyses the transcendental relevance of intersubjectivity, and argues that an intersubjective transformation of transcendental philosophy can already be found in phenomenology, especially in Husserl. Husserl eventually came to believe that an analysis of transcendental subjectivity was a conditio sine qua non for a phenomenological philosophy. Drawing on both published and unpublished manuscripts the book examines his reasons for this conviction and delivers a detailed analysis of his radical and complex concept of intersubjectivity, showing that precisely (...) his reflections on transcendental intersubjectivity are capable of clarifying his phenomenological core-concepts, thus making possible a new understanding of his philosophy. Against this background the book then attempts to establish to what extent the phenomenological approach to intersubjectivity can contribute to the current discussions of intersubjectivity. This is achieved through a systematic confrontation with the language-pragmatical positions of Apel and Habermas. Die Abhandlung untersucht die transzendentale Relevanz der Intersubjektivität und zeigt, daß eine intersubjektive Transformation der Transzendentalphilosophie schon innerhalb der Phänomenologie - besonders der Husserlschen - zu finden ist. Husserl gelangte zu der Auffassung, daß eine Analyse und Einbeziehung der transzendentalen Intersubjektivität als conditio sine qua non für eine phänomenologische Philosophie zu betrachten sei. Die Gründe, die Husserl zu dieser Überzeugung führten, werden herausgearbeitet. Dabei weist die Analyse des radikalen und komplexen Begriffs der Intersubjektivität auf, daß erst seine Überlegungen zur transzendentalen Intersubjektivität viele phänomenologische Grundbegriffe ins rechte Licht stellen können und darüber hinaus ein neues Grundverständnis seiner Phänomenologie ermöglichen. Vor diesem Hintergrund wird die Frage, inwieweit die Phänomenologie zur gegenwärtigen Intersubjektivitätsdiskussion beitragen kann, durch eine systematische Auseinandersetzung mit der sprachpragmatischen Intersubjektivitätstheorie von Apel und Habermas beantwortet. (shrink)

Background While there are many guidelines on how to make ethical decisions at the end of life, there is little evidence regarding the quality of this sort of ethical guidelines. Objectives First, this study aims to demonstrate the conceptual transferability of the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument for the quality assessment of ethical guidelines. Second, it aims to illustrate the status quo of the quality of guidelines on end-of-life decision-making by using the AGREE instrument in a (...) first practice test. Method The transferability of the AGREE instrument on the quality assessment of ethical guidelines is demonstrated by conceptual analysis. Guidelines on end-of-life decisions in medicine are identified through a systematic search in MEDLINE (from June 1999 to June 2009). The quality of all included guidelines was assessed with a slightly modified AGREE instrument. Results Of 103 guidelines identified, 34 were included as relevant. The majority of the guidelines analysed in this study were assessed as qualitatively insufficient in five out of six AGREE quality domains. A few guidelines demonstrated, however, that a high level of quality in accordance with the AGREE requirements is possible. Conclusion This review concludes that the quality of many ethical guidelines should and can be improved in all quality domains specified by the AGREE instrument. Furthermore, conceptual analysis indicates that a slightly modified AGREE instrument is transferable to the comprehensive evaluation of the quality of ethical guidelines. Nevertheless, future research is needed to improve the assessment of the presentation of the guidelines' normative basis. (shrink)

Screening programmes are becoming increasingly popular since prevention is considered 'better than cure'. While earlier diagnosis may result in more effective treatment for some, there will be consequent harm for others due to anxiety, stigma, side-effects etc. A screening test cannot guarantee the detection of all 'abnormal' cases, therefore there will be false reassurance for some. A proper consideration of the potential benefit and harm arising from screening may lead to the conclusion that the programme should not be offered. A (...) modified utilitarian approach may be used for allocation of scarce resources in health care. Ethics has an important role in this evaluation. (shrink)

La foi et la raison. La foi, don de Dieu. La raison, don de l'homme ou don de Dieu? La foi et la raison eurent à combattre, comme si le ciel et la terre vivaient en conflit incessant. Le combat demeure, différent certes, parce que l'homme oublie ses origines sans en regarder la cause. Jean-Paul II s'est lancé dans cette épreuve, en rédigeant une encyclique, pour enfin tenter de sortir l'homme de son enfermement dialectique. Le magistère de l'Eglise catholique lui (...) en donne l'autorité et la lui demande, pour enfin réconcilier l'homme avec lui-même et avec Dieu"-- Back cover. (shrink)

The foundation of the mathematical theory of probabilities is still a controversial subject. There are schools of insufficient reasoning and of cogent reasoning, of a priori determination and of frequency determination, of subjective and of objective probability. Two main difficulties exist. The first is the definition of equally like events. The second difficulty is the relation between the laws of causal natural science and the laws of statistical regularity. Is it really necessary to add to the laws of mechanics one (...) or more independent “laws of large numbers” to explain the regularities in dice throwing? In all these cases different answers exist, and the existence of a mathematical theory of probabilities remains a kind of miracle, as esoteric to the further domain of natural science as the resurrection of the dead. (shrink)

Human aesthetic experiences are pervasive; they are triggered by faces, art, natural scenery, foods, ideas, theories, and decision-making situations, among many sources, and seem to be a distinctive trait of our species. Our moral sense, understood as our capacity to judge events, actions, or people as good or bad, appropriate or inappropriate, also seems to be an exclusively human endowment (Ayala 2010). As part of the scientific efforts to characterize the biological foundations of our human uniqueness, recently there has been (...) interest in the brain’s underpinnings of aesthetic reactions to art on the one hand, and in the neural correlates of moral judgment and decision-making on the other (Greene and Paxton .. (shrink)

ABSTRACT Translating archaic Greek philosophies presents a complex of opportunities and challenges for translators, several of which are regularly overlooked. Among these figure prominently the culture and thematics of oralcy and the predisciplinarity in which early Greek thinking took shape. Additionally, translators engaged with early Greek thinking face layers of interpretive history and expectations that can determine the scope of possible translation, which, in turn, limits the range of interpretive possibilities. Yet their predisciplinary or at least hybrid modes summon a (...) broad attention to contexts of language, forms, and meanings that may challenge, or even disrupt, the predominant lines of inquiry and interpretation. How can translation motivated by the oralcy and predisciplinarity of archaic Greece open new directions for interpretation of the early Greek thinkers? Ranging through Anaximander, Xenophanes, Heraclitus, Parmenides, and others, this article articulates some possibilities for translating on and beyond the boundaries of philosophy. (shrink)

On creating a grammar for living together The article is about the question whether it is possible for South Africans to learn a new common moral language. Six well-known positions are considered: a common political language, a common economic language, a common Biblical language, a common Christian language, a common language of survival, and a common rational language.

The concept of quantum principle is introduced as a principle whose formulation is based on specific quantum ideas and notions. We consider three such principles, viz, those of quantizability, local gauge symmetry, and supersymmetry, and their role in the development of the quantum field theory (QFT). Concerning the first of these, we analyze the formal aspects and physical contents of the renormalization procedure in QFT and its relation to ultraviolet divergences and the renorm group. The quantizability principle is formulated as (...) an existence condition of a self-consistent quantum version with a given mechanism of the field interaction. It is shown that the consecutive (from a historical point of view) use of these quantum principles puts still larger limitations on possible forms of field interactions. (shrink)

Does South Africa need a common moral language? Many people are of the opinion that South Africa finds itself 'after Babel’ and needs a common moral language (1). The author considers some of the arguments of people who disagree with this analysis, because they do not define the problem in this way (2); because they find the language- or Babel-methaphor confusing (3); because they agree with the description of the problem, but not with the suggested solution, namely a common moral (...) language (4); or because they accept the solution, but do not regard it as the proper task of the Christian church to be involved in this search for a common moral language (5). (shrink)

This paper argues that the concept and role of ‘institutional racism’ in contemporary discussions of race should be reconsidered. It starts by distinguishing between ‘intrinsic institutional racism’, which holds that institutions are racist in virtue of their constitutive features, and ‘extrinsic institutional racism’, which holds that institutions are racist in virtue of their negative effects. It accepts intrinsic institutional racism, but argues that a ‘disparate impact’ conception of extrinsic conception faces a number of objections, the most serious being that it (...) has no plausible account of what it is that makes extrinsically racist institutions racist. It also argues that claims about the explanatory indispensability of institutional racism are overstated (individual racism is at least as important), critiques structural approaches to racial inequality, and suggests that there is reason to doubt whether institutional reform can provide us with all that morality may require in the racial domain. (shrink)