The power of fathers over their children – especially over their daughters – is a central theme of Boccaccio’s ‘Decameron’. Novella V,7 situates the ‘patria potestas’ in a tension-filled position between honour and law, vigilante justice and public prosecution. The legitimation of cruelty and violence by invoking the ‘patria potestas’ is questioned through the confrontation with poetic justice.

Rather than focusing on political and legal debates surrounding attempts to determine if and when genocidal rape has taken place in a particular setting, this essay turns instead to a crucial, yet neglected area of inquiry: the moral significance of genocidal rape, and more specifically, the nature of the harms that constitute the culpable wrongdoing that genocidal rape represents. In contrast to standard philosophical accounts, which tend to employ an individualistic framework, this essay offers a situated understanding of harm that (...) features the importance of interdependence and relationality and that conceptualizes harms as embodied and contextual. The paper ultimately reveals what is distinctive about this particular crime of sexual violence by exploring the logic of genocidal rape: genocidal rape involves the harm of forced self-betrayal unleashed relationally, causing victims as representatives of their group to participate inadvertently in the destruction of that group. (shrink)

Definition of the problemThe article addresses the relationship between reproduction, time and the good life. Services offered by reproductive medicine and conceptions of the good life in time influence each other reciprocally. This interaction is characterised by implicit and explicit normative settings and expectations of appropriate temporality.ArgumentsWe first discuss the significance of time for the life course and for parenthood from a sociological and social psychological perspective. Reproductive medicine can increase the options for becoming a parent and thus for life-time (...) autonomy. However, in the context of societal imperatives for optimisation and efficiency, it can also have opposite effects and increase heteronomy. Overall, this leads to changed forms of adaptation and self-determination, new dilemmas and ambivalences in the temporal optimisation of parenthood.ConclusionsAgainst this background, we explain how the ethics of reproductive medicine could benefit from interdisciplinary research that focuses on life in its temporal course. (shrink)

Parental burnout is a unique and context-specific syndrome resulting from a chronic imbalance of risks over resources in the parenting domain. The current research aims to evaluate the psychometric properties of the Spanish version of the Parental Burnout Assessment across Spanish-speaking countries with two consecutive studies. In Study 1, we analyzed the data through a bifactor model within an Exploratory Structural Equation Modeling on the pooled sample of participants obtaining good fit indices. We then attained measurement invariance across both gender (...) and countries in a set of nested models with gradually increasing parameter constraints. Latent means comparisons across countries showed that among the participants’ countries, Chile had the highest parental burnout score, likewise, comparisons across gender evidenced that mothers displayed higher scores than fathers, as shown in previous studies. Reliability coefficients were high. In Study 2, we tested the relations between parental burnout and three specific consequences, i.e., escape and suicidal ideations, parental neglect, and parental violence toward one’s children. The medium to large associations found provided support for the PBA’s predictive validity. Overall, we concluded that the Spanish version of the PBA has good psychometric properties. The results support its relevance for the assessment of parental burnout among Spanish-speaking parents, offering new opportunities for cross-cultural research in the parenting domain. (shrink)

This paper deals with Claudia Card's important contributions to a theory of evil that steps out from traditional models of thinking about this problem . Instead, our author seeks to explore important elements from other theorists in order to build up her ideas of what she calls the "atrocity paradigm." This critical essay focuses mainly in the spaces where Card's conclusions need to rethink the limits and constraints of her theory.

This essay reflects on issues raised by commentators regarding my book, The Atrocity Paradigm: A Theory of Evil (Oxford 2002). They are (1) Robin Schott's observation of the tension between my discussion of forgiveness and of castration fantasies; (2) Bat-Ami Bar On's questions regarding whether evil is ethical, political, or both; (3) Adam Morton's queries regarding the relative seriousness of evils and injustices; and (4) María Pía Lara's concerns regarding what is valuable in Kant's ethics.

This paper deals with Claudia Card's important contributions to a theory of evil that steps out from traditional models of thinking about this problem (theodicies, metaphysical theories, etc.). Instead, our author seeks to explore important elements from other theorists (such as Kant and Nietzsche) in order to build up her ideas of what she calls the "atrocity paradigm." This critical essay focuses mainly in the spaces where Card's conclusions need to rethink the limits and constraints of her theory.

: This paper deals with Claudia Card's important contributions to a theory of evil that steps out from traditional models of thinking about this problem (theodicies, metaphysical theories, etc.). Instead, our author seeks to explore important elements from other theorists (such as Kant and Nietzsche) in order to build up her ideas of what she calls the "atrocity paradigm." This critical essay focuses mainly in the spaces where Card's conclusions need to rethink the limits and constraints of her theory.

Slurs are derogatory terms targeting individuals and groups of individuals on the basis of race, nationality, religion, gender or sexual orientation. The aim of my paper is to propose an account of appropriated uses of slurs – i.e. uses by targeted groups of their own slurs for non-derogatory purposes, as in the appropriation of ‘nigger’ by the African-American community, or the appropriation of ‘queer’ by the homosexual community. In my proposal appropriated uses are conceived as echoic, in Relevance Theory terms: (...) in-groups echo derogatory uses in ways and contexts that make manifest the dissociation from the offensive contents. I will show that the echoic strategy has interesting advantages over alternative theories, and especially over Anderson and Lepore’s deflationary strategy. (shrink)

What distinguishes evils from ordinary wrongs? Is hatred a necessarily evil? Are some evils unforgivable? Are there evils we should tolerate? What can make evils hard to recognize? Are evils inevitable? How can we best respond to and live with evils? Claudia Card offers a secular theory of evil that responds to these questions and more. Evils, according to her theory, have two fundamental components. One component is reasonably foreseeable intolerable harm -- harm that makes a life indecent and (...) impossible or that makes a death indecent. The other component is culpable wrongdoing. Atrocities, such as genocides, slavery, war rape, torture, and severe child abuse, are Card's paradigms because in them these key elements are writ large. Atrocities deserve more attention than secular philosophers have so far paid them. They are distinguished from ordinary wrongs not by the psychological states of evildoers but by the seriousness of the harm that is done. Evildoers need not be sadistic:they may simply be negligent or unscrupulous in pursuing their goals. Card's theory represents a compromise between classic utilitarian and stoic alternatives (including Kant's theory of radical evil). Utilitarians tend to reduce evils to their harms; Stoics tend to reduce evils to the wickedness of perpetrators: Card accepts neither reduction. She also responds to Nietzsche's challenges about the worth of the concept of evil, and she uses her theory to argue that evils are more important than merely unjust inequalities. She applies the theory in explorations of war rape and violence against intimates. She also takes up what Primo Levi called "the gray zone", where victims become complicit in perpetrating on others evils that threaten to engulf themselves. While most past accounts of evil have focused on perpetrators, Card begins instead from the position of the victims, but then considers more generally how to respond to -- and live with -- evils, as victims, as perpetrators, and as those who have become both. (shrink)

Altersarmut, Bildungsunterschiede, eine wachsende Kluft zwischen Arm und Reich - die deutsche Gesellschaft spaltet sich, und viele fordern mehr Soziale Gerechtigkeit. Die Autorin untersucht, wie sich das Verstandnis von Sozialer Gerechtigkeit in Philosophie und Politik gewandelt hat, und hinterfragt, inwieweit Politiker Soziale Gerechtigkeit als Akzeptanzmittel fur ihre Entscheidungen nutzen.

Pia Becker entwirft eine Konzeption von Patientenautonomie, die sich im Gegensatz zu in der Medizinethik bisher dominierenden Konzeptionen an der grundsätzlichen Fähigkeit des Patienten zur Autonomie orientiert. Ausgangspunkt bildet die Notwendigkeit der informierten Einwilligung, die neben der Patientenautonomie vor allem auch die körperliche Integrität des Patienten schützt. Als Adäquatheitsbedingungen dienen die beiden normativen Funktionen der Patientenautonomie als Barriere und Schlüssel einer medizinischen Behandlung. Diese Konzeption von Patientenautonomie hat den Vorteil, Patienten besser vor Überforderungen zu bewahren und deren Bedarf an Unterstützungsangeboten (...) zur Förderung der Patientenautonomie deutlicher hervorzuheben. (shrink)

One way to silence the powerless, Langton has taught us, is to pre-emptively disable their ability to do things with words. In this paper I argue that speakers can be silenced in a different way. You can let them speak, and obscure the meaning of their words afterwards. My aim is to investigate this form of silencing, that I call retroactive distortion. In a retroactive distortion, the meaning of the words of a speaker is distorted by the effect of a (...) subsequent speech act by a different speaker. After introducing this notion, I explore some reasons why retroactive distortions can be difficult to challenge and argue that, besides constituting a communicative injustice, they can eliminate topics from public consideration and therefore erode public debate. (shrink)

The article introduces the problematics of the classical two-valued logic on which Western thought is generally based, outlining that under the conditions of its logical assumptions the subject I is situated in a world that it cannot address. In this context, the article outlines a short history of cybernetics and the shift from first- to second-order cybernetics. The basic principles of Gordon Pask’s 1976 Conversation Theory are introduced. It is argued that this second-order theory grants agency to others through a (...) re-conception of living beings as You logically transcending the I. The key principles of Conversation Theory are set in relation to the poetic forms of discourse that played a key role in art as well as philosophical thinking in China in the past. Second-order thinking, the article argues, is essentially poetic. It foregoes prediction in favour of the potentiality of encountering tomorrow’s delights. (shrink)

The editorial introduces issue 21.1 of Technoetic Arts via a critical reflection on the artificial intelligence hype (AI hype) that emerged in 2022. Tracing the history of the critique of Large Language Models, the editorial underscores that there are substantial ethical challenges related to bias in the training data, copyright issues, as well as ecological challeges which the technology industry has consistently downplayed over the years. -/- The editorial highlights the distinction between the current AI technology’s reliance on extensive pre-existing (...) human-generated data for pattern recognition and the performative process inherent in art practice. Patterns of creative output can be replicated without a thorough understanding of underlying concepts. In contrast, the performative process of art practice, as explored through the conceptual frameworks of creativity by Noam Chomsky, Charles Sanders Peirce, and Roger T. Ames and with reference to an earlier publication of the editorial’s author, creates concepts and continually ‘strives to extend itself towards the unknown.’ -/- Following this introductory section, the editorial provides an overview of the ten articles featured in this issue of Technoetic Arts. The first four texts engage with emerging technologies from various perspectives in art and design. The subsequent six articles, part of a special section titled 'Perspectives from Chandigarh,' reflect a quest for meaningful existence within colonial, patriarchal, and biopolitical structures that frame everyday practices of exclusion and oppression. (shrink)

Democracy is increasingly being challenged, by disengagement and by anti-pluralist movements (Levitsky and Ziblatt in How Democracies Die: What History Reveals About Our Future, Viking, New York, 2018; Wikforss in _Därför demokrati. Om kunskapen och folkstyret_ [Because of this, democracy. On knowledge and people’s rule] Fri Tanke, 2021; Svolik et al. in J Democr 34(1):5–20, 2023). This article draws upon a theoretical discussion about democracy, pluralism, and threats to democracy. Departing from Dewey, Laclau, Mouffe, Young and Allen, we address democracy (...) as an ideology that centers around pluralism, or an ever-increasing inclusion of voices from the margins as its goal. We argue that perceiving democracy pedagogically as a pluralistic ideology would support students’ democratic citizenship and equip them for a world where threats to democracy are being reported. Employing a case study on Finnish social studies textbooks, we analyze how democracy as well as threats to democracy are discursively portrayed. Our study shows that the textbooks present democracy as predominantly institutional and static. We also find that while disengagement is portrayed as a problem for democracy, anti-pluralist movements are generally not referred to as a threat. Additionally, we examine a discourse in the textbooks that connects freedom of speech with democracy in a way that favors a multitude of opinions, even antidemocratic ones, over creating space for marginalized voices. Drawing on the theoretical discussion and the results of the analysis, we argue that a focus on pluralism as the core of democracy makes the opposition between restricting hate speech and advocating for democracy redundant. (shrink)

Statements such as “X is beautiful but I don’t like how it looks” or “I like how X looks but it is not beautiful” sound contradictory. How contradictory they sound might however depend on the object X and on the aesthetic adjective being used (“beautiful”, “elegant”, “dynamic”, etc.). In our study, the first sentence was estimated to be more contradictory than the latter: If we describe something as beautiful, we often intend to evaluate its appearance, whereas it is less counterintuitive (...) to appreciate an appearance without finding it beautiful. Furthermore, statements including “beautiful” appeared more contradictory than those including “elegant” and “dynamic”, pointing to its greater evaluative component. When related to artworks, sentences could appear less contradictory due to readers’ consideration of the divergence between conventional beauty and art-related sensory pleasures that can even include negative valence. Such ambivalence might be more frequent in art-objects than in other artefacts. Indeed, in our study, sentences referring to artworks were estimated to be less contradictory compared to sentences referring to other artefacts. Meanwhile, an additional small group of graphic design students showed a less clear difference between art-related and non-art-related sentences. We discuss the potential influence of art experience and interest as well as theoretical and methodological challenges like the conceptualization of beauty. (shrink)

El artículo realiza una exploración inicial acerca de las políticas archivísticas en la provincia de La Pampa, que –en el periodo considerado– guardan una estrecha relación con las políticas culturales. En primer lugar se repasan los conceptos de política cultural y política archivística; en segundo lugar se presentan rápidamente algunas características de las políticas culturales en la provincia de La Pampa y en tercer lugar nos detenemos en las instancias referidas a las prácticas, disposiciones e iniciativas en relación al Archivo (...) Histórico Provincial, principal espacio de desarrollo de las escasas políticas existentes en la materia en la provincia. Se sostiene que en general la gestión del AHP surgió en vinculación a políticas culturales que a principios de la década de 1970 adherían a una noción antropológica de la cultura y se asociaron a una serie de prácticas y políticas destinadas a desarrollar investigaciones para identificar procesos históricos específicos y supuestos rasgos que caracterizarían a la identidad regional, o pampeanidad. En la provincia, las prácticas y políticas archivísticas han permanecido asociadas a esa mirada y con cada vez menor cantidad de recursos para su funcionamiento. (shrink)

Addressing studying as a distinct educational concept and phenomenon in its own right, the essays in this volume consider study and studying from a range of perspectives. Countering dominant educational discourses, which place a heavy emphasis on learning and instruction, the contributors explore questions such as: What does it mean to study something? How is studying something different from being taught about it, or learning something about it? What does the difficulty demanded by study mean for the one who studies (...) and for the teacher? What mode of existence does study induce? The book highlights the significance of study not only, or even primarily, for its educational outcome, but as a human activity. (shrink)

This paper sets out to conduct an embodied and situated aural analysis of what silence in Northern Norway is about, with the aim of bringing forward the background noise. The paper brings together theories on construction of the rural, time-space relations, soundscape ecology, and on affect and power, and it merges academic traditions about how to communicate findings from non-visual biased studies. This interdisciplinary framework provides a novel structure for both analysing material and communicating findings from embodied studies of listening (...) out. The study found that silence in Northern Norway is about not listening to the economy of scale, to the commodification of the natural conditions and the suppression of lifestyles and territory. The paper illustrates how power is an inherent part of listening and how listening is a practice that is enacted to create emotions that are associated with a specific time-space relation. (shrink)

The basics -- The dignity of the human person -- Autonomy, consent, refusing treatment and boundaries -- Ethics and non-autonomous patients -- Confidentiality, privacy, data protection, truth telling and trust -- Ethical issues at the beginning of life -- Ethical issues about babies, children and young adults -- Ethical issues at the end of life -- Dying and death: ethical issues -- Loss, grief and bereavement, burn-out and the wounded healer -- Conscientious objection and loyalties.

Traditional interpretations of Aristotle’s theory of perception mainly focus on uncovering the underlying mechanisms that are at stake when perceivers are affected by sensible qualities. Investigating the nature of sense perception is one of Aristotle’s main worries and one that he explicitly relates to the question of its causes (e. g.Sens. 436a16–17, 436b9) and its ends (e. g.de An. 434a30 ff.). Therefore I suggest that, in order to fully explain Aristotle’s view of perceptual phenomena, the possibilities, the constraints, and the (...) goals defined by the embodied and situated engagement of perceivers with the external world must be taken into account. Accordingly, in this paper, I provide an affective reading of Aristotle’s theory of perception. I shall ask what, in addition to functioning sense organs and appropriate response mechanisms, the perceiver contributes to perceptual content. Specifically, I propose to shed light on the significance of perceptual experience for the perceiver and I aim to show that, according to Aristotle, one’s biological and personal qualities are perceptually relevant, meaning that they underpin perception, rather than coming into play after perception has occurred and its objects have been discerned. The paper is divided into two parts, respectively dealing with sensory affections and more complex affective phenomena. As regards the domain of primal sense perception, I will focus on smell as a representative example: since Aristotle identifies it as the least developed of human sensory faculties, it will serve as a revealing illustration of how sense perception is informed and qualified by what, drawing on contemporary philosophical terminology, I will call ‘perceptual interests’, viz. the affective sense of what is at stake in the living being’s interaction with the environment. I will then proceed to consider the way more complex affective phenomena underpin perception by examining the case of emotions and that of virtues of character. By showing how perception is affectively inflected and how emotion is rooted in perception’s bodily nature, I aim to sketch out the general lines along which I believe that the Aristotelian theory of perception should be approached. (shrink)

In recent times, phenomena of conversational asymmetry have become a lively object of study for linguists, philosophers of language and moral philosophers—under various labels: illocutionary disablement and silencing, discursive injustice :440–457, 2014; Lance and Kukla in Ethics 123:456–478, 2013), illocutionary distortion. The common idea is that members of underprivileged groups sometimes have trouble performing particular speech acts that they are entitled to perform: in certain contexts, their performative potential is somehow undermined, and their capacity to do things with words is (...) distorted or even annulled. In this paper I will assess this idea, focusing on Rebecca Kukla’s and Rae Langton’s accounts; in particular, I will criticize the role the notion of uptake plays in their accounts, and claim that it may ultimately undermine the very idea of discursive injustice. While, according to Kukla and Langton, members of disadvantaged groups are victims of a kind of uptake failure, leading to illocutionary disablement and even silencing, in the account I present they are victims of a kind of communicative disablement. My overall aim is to develop a notion of discursive injustice that is more plausible and more effective for our broader purposes of criticising the structures of power and oppression. (shrink)

Clinical Ethics Consultation (CEC) has grown significantly in the last decade, and efforts are being made to professionalize the practice. The American Society for Bioethics and Humanities (ASBH) has been instrumental in this process, having published the _Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants_ and founded and endorsed the creation of the _Healthcare Ethics Consultant Certified (HCEC) Certification Commission._ The ASBH also published “core competencies” for healthcare ethics consultants and has delineated a clear identity and role of (...) such consultants distinct from that other healthcare professionals. In addition, more enter the field armed with advanced degrees (MA and PhD) or certification in clinical ethics consultation. While some have questioned the trend toward professionalization, the momentum is clearly in its favor. This paper explores three questions: Does the professionalization of healthcare ethics consultation expose those engaged in the field to the types of liability claims faced by professionals in other fields? What specific liabilities could affect a healthcare ethics consultant? And finally, what should healthcare ethics consultants do to protect themselves against liability claims? We conclude that while the risk of liability remains low, those engaged in the field should accept that risk just as part of their status as professionals and, like those in allied professions, seek appropriate protection in the form of liability insurance. (shrink)

Developing virtues requires attending to the affective and cognitive components of virtue. The former component implies cultivating apt emotional responses to specific situations. The cognitive part requires the (meta) virtue of phronesis. In dealing with “Phronesis in educating emotions,” this article attends to the nature of emotions and phronesis as its role in cultivating good action habits and virtuous emotional habits. It understands emotion regulation as one of the functions of phronesis. In the broader sense, phronesis includes elements other than (...) deliberation, such as dialectics and rhetoric, which can be helpful to induce a certain suspicion or to persuade somewhat since our affectivity is susceptible to persuasion (i.e. Aristotle’s political dominion of emotions). As a topic in the intersection of moral psychology and moral philosophy, we get valuable insights into a psychologist’s work, Magda Arnold’s (1903–2002) emotion theory. Her understanding of emotion elicitation elucidates the relation between phronesis and emotions. The article focuses on one of the central elements of emotion elicitation, the appraisal. This piece can make the education of emotions for virtue development more understandable. At first glance, our initial appraisal may be hasty and inaccurate, leading to emotional reactions. However, with careful reflection, we can correct and improve upon our initial appraisal and subsequent emotions. If our initial assessment was flawed, this second, more thoughtful evaluation can be enhanced through phronesis. Due to the appraisal’s spontaneity, cultivating educated emotions requires values’ teaching, learning, and thus, appraising good things. With the development of virtues, intuitive estimates become adequate, so emotional responses are more attuned to diverse situations. (shrink)

Die Arbeit zur regionalen Variation der Intonation bietet einen Forschungsüberblick über existierende Studien zum Thema und widmet sich dann der Analyse der Intonation der kölnischen Regionalvarietät auf der Basis von spontansprachlichen Daten. Die Analyse kombiniert Methoden des autosegmental-metrischen Ansatzes mit denen der Interaktionalen Linguistik. Da sich der autosegmental-metrische Ansatz in den letzten Jahren zum gängigen Beschreibungsansatz in der Intonationsforschung entwickelt hat, ist auf diese Weise eine Vergleichbarkeit der verschiedenen Untersuchungsergebnisse gewährleistet. Der Ansatz der Interaktionalen Linguistik erlaubt es darüber hinaus, die (...) tatsächliche Verwendungsweise der Intonationsverläufe durch die Interaktionsteilnehmer aufzuzeigen. Im Zentrum des Interesses stehen zwei steigend-fallende Konturen, die typisch für das Kölnische sind. Sie werden auf phonetischer, tonologischer und phonologischer (d.h. konversationell-funktionaler) Ebene analysiert. Die Arbeit verdeutlicht die große Bandbreite formaler Variation und zeigt, wie die Beteiligten Intonation als Ressource zur Gestaltung der Interaktion nutzen. (shrink)

It is often suggested that during development the brain barriers are immature. This argument stems from teleological interpretations and experimental observations of the high protein concentrations in fetal cerebrospinal fluid (CSF) and decreases in apparent permeability of passive markers during development. We argue that the developmental blood–CSF barrier restricts the passage of lipid‐insoluble molecules by the same mechanism as in the adult (tight junctions) rendering the paracellular pathway an unlikely route of entry. Instead, we suggest that both protein and passive (...) markers are transferred across the epithelium through a transcellular route. We propose that changes in volume of distribution can largely explain the decrease in apparent permeability for passive markers and that developmentally regulated cellular transfer explains changes in CSF protein concentrations. The blood–CSF tight junctions are functionally mature from very early in development, and it appears that transfer from blood into embryonic brain occurs predominately via CSF rather than the vasculature. BioEssays 30:237–248, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

The biological body has remained peripheral to much feminist theory which is the consequence of a legitimate critique of biologicaldeterminism. However, rejecting the biological body altogether runs the risk of treating the body as a sociopolitical effect. It is my argument that corporeal reality can be theorized without lapsing into the totalizing perspectives of essentialism or relativism. To do so Ipropose drawing upon Judith Butler’s analysis of the productive effect of power relations that materialize the body’s sex, and Margaret Lock’s (...) notion of local biology which introduces the notion that biological matter has dynamism of its own that is not reducible to discourse/power. Bringing together these two perspectives on the body holds the prospect of capturing the complex interrelationship between biology, culture, social structure, and power. (shrink)

The biological body has remained peripheral to much feminist theory which is the consequence of a legitimate critique of biologicaldeterminism. However, rejecting the biological body altogether runs the risk of treating the body as a sociopolitical effect. It is my argument that corporeal reality can be theorized without lapsing into the totalizing perspectives of essentialism or relativism. To do so Ipropose drawing upon Judith Butler’s analysis of the productive effect of power relations that materialize the body’s sex, and Margaret Lock’s (...) notion of local biology which introduces the notion that biological matter has dynamism of its own that is not reducible to discourse/power. Bringing together these two perspectives on the body holds the prospect of capturing the complex interrelationship between biology, culture, social structure, and power. (shrink)

Health-care goods are goods with peculiar properties, and where they are scarce, societies face potentially explosive distributional conflicts. Animated public and academic debates on the necessity and possible justice of limit-setting in health care have taken place in the last decades and have recently taken a turn toward procedural rather than substantial criteria for justice. This article argues that the most influential account of procedural justice in health-care rationing, presented by Daniels and Sabin, is indeterminate where concrete properties of rationing (...) institutions are concerned. Such properties inscribe substantial norms into institutions. These norms can derive validity only from democratic majority decisions, which must be seen as an instance of pure procedural justice. We therefore have to move the discussion to a meta-level and ask how concrete properties of institutions are being chosen. I suggest four criteria for sufficiently democratic institutional design choice and conclude that as institutional properties are likely to have effects on the resulting distribution of health care, design choices should be empirically informed and taken both democratically and deliberately. (shrink)