Is a phenomenal pain a conscious primitive or composed of more primitive phenomenal states? Are pain experiences necessarily or only contingently unpleasant? Here, I sketch how to answer such questions concerning intra-phenomenal metaphysics using the example of pain and unpleasantness. Arguments for a symmetrical metaphysical independence of phenomenal pain and unpleasant affect are presented, rejecting a composite view like the IASP definition and dimensional views. The motivating intuition of these views is explained by common binding mechanisms in consciousness and characterized (...) as fallacious if generalized. There are, however, underlying commonalities between pain perception and unpleasant affect, e.g. formal content or evolutionary ancestry. (shrink)

Can we find necessary and sufficient conditions for a mental state to be a pain state? That is, does pain have a nature? Or is the term ‘pain’ ambiguous? I argue here that our expression ‘pain’ lacks necessary use conditions if one considers a range of contexts. As use conditions constrain the reference class, I argue that ‘pain’ does not refer to a natural category, but binds together a bunch of loosely resembling phenomena. This leads to problems for scientific and (...) clinical discourse. To solve these, a method of explication is suggested, based on a discursive combination between analysis of first-person reports and theories of natural science. Lastly, I consider the ethical implications of this ambiguity that lead to a reformulation of the goal of pain science: Not alleviation of all pains ought to be our goal, but only manipulation of conscious and negatively emotionally charged pains. (shrink)

I argue that the understanding of "pain" as presented in the official medical definition by the IASP is ambiguous and likely a cluster concept.

In this article, I focus on what is we know when we know pain or that someone is in pain. I argue that claims of knowledge about pains are problematic because of the complex nature of the phenomenon and because of "pain" is a cluster concept.

In this consensus report by a diverse group of academics who conduct and/or are concerned about social and behavioral genomics (SBG) research, the authors recount the often‐ugly history of scientific attempts to understand the genetic contributions to human behaviors and social outcomes. They then describe what the current science—including genomewide association studies and polygenic indexes—can and cannot tell us, as well as its risks and potential benefits. They conclude with a discussion of responsible behavior in the context of SBG research. (...) SBG research that compares individuals within a group according to a “sensitive” phenotype requires extra attention to responsible conduct and to responsible communication about the research and its findings. SBG research (1) on sensitive phenotypes that (2) compares two or more groups defined by (a) race, (b) ethnicity, or (c) genetic ancestry (where genetic ancestry could easily be misunderstood as race or ethnicity) requires a compelling justification to be conducted, funded, or published. All authors agree that this justification at least requires a convincing argument that a study's design could yield scientifically valid results; some authors would additionally require the study to have a socially favorable risk‐benefit profile. (shrink)

This paper argues that Immanuel Kant’s practical philosophy contains a coherent, albeit implicit, defense of the legitimacy of capital punishment, one that refutes the most important objections leveled against it. I first show that Kant is consistent in his application of the ius talionis. I then explain how Kant can respond to the claim that death penalty violates the inviolable right to life. To address the most significant objection – the claim that execution violates human dignity – I argue that (...) motives of honor, as Kant conceives it, require a rational person to will her own execution, were she to commit murder. (shrink)

Many philosophers and legal theorists worry about punishing the socially disadvantaged as severely as their advantaged counterparts. One philosophically popular explanation of this concern is couched in terms of moral standing: seriously unjust states are said to lack standing to condemn disadvantaged offenders. If this is the case, institutional condemnation of disadvantaged offenders (especially via hard treatment) will often be unjust. I describe two problems with canonical versions of this view. First, its proponents groundlessly claim that disadvantaged offenders may be (...) punished as severely as advantaged ones, even though such punishment is unjust in light of the state’s loss of standing. Second, and more importantly, moral standing arguments prohibit states from blaming advantaged as well as disadvantaged offenders. This unwelcome outcome suggests that standing approaches incorrectly analyze the source of moral misgivings about punishing the disadvantaged. I conclude that those who share such concerns should put standing accounts aside. (shrink)

In response to the racial disparities that plague the American criminal justice system, the Movement for Black Lives calls for an end to policing and punishment “as we know it.” But refusing to punish violent offenses leaves unprotected those most vulnerable to crime, and outright abolition thus appears to undermine black rights and liberties. I call this the decarceration dilemma. After discussing Tommie Shelby and Christopher Lewis’s attempts to resolve the dilemma, I offer my own, which employs a procedural rather (...) than a substantive solution. I lean on the principle of expanded asymmetry (EA), which holds that it is better to underpunish than overpunish. After defending EA, I note that it obtains only under conditions of uncertainty. I then show that because virtually all trials of black offenders meet the uncertainty condition, sentencing authorities are obliged to treat black offenders leniently. I conclude by noting the advantages of my proceduralist approach. (shrink)

Capital punishment—the legally authorized killing of a criminal offender by an agent of the state for the commission of a crime—stands in special need of moral justification. This is because execution is a particularly severe punishment. Execution is different in kind from monetary and custodial penalties in an obvious way: execution causes the death of an offender. While fines and incarceration set back some of one’s interests, death eliminates the possibility of setting and pursuing ends. While fines and incarceration narrow (...) one’s routes to happiness, death eliminates its possibility. Not surprisingly, there is much debate about the moral permissibility of capital punishment. This entry maps the terrain of this debate. The first section discusses justifications of the death penalty as they appear in major theories of punishment. The second section surveys moral objections to execution that apply to most justifications. The third addresses procedural criticisms, which do not target the morality of execution so much as the justice of its implementation. (shrink)

Many philosophers and legal theorists worry about punishing the socially disadvantaged as severely as their advantaged counterparts. One philosophically popular explanation of this concern is couched in terms of moral standing: seriously unjust states are said to lack standing to condemn disadvantaged offenders. If this is the case, institutional condemnation of disadvantaged offenders (especially via hard treatment) will often be unjust. I describe two problems with canonical versions of this view. First, its proponents groundlessly claim that disadvantaged offenders may be (...) punished as severely as advantaged ones, even though such punishment is unjust in light of the state’s loss of standing. Second, and more importantly, moral standing arguments prohibit states from blaming advantaged as well as disadvantaged offenders. This unwelcome outcome suggests that standing approaches incorrectly analyze the source of moral misgivings about punishing the disadvantaged. I conclude that those who share such concerns should put standing accounts aside. (shrink)

This paper advocates for a general policy of penal leniency: judges should often sentence offenders to a punishment less severe than initially preferred. The argument’s keystone is the relatively uncontroversial Minimal Invasion Principle (MIP). MIP says that when more than one course of action satisfies a state’s legitimate aim, only the least invasive is permissibly pursued. I contend that MIP applies in two common sentencing situations. In the first, all sentences within a statutorily specified range are equally proportionate. Here MIP (...) applies directly. In the second, judges reasonably believe that one of the sentences within the range is the most proportionate, but can’t identify it with any certainty. In these cases of sentencing uncertainty, judges must be indifferent between their preferred sentence and a softer one, and this indifference triggers MIP. MIP thus frequently mandates some degree of leniency. I conclude with some comments on statistical uncertainty. (shrink)

To vindicate morality against skeptical doubts, Kant must show that agents can be moved to act independently of their sensible desires. Kant must therefore answer a motivational question: how does an agent get from the cognition that she ought to act morally to acting morally? Affectivist interpretations of Kant hold that agents are moved to act by feelings, while intellectualists appeal to cognition alone. To overcome the significant shortcomings of each view, I develop a hybrid theory of motivation. My central (...) interpretive claim is that Kant is a special kind of motivational internalist: on his view, agents are moved to act by a feeling of intellectual pleasure at the prospect of accomplishing a task they have set for themselves, a feeling that originates in free choice. The resulting theory is immune to the challenges facing intellectualism and affectivism, thus strengthening the prospects of Kant’s justification of morality. (shrink)

Kant famously insists that free will is a condition of morality. The difficulty of providing a demonstration of freedom has left him vulnerable to devastating criticism: critics charge that Kant's post-Groundwork justification of morality amounts to a dogmatic assertion of morality's authority. My paper rebuts this objection, showing that Kant offers a cogent demonstration of freedom. My central claim is that the demonstration must be understood in practical rather than theoretical terms. A practical demonstration of x works by bringing x (...) into existence, and what the demonstration of freedom brings into existence is a moral will, a will regulated by the moral law and capable of acting in accordance with it. Since to act morally is to act freely, bringing a moral will into existence actualizes our capacity for freedom and demonstrates that we possess it. To confirm the viability of such a demonstration, Kant must establish that agents can regulate their wills by practical principles, and that practical judgments are efficacious of themselves (i.e., that non-Humean motivational internalism is true). Kant, I argue, is successful on both counts. (shrink)

One of the many arguments against capital punishment is that execution is irrevocable. At its most simple, the argument has three premises. First, legal institutions should abolish penalties that do not admit correction of error, unless there are no alternative penalties. Second, irrevocable penalties are those that do not admit of correction. Third, execution is irrevocable. It follows that capital punishment should be abolished. This paper argues for the third premise. One might think that the truth of this premise is (...) self-evident. But in his paper “Is the Death Penalty Irrevocable?” Mike Davis argues that it is false: the death penalty is not irrevocable. While Davis’ argument is itself somewhat compelling, it receives additional support from work in the metaphysics of death, specifically the literature on posthumous harm. Strengthened in this way, the argument deserves careful consideration. I begin with a quick sketch of Davis’ argument, then show how the Pitcher-Feinberg theory of posthumous harm enables a more robust argument against the irrevocability of capital punishment, defending their theory of harm against standard objections in the literature. Having established the coherency of the robust argument, I conclude that it nevertheless fails to make the case against irrevocability. This is because it ignores the full set of practical requirements incumbent on legal institutions that wrongly punish someone. (shrink)

Half of the drug offenders incarcerated in the United States are black, even though whites and blacks use and sell drugs at the same rate, and blacks make up only 13 percent of the population. Noncomparativists about retributive justice see nothing wrong with this picture; for them, an offender’s desert is insensitive to facts about other offenders. By contrast, comparativists about retributive justice assert that facts about others can partially determine an offender’s desert. Not surprisingly, comparativists, especially comparative egalitarians, contend (...) that differential punishment is retributively unjust. I agree with this assessment, but take issue with the reasons egalitarians cite in its favor. In this paper, I argue that differential punishment violates retributive justice because it contributes to structural racial oppression. Over the course of developing and defending this claim, I identify the shortcomings of both comparative egalitarianism and respectarianism, which is the most popular and plausible brand of noncomparativism. (shrink)

Andrew Eshleman has argued that atheists can believe in God by being fully engaged members of religious communities and using religious discourse in a non-realist way. He calls this position 'fictionalism' because the atheist takes up religion as a useful fiction. In this paper I critique fictionalism along two lines: that it is problematic to successfully be a fictionalist and that fictionalism is unjustified. Reflection on fictionalism will point to some wider problems with religious anti-realism.

The rapid development of COVID-19 vaccines in 2020 involved an unprecedented clinical research initiative. The case here involves a Phase I clinical trial of “second-generation” COVID-19 vaccines d...

While Hume has often been held to have been an agnostic or atheist, several contemporary scholars have argued that Hume was a theist. These interpretations depend chiefly on several passages in which Hume allegedly confesses to theism. In this paper, I argue against this position by giving a threshold characterization of theism and using it to show that Hume does not confess. His most important confession does not cross this threshold and the ones that do are often expressive rather than (...) assertive. I then argue that Hume is best interpreted as an atheist. Instead of interpreting Hume as a proto-logical positivist and arguing on the basis of Hume’s theories of meaning and method, I show that textually he appears to align himself with atheism, that his arguments in the Dialogues on Natural Religion support atheism, and that this position is most consistent with Hume’s naturalism. But, I hold that his atheism is soft and therefore distinct from that of his peers like Baron d’Holbach—while Hume really does reject theism, he neither embraces a dogmatically materialist position nor takes up a purely polemical stance towards theism. I conclude by suggesting several ways in which Hume’s atheistic philosophy of religion is relevant to contemporary discussions. (shrink)

This chapter offers a proceduralist argument against capital punishment. More specifically, it contends that the possibility of irrevocable mistakes precludes the just administration of the death penalty. At stake is a principle of political morality: legal institutions must strive to remedy their mistakes and to compensate those who suffer from wrongful sanctions. The incompatibility of remedy and execution is the crux of the irrevocability argument: because the wrongly executed cannot enjoy the morally required compensation, execution is impermissible. Along with defending (...) his key premises, Yost explains the complicated role that sentencing uncertainty plays in the argument. He concludes by noting some of the flaws in substantive consequentialist and retributivist justifications of capital punishment. (shrink)

Volume 20, Issue 4, May 2020, Page 102-103.

Medical practice should evolve alongside medical ethics. As our understanding of the ethical implications of physician-patient interactions becomes more nuanced, physicians should integrate those lessons into practice. As early as the 1930s, epidemiological studies began to identify that the rates of medical procedures varied significantly along geographic and socioeconomic lines. Dr. J. Alison Glover recognized that tonsillectomy rates in school children in certain school districts in England and Wales were in some cases eight times the rates of children in other (...) districts, with the only significant predictive factors being the current chief medical officer in the area and the socioeconomic well-being of the child's parents. Unfortunately, Dr. Glover's work revealed that the increase in tonsillectomies did not improve the health of adolescent patients and appeared to be performed “as a routine prophylactic ritual for no particular reason and with no particular result.”. (shrink)

In the absence of centralized human rights leadership in an increasingly fragmented global health policy landscape, regional health offices have stepped forward to advance the rights-based approach to health. Reviewing the efforts of the Pan American Health Organization, this article explores the evolution of human rights in PAHO policy, assesses efforts to mainstream human rights in the Pan American Sanitary Bureau, and analyzes the future of the rights-based approach through regional health governance, providing lessons for other regional health offices and (...) global health institutions. This article explores PAHO's 15-year effort to mainstream human rights through PASB technical units, national capacity-building, the Inter-American human rights system, and the PAHO Directing Council. Through documentary analysis of PAHO policies and semi-structured interviews with key PASB stakeholders, the authors analyze the understandings and actions of policymakers and technical officers in implementing human rights through PAHO governance. Analyzing the themes arising from this narrative, the authors examine the structural role of secretariat leadership, state support, legal expertise, and technical unit commitment in facilitating a rights-based approach to the health in the Americas. Human rights are increasingly framing PAHO efforts, and this analysis of the structures underlying PAHO's approach provides an understanding of the institutional determinants of the rights-based approach to health, highlighting generalizable themes for the mainstreaming of human rights through regional health governance. With this regional-level understanding of health governance, future national-level research can begin to understand the causal forces linking regional human rights work with national policy reforms and public health outcomes. (shrink)

In the development of a rights-based approach to global health governance, international organizations have looked to human rights under international law as a basis for public health. Operationalizing human rights law through global health policy, the World Health Organization has faced obstacles in efforts to mainstream human rights across the WHO Secretariat. Without centralized human rights leadership in an increasingly fragmented global health policy landscape, regional health offices have sought to advance human rights in health governance and support states in (...) realizing a rights-based approach to health. Examining the efforts of the Pan American Health Organization, this article explores the evolution of human rights in PAHO policy, assesses the mainstreaming of human rights in the Pan American Sanitary Bureau, and analyzes the future of the rights-based approach through regional health governance. (shrink)

Clinical evidence suggests that many patients undergo surgery that they would decline if fully informed. Failure to communicate the relevant risks, benefits, and alternatives of a procedure violates medical ethics and wastes medical resources. Integrating shared decision-making, a method of communication between provider and patient, into medical decisions can satisfy physicians' ethical obligations and reduce unwanted procedures. This article proposes a three-step process for implementing a nationwide practice of shared decision-making: create model integration programs; provide legal incentives to ease the (...) transition; and incorporate shared decision-making into medical necessity determinations. (shrink)

Most readers believe that it is difficult, verging on the impossible, to extract concrete prescriptions from the ethics of Emmanuel Levinas. Although this view is largely correct, Levinas’ philosophy can, with some assistance, generate specific duties on the part of legal actors. In this paper, I argue that the fundamental premises of Levinas’ theory of justice can be used to construct a prohibition against capital punishment. After analyzing Levinas’ concepts of justice, responsibility, and interruption, I turn toward his scattered remarks (...) on legal institutions, arguing that they enable a sense of interruption specific to the legal domain. It is here that we find the conceptual resources most important to my Levinasian abolition. I argue that the interruption of legal justice by responsibility implies what I call the principle of revisability. The principle of revisability states a necessary condition of just legal institutions: To be just, legal institutions must ensure the possibility of revising any and all of their rules, principles, and judgments. From this, the argument against capital punishment easily follows. Execution is a legal act, perhaps the only legal act, that cannot be undone. An application of the principle of revisability to this fact leads to the conclusion that legal institutions cannot justly impose capital punishment. After defending these points at length, I conclude with some observations on the consequences of the principle of revisability for law more generally. (shrink)

The first part of this chapter defends the claim that the over-incarceration of disadvantaged social groups is unjust. Many arguments for penal reform are based on the unequal distribution of punishment, most notably disproportionate punishment of the poor and people of color. However, some philosophers use a noncomparative conception of desert to argue that the justice of punishment is independent of its distribution. On this view, which has significant influence in 14th Amendment jurisprudence, unequal punishment is not unjust. After detailing (...) the “noncomparativist challenge,” this chapter argues that Levinasian conceptions of desert enable a theory of penal justice according to which comparative considerations are essential. In so doing, it shows that the noncomparativist challenge can be met. The chapter concludes by considering whether Levinasian conceptions of desert and responsibility show members of socially advantaged groups to be more blameworthy for their wrongdoing than members of disadvantaged groups. (shrink)

The Office of Human Research Protections was not justified in issuing findings against the SUPPORT Institutions. Our community can learn from the evolving healthcare transformation into learning health systems by thinking about the novel ethical issues about standard of care research raised by the SUPPORT with the same spirit of quality improvement. The current regulatory framework and the concept of foreseeable research risks is insufficient to advance the debate about the ethics of randomization of standard clinical interventions. This article uses (...) the example of the Wisconsin cystic fibrosis randomized clinical trial for newborn screening trial to explore the distinctions between risks of research and clinical care and waivers of informed consent for randomization. Collaborative exploration of these complex policy issues is needed and further deliberation, community engagement, and social science research will be critical to advance novel approaches for informed consent. (shrink)

This review essay looks at Andrew Brei’s edited volume, Ecology, ethics and hope, Candis Callison’s How climate change comes to matter: The communal life of facts, Randall Curren and Ellen Metzger’s Living well now and in the future: Why sustainability matters, Willis Jenkins’ The future of ethics: Sustainability, social justice, and religious creativity, and Byron Williston’s The Anthropocene project: Virtue in the age of climate change. These recent works highlight various normative approaches for engaging with what is often referred to (...) as the Anthropocene. Drawing on virtue ethics, pragmatism, and concepts such as intergenerational justice, they seek to address some of the defining moral challenges of our time: how we should respond to this unprecedented era of anthropogenic climate and environmental change, and what ethical resources we can draw on to guide our response. On a larger level, they reveal how the climate crisis is testing the limits of our current moral systems and helping to drive greater ethical innovation and adaptation in the process. (shrink)

This paper argues that it is prudentially wise to defer to groups about how they are essentially constituted and defined. After a few words situating the paper in my greater research project (§1), I articulate the kind of deference I have in mind (§2). Then I offer two conditional arguments on why it is epistemically desirable to let other people tell you how they ought to be identified (§3). The first argument is that people are owed lexical sovereignty because denying (...) it is absurd; the second is that modest skeptics ought to agree with it on the basis of some relatively anodyne and plausible epistemic considerations. (shrink)

In this paper I argue that Poston and Dougherty's attempt to undermine the problem of divine hiddenness by using the notion of belief de re is problematic at best. They hold that individuals who appear to be unbelievers (because they are de dicto unbelievers) may actually be de re believers. I construct a set of conditions on ascribing belief de re to show that it is prima facie implausible to claim that seemingly inculpable and apparent unbelievers are really de re (...) believers. Thus, while it is indeed possible that a de dicto unbeliever is a de re believer, it is unlikely that this has sufficiently general application to actual individuals to alleviate the problem of divine hiddenness. (shrink)

Volume 20, Issue 10, October 2020, Page 90-91.

Artificial intelligence systems advising healthcare professionals will be widely introduced into healthcare settings within the next 5–10 years. This paper considers how this will sit with tort/negligence based legal approaches to compensation for medical error. It argues that the introduction of AI systems will provide an additional argument pointing towards no-fault compensation as the better legal solution to compensation for medical error in modern health care systems. The paper falls into four parts. The first part rehearses the main arguments for (...) and against no-fault compensation. The second explains why it is likely that AI systems will be widely introduced. The third part analyses why it is difficult to fit AI systems into fault-based compensation systems while the final part suggests how no-fault compensation could provide a possible solution to such challenges. (shrink)

This paper explores the possibility that Hobbesian jurisprudence is best understood as a ‘third way’ in legal theory, irreducible to classical natural law or legal positivism. I sketch two potential ‘third theories’ of law -- legal pragmatism and legal dualism -- and argue that, when considered in its broadest sense, Leviathan is best viewed as an example of legal pragmatism. I consider whether this legal pragmatist interpretation can be sustained in the examination of Leviathan’s treatment of civil law, and argue (...) that the pragmatic interpretation can only be successful if we can resolve two textual issues in that chapter. First, while Hobbes argues that law entails the existence of public (sharable) reasons, he does not adequately defend the view that the sovereign is the unique authority over such reasons in all cases, especially as far as they concern known collective emergencies. Second, Hobbes both affirms and denies that a sovereign can fail to do justice, which is paradoxical. Both problems are best resolved by legal pragmatism, though the second problem resists a fully satisfying resolution. The upshot is that, although Leviathan ought to be regarded as an episode of legal pragmatism, there are trade-offs on every reading. (shrink)