Attempts to justify the patent system can be based on three grounds: (1) natural rights; (2) distributive justice; and (3) utilitarian (economic) arguments. Each of these arguments is problematic in many ways. The first two are dealt with very briefly. The utilitarian argument is discussed more in depth.

An ‘Information Centre’ has recently been established by law which has the power to collect, collate and provide access to the medical information forall patients treated by the National Health Service in England, whether in hospitals or by General Practitioners. This so-called ‘care.data’ scheme has given rise to major and ongoing controversies. We will sketch the background of the scheme and look at the responses it has elicited from citizens and medical professionals. In Autumn 2013, NHS England set up a (...) care.data website where citizens could record their concerns regarding the collection of health-related data by the Information Centre. We have reviewed all the comments on this website up until June 2015. We have also analysed the readers’ comments on the coverage of the care.data scheme in one of the main national UK newspapers. When discussing the responses of citizens, we will make a distinction between the problems that citizens detect and the solutions they propose. The solutions that are being perceived as the most relevant ones can be summarized as follows: citizens wish to further the common good without being manipulated into doing it, while at the same time being safeguarded against various abuses. The issue of trust turns out to figure prominently. Our analysis of reactions to the scheme in no way pretends to be exhaustive, yet it provides various relevant insights into the concerns identified by citizens as well as medical professionals. These concerns, moreover, have a more general relevance in relation to other contexts of medical data-mining as well as biobank research. Our analysis also offers important pointers as to how those concerns might be addressed. (shrink)

Management of the renewable natural resources in Madagascar is gradually being transferred to the local communities, particularly that of forest resources. However, these local communities are struggling to assess the consequences of management plans that they themselves must develop and implement on ecologically, economically and socially sustainable grounds. In order to highlight key aspects of different management options beforehand, we have developed MIRANA, a computer model to simulate various scenarios of management plan implementation. MIRANA differs from other simulation models by (...) not only taking into account individual practices and economic exchanges, but also by accounting for the applicable regulations. These regulations are taken into consideration by means of a multiplicity of normative structures within a spatial context. The objective of this paper is to describe the representations of institutions, norms and territories proposed by MIRANA and to discuss these representations in relation to the state of the art in the field of normative multi-agent systems. (shrink)

Research regarding the drivers of acceptance of clinical decision support systems by physicians is still rather limited. The literature that does exist, however, tends to focus on problems regarding the user-friendliness of CDSS. We have performed a thematic analysis of 24 interviews with physicians concerning specific clinical case vignettes, in order to explore their underlying opinions and attitudes regarding the introduction of CDSS in clinical practice, to allow a more in-depth analysis of factors underlying acceptance of CDSS. We identified three (...) general themes from the results. First, ‘the perceived role of the AI’, including items referring to the tasks that may properly be assigned to the CDSS according to the respondents. Second, ‘the perceived role of the physician’, referring to the aspects of clinical practice that were seen as being fundamentally ‘human’ or non-automatable. Third, ‘concerns regarding AI’, including items referring to more general issues that were raised by the respondents regarding the introduction of CDSS in general and/or in clinical medicine in particular. Apart from the overall concerns expressed by the respondents regarding user-friendliness, we will explain how our results indicate that our respondents were primarily occupied by distinguishing between parts of their job that should be automated and aspects that should be kept in human hands. We refer to this distinction as ‘the division of clinical labor.’ This division is not based on knowledge regarding AI or medicine, but rather on which parts of a physician’s job were seen by the respondents as being central to who they are as physicians and as human beings. Often the respondents’ view that certain core parts of their job ought to be shielded from automation was closely linked to claims concerning the uniqueness of medicine as a domain. Finally, although almost all respondents claimed that they highly value their final responsibility, a closer investigation of this concept suggests that their view of ‘final responsibility’ was not that demanding after all. (shrink)

ABSTRACTMore than a third of the world's population has no access to essential drugs. More than half of this group of people live in the poorest regions of Africa and Asia. Several factors determine the accessibility of drugs in developing countries. Hardly any medicines for tropical diseases are being developed, but even existing drugs are often not available to the patients who need them.One of the important determinants of access to drugs is the working of the patent system. This paper (...) first maps out some facts about the global patent regime that has emerged as a consequence of the conclusion of the WTO‐TRIPs Agreement in 1994. Attempts to construct a moral justification of the patent system have been based on three grounds: natural rights, distributive justice, and utilitarian arguments. This paper examines to what extent and on which grounds drug patents can be justified. The final section looks at the so‐called ‘Doha Declaration on the TRIPs Agreement and Public Health’, which was adopted by the WTO Ministerial Conference two years ago, recognising the primacy of public health over the interests of patent proprietors. (shrink)

Continuous sedation until death is an increasingly common practice in end-of-life care. However, it raises numerous medical, ethical, emotional and legal concerns, such as the reducing or removing of consciousness, the withholding of artificial nutrition and hydration, the proportionality of the sedation to the symptoms, its adequacy in actually relieving symptoms rather than simply giving onlookers the impression that the patient is undergoing a painless 'natural' death, and the perception that it may be functionally equivalent to euthanasia. This book brings (...) together contributions from clinicians, ethicists, lawyers and social scientists, and discusses guidelines as well as clinical, emotional and legal aspects of the practice. The chapters shine a critical spotlight on areas of concern and on the validity of the justifications given for the practice, including in particular the doctrine of double effect. (shrink)

This paper examines the effect that focus has on repetitive versus restitutive again. It is argued that a pragmatic explanation of the effect is the right strategy. The explanation builds largely on a standard focus semantics. To this we add an anaphoric analysis of again’s presupposition and a detailed analysis of the alternatives triggered when focus falls on again.

A semantics for interrogatives is presented which is based on Karttunen's theory, but in a flexible manner incorporates both weak and strong exhaustivity. The paper starts out by considering degree questions, which often require an answer picking out the maximal degree from a certain set. However, in some cases, depending on the semantic properties of the question predicate, reference to the minimal degree is required, or neither specifying the maximum nor the minimum is sufficient. What is needed is an operation (...) which defines the maximally informative answer on the basis of the Karttunen question denotation. Shifting attention to non-degree questions, two notions of answerhood are adopted from work by Heim. The first of these is weakly exhaustive and the second strongly exhaustive. The second notion of answerhood is proven to be equivalent to Groenendijk and Stokhof's interrogative semantics. On the basis of a wide range of empirical data showing that questions often are not interpreted exhaustively, it is argued that a fairly rich system of semantic objects associated with questions is needed to account for the various ways in which questions contribute to the semantics and pragmatics of the utterances in which they appear. (shrink)

Limits of a (historico-)philosophical discourse vis-a-vis the rutpure in the fabric of civilization marked by the shoah. Examines the textual place of those aspects of history which elude rational analysis.

The paper provides a semantic analysis of intervention effects in wh-questions. The interpretation component of the grammar derives uninterpretability, hence ungrammaticality, of the intervention data. In the system of compositional interpretation that I suggest, wh-phrases play the same role as focused phrases, introducing alternatives into the computation. Unlike focus, wh-phrases make no ordinary semantic contribution. An intervention effect occurs whenever a focus-sensitive operator other than the question operator tries to evaluate a constituent containing a wh-phrase. It is argued that this (...) approach can capture the universal as well as the crosslinguistically variable aspects of intervention effects, in a way that is superior to previous approaches. Further consequences concern other focus-related constructions: multiple focus data, NPI licensing, and alternative questions. (shrink)

Since the adoption of the WTO-TRIPS Agreement in 1994, there has been significant controversy over the impact of pharmaceutical patent protection on the access to medicines in the developing world. In addition to the market exclusivity provided by patents, the pharmaceutical industry has also sought to further extend their monopolies by advocating the need for additional ‘regulatory’ protection for new medicines, known as data exclusivity. Data exclusivity limits the use of clinical trial data that need to be submitted to the (...) regulatory authorities before a new drug can enter the market. For a specified period, generic competitors cannot apply for regulatory approval for equivalent drugs relying on the originator's data. As a consequence, data exclusivity lengthens the monopoly for the original drug, impairing the availability of generic drugs. This article illustrates how the pharmaceutical industry has convinced the US and the EU to impose data exclusivity on their trade partners, many of them developing countries. The key arguments formulated by the pharmaceutical industry in favor of adopting data exclusivity and their underlying ethical assumptions are described in this article, analyzed, and found to be unconvincing. Contrary to industry's arguments, it is unlikely that data exclusivity will promote innovation, especially in developing countries. Moreover, the industry's appeal to a property rights claim over clinical test data and the idea that data exclusivity can prevent the generic competitors from ‘free-riding’ encounters some important problems: Neither legitimize excluding all others. (shrink)

More than a third of the world's population has no access to essential drugs. More than half of this group of people live in the poorest regions of Africa and Asia. Several factors determine the accessibility of drugs in developing countries. Hardly any medicines for tropical diseases are being developed, but even existing drugs are often not available to the patients who need them.One of the important determinants of access to drugs is the working of the patent system. This paper (...) first maps out some facts about the global patent regime that has emerged as a consequence of the conclusion of the WTO‐TRIPs Agreement in 1994. Attempts to construct a moral justification of the patent system have been based on three grounds: natural rights, distributive justice, and utilitarian arguments. This paper examines to what extent and on which grounds drug patents can be justified. The final section looks at the so‐called ‘Doha Declaration on the TRIPs Agreement and Public Health’, which was adopted by the WTO Ministerial Conference two years ago, recognising the primacy of public health over the interests of patent proprietors. (shrink)

Three attempts are usually made to justify patents: natural rights, distributive justice, and consequentialist arguments, all of which I contest.The natural rights argument is traced back to John Locke, defender of the ‘labour theory of property,’ who essentially holds that persons have a right to property insofar as they have mixed their labour with it, and insofar as they have appropriated natural things without exhausting them or taking more than their share. Yet, the inventor’s mixing of labour is often the (...) last step of a longer historical process, and patents seem to encourage waste, since they restrict the use of an idea.The distributive justice argument holds that patents reward the initiative of inventors – with out this reward, ‘free riders’ would be able to compete unfairly; the exclusivity granted by patents corrects this hole in the free market. However, our current system does not necessarily reflect this principle; it is difficult to clarify the criteria on which an inventor deserves a reward; unsuccessful inventors and basic researchers also invest much initiative, and yet are not rewarded; it is unclear that justice should reward someone by granting them the exclusive right to determine what is done with knowledge; and no link exists between the social usefulness of an invention and the scope of protection granted by a patent.The consequentialist justification holds that patents encourage innovation, and the disclosure of knowledge. Although it is clear that patents encourage inventions, it is not clear that they encourage progress – they may even limit progress by restricting use of previous knowledge. As for the disclosure of knowledge: such knowledge is hard to keep secret in the first place, and patent offices grant overly broad patents.In conclusion, this paper offers some suggestions concerning the true costs of the patent system. (shrink)

This paper investigates the semantics of adverbials like ‘page by page’ and ‘stone upon stone’. An analysis is developed in which sentences containing such adverbials have a pluractional semantics; that is, pluralization affects simultaneously the event- and the individual-argument slot of a predicate. Sternefeld's system of plural operators is used and extended for this purpose. The adverbial constrains the relation that is pluralized and makes visible a higher plural operator. In the case of ‘page by page’-type adverbials, this is a (...) fairly standard operator that leads to a simple divisional interpretation. In the case of ‘stone upon stone’-type adverbials, the operator has a stronger semantics that leads to a sequence interpretation. The generality of our theory permits straightforward extension to data like ‘she ran and ran’ and ‘she climbed higher and higher’, among others. Finally we propose that inclusive alternative ordering reciprocals have a pluractional sequence interpretation as well. (shrink)

This essay discusses totalitarian theories with regard to their capacity to interpret in a normatively plausible way such different dictatorships as Nazism, Stalinism and post-Stalinism. In contrast to theoretical approaches which subsume all these regimes under a single concept (totalitarianism as total control), it argues in favor of discerning terror and ideology as main characteristics (totalitarianism as extermination). The focus on National Socialism and Stalinism needs further differentiation. Theories of bureaucratic structures and charismatic domination may help in distinguishing both regimes' (...) very particularities; at the same time, however, they seem to fail relevant aspects of historical reality. (shrink)

This article investigates a multiparty interaction in an accounting office by applying a multimodal approach to discourse. This approach allows the incorporation of all relevant communicative modes and is based on the following three notions: 1) the notion of mediated action; 2) the notion of modal density; and 3) the notion of a foreground– background continuum of attention/awareness. The article illustrates that a social actor in a multiparty interaction simultaneously co-constructs several higher-level actions with the various participants on different levels (...) of their attention/awareness. On a theoretical level, the article argues that traditional approaches to discourse analysis, with their unconditional focus on language as the primary mode, misconstrue the multiple higher-level actions that a social actor is engaged in simultaneously as dyadic or triadic interactions in quick succession. (shrink)

This paper proposes that elementary reciprocal sentences have four semantic readings: a strongly reciprocal interpretation, a weakly reciprocal interpretation, a situation-based weakly reciprocal reading, and a collective reading. Interpretational possibilities of reciprocal sentences that have been discussed in the literature are identified as one of these four. A compositional semantic analysis of all of these readings is provided in which the reciprocal expression is uniformly represented as 'the other ones among them' (recasting Heim, Lasnik and May 1991a, b). A reciprocal (...) sentence is thus a special kind of relational plural. Interpretational variability comes about by the same mechanisms of plural predication at work in relational plurals: pluralization operators, LF operations like QR, and addition of contextual information. (shrink)

In this paper I argue for a restriction on certain types of LF movement, which I call ‘wh-related LF movement’. Evidence comes from a number of wh-in-situ constructions in German, such as the scope-marking construction and multiple questions. For semantic reasons, the in situ element in those constructions has to move at LF to either a position reserved for wh-phrases, or even higher up in the structure. The restriction (the Minimal Quantified Structure Constraint, MQSC) is that an intervening quantified expression (...) blocks this movement. In the case of every, the MQSC leads to an unambiguously distributive interpretation of the question. In the case of all other intervening operators, including negation, it leads to ungrammaticality. (shrink)

Wie müssen wir zurückschauen, um Was sehen zu können und darüber unseren Blick für das Gegenwärtige und Kommende zu schärfen?0Die Beiträge des Bandes, der zu Ehren von Sigrid Schade erscheint, beziehen sich auf vielschichtige Diskursgeschichten an den Schnittstellen von Kunst-, Kultur- und Medienwissenschaften. Sie beleuchten künstlerische, kulturelle und soziale Praktiken und Ordnungen als Aushandlungsort komplexer Bedeutungs- und Beziehungsgefüge.

(1) a. Satoshi sent Thilo the Schw¨abische W¨orterbuch. b. Satoshi sent the Schw¨abische W¨orterbuch to Thilo. Many have entertained the notion that there is a rule that relates sentences such as these. This is suggested by the fact that it is possible to learn that a newly coined verb licenses one of them and automatically know that it licenses the other. Marantz (1984) argues for the existence of such a rule in this way, noting that once one has learned of (...) the new verb shin by exposure to (2a), the grammaticality of (2b) is also learned. (2) a. Thilo shinned the ball to Satoshi. b. Thilo shinned Satoshi the ball. This is explained if there is a rule that ties the double object frame together with the NP+PP frame, making it sufficient to know that a verb licenses one if it licenses the other. Frequently, the rule involved has been taken to be syntactic in nature. See, among many others, Fillmore (1965), Oehrle (1976), Baker (1988), and Larson (1988). The leading idea under this view is that the two frames are simply different surface manifestations of the same underlying structure. Typically, this approach posits that the NP+PP frame represents that underlying structure from which the double object frame is transformationally derived. There is evidence, however, that the two frames instead have different underlying structures, and are not related by transformation. This evidence, then. (shrink)

Assembled here for the first time in English translation, Sigrid Weigel and Georgina Paul offer illuminating new insights into Benjamin's theory, combining impulses from post-structuralism, feminism, cultural anthropology and psychoanalysis.

Continuous sedation at the end of life is a practice that has attracted a great deal of attention. An increasing number of guidelines on the proposed correct performance of the practice have been drafted. All of the guidelines stress the importance of using sedation in proportion to the severity of the patient’s symptoms, thus to reduce the patient’s consciousness no more than is absolutely necessary. As different patients can have different experiences of suffering, the amount of suffering should, ideally, be (...) assessed subjectively; that is, via communication with the patient. Continuously sedated patients are often unable to communicate, however, making subjective methods of pain assessment unusable. For these patients, the degree of consciousness is the sole available measure. It therefore seems important to adequately measure how deeply the patient is sedated, thereby allowing sedation to be increased when it is too light and decreased when it is too heavy. This is in accordance with the idea that reducing consciousness is not an ethically neutral act.Although consciousness measuring techniques are a hot topic in anesthesiology, almost no research exists on the use of such techniques in the context of continuous sedation at the end of life. This article aims to review existing techniques to measure consciousness and to evaluate their applicability, efficiency, and invasiveness for patients who are continuously sedated until death.Techniques commonly used to assess the depth of sedation in continuously sedated patients are basic clinical assessment and sedation scales, as they are often considered reliable and noninvasive. These techniques might not be very reliable, however, since it is known that some patients are nonresponsive and yet aware. Moreover, sedation scales require stimulation of the patient (for example prodding, shaking, or providing painful stimuli), and can thus be considered invasive of one’s bodily integrity or dignity. Other techniques, such as EEG (electroencephalography) derivatives, may score better on reliability and invasiveness. Yet these have so far never been compared to sedation scale scores for patients receiving continuous sedation at the end of life.Therefore, we conclude that, for both clinical and ethical reasons, research into the efficiency and applicability of other techniques, such as derivatives of EEG, are urgently needed. (shrink)

We expand on Della Croce’s ambition to interpret “epistemic injustice” as a specification of non-maleficence in the use of the influential four-principle framework. This is an alluring line of thought for conceptual, moral, and heuristic reasons. Although it is commendable, Della Croce’s attempt remains tentative. So does our critique of it. Yet, we take on the challenge to critically address two interrelated points. First, we broaden the analysis to include deliberations about hermeneutical injustice. We argue that, if due consideration of (...) epistemic injustice is to require more than negative ethical obligations in medicine, dimensions of hermeneutical injustice should be explored as an avenue to arrive at such positive duties. Second, and relatedly, we argue that this may encompass moral responsibilities beyond the individual level, that is: positive obligations to take action on a structural level. Building on Dotson’s concept of “contributory injustice” and Scheman’s concept of “perceptual autonomy,” we suggest that the virtues of testimonial and hermeneutical justice may provide additional content not only to negative prohibitions of action (i.e. non-maleficence) but also to positive requirements of action, like respecting patient autonomy. (shrink)

The article ‘The active recruitment of health workers: a defence’ by Hidalgo1 discusses a highly interesting and relevant topic. It provides, in clear language, a mix of ethical arguments and empirical data, which are used to assess the validity of two arguments that are invoked by some who claim that the active recruitment of health workers from poor countries is morally impermissible. However, the article has two main shortcomings: the analysis is too narrow ; and various elements of the analysis (...) are problematic.The analysis is too narrowIf the question is whether promoting a ‘medical brain-drain’ from poor to rich countries is morally acceptable, then it is not only the actions of the persons soliciting relocation and those considering relocation that need to be considered. Within the status quo and mores of a free market society, these actors may very well be perceived as innocent—it may be the actions of others who maintain the status quo that may be at fault, if fault there is. Consider the question: is it acceptable to sell your slave to anyone, or only to someone who will be kind to her? This invites only the answers or . A potentially unacceptable starting point is presumed to be acceptable. The same problem arises, to some extent, with this article.The emigration of medical professionals clearly falls into two categories : where the country's investment in training the professional is adequately returned through payments by the emigrant to the state—that is, a state of affairs possibly more likely to exist with nurses and other carers who are not so costly to train; and …. (shrink)

An extensive body of research documents that women experience a motherhood penalty at work whereas men experience a fatherhood premium. Yet much of this work presupposes that employers are aware of a worker’s parental status. Given the different consequences that parenthood has on outcomes such as pay and promotions, it is conceivable that men and women may deploy their status as parents differently when interacting with employers. Drawing on in-depth interviews with a racially diverse sample, this article examines how mothers (...) and fathers working in the service sector use their parental status when negotiating work and child care responsibilities. Mothers, particularly black mothers, were less likely to openly discuss their children at work. In some cases, women purposefully concealed from their employers the fact that they were mothers or found other ways of signaling their commitment to their jobs. Fathers, on the other hand, were more likely to discuss their children with their employers and overwhelmingly characterized their managers as understanding of their parenting obligations. Together, these findings help us understand how mothers and fathers navigate the consequences of parenthood in the workplace and add nuance to previous studies of motherhood penalties and fatherhood premiums. (shrink)

Since the 1980s in the US and the 1990s in Europe, patenting and licensing activities by universities have massively increased. This is strongly encouraged by governments throughout the Western world. Many regard academic patenting as essential to achieve ‘knowledge transfer’ from academia to industry. This trend has far-reaching consequences for access to the fruits of academic research and so the question arises whether the current policies are indeed promoting innovation or whether they are instead a symptom of a pro-intellectual property (...) (IP) culture which is blind to adverse effects. Addressing this question requires both empirical analysis (how real is the link between academic patenting and licensing and ‘development’ of academic research by industry?) and normative assessment (which justifications are given for the current policies and to what extent do they threaten important academic values?). After illustrating the major rise of academic patenting and licensing in the US and Europe and commenting on the increasing trend of ‘upstream’ patenting and the focus on exclusive as opposed to non-exclusive licences, this paper will discuss five negative effects of these trends. Subsequently, the question as to why policymakers seem to ignore these adverse effects will be addressed. Finally, a number of proposals for improving university policies will be made. (shrink)

The last decade has seen a new wave of interest in philosophical and theoretical circles in the writings of Walter Benjamin. In _Body-and Image-Space_ Sigrid Weigel, one of Germany's leading feminist theorists and a renowned commentator on the work of Walter Benjamin, argues that the reception of his work has so far overlooked a crucial aspect of his thought - his use of images. Weigel shows that it is precisely his practice of thinking in images that holds the key (...) to understanding the full complexity, richness and topicality of Benjamin's theory. (shrink)

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This article analyses how Benjamin takes Kraus's reference to the creaturely as a symptom of an ahistorical attitude which projects the state of genesis, i.e. the world of God's creatures, into history. It reads the essay on Karl Kraus as a main site for Benjamin's dialectical approach to secularization, which is characterized by the distance both from genesis and redemption. The awareness of the fundamental difference which separates human concepts from biblical ideas or words which may be observed in many (...) of Benjamin's texts forms a kind of leitmotif of his work. It is only from this radical separation that he is able to deal with the echo realm of the sacred in modernity. (shrink)

Grammatology of Images radically alters how we approach images. Instead of asking for the history, power, or essence of images, Sigrid Weigel addresses imaging as such. The book considers how something a-visible gets transformed into an image. Weigel scrutinizes the moment of mis-en-apparition, of making an appearance, and the process of concealment that accompanies any imaging. Weigel reinterprets Derrida's and Freud's concept of the trace as that which must be thought before something exists. In doing so, she illuminates the (...) threshold between traces and iconic images, between something immaterial and its pictorial representation. Chapters alternate between general accounts of the line, the index, the effigy, and the cult-image, and case studies from the history of science, art, politics, and religion, involving faces as indicators of emotion, caricatures as effigies of defamation, and angels as embodiments of transcendental ideas. Weigel's approach to images illuminates fascinating, unexpected correspondences between premodern and contemporary image-practices, between the history of religion and the modern sciences, and between things that are and are not understood as art. (shrink)