Since 1995, Public-Private Partnerships mode has been applied in mainland China accompanied by the issuance of a series of PPPs policies. Taking 201 policy documents promulgated from 1995 till 2019 as a research sample, this paper explores PPPs policy entity network change and policy learning behind it in China. Research results show the following: China’s PPPs policy entity network has mainly gone through three stages: partial-focus network with bad stability, loose-multiactor network with general stability, and balanced-multiactor network with good stability; (...) the key players are NPC in the first stage, MOF and NDRC in the second stage, and MOF and 8 other government entities in the third stage; policy learning behind PPPs policy entity network change is government learning in the first stage and lesson-drawing in the second and third stages. (shrink)

CSR-PPPs are a new and especially relevant phenomenon in today’s world politics. Little is known, however, about the effects of this “New Mode of GlobalGovernance”. The paper addresses this deficit and presents a theoretical model from which hypotheses about the effects of CSR-PPPs can be deduced. It furthermore illustrates the applicability of the model by generating hypotheses about the effectiveness of CSR initiatives in the large retailer industry sector.

Readers, please welcome the new Philosophy, Psychiatry, & Psychology editorial team of Senior Editors and our Managing Editor. We are grateful to keep our veteran Senior Editors Tim Thornton, Nancy Potter, Mona Gupta, and Werdie van Staden. However, we are equally grateful to have our new cohort of Senior editors, Awais Aftab, Anna Bergqvist, Derek Strijbos, and Michael Wong, revitalize our efforts. Many of you already know our efficient and capable Managing Editor, Sébastien Arviset, who has been with us for (...) several years now. This new influx of talent and energy we hope will invigorate the Journal and keep our editorial operations smooth and efficient. In alphabetical order, our editors can tell you a little... (shrink)

Tarekat teaches its followers not to glorify conglomerates, to keep their distance from leader, and to live in a way of zuhud, including in the matters of politics. But the Tarekat Qadiriyah wa Naqsyabandiyah in Cukir Jombang was actually involved in practical politics as a supporter of Partai Persatuan Pembangunan. This paper, which was written in the form of ethnographic design according to the concept of the power relations of Foucault to find new perspectives about the actions of Tarekat communities (...) in politics, in this case explaining the pattern of relations that occurred between the Tarekat Cukir and PPP and discovering the factors causing Tarekat Cukir to support PPP. This paper concludes that between Tarekat Cukir and PPP, there is a mutually beneficial pattern of relations in terms of proximity, but in terms of economic politics, the Tarekat Cukir feels disadvantaged. The dominant reason the Tarekat Cukir supports PPP is because of the dependence of Santri on their Mursyid who is a PPP politician. This is reinforced by the history between the two parties and the spiritual ties that connect the teachers who are both PPP politicians and Santris. (shrink)

An equal and high-quality partnership between public and private sectors is essential to the sustainable development of public–private partnership projects. However, in the special social circumstance in China, the public sector has a strong voice in PPP projects. According to the existing research on PPP project failure, the government's dishonest performance and negative cooperative attitude and the private sector's speculative behavior of concealing information will lead to termination or even failure of project. The attitude and behavior that reflect the relationship (...) orientation of public sector may determine whether the private sector adopts an opportunistic behavior. However, few studies have revealed the mechanism of relationship orientation on opportunism in PPP projects. This paper proposes the connotation of the public sector's relationship orientation and designs a measurement scale from three aspects: emotional relationship orientation, instrumental relationship orientation, and rent-seeking relationship orientation. Based on the data from large construction enterprises, financial institutions and investors, and scholars with practical experience in PPP projects, this paper explores the mechanism of the public sector's relationship orientation on the private sector's justice perception and opportunistic behavior by using the structural equation model. The results show that the public sector's relationship orientation significantly affects the formation and development of the private sector's justice perception and opportunistic behavior, justice perception plays a mediating role in the process of relationship orientation acting on opportunistic behavior, and the instrumental relationship orientation is more conducive to reducing the opportunistic behavior. The results provide new ideas for changing the public sector's concept and attitude and regulating behavior in PPP projects. (shrink)

The selection of the procurement model, which is a process of discretion exercised by procurement officials, is crucial to the Public-private Partnership procurement performance. From theoretical analysis and international practice, we could find that the negotiation method is more suitable for complex PPP projects, while the tendering method is widely used in China’s PPP procurement. To analyze the reasons for the phenomenon, we used the logit regression model to examine the influence of regulatory competition, risk aversion preference, and tacit interaction (...) on the procurement model selection based on the data of 8,926 PPP projects from 2009 to 2021 in China. The results indicate that regulatory competition leads to confusion in procurement model selection, while risk aversion preference and tacit interaction significantly promote the application of tendering. Moreover, the heterogeneity analysis of regions and return models prove that provincial capitals and municipalities are more susceptible to regulatory competition, risk aversion preference, and tacit interaction than ordinary cities. Compared with user-pay projects, government-pay projects and viability gap funding projects are more susceptible to regulatory competition and risk aversion preference, and less affected by tacit interaction. Therefore, to optimize the procurement model selection, policymakers should improve procurement policies to reduce the adverse effects of regulatory competition, risk aversion preference, and tacit interactions. (shrink)

Public health ethics is emerging as a new field of inquiry, distinct not only from public health law, but also from traditional medical ethics and research ethics. Public health professional and scholarly attention is focusing on ways that ethical analysis and a new public health code of ethics can be a resource for health professionals working in the field. This article provides a preliminary exploration of the ethical issues faced by public health professionals in day-to-day practice and of the type (...) of ethics education and support they believe may be helpful. (shrink)

Pasolini, imaginó África como el escenario de una Orestiada ideal del siglo XX, el primer capítulo de un amplio proyecto dedicado al hemisferio sur, lamentablemente inacabado. Sin embargo, queda el documental Notas para una Orestiada (1970), realizado tras dos estancias en Uganda y Tanzania respectivamente en diciembre de 1968 y febrero de 1969. En su recorrido por ciudades y pueblos tras la pista de una sociedad suspendida entre la industrialización y la herencia espiritual de la antigüedad hecha de mitos y (...) dioses, Pasolini buscaba los orígenes de la humanidad, rindiendo un homenaje platónico al Hombre de Kibish y, buscando, al mismo tiempo, una humanidad todavía no contaminada por el neocapitalismo. Nuestro texto quiere hacer hincapié en las contradicciones de esta obra de Pasolini y también en su lectura original del África poscolonial. (shrink)

Patient preference predictors (PPPs) promise to provide medical professionals with a new solution to the problem of making treatment decisions on behalf of incapacitated patients. I show that the use of PPPs faces a version of a normative problem familiar from legal scholarship: the problem of naked statistical evidence. I sketch two sorts of possible reply, vindicating and debunking, and suggest that our reply to the problem in the one domain ought to mirror our reply in the other. The conclusion (...) is thus conditional: if we think the problem of naked statistical evidence is a serious problem in the legal domain, then we should be concerned about the symmetrical problem for PPPs. (shrink)

The Patient Preference Predictor (PPP) proposal places a high priority on the accuracy of predicting patients’ preferences and finds the performance of surrogates inadequate. However, the quest to develop a highly accurate, individualized statistical model has significant obstacles. First, it will be impossible to validate the PPP beyond the limit imposed by 60%–80% reliability of people’s preferences for future medical decisions—a figure no better than the known average accuracy of surrogates. Second, evidence supports the view that a sizable minority of (...) persons may not even have preferences to predict. Third, many, perhaps most, people express their autonomy just as much by entrusting their loved ones to exercise their judgment than by desiring to specifically control future decisions. Surrogate decision making faces none of these issues and, in fact, it may be more efficient, accurate, and authoritative than is commonly assumed. (shrink)

The Patient Preference Predictor (PPP) is intended to improve treatment decision making for incapacitated patients. The PPP would collect information about the treatment preferences of people with different demographic and other characteristics. It could be used to indicate which treatment option an individual patient would be most likely to prefer, based on data about the preferences of people who resemble the patient. The PPP could be incorporated into existing US law governing treatment for incapacitated patients, although it is unclear whether (...) it would be classified as evidence of a specific patient’s preferences or those of a reasonable person sharing certain characteristics with the patient. Ethical concerns about the quality and significance of PPP choices could influence legal decision makers’ views of the PPP. (shrink)

The polluter pays principle (PPP) has the form of a reparative principle. It holds that since some countries have historically contributed more to global warming than others, these countries have the follow-up responsibility now to do more to address climate change. Yet in the climate justice debate, PPP is often rejected for two reasons. First, so the objection goes, it wrongly burdens present-day individuals because the actions of their predecessors. This is the unfairness objection. The second objection is that early (...) polluters were not aware of the harm that they were doing, and so ought not to be held culpable. This is the objection from excusable ignorance. In this commentary, I defend PPP against these two objections. The aim of this short reflection is not to provide a full justification of PPP, or to respond to all objections that have been made against it. My more limited but, I hope, important goal is to show that PPP is neither immediately unfair (in making innocent parties pay) nor immediately unreasonable (in making excusably ignorant parties pay) as is commonly noted, and is therefore worthy of further consideration as a principle of climate justice. (shrink)

The Polluter Pays Principle (PPP) states that polluters should bear the burdens as- sociated with their pollution. This principle has been highly contested because of the pu- tative impossibility of considering individuals morally responsible for an important amount of their emissions. For the PPP faces the so-called excusable ignorance objec- tion, which states that polluters were for a long time non-negligently ignorant about the negative consequences of greenhouse gas emissions and, thus, cannot be considered morally responsible for their negative consequences. (...) This paper focuses on the concept of moral responsibility as it appears in the excusable ignorance objection. I claim that this objection stems from a narrow notion of moral responsibility and that a more fundamen- tal notion of moral responsibility would pave the way to overcome it. I show that it should be out of the question whether historical polluters should bear some burdens asso- ciated with climate change because of their historical emissions. The relevant question is which kind of burdens they can legitimately be asked to bear. I argue that this notion of moral responsibility allows us to assign burdens of symbolic reparation, which are at the core of ‘Loss and Damage’ policies. (shrink)

Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help make (...) treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (shrink)

When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such (...) a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient’s (former) autonomy since it draws on the ‘wrong’ kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently ‘fine-tuned’ on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient’s preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient’s own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies. (shrink)

The patient preference predictor is a proposed computer-based algorithm that would predict the treatment preferences of decisionally incapacitated patients. Incorporation of a PPP into the decision-making process has the potential to improve implementation of the substituted judgement standard by providing more accurate predictions of patients’ treatment preferences than reliance on surrogates alone. Yet, critics argue that methods for making treatment decisions for incapacitated patients should be judged on a number of factors beyond simply providing them with the treatments they would (...) have chosen for themselves. These factors include the extent to which the decision-making process recognises patients’ freedom to choose and relies on evidence the patient themselves would take into account when making treatment decisions. These critics conclude that use of a PPP should be rejected on the grounds that it is inconsistent with these factors, especially as they relate to proper respect for patient autonomy. In this paper, we review and evaluate these criticisms. We argue that they do not provide reason to reject use of a PPP, thus supporting efforts to develop a full-scale PPP and to evaluate it in practice. There are no data in this work. (shrink)

Action must be taken to combat climate change. Yet, how the costs of climate action should be allocated among states remains a question. One popular answer—the polluter-pays principle (PPP)—stipulates that those responsible for causing the problem should pay to address it. While intuitively plausible, the PPP has been subjected to withering criticism in recent years. It is timely, following the Paris Agreement, to develop a new version: one that does not focus on historical production-based emissions but rather allocates climate burdens (...) in proportion to each state’s annual consumption-based emissions. This change in carbon accounting results in a fairer and more environmentally effective principle for distributing climate duties. (shrink)

Public-private partnerships are established to specifically harness the potential of Big Data in healthcare and can include partners working across the data chain—producing health data, analysing data, using research results or creating value from data. This domain paper will illustrate the challenges that arise when partners from the public and private sector collaborate to share, analyse and use biomedical Big Data. We discuss three specific challenges for PPPs: working within the social licence, public antipathy to the commercialisation of public sector (...) health data, and questions of ownership, both of the data and any resulting intellectual property or products. As a specific example we consider the case of the UK National Health Service providing patient data to Google’s DeepMind AI program to develop a diagnostic app for kidney disease. This article is an application of the framework presented in this issue of ABR. Please refer to that article for more information on how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. We use four specific values to help analysis these issues: public benefit, stewardship, transparency and engagement. We demonstrate how the Deliberative Framework can support ethical governance of PPPs involving biomedical big data. (shrink)

The proliferation of public–private partnerships for development as an answer to many public challenges calls for careful evaluation. To this end, tailored frameworks are fundamental for helping understand the PPPs’ impact and for guiding corrective adjustment. Scholars have developed frameworks focusing on the partners’ relationships, the order of effects, and the distinction between outputs and outcomes. To capture a PPP’s complexity and multiple linkages with its environment, we argue that a thorough evaluation should adopt a stakeholder-oriented approach and consider the (...) costs and benefits that a PPP implies for them—especially as taxpayers’ money is involved. For this purpose, we build on a stakeholder-oriented evaluation framework from the nonprofit business partnership literature. In line with our broad evaluation conception, we extend it with the manifold ripple effects that PPPs for development have and include the time dimension for the links between different PPP stages and related outcomes to become clearer. Applying this framework to an illustrative case, we highlight important direct and especially indirect stakeholder outcomes, which a narrow evaluation would omit, point to the challenges involved in the evaluation endeavor, and identify interesting future research areas. (shrink)

Recently, Jardas _et al_ have convincingly defended the patient preference predictor (PPP) against a range of autonomy-based objections. In this response, I propose a new autonomy-based objection to the PPP that is not explicitly discussed by Jardas _et al_. I call it the ‘objection from higher-order preferences’. Even if this objection is not sufficient reason to reject the PPP, the objection constitutes a pro tanto reason that is at least as powerful as the ones discussed by Jardas _et al._.

There are substantial data establishing that surrogates are often mistaken in predicting what treatments incompetent patients would have wanted and that supplements such as advance directives have not resulted in significant improvements. Rid and Wendler’s Patient Preference Predictor (PPP) proposal will attempt to gather data about what similar patients would prefer in a variety of treatment choices. It accepts the usual goal of patient autonomy and the Substituted Judgment principle for surrogate decisions. I provide reasons for questioning sole reliance on (...) autonomy when surrogates, not patients, are deciding and for giving some independent weight to patient well-being. Moreover, that family members, typical surrogates, will know best what the patient if incompetent would have wanted is not the only reason why they are chosen. The more pressing problem is that the PPP would fail to remove the more serious mistakes that empirical psychology over the last few decades has shown to infect such decision making. (shrink)

The standard approach to treatment decision making for incapacitated patients often fails to provide treatment consistent with the patient’s preferences and values and places significant stress on surrogate decision makers. These shortcomings provide compelling reason to search for methods to improve current practice. Shared decision making between surrogates and clinicians has important advantages, but it does not provide a way to determine patients’ treatment preferences. Hence, shared decision making leaves families with the stressful challenge of identifying the patient’s preferred treatment (...) option. To address this concern, the present paper proposes to incorporate the use of a “Patient Preference Predictor” (PPP) into the shared decision-making process between surrogates and clinicians. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Use of a PPP is likely to increase the chances that incapacitated patients are treated consistent with their preferences and values and might reduce the stress and burden on their surrogates. Including a PPP in the shared decision-making process therefore has the potential to realize important ethical goals for making treatment decisions for incapacitated patients. The present paper justifies this approach on conceptual and normative grounds. (shrink)

The question of how to treat an incapacitated patient is vexed, both normatively and practically—normatively, because it is not obvious what the relevant objectives are; practically, because even once the relevant objectives are set, it is often difficult to determine which treatment option is best given those objectives. But despite these complications, here is one consideration that is clearly relevant: what a patient prefers. And so any device that could reliably identify a patient’s preferences would be a promising tool for (...) guiding the treatment of incapacitated patients. The patient preference predictor is just such a tool—an algorithm that takes as inputs a patient’s sociodemographic characteristics, and outputs a reliable prediction about that patient’s treatment preferences.1 But some have worried that the use of such a tool would violate or fail to appropriately respect patients’ autonomy. There are, I think, two ways to understand this kind of criticism. First, globally—as a worry that any systematic implementation of the PPP would be problematic on the grounds that it would result in significant or pervasive autonomy violations. Second, locally—as a worry that in some important range of cases, certain uses of the PPP would be problematic on autonomy grounds. Jardas et al, as I read them, address global autonomy-based criticisms, arguing—convincingly, in my view—that there’s no reason to suspect the autonomy concerns raised by the PPP would be so significant and pervasive as to render any implementation of it generally problematic.1 But even with the global criticisms rebuffed, there remains work to be done. Any ethically acceptable implementation of the PPP must be sensitive to the more local autonomy-based criticisms, with restrictions and safeguards in place to ensure respect for autonomy in the kinds of cases in which the use of the PPP might otherwise threaten …. (shrink)

It has recently been proposed to incorporate the use of a “Patient Preference Predictor” (PPP) into the process of making treatment decisions for incapacitated patients. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Including a PPP in the shared decision-making process between clinicians and surrogates has the potential to better realize important ethical goals for making treatment decisions (...) for incapacitated patients. However, developing and implementing a PPP poses significant practical challenges. The present paper discusses these practical challenges and considers ways to address them. (shrink)

Like many, I find the idea of relying on patient preference predictors in life-or-death cases ethically troubling. As part of his stimulating discussion, Sharadin1 diagnoses such unease as a worry that using PPPs disrespects patients’ autonomy, by treating their most intimate and significant desires as if they were caused by their demographic traits. I agree entirely with Sharadin’s ‘debunking’ response to this concern: we can use statistical correlations to predict others’ preferences without thereby assuming any causal claim. However, I suspect (...) that, for at least some of us, our unease about PPPs stems from a different kind of ‘autonomy’ concern. In this commentary, then, I will explore this concern, and show how it relates to Sharadin’s work. Very many of our preferences are caused, ultimately, by facts which are outside our control, such as our demographic features. However, I suggest that we can still act autonomously on the basis of such preferences, when they are preferences which we endorse. Imagine, for example, that Jane has grown up in a church-growing environment, which has shaped many of her preferences, …. (shrink)

In this paper, I set out two ethical complications for Rid and Wendler’s proposal that a “Patient Preference Predictor” (PPP) should be used to aid decision making about incapacitated patients’ care. Both of these worries concern how a PPP might categorize patients. In the first section of the paper, I set out some general considerations about the “ethics of apt categorization” within stratified medicine and show how these challenge certain PPPs. In the second section, I argue for a more specific—but (...) more contentious—claim that proper respect for the autonomy of incapacitated patients might require us to act on reasons which they could endorse and show how this claim places important limits on the categories employed by an ethically acceptable PPP. The conclusion shows how these concerns about apt categorization relate to more familiar worries about Rid and Wendler’s proposals. (shrink)

Publication pressure has been touted to promote questionable research practices (QRP) and scientific or research misconduct (RM). However, logically attractively as it is, there is no unequivocal evidence for this notion, and empirical studies have produced conflicting results. Other than difficulties in obtaining unbiased empirical data, a direct causal relationship between perceived publication pressure (PPP) and QRP/RM is inherently difficult to establish, because the former is a complex biopsychosocial construct that is variedly influenced by multiple personal and environmental factors. To (...) effectively address QRP/RM by tackling the sources of PPP would also be difficult because of the competitive nature of the reward and merit system of contemporary science. We might do better with efforts in enhancing knowledge in research ethics and integrity among the practitioners, as well as institutional infrastructures and mechanisms to fairly and efficiently adjudicate cases of QRP/RM. (shrink)

When a patient lacks sufficient capacity to make a certain treatment decision, whether because of deficits in their ability to make a judgement that reflects their values or to make a decision that reflects their judgement or both, the decision must be made by a surrogate. Often the best way to respect the patient’s autonomy, in such cases, is for the surrogate to make a ‘substituted’ judgement on behalf of the patient, which is the decision that best reflects the patient’s (...) values and identity-infused beliefs as they were when the patient last possessed capacity. It is by now well-known that there is troubling evidence that surrogates do only slightly better than chance at making accurate substituted judgements. The use of a patient preference predictor, an algorithm that predicts patient preferences based on characteristics like the patient’s age, gender, socioeconomic status and education level, could help. Rid and Wendler have done important work making a moral case for using the PPP.1 If it were shown to enhance accuracy, it is not at all obvious what objections there could be to its use. Yet several subtle criticisms of the PPP have emerged in the literature. In their feature article, Jardas, Wasserman and Wendler select six of the most prominent objections to the PPP in the literature and defend the PPP against them.2 Along the way they make significant contributions to broader issues concerning the proper uses of statistical evidence and limits on the kinds of preferences there can be reasons of autonomy to respect. Since I found the authors’ answers to the final two objections—that the PPP relies on naked statistical evidence and that it uses non-endorsed reasons—to be especially interesting and provocative, I will examine those answers and raise a few questions about …. (shrink)

The combinatorial parity principle states that there is no perfect matching on an odd number of vertices. This principle generalizes the pigeonhole principle, which states that for a fixed bipartition of the vertices, there is no perfect matching between them. Therefore, it follows from recent lower bounds for the pigeonhole principle that the parity principle requires exponential-size bounded-depth Frege proofs. Ajtai previously showed that the parity principle does not have polynomial-size bounded-depth Frege proofs even with the pigeonhole principle as an (...) axiom schema. His proof utilizes nonstandard model theory and is nonconstructive. We improve Ajtai's lower bound from barely superpolynomial to exponential and eliminate the nonstandard model theory. Our lower bound is also related to the inherent complexity of particular search classes . In particular, oracle separations between the complexity classes PPA and PPAD, and between PPA and PPP also follow from our techniques. (shrink)

This feature in Philosophy, Psychiatry, & Psychology (PPP) is intended to provide ongoing commentary on main articles previously published in PPP. The essay by Bortolotti below is a response to John Rhodes and Richard Gipps's paper in PPP (15, no. 4:295-310).Can we understand people who report delusional beliefs? In their thought-provoking paper, "Delusions, Certainty, and the Background", John Rhodes and Richard Gipps (2008) present a novel account of delusions which has two main purposes: (1) offer an explanation of the truly (...) puzzling features of delusional reports and (2) put forward a theory about what is likely to cause delusions. The authors claim that current theories of delusions that appeal to unusual .. (shrink)

A key challenge in the management of the public-private partnership project is to understand the critical factors for sustainability performance as well as their complex interaction. Majority of existing studies focus on identifying general factors without consideration of specific context of individual sector. To bridge the gap, unique characteristics of water PPP projects are taken into consideration in this study where the relationship among critical factors to achieve sustainable performance is analyzed from a network perspective. Stakeholder-associated factors and their interrelations (...) were identified via extensive literature review and structured interview, and the social network analysis method was employed to recognize the critical factors and their interactions in sustainability achievement of water PPP projects. As a result, seven stakeholder groups and 18 critical factor nodes were identified and further classified into four challenges when achieving sustainability. These challenges are promoting ecological awareness and responsible citizen behaviour; project construction quality; ecological designs and technology innovations; and project management capacity. These findings provide the stakeholders of water PPP projects with useful references for mitigating the risks and facilitating efforts to achieve better sustainability performance. (shrink)

Biotechnology and genomic innovation are seen as increasingly important for achieving public health goals in Africa. In particular, vaccines based on advances in genomic technology are deemed vital in the fight against HIV/aids. Public-Private Partnerships (PPPs) provide a collaborative mechanism to ensure these vaccines are developed when the private sector lacks incentives to develop these products. These partnerships provide new mechanisms for transferring the knowledge required to ensure vaccine development occurs as quickly and efficiently as possible. One such accine partnership (...) is the South African AIDS Vaccine Initiative (SAAVI). This has been successful in ensuring 'value added' (benefit gained by taking part) is created for those involved particularly in the area of intangible value added determinants of collaboration and knowledge capacity. This paper outlines the results of a case study of SAAVI and argues that it provides evidence of a need to strengthen our understanding of the linkage between wider conceptual 'systems' of innovation and health. In particular, it espouses the usefulness of 'Systems of Innovation' thinking as a means to ensure that more specific focus is placed on process outputs such as collaboration and knowledge capacity. This will ensure that necessary knowledge flow is transferred between those working in the vaccine project for more efficient and effective operations. The research also raises questions about the possibility of such case studies highlighting areas of attention that need addressing if greater linkage is to occur between innovation and health at a wider health research policy level. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors’ IntroductionK. W. M. Fulford and John Z. SadlerThe editors are delighted to present the debut of a new feature in Philosophy, Psychiatry, & Psychology, “Clinical Anecdotes.” Clinical Anecdotes are short narrative essays that present, in concise fashion, several philosophical/conceptual issues concerning the experience of psychiatric practice in a realistic, nitty-gritty story format. A Clinical Anecdote essay serves as a stimulus to selected commentators from diverse fields, who will (...) prepare short responses that address any feature of the anecdote that captures their interest and imagination. Clinical Anecdote authors may then conclude the section with their own brief response, if desired.We encourage anyone (clinicians, patients, philosophers, others) interested in the conceptual aspects of psychiatric practice to submit their own Clinical Anecdotes for publication. Submissions should be formatted as a PPP Main Paper, with no requirement for references or an abstract. Clinical Anecdotes should not exceed a 1,500-word limit, and should have an original title relevant to the narrative content of the piece.How will Clinical Anecdotes submissions be evaluated? They will be sent out for peer review as with any other PPP main article, however, what reviewers will be looking for is:• a vivid, engaging, and compelling writing style,• a story that generates multiple areas of conceptual, philosophical, or ethical interest,• relevance to the editorial focus of PPP, and• novelty of theme (the submission addresses issues that have not previously been considered as a Clinical Anecdote).We hope you will find this inaugural essay from Dr. Christopher Bailey thought provoking. [End Page 221]Copyright © 2009 The Johns Hopkins University Press... (shrink)

This feature in Philosophy, Psychiatry, & Psychology (PPP) is intended to provide ongoing commentary on main articles previously published in PPP. The essay by Pickering below is a response to Bengt Brülde’s paper in PPP (14, no. 2:93–102).

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)

In recent years, the United Nations has taken a lead in advocating public-private partnerships (PPPs), and various UN entities actively seek partnerships and alliances with transnational corporations and other companies. Although there has been a rapid growth of PPPs, relatively little is known about their contribution to basic UN goals associated with inclusive, equitable and sustainable development. In response to this situation, there are increasing calls for impact assessments. This article argues that such assessments need to recognize the range of (...) ideational, institutional, economic and political factors and forces underpinning the turn to PPPs, and the very different logics and agendas involved, some of which seem quite contradictory from the perspective of equitable development and democratic governance. The article examines these different forces and logics, focusing on (a) the institutional turn towards "good governance", (b) economic contexts that relate to the very mixed "fortunes" of UN agencies and corporations, (c) structural determinants associated with "corporate globalisation" and (d) political drivers that relate to the struggle for hegemony and legitimisation. The article ends by reflecting critically on the tendency within mainstream development institutions and some strands of academic literature to highlight logics associated with good governance and pragmatism, and to disregard those associated with the strengthening of corporate interests and the neoliberal policy regime. It is argued that knowledge networks associated with the UN need to go beyond "best practice learning" and embrace "critical thinking", which has waned within UN circles since the 1980s. (shrink)

This dissertation abstract and the reflection commentary present the work done by Dr. Lea Stadtler. Comprising four articles, the dissertation explores the challenge of designing successful public–private partnerships for development and contributes to the discourse on partnerships and business engagement in society. Article I adopts the company perspective and develops a conceptual framework for interest alignment in PPPs for development. Based on a theoretical analysis, Article II examines the role that different structures play in handling common design challenges. Articles III (...) and IV are empirical: The former analyzes how partners cope with tensions occurring on the PPP’s boundaries, while Article IV explores the roles of broker organizations, which increasingly facilitate the partnering process of PPPs for development. This extended dissertation abstract introduces the dissertation’s research focus and summarizes each article’s research question, methods, and main findings. The reflection commentary in the appendix discusses the author’s views of her dissertation journey as a junior scholar and the research process. (shrink)

In their contribution ‘Ethics of the algorithmic prediction of goal of care preferences’1 Ferrario et al elaborate a from theory to practice contribution concerning the realisation of artificial intelligence (AI)-based patient preference prediction (PPP) systems. Such systems are intended to help find the treatment that the patient would have chosen in clinical situations—especially in the intensive care or emergency units—where the patient is no longer capable of making that decision herself. The authors identify several challenges that complicate their effective development, (...) application and evaluation—and offer solutions to them. One of these issues is the question of who should ultimately use said systems. While it is undisputed that clinicians should use these AI systems for their decision-making process, there is an ongoing debate about whether next of kin should use them as well. The authors advocate that ‘’access should be provided to both clinicians and loved ones with due explanations and as desired’. We will disagree with this assessment and explain in our commentary why it is important that surrogates provide their own assessments with as little external (AI) influence as possible. Why do next of kin actually participate in the process of preference finding and treatment decision-making? A key reason is that clinicians usually …. (shrink)

Rid and Wendler propose the development of a Patient Preference Predictor (PPP), an actuarial model for predicting incapacitated patient’s life-sustaining treatment preferences across a wide range of end-of-life scenarios. An actuarial approach to end-of-life decision making has enormous potential, but transferring the logic of actuarial prediction to end-of-life decision making raises several conceptual complexities and logistical problems that need further consideration. Actuarial models have proven effective in targeted prediction tasks, but no evidence supports their effectiveness in the kind of broad (...) spectrum prediction task that is the proposed goal of the PPP. We argue that a more focused approach, targeting specific medical conditions and generating treatment predictions based on the preferences of individuals with actual disease experience, is both more firmly grounded in past research and is a more prudent initial strategy for exploring the efficacy of actuarial prediction in end-of-life decision making. (shrink)

In this paper we prove the following theorem: Any one-dimensional definably connected group G over an o-minimal structure is, as an abstract group, isomorphic to either pPp∞δ or δ.

Climate justice demands polluters to take responsibility for both present and future harm caused by past GHG emissions and for future harm caused by future GHG emissions. One problem with this is double climate taxation: people living in historical polluting countries must both shoulder the burden of an effective and inclusive climate transition and repay the climate debt incurred by their predecessors. Although double climate taxation might be defensible on normative grounds, it risks making climate justice politically infeasible. I therefore (...) maintain that global climate justice should focus on future, rather than past, climate harms. The forward-looking polluter pays principle (FL-PPP) can ensure both a cost-effective climate transition and a fair distribution of the climate burden, provided it is applied as follows: i) each country must introduce a carbon price calibrated to the global social cost of carbon; ii) each country must transfer part of carbon revenues collected at the country level to an international fund; iii) global carbon revenues must be redistributed on the basis of the country-level social cost of carbon. The FL-PPP burden can be made more progressive, moreover, if the formula for allocating global carbon revenues is adjusted through two coefficients, one consumption-based and one priority-sensitive. (shrink)

“What’s the big deal?”The meaning of this interrogative depends on the inflection. From the mouths of proponents of public–private partnerships (PPPs) related to food and health, it asks—perhaps with some skepticism or bewilderment—what objections there could possibly be to public–private partnerships intended to address some of our most pressing public health challenges. This is due, in no small part, to the way such partnerships are often characterized by participants and proponents alike: they are a “win–win–win,” for the public sector actor, (...) for the private sector actor, and for the general public or relevant publics (often characterized as consumers).1 Posed by critics of PPPs, the question cynically .. (shrink)

The authority of surrogates—often close family members—to make treatment decisions for previously capacitated patients is said to come from their knowledge of the patient, which they are to draw on as they exercise substituted judgment on the patient’s behalf. However, proxy accuracy studies call this authority into question, hence the Patient Preference Predictor (PPP). We identify two problems with contemporary understandings of the surrogate’s role. The first is with the assumption that knowledge of the patient entails knowledge of what the (...) patient’s choice of treatment would be. The second is with the assumption that a good decision reproduces the content of that choice. If we are right, then the PPP, helpful though it might be in guiding surrogates’ decisions, nevertheless would hold them to the wrong standards and in that way could add to, rather than relieve, the stress they experience as they try to do their job. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this particular (...) point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

Climate change involves changes in the climate system caused by polluting human activities and the social and natural effects of these changes. The historical and anthropogenic grounds of climate change play an important role in climate justice claims. Many climate justice scholars believe that principles of climate justice should account for the historical and anthropogenic sources of climate change. Two main backward-looking principles have been proposed: the polluter pays principle (PPP) and the beneficiary pays principle (BPP). The BPP emerged in (...) the literature on climate justice in response to certain objections raised against the PPP. In this paper, I focus on two of these objections: the causation objection and the excusable ignorance objection. Defenders of the BPP have traditionally assumed that this principle is not vulnerable to those objections, which renders the BPP superior to the PPP. In this paper, I challenge this underlying assumption. My argument here is simple: moving from the PPP to the BPP in response to any of these objections might be unjustified because the BPP is affected by at least some of the considerations giving rise to these objections. (shrink)

The patient preference predictor is a computer-based algorithm devised to predict the medical treatment that decisionally incapacitated patients would have preferred. The target paper argues against various criticisms to the effect that the use of a PPP is inconsistent with proper respect for patient autonomy.1 In this commentary, I aim to add some clarifications to the complex relationship between autonomy and the PPP. First, I highlight one way in which the decision of a surrogate designated by the patient realises respect (...) for patient autonomy in a way that PPP cannot realise by introducing the idea of shared agency. Second, I show how the attempt to predict someone’s hypothetical choice can be disrespectful to her autonomy. Following the treatment decision of a surrogate designated by the patient counts as a way of respecting the patient’s own autonomy. Designating someone as one’s surrogate is a case of entrusting her with the task of making important life decisions on one’s behalf. To entrust someone with a certain matter is to assign her the responsibility for that matter based on the trust that she will take a good care of it. When a patient entrusts a surrogate decision-maker, what is the matter that she is trusted to take a good care of? In many contexts, the surrogate is r egarded as an epistemic proxy, one who is likely to know the patient’s preferences the best. It is often thought that the point of practising surrogate decision making is to respect the patient’s autonomy by following what the patient most likely would have preferred. Using a PPP in the decision-making process has the same goal of making a more accurate prediction of the patient’s treatment preference. However, at least in some cases, designating the patient’s intimates or ones she loves and cares …. (shrink)

This paper makes a contribution to ongoing debates about whether and how we can empirically assess the potential, limitations, and actual impacts of public-private partnerships in developing countries. Several United Nations and bilateral aid agencies have called for the development of impact assessment methodologies that can help clarify when, how, where, and for whom partnerships work. This paper scrutinizes some of the key assumptions underlying this debate, arguing that no objective ' truth' about the effects of PPPs can be discovered (...) through the use of such methodologies. The paper then investigates what can actually be known about a PPP's effects by testing a PPP IA framework that is recommended by the Organization for Economic Cooperation and Development. This is done using a case study from Pakistan. The paper shows that IA methodology may provide an indication of how well a PPP has fared, but not why the PPP has turned out the way it has. At the same time, win-win and win-lose outcomes may exist simultaneously, even for the same stakeholder in the PPP. While the importance of ensuring proper design, monitoring, and IA of PPPs cannot be denied, their effects must be seen as an outcome of struggles between a variety of actors over the distribution of social and environmental hazards associated with broader processes of economic development and industrialization. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction to the 30th Anniversary Issue of Philosophy, Psychiatry, & PsychologyJohn Z. Sadler (bio)This issue marks the 30th anniversary of Philosophy, Psychiatry, and Psychology (PPP). All of us at the journal are grateful to our authors, readers, editors, and publishers for enabling this landmark. To commemorate this event, I invited our Founding Editor and Chair of the Advisory Board, K.W.M. "Bill" Fulford to write a brief essay, along with (...) our panel of smart and industrious senior editors. Their instructions were simple: 500 words on PPP past, present, and/or future. These essays appear in the pages to follow. As Editor-in-Chief, I write about PPP's early commitments as a scholarly journal, situate these in the history of academic publishing, and muse over our current moment.Bill Fulford briefly discusses the early years of the journal in his essay. My perspective emerges from an editor's perspective. As co-editors in the early years, Bill and I were committed to an international authorship with comparable editorial oversight. We wanted to build a journal that would equally recognize clinical science and practice and philosophy, maintaining the rigor of each field. We saw philosophers and mental health practitioners as equal partners, collaborators, innovators, and educators. More important, PPP was intended to offer up the best criticism of the mental health and related fields.The scattershot history of scholarly editing has identified several functions of the editor over the centuries following Gutenberg's invention of the printing press in the mid-1440s. The earliest editors took liberties with the language of the Bible, trying to make it more accessible to the public; the printing press permitted fast and inexpensive reproduction. Not surprisingly, this popularizing of the Bible led to praise as well as outrage. The printing of other scholarly works followed quickly. In 1470, only about 25 years after the invention of the printing press, Niccolo Perroni called for Pope Paul II to censor Andrea Bussi's edition of Pliny the Elder's Natural History, an anthology of then-ancient writings about the natural world. This marked the first recorded instance of censorship of a more-or-less secular scholarly work (Monfasani, 1988). In the ensuing centuries, "editors" initially were the popularizers, and later the gatekeepers of texts worth (and not worth) reading. In the [End Page 1] ensuing centuries into the present, editors have been venerated both as defenders of good reading and reviled as censors or intellectual selfaggrandizers.The current moment, in my view, represents a crisis in the history of editing and editorship. Digital communications have liberated communications worldwide. However, this liberty has come at the cost of colossal amounts of material not worth reading and an explosion of divisive, destructive discourse. Even worse, internet "trolls" on social media have moved bullying out of the schoolyard and into international cyberspace. Determining what is worth reading has moved away from a cluster of (hopefully) responsible editors to anyone who wants to go to the small effort of silencing others through online harassment and even violent threats. Such cyberbullying does not eliminate elitism, but instead substitutes a toxic online "elite" without principle other than self-promotion and the alienation of others. Our contemporary online culture has yet to figure out how to shape what is, and is not, worth reading.My wish and intent for the future of PPP is to maintain and grow our place of rational, deliberative, and open discourse, even in the face of such disruptive cultural change.John Z. Sadler John Z. Sadler, MD, is the Editor-in-Chief of PPP. He is the Daniel W. Foster, MD, Professor of Medical Ethics at the University of Texas Southwestern Medical Center, as well as a Professor of Psychiatry there. He has been a PPP editor since its inception.ReferenceMonfasani, J. (1988). The first call for press censorship: Niccolo Perotti, Giovanni Andrea Bussi, Antonio Moreto, and the editing of Pliny's Natural History. Renaissance Quarterly, 41, 1–31. Google ScholarCopyright © 2023 Johns Hopkins University Press... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Standards and Assumptions, the Limits of Inclusion, and Pluralism in PsychiatryBennett Knox*, MA (bio)Let me begin by expressing my gratitude to AAPP, PPP, and the Jaspers Award Committee—I am deeply honored to receive this award. So too let me thank Anke Bueter (2022) and Awais Aftab (2022) for their thought-provoking commentaries. Many of the concerns they bring up are ones that I share, so I am delighted to have (...) a chance to discuss them in my response. I will bring up three central issues in turn: 1) the role of shared standards versus background assumptions, 2) the limits of inclusion, and 3) pluralism in psychiatry.Shared Standards or Background Assumptions?Both Bueter and Aftab reference Longino's "shared public standards" criterion for social objectivity (1990, p. 77; 2002, p. 130), which I did not explicitly discuss in the original paper (Knox, 2022). This was a choice I made partly because in the case of psychiatry determining what constitutes an appropriate "shared public standard" is often not at all straightforward, which points to a potential problem for Longino's view. Namely, in some cases it is a matter of dispute whether some assumption shared within a scientific field should be counted as a "shared public standard" (which Longino requires that there be) or a "background assumption" (which she requires be subjected to critical scrutiny). And it is sometimes unclear how we could effectively adjudicate this type of disagreement.Take the example Bueter uses of "psychiatrists aiming for biomedical explanations of a particular mental disorder, whereas the critics value research that does not assume the existence of mental disorders" (2022, p. 273). A conflict along these lines often does arise between advocates of the pathology paradigm and the neurodiversity paradigm with regard to Autism, for example.1 A psychiatrist working within the pathology paradigm may argue that something like "psychiatry must deal only with mental disorders, understood as pathologies" constitutes a shared standard, and so psychiatric research on Autism must understand it as a pathology. An advocate of the neurodiversity paradigm, however, might argue that this same proposition [End Page 275] is merely a normative background assumption shared among many psychiatrists, which ought to be questioned and ultimately rejected. How might we adjudicate this meta-disagreement about the status of this standard/assumption?Bueter gives some helpful guidance on this issue by pointing to Carrier's requirement that participants exhibit the "epistemic attitude" (2013). I agree that if all participants commit themselves to this attitude, then "…differences in conceptual resources and standards of assessment need not make shared deliberation impossible, and the standards can be a subject of discussion themselves" (Bueter 2022, p. 273). For instance, since this attitude requires some commitment to empirical adequacy, we might search for some empirical evidence that favors one paradigm over the other. But advocates of both paradigms might actually agree on all the empirical facts, and yet still have a deep disagreement about which paradigm's understanding should be accepted as a shared standard. If participants are committed to some common standards and goals, we may often be able to resolve this sort of problem. But there is still a danger that we may arrive at an impasse, with no clear idea how to proceed.Though in many cases scientific experts must be allowed some power to set the standards in their domain (lest we dilute that expertise in ways that Aftab rightly points out would be problematic), I would also caution against accepting that something is a legitimate shared public standard just because the members of a scientific community say so. In keeping with the spirit of Longino's reliance on Quine, none of our shared standards are in principle immune from revision—save perhaps a minimal commitment to empirical evidence and rational argument.The Limits of InclusionMy impression is that Longino's response to the "Nazi problem" presented by Hicks (2011) might be to bite the bullet: her account does require allowing Nazi scientists to participate, and perhaps even cultivating their participation. But if (as seems likely) the Nazi shows themself to be unable to adhere to the shared standards... (shrink)