Description Logics (DLs) are a family of well-known terminological knowledge representation formalisms in modern semantics-based systems. This research focuses on analysing how our developed Occurrence Logic (OccL) can conceptually and logically support the development of a description logic. OccL is integrated into the alternative theory of natural language syntax in `Deviational Syntactic Structures' under the label `EFA(X)3' (or the third version of Epi-Formal Analysis in Syntax, EFA(X), which is a radical linguistic theory). From the logical point of view, OccL (...) is a formal logic that mainly deals with the occurrences of symbols as well as with their priorities within linguistic descriptions, i.e. natural language syntax, semantics and phonology. In this article---based on our OccL-based definitions of the concepts of `strong implication' and `occurrence value' as well as of the logical concept `identical occurrence constructor (IDOC)' that is the most fundamental logical concept in our formalism---we will model Occurrence Description Logic ($\mathcal{ODL}$). Accordingly, we will formally-logically analyse `occurrence(s) of symbol(s)' within descriptions of the world in $\mathcal{ODL}$. In addition, we will analyse and assess the logical concepts of `occurrence' and `occurrence priority' in $\mathcal{ODL}$. This research can make a strong logical background for our future research in the development of a Modal Occurrence Description Logic. (shrink)

In this research I will focus on a basis for a formal model based on an alternative kind of logic invented by Hans Götzsche: Occurrence Logic (Occ Log), which is not based on truth values and truth functionality. Also, I have taken into account tense logic developed and elaborated by A. N. Prior. In this article I will provide a conceptual and logical foundation for formal Occurrence Logic based on symbolic logic and will illustrate the most important relations (...) between symbolic logic and Occurrence Logic. There will be a special need to focus on arguments based on symbolic occurrence logic. The interrelationships and dependencies between symbolic logic and Occ Log could be conducive to an approach that can express and analyse ‘the occurrences of the world’s descriptions based on various logical principles at different moments’. Symbolic Occ Log checks the occurrence conditioning and the priority of occurrences by employing occurrence values. I shall conclude that the desired approach could gradually support me in providing a truth-functional independent first-order predicate calculus that could work on semantic analysis of different propositions within world descriptions. (shrink)

More philosophical effort is spent articulating evolutionary rationales for the development of belief-like capacities than for precursors of desires or preferences. Nobody, though, seriously expects naturally evolved minds to be disinterested epistemologists. We agree that world-representing states won’t pay their way without supporting capacities that prioritise from an organism’s available repertoire of activities in light of stored (and occurrent) information. Some concede that desire-like states would be one way of solving this problem. Taking preferences as my starting point instead of (...) belief-like states, I defend two conclusions. First, psychologically real preference states, which approximately token expected utilities, have a quite general evolutionary rationale. They are a solution to the problem of efficiently allocating capacities with incompatible uses. This argument is a version of the Environmental Complexity Thesis. Second, preferences can plausibly function and naturally evolve without belief-like states, even though the converse claim is incredible. Preferences, that is, can mediate between discriminations of occurrent states (‘internal’ or ‘external’) and the processes selecting activity without mediation by stored indicative representations. By tokening expected utilities of actions conditional on discriminated state, they can increase the rate at which the ‘right thing’ is done at appropriate times, and they can do this without the support of belief-like, world-representing states. Preferences, even incomplete and noisy sets of them, are a fuel for success that will tend to be favoured when environments are complex in ways that matter to an organism, and when the organisms have complex behavioural repertoires with heterogenous returns and costs. (shrink)

Priority for solid organ transplant generally does not consider the underlying cause of the need for transplantation. This paper argues that a distinctive set of factors justify assigning lower priority to willfully unvaccinated individuals who require transplant as a result of suffering from COVID‐19. These factors include the personal responsibility of the patients for their own condition and the public outrage likely to ensue if willfully unvaccinated patients receive organs at the expense of vaccinated ones. The paper then (...) proposes a three‐prong test for similar deviations from the current allocation standard that incorporates patient responsibility, foreseeability and avoidability, and the frequency of the occurrence. (shrink)

Between the 1930s and the mid 1970s, it was commonly believed that in 1880 Karl Marx had proposed to dedicate to Charles Darwin a volume or translation of Capital but that Darwin had refused. The detail was often interpreted by scholars as having larger significance for the question of the relationship between Darwinian evolutionary biology and Marxist political economy. In 1973–4, two scholars working independently—Lewis Feuer, professor of sociology at Toronto, and Margaret Fay, a graduate student at Berkeley—determined simultaneously that (...) the traditional story of the proposed dedication was untrue, being based on a long-standing misinterpretation of the relevant correspondence. Between the two, and among several other scholars who became their respective allies, there developed a contest of authority and priority over the discovery. From 1975 to 1982, the controversy generated a considerable volume of spilled ink in both scholarly and popular publications. Drawing on previously unexamined archival resources, this article revisits the ‘case’ of the so-called ‘Darwin–Marx correspondence’ as an instance of the phenomenon of ‘multiple discovery’. A familiar occurrence in the natural sciences, multiple discovery is rarer in the humanities and social sciences. The present case of a priority dispute in the history of ideas followed patterns familiar from such disputes in the natural sciences, while also diverging from them in ways that shed light on the significance of disciplinary norms and research infrastructures. (shrink)

Kant’s enigmatic term, “Gesinnung”, baffles many readers of Religion within the Bounds of Bare Reason. Detailed analysis of Kant’s theory of Gesinnung, covering all 169 occurrences of cognate words in Religion, clarifies its role in his theories of both general moral decision-making and specifically religious conversion. Whereas the convention of translating “Gesinnung” as “disposition” reinforces a tendency to interpret key Kantian theories metaphysically, and Pluhar’s translation as “attitude” has psychological connotations, this study demonstrates that Kantian Gesinnung is volitional, referring to (...) a person’s principle-based choice to live a certain way. Interpreted as principled “conviction”, Kantian Gesinnung is a religiously-manifested, moral form of Überzeugung (“convincing”). (shrink)

Kants theories of both general moral decision-making and specifically religious conversion. It is argued that Kantian Gesinnung is volitional, referring to a personconvictionberzeugung (). This is confirmed by a detailed analysis of the 169 occurrences of Gesinnung and cognate words in Religion. It contrasts with what is suggested by translating Gesinnung as, which reinforces a tendency to interpret the notion more metaphysically, and also with Pluharattitude’, which has too strongly psychological connotations.

A mental-occurrence instance is conscious if it is an object of inner consciousness; that is, if a mental-occurrence instance occurs and is conscious on that occasion, one is conscious of it on the spot without having to take notice first of something else. In contrast, Freud's preconscious and unconscious psychical processes, whenever they occur, are examples of nonconscious mental-occurrence instances, which are not objects of inner consciousness; that is, one has no consciousness of them unless one takes (...) notice of something else and infers, therefrom, their occurrence. Determining how inner consciousness transpires will soon have high priority on the scientific agendas of psychologists of consciousness. To assist in their forthcoming explanatory search, I present a straightforward survey of a number of intrinsic theories of consciousness. Intrinsic theory holds that any conscious mental-occurrence instance has itself as object, plus whatever else it may give consciousness of; it is conscious due to its own structure, not due to what happens next or later. Intrinsic theory differs from appendage theory and mental-eye theory, which both hold that a mental-occurrence instance cannot be conscious on its own, cannot give any consciousness of itself, only of something else at most. (shrink)

This paper argues that Wittgenstein, both early and late, rejects the idea that the logically simpler and more fundamental case is that of "the mere sign" and that what a meaningful symbol is can be explained through the elaboration of an appropriately supplemented conception of the sign: the sign plus something. Rather the sign, in the logically fundamental case of its mode of occurrence, is an internal aspect of the symbol. The Tractatus puts this point as follows: “The sign (...) is that in the symbol which is perceptible by the senses.” Conversely, this means that it is essential to a symbol – to what a symbol is – that it have an essentially perceptible aspect. For Wittgenstein there is no privileged direction of explanatory priority between symbol and sign here: without signs there are no symbols and without some sort of relation to symbols there are no signs. (shrink)

This paper is devoted to showing that a safety priority should be accorded the highest priority in decision-making and that such a prioritisation is an ethical responsibility. The connection between a safety-first priority and ethics is that an ultimate concern for safety is an integral feature of respect for human life. This paper exposes the illogic behind the misleading phrase "risky technology" and the fallacies which underlie the seemingly morally neutral phrase "risk assessment". It is argued that (...) human beings ultimately possess the responsibility of the choice to employ one technological system as over another and hence the decision to employ unsafe technology is a case of "risky assessment" rather than "risky technology". The phrase "risky technology" implies that the risk factor is inherent to the technology when the risk factor is inherent to the choice of which technology to employ. Risk assessment has been portrayed as amoral numerical calculation without clarifying the basis of the assessment. It is argued here that risk assessment must include the basis of its figures and that, to be epistemologically sound, the basis should be past engineering performance and not "subjective engineering judgement". To be ethically sound, risk assessment must take into account not only probabilities of occurrence but consequences of occurrence, such as life or death risks to risk takers and all those on whom the risk taken will ultimately make an impact. It is argued that risk takers possess a right to know of the specific risks to which they are exposing themselves and that risk makers possess the corresponding duty to inform risk takers. The Challenger case is utilised as a lesson in unsound and unethical risk assessment. It is also utilised as a case in which the right of the astronauts and civilian passengers to know of the risk they were taking was not respected and the ethical duty to inform the astronauts and civilian passengers of the risk they were taking was not observed. Distinctions are drawn between general and unknown risks of space travel and the specifically foreknown risks of a design deficient O-ring which malfunctioned below specific temperature readings. The belief that progress requires risk taking is exposed as an oversimplification since progress can be made as in the case of the development of commercial air travel without taking reckless risks. Passenger aircraft must meet certain criteria of safety to be operable but this is not an obstacle to progress. The observance of the right to know and the duty to inform is an asset to business. In the case of Delta Airlines and Northwest Airlines, the decision to notify the public of bomb threats may have given business a boost since passengers have deduced in absence of such a threat that their flight was a safe one as they trusted these airlines. (shrink)

This paper argues that Wittgenstein, both early and late, rejects the idea that the logically simpler and more fundamental case is that of “the mere sign” and that what a meaningful symbol is can be explained through the elaboration of an appropriately supplemented conception of the sign: the sign plus something (say, an interpretation or an assignment of meaning). Rather the sign, in the logically fundamental case of its mode of occurrence, is an internal aspect of the symbol. The (...) Tractatus puts this point as follows: “The sign is that in the symbol which is perceptible by the senses.” Conversely, this means that it is essential to a symbol – to what a symbol is – that it have an essentially perceptible aspect. For Wittgenstein there is no privileged direction of explanatory priority between symbol and sign here: without signs there are no symbols (hence without language there is no thought) and without some sort of relation to symbols there are no signs (hence the philosopher’s concept of the supposedly “merely linguistic” presupposes an internal relation to symbols). (shrink)

This thesis develops a deeper understanding of and provides an answer to the paradox of deontology. Traditional deontological views include deontic constraints that prohibit us from harming innocent people even to prevent greater harms of the same type. Although constraints correspond to widely shared moral intuitions, they seem to make traditional deontology unavoidably paradoxical: for how can it ever be morally wrong to minimise morally objectionable harm? The thesis argues that previous attempts to solve this paradox have been insufficient because (...) they have failed to distinguish clearly between two distinct puzzles that together constitute the paradox. The first puzzle—the rationality paradox—says that if we think that we should not harm others in a certain way, it is rational by default to think that we should minimise the occurrences of that kind of harm overall. Thus, to answer the rationality paradox the deontologist must justify constraints by reference to some value that cannot be furthered by minimising the occurrences of harm. However, this will make her vulnerable to a second puzzle—the value paradox—which says that in the face of the severe harm that awaits the greater number of individuals, it seems morally inappropriate to be concerned with anything other than the minimisation of the occurrences of that kind of harm overall. The thesis develops a comprehensive approach that can address both these paradoxes. The hyperinviolability account developed in this thesis shows that traditional deontology ceases to appear paradoxical once we understand it as an agent-neutral moral theory that gives priority to our moral standing over the moral significance of what might happen to us. (shrink)

This dissertation defends and develops the thesis that some instances, or tokens, of dispositional properties are pure. A pure disposition has no causal basis in any further properties beyond the disposition. A causal basis typically consists of some set of properties underlying a disposition that enables the disposition to manifest when stimulated in the appropriate circumstances. For example, a vase is fragile because it is disposed to break when a hammer or other suitable object strikes it, where the causal basis (...) for fragility is the underlying micro-structure of the vase. Moreover, micro-structural properties of the vase seem to anchor the continuous existence of the vase’s fragility when the vase is not actually breaking. In contrast to the neo-Humean metaphysical assumption that any disposition requires a causal basis in further properties, as in the example of fragility, the Pure Dispositions Thesis denies this. This dissertation achieves four goals. First, it defends the Pure Dispositions Thesis from notable objections: the Powers Regress Argument, the Insufficient Causal Basis Argument, the Argument from the Identity Thesis, and the Argument from Spatial Occupation. Second, it evaluates several theories of the continuous existence of pure dispositions, and argues that some pure dispositions are self-grounded via a minimally sufficient occurrence of their own power. Third, it presents two arguments that some pure dispositions are extrinsically grounded, the Argument from the Higgs Field and the Argument from Priority Monism, and deflects numerous objections to those arguments. Finally, it develops and defends an account of systems of pure dispositions, arguing that a pure dispositional system may generate higher-level categorical and dispositional properties by way of an emergence mechanism involving the union of two pure dispositions. (shrink)

This multi-authored book explores the ways that many influential ethical traditions - secular and religious, Western and non-Western - wrestle with the moral dimensions of poverty and the needs of the poor. These traditions include Buddhism, Christianity, Confucianism, Hinduism, Islam, and Judaism, among the religious perspectives; classical liberalism, feminism, liberal-egalitarianism, and Marxism, among the secular; and natural law, which might be claimed by both. The basic questions addressed by each of these traditions are linked to several overarching themes: what poverty (...) is, the particular vulnerabilities of high-risk groups, responsibility for the occurrence of poverty, preferred remedies, how responsibility for its alleviation is distributed, and priorities in the delivery of assistance. This volume features an introduction to the types, scope, and causes of poverty in the modern world and concludes with Michael Walzer's broadly conceived commentary, which provides a direct comparison of the presented views and makes suggestions for further study and policy. (shrink)

In the article the essence of the public- private partnership is defined; on the basis of the experience of European countries priority areas for the implementation of PPP projects are identified. They are transport and utilities infrastructure. Generalized approach to evaluating the effectiveness of investment projects help to highlight two areas: economic and social efficiency. The indexes of social efficiency of PPP projects and efficiency indicators for projects of public and private partners and services consumer are defined. The main (...) stages of the analysis of public- private partnerships are defined. Key factors in choosing the best investment proposal are the minimization of utility rates, terms and government involvement in the financing of projects. Economic evaluation of PPP projects is based on an analysis of four major factors: profitability index, net present value, internal rate of return, discounted payback period. Assessing the economic efficiency of PPP projects take into account the index of riskiness of the project is proposed. This index is calculated by determining the list of major risks for the private partner, dividing them into groups by priority, assessing the probability of occurrence of each event using the method of expert estimates, the calculation point scoring system for the project. The resulting score is a general indicator of the riskiness of the project. This index allows to estimate the minimum possible economic benefit to which an investor can expect a high probability of a specified list of risks. (shrink)

The loss of friendship can be a frequent occurrence for children as they explore their social worlds and navigate their way through the demands of particular relationships. Given that friendship is a relationship of special regard, and associated with a particular partiality to our friends, the ending of friendship and the subsequent interactions between former friends, can be difficult areas for schools to deal with. Whilst there has been considerable research on the formation and maintenance of friendship, a consideration (...) of what happens after friendship has had surprisingly limited attention. Much of our current understanding of issues on moral behaviour fails to fully address the positioning of former friends in our moral thinking particularly as regards matters arising from the priority of attachment. Recent empirical research seems to indicate that the memory of prior encounters has a far greater influence on future reciprocal exchanges than previously accepted. This paper considers suggests that this view of memory can be played out in two contrasting ways. First, a prudential view suggests that as our former friends were previously given access to our intimate secrets and confidences, self-interest would seem to indicate that we treat them well. Secondly, a residual duties view suggests that some obligations remain after the friendship has ended based on the history of the relationship. Finally, I then draw out some of the implications this may have for schools and the education of children. (shrink)

The loss of friendship can be a frequent occurrence for children as they explore their social worlds and navigate their way through the demands of particular relationships. Given that friendship is a relationship of special regard, and associated with a particular partiality to our friends, the ending of friendship and the subsequent interactions between former friends, can be difficult areas for schools to deal with. Whilst there has been considerable research on the formation and maintenance of friendship, a consideration (...) of what happens after friendship has had surprisingly limited attention. Much of our current understanding of issues on moral behaviour fails to fully address the positioning of former friends in our moral thinking particularly as regards matters arising from the priority of attachment. Recent empirical research seems to indicate that the memory of prior encounters has a far greater influence on future reciprocal exchanges than previously accepted. This paper considers suggests that this view of memory can be played out in two contrasting ways. First, a prudential view suggests that as our former friends were previously given access to our intimate secrets and confidences, self-interest would seem to indicate that we treat them well. Secondly, a residual duties view suggests that some obligations remain after the friendship has ended based on the history of the relationship. Finally, I then draw out some of the implications this may have for schools and the education of children. (shrink)

Between the zone of certainty beyond all doubt and the zone of incomprehensible uncertainty, the sources of which are nothing but chance, we need to use solid results from a vast interdisciplinarity. We wish to give here a sense of the factors in play and the state of the debate and advance in the territory of how interdisciplinarity may help to solve problems which are common in many areas of knowledge. Chaos and complexity certainly put limits on what we can (...) know. High complexity, asymmetry and/or non-linearity are universal types of imprecision. Can hazard have purpose and direction?The idea is that the more effort we put into project design to cover as many details and possible consequences as possible we can grasp in our in-depth analysis aiming to create the project (in art or science or society), the greater the chances that the random occurrence of the unpredictable event will settle on the project's purpose and direction and not on contrary to them. There is no vicious circle here. This kind of method can explain many good results already obtained in such circumstances. Simplicity, beauty, rationalistic optimism, are features of unshakeable scientific results We may call this feature of scientific theory or art _uniqueness. _Uniqueness is strongly correlated with _essentialization. _Science is working in that sense: to simplify a phenomenon to its essence in order to study it easily without losing anything important in the analysis. That is _essentialization. _Why and how complex systems move to the edge of chaos? And what do they do to stay there? They are in constant struggle to create or keep order in complexity. That is the pattern of self-organization, the specific feature of human nature. That is why our action is meant to build resilience to deal better with unpredictable events and prevent the emergence of a critical threshold. Uncertainty, indeterminacy, randomness, and contradictions appear, not as non-essential substances of debate to be eliminated by explanation, but as everlasting ingredients of our conception of reality. There are compelling reasons to believe that it is impossible to make accurate, nontrivial predictions concerning human behavior. Logic and reason are and remain priority, but unpredictability forces us to imagination and creative thinking. Indeed we are confronted with a new human landscape. The anomalies become the new normal. (shrink)

Depuis la littérature chrétienne patristique, mais aussi et souvent encore, moderne, il est un lieu commun de l’exégèse de montrer en quoi « l’accomplissement de la Loi » par Jésus devait se traduire par l’abolition pure et simple de ses rites, en particulier du Chabbat qui devait être remplacé par le « huitième jour » . Or, il est aujourd’hui notable que rien de tel ne fut jamais avancé explicitement par Jésus qui se rendait régulièrement à la synagogue le Chabbat, (...) y enseignait et « montait à la Tora ». Le seul véritable point d’ancrage permettant d’affirmer le déni du Chabbat par Jésus repose sur un fait qui, il faut bien l’admettre, est incontournable : à diverses occasions, il le « transgresse » délibérément. La thèse du Rabbin Krygier est que pour les évangélistes eux-mêmes, Jésus ne rompt pas le Chabbat pour manifester l’inanité de son observance, mais pour subvertir l’ordre des priorités, en l’occurrence, privilégier le salut des personnes dont il se veut l’agent et le garant.Since patristic Christian literature , there is a commonplace of exegesis to show how “the accomplishment of the Law” by Jesus would result purely and simply in abolishing its rites, especially the Sabbath, which would be replaced by the “eighth day” . It is noteworthy today, however, that no such position was ever explicitly put forward by Jesus, who regularly went to the synagogue on the Sabbath, taught there and “went up to the Torah.” The only real grounds for affirming Jesus’ denial of the Sabbath depends on a fact which is, one must admit, unquestionable: on various occasions he deliberately “transgressed” it. The thesis of Rabbi Krygier is that, for the evangelists themselves, Jesus did not break the Sabbath to show the futility of its observance, but rather to subvert the order of priorities: in this case, to give preference to the salvation of people of which he himself wishes to be the agent and guarantee. (shrink)

We have noticed a pattern of arguments that exhibit a type of irrationality or a particular informal logical fallacy that is not fully captured by any existing fallacy. This fallacy can be explored through three examples where one misattributes a cause by focusing on a smaller portion of a larger set—specifically, the last or least known—and claiming that that cause holds a unique priority over other contributing factors for the occurrence of an event. We propose to call this (...) fallacy the “last straw fallacy” and will argue why these examples actually warrant a new logical name. Finally, we will show how these cases point to a deeper insight about the contexts in which we typically invoke this type of reasoning and some significant harmful consequences of doing so. (shrink)

The fact that the Odyssey and the Theogony share a number of verses in common seemed to most scholars of the nineteenth and early twentieth centuries reason enough to assume that one work has influenced the other. Now that more is known about the techniques of oral poetry, which have clearly influenced the composition of both works, a greater caution is rightly shown in arguing for the priority of the one or the other on the basis of individual verses (...) or phrases, since these may in fact be formulaic and thus common property which could have been used by any poet working in that tradition. In one case, however, Odyssey 8. 166–77 and Theogony 79–93, what is common is not a single verse but two and a half lines, so that the possibility of chance occurrence of the same formulas is virtually ruled out. Quite rightly therefore few critics have doubted that here either Homer has directly influenced Hesiod or vice versa. For this reason a good deal of the argumentation for the priority of the Odyssey or of the Theogony has concentrated on an examination of Od. 8. 166–77 and Th. 79–93. However, as is usual in such cases, most of the arguments which have been adduced in favour of the priority of the one or of the other are reversible because they are based on subjective grounds such as alleged incompetent adaptation of the earlier work, which is tacitly assumed to be superior. Since these arguments have recently been discussed in detail by Heinz Neitzel in a useful survey, it will not be necessary to review them here. (shrink)

This paper gives a retrospective of the events in the Balkans in the last 20 years. Hence, it indicates the problems, the progress and the challenges in terms of respecting and promoting diversity. The Western Balkans has always been a very interesting region with many challenges during different historical periods. If we take into consideration all the differences and diversities in this region, then this shouldn’t strike us as surprising. During history the Balkan region has always been a crossroads of (...) many events, conflicts, changes and destructive occurrences. In order to understand the connection between ethnic and the religious diversity, as well as the future of the Western Balkan countries in terms of Euro-Atlantic integration, we need to provide some information about the political, economic and social changes in these countries during the past, especially in the last two decades. To get a better understanding of all the processes and events we need to take a look at the 90s of the last century. This period was one of the most important turning points in international relations. By the end of the Cold War there were two blocks within the societies – The Western and the Eastern, and an agreement for the Balkans to be a balance between these two blocks. This fact was important for the promotion of the concept of the nation-state, which refers generally to both of the blocks. However, changes such as the dissolution and breakdown of the USSR and Yugoslavia, as well as the official Eastern bloc fiasco, brought an increase in the individual identity of the citizens living in these countries. This was the beginning of a new era to be characterized by conflicts, wars, refugees, humanitarian crises, a large number of casualties and injured people, because of the idea that the emerging countries, especially from the Balkan region, should be nation-state countries, i.e. composed of a nation thereby ignoring the ethnic and religious differences or the unrecognized diversity of the citizens of different ethnic groups living in these countries. The establishment of the Euro-Atlantic integration concept as a key national and state priority of almost every country in this region led to the understanding of differences as an asset, and not as an obstacle for the faster integration to the EU and NATO. This fact undoubtedly contributed to the establishment of the criteria for membership, and in particular to the promotion of the rights and freedoms of minorities as most important for the integration process. (shrink)

Pain is the single most common reason patients seek care in the emergency department. Given the prevalence of pain as a presenting complaint, one might expect emergency physicians to assign its treatment a high priority; however, pain is often seemingly invisible to the emergency physician. Multiple research studies have documented that the undertreatment of pain, or oligoanalgesia, is a frequent occurrence. Pain that is not acknowledged and managed appropriately causes dissatisfaction with medical care, hostility toward the physician, unscheduled (...) returns to the emergency department, delayed return to full function, and potentially, an increased risk of litigation. Failure to recognize and treat pain may result in anxiety, depression, sleep disturbances, increased oxygen demands with the potential for end organ ischemia, and decreased movement with an increased risk of venous thrombosis. (shrink)

Pain is the single most common reason patients seek care in the emergency department. Given the prevalence of pain as a presenting complaint, one might expect emergency physicians to assign its treatment a high priority; however, pain is often seemingly invisible to the emergency physician. Multiple research studies have documented that the undertreatment of pain, or oligoanalgesia, is a frequent occurrence. Pain that is not acknowledged and managed appropriately causes dissatisfaction with medical care, hostility toward the physician, unscheduled (...) returns to the emergency department, delayed return to full function, and potentially, an increased risk of litigation. Failure to recognize and treat pain may result in anxiety, depression, sleep disturbances, increased oxygen demands with the potential for end organ ischemia, and decreased movement with an increased risk of venous thrombosis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:164 BOOK REVIEWS Thomas Buckingham and the Contingency of Futures-The Possibility of Human Freedom: A Study and Edition of Thomas Buckingham, De contingentia futurorum et arbitrii libertate. By BARTHOLOMEW R. DE LA TORRE, O.P. University of Notre Dame, The Medieval Institute Publications in Medieval Studies, Vol. XXV. Notre Dame, Indiana: University of Notre Dame Press, 1987. Pp. xii +394. In this volume, Fr. Batholomew de la Torre offers the (...) text and an extended study of Thomas Buckingham's De contingentia futurorum et arbitrii libertate, which is the first of six questions of this scholastic's Quaestiones theologicae, more properly entitled Ostensio meriti liberae actionis. The six questions are found in their entirety in two English manuscripts, namely Oxford New College 134 and Oxford Merton 143. The New CoUege (late fourteenth century) manuscript is earlier and superior to Merton (early fifteenth century), and accordingly the editor adopts it except in cases where the Merton reading makes better sense. The author, Thomas Buckingham, born in the early days of the fourteenth century, was an Oxford scholar at Merton, chancellor of Exeter, and died, very likely a victim of the Black Death, in 1348. The work edited here probably formed a part of Buckingham's exercise prescribed by University statute for those incepting as Masters of Theology. In the editor's view, this inception took place sometime between 1341 and 1346, when Thomas departed Oxford to take up duties at Exeter. There is some reason to believe that Buckingham may have been a student of Thomas Bradwardine (p. 7); irt is certain, however, that the present work "is a sustained attack on Bradwardine's notion that all future contingents come about by antecedent necessity relative to the first cause, God" (p. 103) • Bradwardine presented his view regarding how we must reconcile God's universal and immutable causality with human freedom in his magnum opus De causa Dei contra Pelagium. De la Torre describes Bradwardine's position this way: "For Bradwardine, God is the universal cause of all things, including future contingents. Future contingents are determined by divine antecedent necessity, for God's will concerning them is omnipotent and unimpedible. Such futures nevertheless remain contingent because only man as a secondary cause-and no other secondary cause-is responsible for his free choice. The theory that, once God has determined what a future shall be, He can still determine otherwise, is patently untenable BOOK REVIEWS 165 for Bradwardine because it predicates mutability of God and nullifies all inspired prophecy, including that of Christ" (p. 101). Bradwardine's exposition here outlined corresponds in its essentials with what Thomas Aquinas had taught in the previous century. The freedom or contingency in man's will act is to he understood in terms of its relationship to secondary or proximate causes. Unlike those events which are determined to come about by virtue of necessitating proximate causes, will acts in this respect remain totally undetermined. Along with this, says Aquinas, we must allow that God, because of His eternal knowledge, knows all futures-determined, as well as contingent -as present. His knowing future contingents, however, does not take away the condition of contingency, since the latter condition rests solely on their mode of occurrence as they relate to secondary or proximate causes. Thomas Buckingham finds this explanation inadequate. In order to safeguard future contingents or human freedom. Buckingham insists there must be a sense in which the ultimate cause, God, is casually contingent with respect to the human will act. Though his exposition is different in many details, Buckingham's fundamental direction is in accord with what certain predecessors, especially Scotus and Ockham, had argued regarding the problem of divine foreknowledge and future contingents. Indeed, in view of the way Buckingham cites Scotus, the editor considers it reasonable to suppose that he regarded himself a disciple of the Subtle Doctor (p. 132). There is at least one instance where Buckingham exhibits a markedly Scotistic and anti-Ockhamist analysis. This occurs in connection with the explanation as to how in one and the same instant, because of the different moments of natural priority and posteriority, the divine will can both will and not will the same thing. The... (shrink)

Priority setting (also known as resource allocation or rationing) occurs at every level of every health system and is one of the most significant health care policy questions of the 21st century. Because it is so prevalent and context specific, improving priority setting in a health system entails improving it in the institutions that constitute the system. But, how should this be done? Normative approaches are necessary because they help identify key values that clarify policy choices, but insufficient (...) because different approaches lead to different conclusions and there is no consensus about which ones are correct, and they are too abstract to be directly used in actual decision making. Empirical approaches are necessary because they help to identify what is being done and what can be done, but are insufficient because they cannot identify what should be done. Moreover, to be really helpful, an improvement strategy must utilize rigorous research methods that are able to analyze and capture experience so that past problems are corrected and lessons can be shared with others. Therefore, a constructive, practical and accessible improvement strategy must be research-based and combine both normative and empirical methods. In this paper we propose a research-based improvement strategy that involves combining three linked methods: case study research to describe priority setting; interdisciplinary research to evaluate the description using an ethical framework; and action research to improve priority setting. This describe-evaluate-improve strategy is a generalizable method that can be used in different health care institutions to improve priority setting in that context. (shrink)

I argue that the truthmaker theorist should be a priority monist if she wants to avoid commitment to mysterious necessary connections. In section 1 I briefly discuss the ontological options available to the truthmaker theorist. In section 2 I develop the argument against truthmaker theory from the Humean denial of necessary connections. In section 3 I offer an account of when necessary connections are objectionable. In section 4 I use this criterion to narrow down the options from section 1. (...) In section 5 I argue that the account leads us to priority monism. (shrink)

We argue that there is a marked shift in the moral weight of an increment in a person's well-being when one moves from a case involving only intra-personal trade-offs to a case involving only inter-personal trads-offs. This shift, we propose, is required by the separateness of persons. We also argue that the Priority View put forward by Parfit cannot account for such a shift. We also outline two alternative views, an egalitarian view and a claims-based view, that can account (...) for this shift. (shrink)

The distribution of scarce healthcare resources is an increasingly important issue due to factors such as expensive ‘high tech’ medicine, longer life expectancies and the rising prevalence of chronic illness. Furthermore, in the current healthcare context lifestyle-related factors such as high blood pressure, tobacco use and obesity are believed to contribute significantly to the global burden of disease. As such, this paper focuses on an ongoing debate in the academic literature regarding the role of responsibility for illness in healthcare resource (...) allocation: should patients with self-caused illness receive lower priority in access to healthcare resources? This paper critically describes the lower priority debate's 12 key arguments and maps out their relationships. This analysis reveals that most arguments have been refuted and that the debate has stalled and remains unresolved. In conclusion, we suggest progression could be achieved by inviting multidisciplinary input from a range of stakeholders for the development of evidence-based critical evaluations of existing arguments and the development of novel arguments, including the outstanding rebuttals. (shrink)

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable (...) public health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This “flu-risk standard” is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: having developed a vaccine, raising taxes to pay for vaccine research and purchase, wanting to eliminate economic and social burdens, and being ineffective in combating COVID-19 through public health interventions. (shrink)

We shall focus on moral theories that are solely concerned with promoting the benefits (e.g., wellbeing) of individuals and explore the possibility of such theories ascribing some priority to benefits to those who are worse off—without this priority being absolute. Utilitarianism (which evaluates alternatives on the basis of total or average benefits) ascribes no priority to the worse off, and leximin (which evaluates alternatives by giving lexical priority to the worst off, and then the second worst (...) off, and so on) ascribes absolute priority to the worse off (i.e., favors even a very small benefit to a worse off person over very large benefits to large numbers of better off people). Neither extreme view, we assume, is plausible. (shrink)

How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems (...) unreasonable that public values would straightforwardly decide the ethical question of how resources should be distributed. On the other hand, in a democratic society, it seems equally unreasonable that they would be considered irrelevant for this question. In this paper we draw on the notion of reflective equilibrium and discuss the relevance and roles that empirical studies may plausibly have for justification in priority setting ethics. We develop a framework for analysing how different kinds of empirical results may have different kinds of implications for justification. (shrink)

This article argues that considerations about the role and predictability of intellectual innovation make the protection of intellectual property morally obligatory even when it greatly reduces short-term welfare. Since the provision of good new ideas is the only productive input not subject to decreasing marginal productivity, welfarist considerations require that no impediment to its maximal provision be erected and the potentially substantial welfare losses imposed by a patent system be mitigated by taxation of other sources of wealth and income. Key (...) Words: patent system • welfarism • decreasing marginal productivity. (shrink)

In this paper we explore the relation between health-care needs and patients’ desires within shared decision-making in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem (...) to arise due to the double focus on a patient’s need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine. (shrink)

ABSTRACT:While tone at the top is widely regarded as an important predictor of ethical behavior in organizations, we argue that recent research overlooks the various conflicting ethical tones present in many multi-organizational work settings. Further, we propose that the resolution processes promulgated in many firms and professional associations to reconcile this conflict reinforce the tone at the bottom or a tone at the top of the employee’s organization, and that both of these approaches can conflict with the tone at the (...) top of other important organizations such as professional and regulatory organizations. Here we adapt Integrative Social Contract Theory’s priority rules to propose a multi-tone reconciliation process which prioritizes conflicting ethical tones based upon features of the organization and the effects on society. Using three contextualizations, we demonstrate the effectiveness of the multi-tone reconciliation process over current processes. We conclude with recommendations for future research and implications for practice. (shrink)

This article provides a systematic analysis of the proposal to use Covid‐19 vaccination status as a criterion for admission of patients with Covid‐19 to intensive care units (ICUs) under conditions of resource scarcity. The general consensus is that it is inappropriate to use vaccination status as a criterion because doing so would be unjust; many health systems, including the UK National Health Service, are based on the principle of equality of access to care. However, the analysis reveals that there are (...) several unique features of Covid vaccination status in the context of a pandemic that make this issue disanalogous to cases (such as lung cancer caused by smoking) discussed previously. First, there is equality in access to care at the point of vaccination; the unvaccinated refuse the offer of preventive care when they decline vaccination, weakening their claim to ongoing care if they become ill (this is qualitatively different from ‘poor lifestyle choices’ such as smoking). Second, the decision of one person to refuse vaccination substantially increases the risk that they will become seriously ill and need ICU care; the person who chooses not to get vaccinated thus potentially increases the pressure on intensive care bed provision, as well as increasing the risk that he or she will infect others who in turn might end up needing ICU care. Third, justice cuts both ways, and giving unvaccinated patients equal priority may itself be unjust when other patients have reduced their risk of ending up on the ICU by getting vaccinated. (shrink)

I address an intuition commonly endorsed by metaphysicians, that there must be a fundamental layer of reality, i.e., that chains of ontological dependence must terminate: there cannot be turtles all the way down. I discuss applications of this intuition with reference to Bradley’s regress, composition, realism about the mental and the cosmological argument. I discuss some arguments for the intui- tion, but argue that they are unconvincing. I conclude by making some suggestions for how the intuition should be argued for, (...) and discussing the ramifications of giving the justification I think best. (shrink)

In this article, I argue against a widely accepted model of utterance interpretation, namely the LS model (literality‐based serial model), according to which the literal interpretation of an utterance (the proposition literally expressed by that utterance) must be computed before nonliteral interpretations can be entertained. Alleged arguments in favor of this model are shown to be fallacious, counter‐examples are provided, and alternative models are sketched.

The debate on responsibility for health takes place within political philosophy and in policy setting. It is increasingly relevant in the context of rationing scarce resources as a substantial, and growing, proportion of diseases in high-income countries is attributable to lifestyle. Until now, empirical studies of medical professionals' attitudes towards personal responsibility for health as a component of prioritisation have been lacking. This paper explores to what extent Norwegian physicians find personal responsibility for health relevant in prioritisation and what type (...) of risk behaviour they consider relevant in such decisions. The proportion who agree that it should count varies from 17.1% to 26.9%. Higher age and being male is positively correlated with acceptance. The doctors are more willing to consider substance use in priority setting decisions than choices on food and exercise. The findings reveal that a sizeable proportion have beliefs that conflict with the norms stated in the Norwegian Patient Act. It may be possible that the implementation of legal regulations can be hindered by the opposing attitudes among doctors. A further debate on the role personal responsibility should play in priority setting seems warranted. However, given the deep controversies about the concept of health responsibility and its application, it would be wise to proceed with caution.Design Nationally representative cross-sectional study. Setting Panel-data. Participants 1072 respondents, response rate 65%. (shrink)

This article argues that positioning disclosure as a primary remedy in addressing the ethical problems posed by conflicts of interest in medicine and health is an error. Instead, bioethical resources should be devoted to the problems associated with sequestration, defined as the elimination of relationships between commercial industries and health professionals in all cases where it is remotely feasible. The argument begins by arguing that adopting Andrew Stark’s conceptual framework for COIs leads to advantages in understanding COIs and in ordering (...) priorities for intervention. The article then draws on prior work establishing that COIs are, under ordinary epidemiologic standards, properly regarded as population health hazards. This justifies attention to possible remedies, of which disclosure generates by far the most analysis. Such primacy is unwarranted given the extensive evidence suggesting that disclosure as a remedy for COIs is at best ineffective. ‘At best’ is justified because the evidence also shows that disclosure may have a perverse effect, intensifying biased behaviors. Expending significant attention on an ineffective or even deleterious intervention is unjustified and also crowds out devotion of resources to the real problems that attend sequestration. Therefore, disclosure ought to be regarded as a lower priority among possible COI interventions. (shrink)

Health care systems across the world are unable to afford the best treatment for all patients in all situations. Choices have to be made. One key ethical issue that arises for health authorities is whether the principle of the “rule of rescue” should be adopted or rejected. According to this principle more funding should be available in order to save lives of identifiable, compared with unidentifiable, individuals. Six reasons for giving such priority to identifiable individuals are considered. All are (...) rejected. It is concluded that the principle of the rule of rescue should not be used in determining the allocation of health resources. (shrink)

When decisionally incapable patients need a surrogate to make medical decisions for them, sometimes the patient has not appointed a healthcare agent and there is intractable disagreement among potential surrogates of equal priority, legal rank, or relation to the patient (e.g., child vs. child, sibling vs. sibling). There is no ethical, legal, or professional consensus about how to identify the appropriate surrogate in such circumstances. This article presents a case study involving an elderly female patient whose four children disagree (...) about whether to continue life-sustaining treatment for their mother, along with an ethical analysis of various strategies for selecting the appropriate surrogate in cases of conflicting equal-rank family members. It critically examines three different strategies—chance, majority rules, and quality of relationship with the patient—and defends the third approach. (shrink)

In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. However, there is a limit where the hospitals may run out of resources to provide critical care, which is heavily dependent on (...) trained staff, just-in-time supply chains for clinical consumables and drugs and advanced equipment. In the first phase, we can still do clinical prioritisation and decision-making as usual, based on the need for intensive care and prognostication: what are the odds for a good result with regard to survival and quality of life. In the next, the resources are mostly available, but the system is stressed by many patients arriving over a short time period and auxiliary beds in different places in the hospital being used. We may have to abandon admittance of patients with doubtful prognosis. In the last phase, usual medical triage and priority setting may not be sufficient to decrease inflow and there may not be enough intensive care unit beds available. In this phase different criteria must be applied using a utilitarian approach for triage. We argue that this is an important transition where society, and not physicians, must provide guidance to support triage that is no longer based on medical priorities alone. (shrink)

This article explores the cooperation of government and the private sector to tackle the ethical dimension of artificial intelligence. The argument draws on the institutionalist approach in philosophy and business ethics defending a ‘division of moral labor’ between governments and the private sector. The goal and main contribution of this article is to explain how this approach can provide ethical guidelines to the AI industry and to highlight the limits of self-regulation. In what follows, I discuss three institutionalist claims. First, (...) principles of AI ethics should be validated through legitimate democratic processes. Second, compliance with these principles should be secured in a stable way. Third, their implementation in practice should be as efficient as possible. If we accept these claims, there are good reasons to conclude that, in many cases, governments implementing hard regulation are in principle the best instruments to secure an ethical development of AI systems. Where adequate regulation exists, firms should respect the law. But when regulation does not yet exist, helping governments build adequate regulation should be businesses’ ethical priority, not self-regulation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume 29, Number 1, April 2003, pp. 29-41 Hume's Argument for the Temporal Priority of Causes TODD RYAN In a section entitled "Of Probability; and of the idea of cause and effect," Hume embarks on a search for the conceptual components of our idea of causation. Rejecting the possibility of analyzing the idea in terms of the qualities of objects, Hume claims to discover two constituent (...) relations. First, a cause and effect must be contiguous in space and time because "nothing can operate in a time or place, which is ever so little remov'd from those of its existence" (T 1.3.2.6; SBN 75).x Second, a cause must be temporally prior to its effect. Although experience is said to confirm this latter requirement "in most instances," Hume goes on to present an argument purporting to demonstrate that the temporal priority of a cause is an essential feature of every instance of causation.2 Despite the extensive treatment that his analysis of causation has occasioned, Hume's argument for the temporal priority of causes has received comparatively little attention. In this paper I hope to remedy this neglect by providing a more accurate explication of the argument than has previously been offered. Hume does not argue directly for the claim that a cause must be temporally prior to its effect. Rather he offers an alleged reductio ad absurdum of the opposing view that "'tis not absolutely necessary a cause shou'd precede its effect; but that any object or action, in the very first moment of its existence, may exert its productive quality, and give rise to another object or action, perfectly co-temporary with itself (T 1.3.2.7; SBN 76)." This careful summary Todd Ryan is Assistant Professor of Philosophy, Trinity College, Hartford, CT 06106-3100, USA. e-mail: [email protected] 30 Todd Ryan of the opposing view provides a clear statement of what Hume takes to be at issue, namely whether it is "absolutely necessary" that a cause be temporally prior to its effect. From this it can readily be inferred precisely what would count as a refutation of his own view. Specifically, if it could be shown that some objects can produce their effect perfectly contemporaneously with themselves, then his position would have to be abandoned.3 It is against this latter possibility that Hume directs his argument. He writes: 'Tis an establish'd maxim both in natural and moral philosophy, that an object, which exists for any time in its full perfection without producing another, is not its sole cause; but is assisted by some other principle, which pushes it from its state of inactivity, and makes it exert that energy, of which it was secretly possest. Now if any cause may be perfectly co-temporary with its effect, 'tis certain, according to this maxim, that they must all of them be so; since any one of them, which retards its operation for a single moment, exerts not itself at that very individual time, in which it might have operated; and therefore is no proper cause. The consequence of this wou'd be no less than the destruction of that succession of causes, which we observe in the world; and indeed, the utter annihilation of time. For if one cause were co-temporary with its effect, and this effect with its effect, and so on, 'tis plain there wou'd be no such thing as succession, and all objects must be co-existent (T 1.3.2.7; SBN 76). The general structure of the argument is reasonably clear. According to the "establish'd maxim" (hereafter EM) any object that does not produce an effect as soon as possible is not the "sole cause" of that effect. Assuming then that causes might occur simultaneously with their effects, it follows that every proper cause must be contemporaneous with its effect. But if every effect occurs simultaneously with its cause, then we arrive at the absurd conclusion that there can be no causal (or indeed temporal) succession in the world. Therefore, the original assumption that a cause may be perfectly co-temporary with its effect must be... (shrink)

The primary claim of this paper is that intellectual conflicts of interest (COIs) exist but are of lower ethical priority than COIs flowing from relationships between health professionals and commercial industry characterized by financial exchange. The paper begins by defining intellectual COIs and framing them in the context of scholarship on non-financial COIs. However, the paper explains that the crucial distinction is not between financial and non-financial COIs but is rather between motivations for bias that flow from relationships and (...) those that do not. While commitments to particular ideas or perspectives can cause all manner of cognitive bias, that fact does not justify denying the enormous power that relationships featuring pecuniary gain have on professional behaviour in term of care, policy, or both. Sufficient reason exists to take both intellectual COIs and financial COIs seriously, but this paper demonstrates why the latter is of higher ethical priority. Multiple reasons will be provided, but the primary rationale grounding the claim is that intellectual COIs may provide reasons to suspect cognitive bias but they do not typically involve a loss of trust in a social role. The same cannot be said for COIs flowing from relationships between health professionals and commercial industries involving financial exchange. The paper then assumes arguendo that the primary rationale is mistaken and proceeds to show why the claims that intellectual COIs are more significant than relationship-based COIs are dubious on their own merits. The final section of the paper summarizes and concludes. (shrink)

Thus far, little work in bioethics has specifically focused on global health research priority-setting. Yet features of global health research priority-setting raise ethical considerations and concerns related to health justice. For example, such processes are often exclusively disease-driven, meaning they rely heavily on burden of disease considerations. They, therefore, tend to undervalue non-biomedical research topics, which have been identified as essential to helping reduce health disparities. In recognition of these ethical concerns and the limited scholarship and dialogue addressing (...) them, we convened an international workshop in September 2015. The workshop aimed to initiate discussion on the appropriate relationship between global and national levels of health research priority-setting and to begin exploring what might be ethically required for priority-setting at each of those levels. This paper comprises our reflections following the workshop. Its main objective is to launch a research agenda for the ethics of global health research priority-setting. We identify three domains of global health research priority-setting—scope, underlying values and substantive requirements, and procedural considerations. For each domain, specific research questions are highlighted and why they need to be explored is explained. Some preliminary thoughts and normative arguments as to how the research questions might be answered are also offered. For example, we provide initial ideas about the appropriate relationship between different priority-setting levels and what values and substantive considerations should guide or underpin global health research priority-setting as a matter of justice. We anticipate that framing a new research agenda for the ethics of global health research priority-setting will spur ethicists, researchers, and policymakers to refocus their efforts on developing more rigorous and ethically sound approaches to priority-setting. (shrink)