In light of many recent critiques of Western modernity and its conceptual foundations, the problem of adequately justifying our most basic moral and political values looms large. Without recourse to traditional ontological or metaphysical foundations, how can one affirm — or sustain — a commitment to fundamentals? The answer, according to Stephen White, lies in a turn to “weak” ontology, an approach that allows for ultimate commitments but at the same time acknowledges their historical, contestable character. This turn, White (...) suggests, is already underway. His book traces its emergence in a variety of quarters in political thought today and offers a clear and compelling account of what this might mean for our late modern self-understanding. (shrink)

Stephen Darwall presents a series of essays that explore the view that morality is second-personal, entailing mutual accountability and the authority to address demands. He illustrates the power of the second-personal framework to illuminate a wide variety of issues in moral, political, and legal philosophy.

In this volume, Stephen M. Gardiner and David A. Weisbach present arguments for and against the relevance of ethics to global climate policy. Gardiner argues that climate change is fundamentally an ethical issue, since it is an early instance of a distinctive challenge to ethical action, and ethical concerns are at the heart of many of the decisions that need to be made. Consequently, climate policy that ignores ethics is at risk of.

"There is no scientist today whose books I look forward to reading with greater anticipation of enjoyment and enlightenment than Stephen Jay Gould."—Martin Gardner Among scientists who write, no one illuminates as well as Stephen Jay Gould doesthe wonderful workings of the natural world. Now in a new volume of collected essays—his sixth since Ever Since Darwin—Gould speaks of the importance of unbroken connections within our own lives and to our ancestralgenerations. Along with way, he opens to us (...) the mysteries of fish tails, frog calls, and other matters, and shows once and for all why we must take notice when a seemingly insignificant creature is threatened, like the land snail Partula from Moorea, whose extinction he movingly relates. (shrink)

Towards the end of his life, Descartes published the first four parts of a projected six-part work, The Principles of Philosophy. This was intended to be the definitive statement of his complete system of philosophy, dealing with everything from cosmology to the nature of human happiness. In this book, Stephen Gaukroger examines the whole system, and reconstructs the last two parts, 'On Living Things' and 'On Man', from Descartes' other writings. He relates the work to the tradition of late (...) Scholastic textbooks which it follows, and also to Descartes' other philosophical writings, and he examines the ways in which Descartes transformed not only the practice of natural philosophy but also our understanding of what it is to be a philosopher. His book is a comprehensive examination of Descartes' complete philosophical system. (shrink)

Hume's Enlightenment Tract is the first full book-length study for forty years of David Hume's Enquiry concerning Human Understanding. The Enquiry has, contrary to its author's expressed wishes, long lived in the shadow of its predecessor, A Treatise of Human Nature. Stephen Buckle presents the Enquiry in a fresh light, and aims to raise it to its rightful position in Hume's work and in the history of philosophy. He argues that the Enquiry is not, as so often assumed, a (...) mere collection of watered-down extracts from the earlier work. It is, rather, a coherent work with a unified argument; and, when this argument is grasped as a whole, the Enquiry shows itself to be the best introduction to the lineaments of its author's general philosophy. Buckle offers a careful guide through the argument and structure of the work. He shows how the central sections of the Enquiry offer a critique of the dogmatic empiricisms of the ancient world, and set in place an alternative conception of human powers based on the sceptical principles of habit and probability. These principles are then put to work, to rule out philosophy's metaphysical ambitions and their consequences: religious systems and their attendant conception of human beings as semi-divine rational animals. Hume's scepticism, experimentalism, and naturalism are thus shown to be different aspects of the one unified philosophy - a sceptical version of the Enlightenment vision. (shrink)

Recent critics have called attention to the alienation of contemporary academics from broad currents of intellectual activity in public culture. The general complaint is that intellectuals are finding a professional home in institutions of higher learning, insulated from the concerns and interests of a wider reading audience. The demands of professional expertise do not encourage academics to work as public intellectuals or to take up social, literary, or political matters in imaginative and perspicuous ways. More problematic is the relative absence (...) of religion in the writings of those who aspire to work as public intellectuals. This essay reviews recent attempts by William Dean, Cornel West, Jean Bethke Elshtain, Stephen Carter, and Robin Lovin to remedy the problem of academic alienation and to address the place of religion in American life. (shrink)

Can we talk meaningfully about God? The theological movement known as Grammatical Thomism affirms that religious language is nonsensical, because the reality of God is beyond our capacity for expression. Stephen Mulhall critically evaluates the claims of this movement to be a legitimate inheritor of Wittgenstein's philosophical methods as well as Aquinas's theological project. The major obstacle to this claim is that Grammatical Thomism makes the nonsensicality of religious language when applied to God a touchstone of Thomist insight, whereas (...) 'nonsense' is standardly taken to be solely a term of criticism in Wittgenstein's work. Mulhall argues that a place can be found in both his early work and his later writings for a more positive role to be assigned to nonsensical utterances--one which depends on exploiting an analogy between religious language and riddles. This allows us to see various ways in which his later work has a perfectionist dimension, and results in a radical reconception of the role of analogous usage in language, and in the relation between philosophy and theology. (shrink)

For serious yoga practitioners curious to know the ancient origins of the art, Stephen Phillips, a professional philosopher and sanskritist with a long-standing personal practice, lays out the philosophies of action, knowledge, and devotion as well as the processes of meditation, reasoning, and self-analysis that formed the basis of yoga in ancient and classical India and continue to shape it today. In discussing yoga's fundamental commitments, Phillips explores traditional teachings of hatha yoga, karma yoga, _bhakti_ yoga, and tantra, and (...) shows how such core concepts as self-monitoring consciousness, karma, nonharmfulness, reincarnation, and the powers of consciousness relate to modern practice. He outlines values implicit in _bhakti_ yoga and the tantric yoga of beauty and art and explains the occult psychologies of _koshas_, _skandhas_, and _chakras_. His book incorporates original translations from the early Upanishads, the _Bhagavad Gita_, the _Yoga Sutra_, the _Hatha Yoga Pradipika_, and seminal tantric writings of the tenth-century Kashmiri Shaivite, Abhinava Gupta. A glossary defining more than three hundred technical terms and an extensive bibliography offer further help to nonscholars. A remarkable exploration of yoga's conceptual legacy, _Yoga, Karma, and Rebirth_ crystallizes ideas about self and reality that unite the many incarnations of yoga. (shrink)

Hume's Enlightenment Tract is the first full book-length study for forty years of David Hume's Enquiry concerning Human Understanding. The Enquiry has, contrary to its author's expressed wishes, long lived in the shadow of its predecessor, A Treatise of Human Nature. Stephen Buckle presents the Enquiry in a fresh light, and aims to raise it to its rightful position in Hume's work and in the history of philosophy. He argues that the Enquiry is not, as so often assumed, a (...) mere collection of watered-down extracts from the earlier work. It is, rather, a coherent work with a unified argument; and, when this argument is grasped as a whole, the Enquiry shows itself to be the best introduction to the lineaments of its author's general philosophy. Buckle offers a careful guide through the argument and structure of the work. He shows how the central sections of the Enquiry offer a critique of the dogmatic empiricisms of the ancient world, and set in place an alternative conception of human powers based on the sceptical principles of habit and probability. These principles are then put to work, to rule out philosophy's metaphysical ambitions and their consequences: religious systems and their attendant conception of human beings as semi-divine rational animals. Hume's scepticism, experimentalism, and naturalism are thus shown to be different aspects of the one unified philosophy - a sceptical version of the Enlightenment vision. (shrink)

James Madison is the thinker most responsible for laying the groundwork of the American commercial republic. But he did not anticipate that the propertied class on which he relied would become extraordinarily politically powerful at the same time as its interests narrowed. This and other flaws, argues Stephen L. Elkin, have undermined the delicately balanced system he constructed. In Reconstructing the Commercial Republic , Elkin critiques the Madisonian system, revealing which of its aspects have withstood the test of time (...) and which have not. The deficiencies Elkin points out provide the starting point for his own constitutional theory of the republic—a theory that, unlike Madison’s, lays out a substantive conception of the public interest that emphasizes the power of institutions to shape our political, economic, and civic lives. Elkin argues that his theory should guide us toward building a commercial republic that is rooted in a politics of the public interest and the self-interest of the middle class. He then recommends specific reforms to create this kind of republic, asserting that Americans today can still have the lives a commercial republic is intended to promote: lives with real opportunities for economic prosperity, republican political self-government, and individual liberty. (shrink)

How did we come to have a scientific culture -- one in which cognitive values are shaped around scientific ones? Stephen Gaukroger presents a rich and fascinating investigation of the development of intellectual culture in early modern Europe, a period in which understandings of the natural realm began to fragment.

The first book to offer an integrated reading of ancient Greek attitudes to laughter. Taking material from various genres and contexts, the book analyses both the theory and the practice of laughter as a revealing expression of Greek values and mentalities. Greek society developed distinctive institutions for the celebration of laughter as a capacity which could bridge the gap between humans and gods; but it also feared laughter for its power to expose individuals and groups to shame and even violence. (...) Caught between ideas of pleasure and pain, friendship and enmity, laughter became a theme of recurrent interest in various contexts. Employing a sophisticated model of cultural history, Stephen Halliwell traces elaborations of the theme in a series of important texts: ranging far beyond modern accounts of 'humour', he shows how perceptions of laughter helped to shape Greek conceptions of the body, the mind and the meaning of life. (shrink)

Bryan Caplan’s The Myth of the Rational Voter treats several immensely important and understudied topics—public ignorance of economics, political ideology, and their connection to policy error—from an orthodox economic perspective whose applicability to these topics is overwhelmingly disproven by the available evidence. Moreover, Caplan adds to the traditional and largely irrelevant orthodox economic notion of rational public ignorance the claim that when voters favor counterproductive economic policies, they do so deliberately, i.e., knowingly. This leads him to assume (without any evidence) (...) that “emotion or ideology” explain mass economic error. Straightforward, unchosen mass ignorance of economic principles—neither “rational” nor “irrational,” but simply mistaken—is a more coherent explanation for economic error, and it is backed up by the vast body of public‐opinion research. (shrink)

In Meaning and Necessity (1947/1950), Carnap advances an intensional semantic framework on which modal claims are true in virtue of semantical rules alone, and so are a priori. In 'Empiricism, Semantics, and Ontology' (1950), Carnap advances an epistemic-ontological framework on which metaphysical claims are either trivial or meaningless, since lacking any means of substantive confirmation. Carnap carried out these projects two decades before Kripke influentially argued, in Naming and Necessity (1972/1980), that some modal claims are true a posteriori. How should (...) a neo-Carnapian respond to Kripke's results? Some (notably, Chalmers and Jackson, in their 2001) have suggested that an extension of intensional semantics along lines of "epistemic two-dimensionalism" can accommodate Kripke's results while largely preserving commitment to the semantics-based a priority of modal claims. Here we consider how best to implement this suggestion, and how the resulting semantics fits with Carnap's second project. We find that the most promising (and most Carnapian!) post-Kripke version of Carnap’s semantics---abductive two-dimensionalism---presupposes an epistemology which undermines Carnap's metaphysical anti-realism. (shrink)

The field of neuroimaging has reached a watershed. Brain imaging research has been the source of many advances in cognitive neuroscience and cognitive science over the last decade, but recent critiques and emerging trends are raising foundational issues of methodology, measurement, and theory. Indeed, concerns over interpretation of brain maps have created serious controversies in social neuroscience, and, more important, point to a larger set of issues that lie at the heart of the entire brain mapping enterprise. In this volume, (...) leading scholars -- neuroimagers and philosophers of mind -- reexamine these central issues and explore current controversies that have arisen in cognitive science, cognitive neuroscience, computer science, and signal processing. The contributors address both statistical and dynamical analysis and modeling of neuroimaging data and interpretation, discussing localization, modularity, and neuroimagers' tacit assumptions about how these two phenomena are related; controversies over correlation of fMRI data and social attributions ; and the standard inferential design approach in neuroimaging. Finally, the contributors take a more philosophical perspective, considering the nature of measurement in brain imaging, and offer a framework for novel neuroimaging data structures. Contributors: William Bechtel, Bharat Biswal, Matthew Brett, Martin Bunzl, Max Coltheart, Karl J. Friston, Joy J. Geng, Clark Glymour, Kalanit Grill-Spector, Stephen José Hanson, Trevor Harley, Gilbert Harman, James V. Haxby, Rik N. Henson, Nancy Kanwisher, Colin Klein, Richard Loosemore, Sébastien Meriaux, Chris Mole, Jeanette A. Mumford, Russell A. Poldrack, Jean-Baptiste Poline, Richard C. Richardson, Alexis Roche, Adina L. Roskies, Pia Rotshtein, Rebecca Saxe, Philipp Sterzer, Bertrand Thirion, Edward Vul The hardcover edition does not include a dust jacket. (shrink)

Historically, male sexual fitness was framed by a patriarchal politics of life centred on regeneration, population and nation. In the later 20th century, as successful ageing became promoted by the lifestyle practices of an idealized healthy and active senior citizenry, traditional gerontocratic power over the sexual risks of youth gave way to a medical sexology concerned with sexual functionality across the lifecourse; in particular, erectility. Recently, erectile dysfunction has expanded to become a population-wide health problem with increasingly refined diagnoses based (...) on `phases', `early warning signs' and preventative regimes, especially as Viagra has become so widely available. This article explores a new bodily configuration in the making; arising, on the one hand, from the pharmacological and scientific technologization of male sexuality, and, on the other, from a contemporary politics of life that both contests the late-life ageism of the past and fosters a mid-life ageism in the present. (shrink)

What might it mean to think of philosophy as being in the condition of modernism -- in which its relation to its own past, and hence its sense of its own future, has become an undismissable problem? If philosophy's hitherto-defining conventions can neither be taken for granted nor rejected, they must be put in question -- which menans re-evealuating the relation between the form and content of philosophical writing, rethinking the demands that such writing must place on its readers, and (...) reconceiving the nature of philosophy itself. Inheritance and Originality argues that the writings of Wittgenstein, Heidegger, and Kierkegaard are best understood as responsive to such questions, and as driven in consequence to strikingly similar reconceptions of language, reason, and understanding, doubt and scepticism, morality, and the structure of selfhood. Through detailed re-readings of these authors' most influential texts, as attentive to their specificity as to their family resemblances, Stephen Mulhall reorients our sense of the philosophical work each text aims to accomplish, to engender a critical dialogue betweeen them from which the elements of a new conception of philosophy might emerge, and to uncover that conception's indebtedness to certain fundamental theological preoccupations. (shrink)

"Growing Moral engages its readers to reflect on and to practice the teachings of Confucianism in the contemporary world. It draws on the whole history of Confucianism, focusing on three thinkers from the classical era and two from the Neo-Confucian era (Zhu Xi and Wang Yangming. In addition to laying out the fundamental teachings of Confucianism, it highlights the enduring and strikingly relevant lessons that Confucianism offers contemporary readers. At its core, this book builds a case for modern Confucianism as (...) a practical way to grow toward more harmonious lives together through reflection, ritual, and compassion; it can help us find balance and joy within our complex and too-often frenetic modern lives. Individual chapter explain how and why to be filial, follow rituals, and cultivate our sprouts of morality; as well as exploring Confucian approaches to reading, music-making, reflection, and socio-political engagement. Overall, the book presents a progressive vision of Confucianism that addresses historical shortcomings within the tradition concerning gender and other forms of hierarchy"--. (shrink)

This paper explores some of the ethical issues around offering COVID-19 vaccines to children. My main conclusion is rather paradoxical: the younger we go, the stronger the grounds for justified parental hesitancy and, as such, the stronger the arguments for enforcing vaccination. I suggest that this is not thereductio ad absurdumit appears, but does point to difficult questions about the nature of parental authority in vaccination cases. The first section sketches the disagreement over vaccinating teenagers, arguing that the UK policy (...) was permissible. The second section outlines a problem for this policy, that it faces justified vaccine hesitancy. The third section discusses three strategies for responding to this problem, arguing that there may be no simple way of overcoming parents’ reasons to resist vaccinations. (shrink)

The current system of ethical oversight in the United States is based on Institutional Review Board (IRB) review. The system was established in response to well-known and egregious mistreatment of subjects in both biomedical and social and behavioral research. In the decades since the research regulations were enacted, reaction to the burden of IRB oversight has led the system to focus on compliance and limit its active oversight disproportionately to studies that could present the risk of physical harm. At the (...) same time, the characteristics of the research enterprise have changed and methodologies now present novel risks that were not envisioned in the regulations. We convened a group of IRB professionals, academic leaders, and others to discuss limitations of the current system, how that system could be changed to recognize evolving risks and an increasing focus on participant and community voice, and how it could better serve the needs of researchers and support the societal project of science as a public good. Recommendations included a call to reexamine the academic incentive structure, to develop a system to support consideration of ethical principles from the time of study design, and to explicitly provide different ethical support and oversight for high-risk interventional trials and lower risk biomedical and social behavioral research. (shrink)

Stephen Salkever shows that reading Aristotle is a starting point for discussing contemporary political problems in new ways that avoid the opposition between liberal individualism and republican communitarianism, between the politics of rights and the politics of virtues. Originally published in 1990. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in (...) durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

Do people who cause themselves to be ill (e.g. by smoking) forfeit some of their rights to healthcare? This paper examines one argument for the view that they do, the restoration argument. It goes as follows. Smokers need more health‐resources than non‐smokers. Given limited budgets, we must choose between treating everyone equally (according to need) or reducing smokers' entitlements. If we choose the former, non‐smokers will be harmed by others' smoking, because there will be less resources available for them than (...) if no‐one smoked. This is unfair: why should non‐smokers suffer because of others' unhealthy lifestyle choices? We should therefore choose the latter and reduce smokers' entitlements. This paper criticises the restoration argument on the following grounds. In order to avoid generating unpalatable conclusions elsewhere, it must be combined with a principle according to which activities which are sufficiently ‘socially valuable’ (e.g. parenting) are immune from restoration claims. This however means that what was supposed to be one of the argument's most attractive features, its compatibility with ‘liberal neutrality’ with respect to the value of different lifestyles, doesn't really exist. Hence, the restoration argument is nowhere near as attractive as it at first appears to be. (shrink)

In matters of responsibility, there are often two sides to the transaction: one party who holds another responsible, and the other who takes responsibility for her conduct. The first side has been closely scrutinized in discussions of the nature of responsibility, due to the influential Strawsonian conjecture that an agent is responsible if and only if it is appropriate to hold her responsible. This preoccupation with holding responsible – with its focus on the second-personal perspective and on responses like blame (...) – contrasts with a relative neglect of the perspective of the agent and the role that she has to play by taking responsibility. I aim to show that this neglect is undeserved – that taking responsibility is both distinct in character from holding responsible and fundamentally important in its own right. I develop a conception of taking responsibility that reveals an under-explored dimension of our responsibility practices. (shrink)

The natural history museum is a place where the line between "high" and "low" culture effectively vanishes--where our awe of nature, our taste for the bizarre, and our thirst for knowledge all blend happily together. But as Stephen Asma shows in Stuffed Animals and Pickled Heads, there is more going on in these great institutions than just smart fun. Asma takes us on a wide-ranging tour of natural history museums in New York and Chicago, London and Paris, interviewing curators, (...) scientists, and exhibit designers, and providing a wealth of fascinating observations. We learn how the first museums were little more than high-toned side shows, with such garish exhibits as the pickled head of Peter the Great's lover. In contrast, today's museums are hot-beds of serious science, funding major research in such fields as anthropology and archaeology. "Rich in detail, lucid explanation, telling anecdotes, and fascinating characters.... Asma has rendered a fascinating and credible account of how natural history museums are conceived and presented. It's the kind of book that will not only engage a wide and diverse readership, but it should, best of all, send them flocking to see how we look at nature and ourselves in those fabulous legacies of the curiosity cabinet."--The Boston Herald. (shrink)

Leslie Stephen was an English biographer, and a writer on philosophy, ethics and literature. He was educated at Eton, King's College, London, and then Trinity College in Cambridge, where he remained as a fellow and a tutor for his entire career. He was also a keen mountaineer, taking part in first ascents of nine peaks in the Alps. He served as the first editor of the Dictionary of National Biography and in 1871 he became editor of the Cornhill Magazine. (...) During his eleven-year tenure he wrote two successful books on ethics, of which this work, published in 1882, was one. It was widely adopted as a standard textbook on moral philosophy, and became one of the most influential publications on the ideas of evolutionary ethics that had been inspired by Darwin's theory of evolution by natural selection. (shrink)

Sir Leslie Stephen (1832–1904), the founding editor of the Dictionary of National Biography, and a writer on philosophy, ethics, and literature, was educated at Eton, King's College London and Trinity College, Cambridge, where he remained as a fellow and a tutor for a number of years. Though a sickly child, he later became a keen and successful mountaineer, taking part in first ascents of nine peaks in the Alps. In 1871 he became editor of the Cornhill Magazine. During his (...) eleven-year tenure, he wrote two successful books on ethics, including The Science of Ethics in 1892, which was widely adopted as a standard textbook. This two-volume work, which was first published in 1896, brings together the lectures he gave to various ethical societies, mostly in London. Both volumes examine the ethical issues surrounding a range of topics including politics, morality, duty, and crime and punishment. (shrink)

Pre-natal-diagnosis technologies allow parents to discover whether their child is likely to suffer from serious disability. One argument for state funding of access to such technologies is that doing so would be “cost-effective”, in the sense that the expected financial costs of such a programme would be outweighed by expected “benefits”, stemming from the births of fewer children with serious disabilities. This argument is extremely controversial. This paper argues that the argument may not be as unacceptable as is often assumed. (...) In doing so, it sets out a more general framework for assessing the relevance of efficiency calculations to policy-making. The final section also investigates the relationship between the paper’s arguments and claims about parental responsibility for child-bearing and rearing, with reference to Scanlon’s work on “substantive responsibility”. (shrink)

Stephen E. Smallman describes the process of new birth and what is common in all authentic conversion experiences--genuine faith in Jesus Christ as Lord and Savior. Spiritual Birthline testifies to new birth in all kinds of people, in all sorts of circumstances. It is helpful to those with a budding curiosity in God as well as to people interested in relational evangelism.

The A to Z of Existentialism explains the central claims of existentialist philosophy and the contexts in which it developed into one of the most influential intellectual trends of the 20th century. This is done through a chronology, an introductory essay, a bibliography, and more than 300 cross-referenced dictionary entries offering clear, accessible accounts of the life and thought of major existentialists like Jean-Paul Sartre, Martin Heidegger, Martin Buber, Karl Jaspers, Gabriel Marcel, Simone de Beauvoir, Albert Camus, and Maurice Merleau-Ponty, (...) as well as thinkers influential to its development such as Wilhelm Dilthey, Henri Bergson, Edmund Husserl, and Max Scheler. (shrink)

This paper considers the problems that arise when death, which is a philosophically difficult concept, is incorporated into healthcare metrics, such as the quality-adjusted life year (QALY). These problems relate closely to the debate over euthanasia and assisted suicide because negative QALY scores can be taken to mean that patients would be ‘better off dead’. There is confusion in the literature about the meaning of 0 QALY, which is supposed to act as an ‘anchor’ for the surveyed preferences on which (...) QALYs are based. In the context of the debate over euthanasia, the QALY assumes an ability to make meaningful comparisons between life-states and death. Not only is this assumption questionable, but the ethical debate is much more broad than the question of whether death is preferable to a state of living. QALYs are derived from preferences about health states, so do not necessarily reflect preferences about events (eg, dying) or actions (eg, killing). This paper presents a new kind of problem for the QALY. As it stands, the QALY provides confused and unreliable information when it reports zero or negative values, and faces further problems when it appears to recommend death. This should preclude its use in the debate over euthanasia and assisted suicide. These problems only apply where the QALY involves or seems to involve a comparison between life-states and death, and are not relevant to the more general discussion of the use of QALYs as a tool for comparing the benefits derived from treatment options. (shrink)

I pose problems for the views that human nature should be the object of study in the social and behavioral sciences and that a concept of human nature is needed to guide research in these sciences. I proceed by outlining three research programs in the social sciences, each of which confronts aspects of human variation. Next, I present Elizabeth Cashdan and Grant Ramsey’s related characterizations of human nature. I go on to argue that the research methodologies they each draw on (...) are more productive resources for social scientists than their competing characterizations of human nature. (shrink)

It is hard to argue with the proposition that value for money should guide health spending. However, even after decades of development, economic evaluation is still a work in progress. As applied, it deals poorly with issues of social justice, ageing and end of life issues; cases involving small numbers—such as decisions about orphan drugs—are also contested. Unfortunately, differences in incremental cost-effectiveness ratios are presented with a degree of precision which contributes to an ‘illusion of validity’.1 Nobel Laureate Amartya Sen (...) has suggested that ‘when all the requirements of ubiquitous market-centred evaluation have been incorporated into the procedures of cost–benefit analysis, it is not so much a discipline as a daydream’.2 As with any approach to public decision making, the use of economic evaluation rests on an implicit social licence, including that the decision making is fair and reasonable. Many countries have developed special policies for rare, ‘ultrarare’ or ‘orphan’ diseases to moderate the effect of a ubiquitous application of economic evaluation. The threshold for defining ‘small’ or rare is a matter of judgement and ranges between 2 and 80 per 100 000 population.3 Magalhaes challenges the ethical basis of special programmes for low incidence conditions and argues against such provisions. In this commentary, I will argue the contrary: that there are good reasons …. (shrink)