BackgroundNusinersen is one of an increasing number of new, expensive orphan drugs to receive authorization. These drugs strain public healthcare budgets and challenge principles for resource allocation. Nusinersen was introduced in the Norwegian public healthcare system in 2018. A national expert group consisting of physicians was formed to oversee the introduction and continuation of treatment in light of specific start and stop criteria.MethodsWe have studied experiences within the expert group with a special emphasis on their application of the start and (...) stop criteria, rationing of treatment, and experienced moral dilemmas. A research interview with six members of the national expert group was performed, then analysed with manifest content analysis. The analysis was supplemented with publically available sources on priority setting and the process leading up to the introduction of nusinersen and the establishment of the expert group.ResultsSixty-six patients have received treatment within the first 25 months since the national expert group’s establishment. Treatment has not been discontinued for any patient. No patients under 18 years of age have been denied treatment, as those who were referred at this age were all deemed to fulfill the start criteria. The expert group has, however, increased geographical treatment equity and facilitated important cooperation at the national level. Furthermore, it has enhanced open and critical discussions of both medical issues and new ethical dilemmas.ConclusionAlthough facilitating equal access to treatment for SMA patients, the national expert group has not discontinued treatment for any patient. It is suggested that in order for clinicians to be able to ration care for individual patients, they require both adequate support and sufficient formal authority. Start and stop criteria need to be re-evaluated as more knowledge and experience are gained regarding the treatment. (shrink)

Through publicness we offer a reconceptualization of marginality in the city, one that makes apparent the “inherent porosity” of the boundaries that organize urban life (Harvey 2006, 19). Our analysis attends to moments of publicness during fieldwork spent in various spaces within the city of Ottawa, Ontario, with individuals who use drugs and/or panhandle. Much of this research took place in central neighborhoods of Ottawa, which serve as the public image of the nation’s capital: Lowertown to the East of Parliament (...) Hill, and Centretown to the South. These neighborhoods hold the largest concentration of national and historical monuments in the city. They also contain the largest concentration of public marginality, including a cluster of homeless shelters and harm reduction services. In this article we examine this paradox of urban marginality and the limits of exclusion for conceptualizing it. While marginal individuals are deemed invisible, unimportant, and apart from “normal” city life, they are present and visible, perhaps more visible than anyone else. Even from marginal positions individuals remain affective participants in the space of the city, and constitutive of the urban experience. (shrink)

A collection of newly commissioned papers on themes from David Albert's Time and Chance (HUP, 2000), with replies by Albert. Introduction [Barry Loewer, Brad Weslake, and Eric Winsberg] I. Overview of Time and Chance 1. The Mentaculus: A Probability Map of the Universe [Barry Loewer] II. Philosophical Foundations 2. The Metaphysical Foundations of Statistical Mechanics: On the Status of PROB and PH [Eric Winsberg] 3. The Logic of the Past Hypothesis [David Wallace] 4. In What Sense Is the Early (...) Universe Fine-Tuned? [Sean M. Carroll] 5. The Meta-Reversibility Objection [Christopher J. G. Meacham] 6. Typicality versus Humean Probabilities as the Foundation of Statistical Mechanics [Dustin Lazarovici] 7. The Past Hypothesis and the Nature of Physical Laws [Eddy Keming Chen] 8. On the Albertian Demon [Tim Maudlin] III. Underwriting the Asymmetries of Knowledge and Intervention 9. Reading the Past in the Present [Nick Huggett] 10. Causes, Randomness, and the Past Hypothesis [Mathias Frisch] 11. Time, Flies, and Why We Can’t Control the Past [Alison Fernandes] 12. The Concept of Intervention in Time and Chance [Sidney Felder] Conclusion [David Albert]. (shrink)

In A Metaphysics for Freedom, Helen Steward argues that agents settle things when they act, and that in order for agents to settle things, the universe must be indeterministic. Steward suggests a ‘weak’ account of settling, on which settling is compatible with determinism, but she rightly claims that this weak account is unacceptable. In this paper, I argue that the weak account of settling is not the best account of settling available to the compatibilist. In the first part of this (...) paper, I present a ‘strong’ compatibilist account of settling, and argue that this account avoids the problems faced by the weak account. In the second part of this paper, I argue against Steward's claim that compatibilist accounts of settling must depend on the truth of causal theories of action. (shrink)

This article explores an important section of Jean-Paul Sartre’s famous early work, Being and Nothingness. In that section Sartre proposes that part of the human condition is to actively engage in a particular kind of self-deception he calls bad faith. Bad faith is recognized by the obvious inconsistency between the purported self-knowledge of an individual and ways of acting and being in the world that are demonstrably in defiance of that stated position. This article begins by exploring examples of this (...) self-deception in education along with a short query into the role pain avoidance might play in the development of this particular skill. The article then goes on to offer a series of manifestations of bad faith that Sartre identified along with possible examples of how each example, perhaps ‘excuse’, of bad faith might appear in education. (shrink)

A short core model induction proof of $\mathsf {AD}^{L(\mathbb {R})}$ from $\mathsf {TD} + \mathsf {DC}_{\mathbb {R}}$.

Prompted by Derrida's work on the animal-fable in eighteenth-century debates about political power, this article examines the role played by the fiction of the animal in thinking of pity as either a natural virtue (in Rousseau's Second Discourse) or as a natural passion (in Mandeville's The Fable of the Bees). The war of fables between Rousseau and Mandeville – and their hostile reception by Samuel Johnson and Adam Smith – reinforce that the animal-fable illustrates not so much the proper of (...) man as the possibilities and limitations of a moral philosophy that is unable to address the political realities of the state. (shrink)

Ethics, Policy & Environment, Volume 15, Issue 1, Page 51-56, March 2012.

A central theme of the unified framework for addiction advanced by Redish et al. is that there exists a common value or incentive process controlling Pavlovian and instrumental conditioning. Here we briefly review evidence from a variety of sources demonstrating that these incentive processes are in fact independent. Clearly the influence of Pavlovian predictors and goal values on choice offer distinct potential targets for pathologies of decision-making.

We prove covering theorems for K, where K is the core model below the sharp for a strong cardinal, and give an application to stationary set reflection.

I argue that the metaphysical import of the Aharonov-Bohm effect has been overstated: correctly understood, it does not require either rejection of gauge invariance or any novel form of nonlocality. The conclusion that it does require one or the other follows from a failure to keep track, in the analysis, of the complex scalar field to which the magnetic vector potential is coupled. Once this is recognised, the way is clear to a local account of the ontology of electrodynamics ; (...) I sketch a possible such account. (shrink)

One of the tasks of Jean‐Paul Sartre's later work was to consider how an individual could live freely within a free community. This paper examines how Sartre describes the process of group formation and the implications of this discussion for education. The paper begins with his metaphor of a bus queue in order to describe a series. Then, by means of Sartre's analysis of the storming of the Bastille, the discussion expands to show how a series becomes a genuine group. (...) Finally, suggestions are offered, extrapolated from Sartre's theorizing about groups, as to how teachers might create and maintain genuine groups in and across schools rather than having them remain merely collections of individuals organized from outside. Throughout the paper, the implications of Sartre's insights into groups and educational settings are examined. (shrink)

Many recent discussions of psychopaths have centered on the question of whether they can express ill-will when they act, a capacity which is generally taken to be required for moral blameworthiness. However, the debate over ill-will currently stands at an impasse; the participants are in substantial agreement as to which attitudes psychopaths can express, but disagree as to which attitudes count as ill-will. I argue that this impasse reflects an underlying, implicit disagreement as to which features of actions are wrong-making. (...) By uncovering this implicit disagreement and addressing it head-on, we should be able to break the impasse. (shrink)

Particularism takes an extremely ecumenical view of what considerations might count as reasons and thereby threatens to ‘flatten the moral landscape’ by making it seem that there is no deep difference between, for example, pain, and shoelace color. After all, particularists have claimed, either could provide a reason provided a suitable moral context. To avoid this result, some particularists draw a distinction between default and non-default reasons. The present paper argues that all but the most deflationary ways of drawing this (...) distinction are either implausible or else insufficient to help the particularist avoid flattening the moral landscape. The difficulty can be avoided, however, if we reject particularism's extremely ecumenical view of reasons. (shrink)

What place, if any, moral principles should or do have in moral life has been a longstanding question f or moral philosophy. For some, the proposition that moral philosophy should strive to articulate moral principles has been an article of faith. At least since Aristotle, however, there has been a rieh counter-tradition that questions the possibility or value of trying to capture morality in principled terms. In recent years, philosophers who question principled approaches to morality have argued under the banner (...) of moral particularism. Particularists can be found in diverse areas of philosophical inquiry, and their positions and arguments are of broad interest. Despite its importance, a proper evaluation of particularism has been hindered both by the diversity of arguments employed to defend it, and, perhaps more significantly, by the diversity of positions that can fairly claim to be particularist. (shrink)

Emmanuel Levinas's Totality and Infinity (1961) is explicitly con cerned with the suppression of the voice of the Other by the synoptic totalizations of the voice of western philosophy. Levinas contests this emergence of Being and the systems of totality it indicates with the irruption of the face of the other, which signifies through contact and sensibility the presence of infinity within the human situation. Derrida's reading of this fundamental testing of western ontology rests on the accusation that western philosophy (...) already has a term for this: empiricism. That is, Derrida exposes an alien voice within Levinas's exposure of the voice alienated from ontological formulations. In the later Otherwise than Being or Beyond Essence (1974) Levinas implic itly recognizes the truth of Derrida's demonstration of a residual con ceptualism, and shifts from the thematization of infinite exteriority given by the Other, alterity and the face-to-face relation, to the search for a signifyingness that will breach the noema's identificational closure, that is, to the direct and exposed gesture of saying. Both the limit terms of Totality and Infinity and the response they produced in Derrida have become the starting-point of Otherwise than Being or Beyond Essence: the testimony that is irreducible to a thematizing knowledge. What saves this saying from becoming in its turn another theme is that, in addition to its acting in the text, it acts upon and as HISTORY OF THE HUMAN SCIENCES Vol. 10 No. 3 © 1997 SAGE Publications (London, Thousand Oaks and New Delhi) [0952-6951(199708)10:3] the text. The vocabulary, form of composition and mode of address of Otherwise than Being or Beyond Essence strain against their inherited limits. And the work this obliges the reader to undergo is, of course, an ethical necessity, given the work's message. (shrink)

Cicero's letters are saturated with learned philosophical allusions and arguments. This innovative study shows just how fundamental these are for understanding Cicero's philosophical activities and for explaining the enduring interest of his ethical and political thought. Dr McConnell draws particular attention to Cicero's treatment of Plato's Seventh Letter and his views on the relationship between philosophy and politics. He also illustrates the various ways in which Cicero finds philosophy an appealing and effective mode of self-presentation and a congenial, pointed medium (...) for talking to his peers about ethical and political concerns. The book offers a range of fresh insights into the impressive scope and sophistication of Cicero's epistolary and philosophical practice and the vibrancy of the philosophical environment of the first century BC. A new picture emerges of Cicero the philosopher and philosophy's place in Roman political culture. (shrink)

This article explores one of the key themes of Hans J. Morgenthau's moral theory, the concept of the lesser evil. Morgenthau developed this concept by reference to classical political theory, especially the articulation of the lesser evil found in Aristotle and Epicurus. The article begins by differentiating Morgenthau's work from that of E. H. Carr, whom he regards as engaged in a Quixotic quest to provide Machiavellism with greater ethical purpose. The article also contrasts the ethics of the lesser evil (...) with Kantian ethics. Morgenthau places the lesser evil in the context of a modernity that has lost the capacity to think about the relationship between politics and morality and stresses the importance of coming to grips with the existential demands of love and power. Finally, the article argues that despite the ubiquity of evil, the existence of the lesser evil gives rise to the development of specifically political virtues such as prudence and moderation which raise the possibility of moral politics beyond mere expedience. (shrink)

Commonsense psychological explanation of action upon objects seems to require not only reference to agents’ demonstrative beliefs about the objects acted upon but also the de re ascription of these demonstrative beliefs. There is an influential objection, however, to the de re component: since de re ascriptions permit the attribution to agents of inconsistent attitudes about the objects acted upon, they cannot explain (or predict) agents’ actions upon those objects. This paper answers the objection by presenting a contextualist theory of (...) de re action explanation according to which agents’ beliefs about objects are logically fragmented. (shrink)

This article examines whether vision in Plato’s Timaeus can realize its primary function of permitting humans to stabilize their misaligned orbits of intelligence by getting to know the universe’s orbits as revealed through the heavenly bodies’ movements. I consider a concern that Timaeus, while seemingly requiring nocturnal vision for this purpose, appears to preclude its possibility, thereby threatening the dialogue’s internal coherence. I then argue that Timaeus has the resources to overcome this worry and to provide a philosophically cogent account (...) of nocturnal vision. (shrink)

This commentary shall focus on the central claim made in Lynch et al.’s paper “Promoting Ethical Payment in Human Infection Challenge Studies.” According to their paper, there is a threefold...

This paper argues against the sufficiency of Alvin Plantinga’s free will defense, as presented in God, freedom, and evil as a response to the logical problem of evil. I begin by introducing the fundamental issues present in the problem of evil and proceed to present Plantinga’s response. Next, I argue that, despite the argument’s wide acceptance in the field, a central notion to the defense, transworld depravity, is internally inconsistent and that attempts to resolve the problem would result in an (...) abandonment of the original terms of the discussion. Finally, I consider some potential alternatives for a free will defense beyond the one presented by Plantinga and conclude that the logical problem of evil may have more worth as a philosophical topic than has been thought in recent years. (shrink)

Tough Choices: Bringing Moral Issues Home is a unique resource for use in Catholic high schools and parish religious education or youth ministry programs. It provides concrete ways for teenagers to learn about, apply, and make choices involving a number of current and practical moral issues. However, the real uniqueness of the material is that it suggests ways for these dilemmas to be shared and discussed between the teens and their parents. How so?

A drug overdose epidemic in North America has sped the expansion of harm reduction services. Drawing on fieldwork in Ottawa, Ontario, we examine forms of care among people offering and accessing these resources. Notably, our interlocutors do not always characterize harm reduction as caring for oneself. Thus, we differentiate between the ethics of care through which one enters desired subject positions, and anethical careful practices. Harm reduction is sometimes anethical, enacted through minor gestures that do not constitute ethical work but (...) allow for its future realization. Une épidémie d’overdose de drogue en Amérique du Nord a accéléré l’expansion des services de réduction des risques. En s’appuyant sur un travail de terrain à Ottawa, Ontario, nous examinons les formes de souci et soin parmi les personnes qui fournissent ces ressources et qui y ont accès. Tout particulièrement, nos interlocuteurs ne caractérisent pas toujours la réduction des risques comme le souci de soi. Ainsi, nous faisons la différence entre l’éthique du souci de soi et des soins par laquelle on entre dans les positions de sujets souhaitées, et les pratiques soignantes anéthiques. La réduction des risques est parfois anéthique, mise en œuvre par des gestes mineurs qui ne constituent pas un travail éthique mais permettent sa réalisation future. (shrink)

The modern lawyer operates within a conception of law as a body of rules. To confront the law of contract, of torts, or of property, is to familiarize oneself with an intricate set of rules. Such familiarity is not yet legal scholarship, much less legal practice. For in order to use the rules as lawyers use them, the rules must be contemplated and considered, and the relationship between the different rules must be understood. Because the intellectual processes involved in handling (...) the rules exhibit a high degree of sophistication, those intellectual processes may themselves become the subject matter of philosophical argument. Thus we may regard jurisprudential theories as embodying differing understandings of the processes of handling legal rules; and we may conceive of legal theory as the attempt to grasp the moral significance of rules as a foundation for social order. This essay shall offer some thoughts on the relationship between the rule of law, considered as a moral ideal, and the notion of rules as the principal means by which legal order is manifested. (shrink)