This article delves into Captain Samuel Alfred Warner’s dogged campaign to sell two inventions – his submersible mine and “long range” missile – to the British government in the 1840s and 1850s. Departing from a historiography that dismisses Warner as a fraudster, it clarifies how he managed to generate widespread interest in his weapons technologies for nearly twenty years. I therefore analyze three key elements of his self-promotion: his personal branding, his pitch, and his simultaneous embrace and rejection of publicity. (...) Neither elite nor highly educated, Warner ran up against a culture of “polite science” that distinguished disinterested practitioners from profit-minded schemers. To establish his credentials, he emphasized his practical maritime experience and represented himself as a martyr willing to bear the scorn of a disbelieving establishment. In pitching his devices, Warner capitalized on alarmism over border security and the integrity of the empire; he declared that they could hobble France’s modernizing navy and quickly end colonial conflicts. When skeptics began to fret over the proliferation of his destructive weapons, Warner flipped the script and lauded the threat of mutual annihilation as a deterrent to needless warfare. The issue of publicity, however, would ultimately be Warner’s professional undoing. Despite successful demonstrations, his clashes with official investigators and his refusal to disclose his chemical secrets led critics to dispute the originality of his discoveries. An examination of Warner’s self-promotional strategies, his fraught interactions with the British state, and the ambivalent public reaction to his contraptions provides insight into how scientific authority was acquired and lost in this period. (shrink)

Thought-intrusions, automatic inferences, and other unintended thought are beginning to play an important role in the study of psychiatric disease as well as normal thought processes. We examine one method for study of task-unrelated imagery and thought . TUIT likelihood was shown to be reliably measured over a wide range of vigilance tasks, to have high short-term and long-term test-retest reliability, and to be sensitive to information processing demands. Likelihood of TUITs was shown to be different as a function of (...) aging, hyperactivity, time of day, and level of depression. Thus, we now can reliably measure the influence of endogenous and exogenous influences on TUITs. In addition, TUIT measurement was proposed as a minimally interfering and natural second task for determining resource utilization in a primary task. Finally, this method was offered as a reliable approach to quantification of such mental states as obsessions and drug craving and addiction. (shrink)

Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for metastatic (...) cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve “rough justice” and “supple solidarity.” The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity. (shrink)

Can Rawlsian public reason sufficiently justify public policies that regulate or restrain controversial medical and technological interventions in bioethics (and the broader social world), such as abortion, physician aid-in-dying, CRISPER-cas9 gene editing of embryos, surrogate mothers, pre-implantation genetic diagnosis of eight-cell embryos, and so on? The first part of this essay briefly explicates the central concepts that define Rawlsian political liberalism. The latter half of this essay then demonstrates how a commitment to Rawlsian public reason can ameliorate (not completely resolve) (...) many of the policy disagreements related to bioethically controversial medical interventions today. The goal of public reason is to reduce the size of the disagreement by eliminating features of the disagreement that violate the norms of public reason. The norms of public reason are those norms that are politically necessary to preserve the liberal, pluralistic, democratic character of this society. What remains is reasonable disagreement to be addressed through normal democratic deliberative processes. Specific issues addressed from a public reason perspective include personal responsibility for excessive health costs, the utility of a metaphysical definition of death for organ transplantation, and the moral status of excess embryos generated through IVF and/or their use in medical research. (shrink)

De Bie et al. (2023) call attention at the conclusion of their essay to the “novel questions” generated by complete ectogenesis. The question I explore is how complete ectogenesis from conception t...

Accelerated approval of aducanumab for mild Alzheimer's by the U.S. Food and Drug Administration on June 7, 2021, has generated substantial medical, scientific, and ethical controversy. That approval was contrary to the nearly unanimous judgment of the FDA's Advisory Committee that little reliable evidence existed of significant benefit, even though the drug did reduce β‐amyloid. Three major ethical problems were created by this approval: (1) Medicare resources would be unjustly squandered, given the drug's $56,000 annual price and the 3.1 million (...) older potential American patients needing the drug; (2) physicians will feel ethically compelled to provide the drug to desperate, insistent patients, given FDA approval and in spite of side effects of brain bleeds and brain swelling; (3) and false hopes are generated for patients. A needed corrective by the federal government would reduce reimbursement to the bare cost of producing the drug (plus only a modest profit) until a phase IV trial has been successfully completed. (shrink)

I fundamentally agree with Childress et al. (2023) in the scenario they have constructed with Mr. J. None of the arguments they critically assess are ethically persuasive enough to justify removing...

John Rawls has held up as a model of public reason the U.S. Supreme Court. I argue that the Dobbs Court is justifiably criticized for failing to respect public reason. First, the entire opinion is governed by an originalist ideological logic almost entirely incongruent with public reason in a liberal, pluralistic, democratic society. Second, Alito’s emphasis on “ordered liberty” seems completely at odds with the “disordered liberty” regarding abortion already evident among the states. Third, describing the embryo/fetus from conception until (...) birth as an “unborn human being” begs the question of the legal status of the embryo/fetus, as if an obiter dictum settled the matter. Fourth, Alito accuses the Roe court of failing to exercise judicial restraint, although Alito argued to overturn Roe in its entirety. In brief, the Dobbs opinion is an illiberal, disingenuous, ideological swamp that swallows up public reason and the reproductive rights of women. (shrink)

Abstract:The American College of Physicians in its ethics manual endorsed the idea that physicians ought to improve their ability to provide care to their patients more parsimoniously. This elicited a critical backlash; critics essentially claimed that what was being endorsed was a renamed form of rationing. In a recent article, Tilburt and Cassel argued that parsimonious care and rationing are ethically distinct practices. In this essay I critically assess that claim. I argue that in practice there is considerable overlap between (...) what they term parsimonious care and what they define as rationing. The same is true of the Choosing Wisely campaign endorsed by the American Board of Internal Medicine. In both cases, if the goal is to control healthcare costs by reducing the use of marginally beneficial care that is not cost effective, then a public conversation about the justness of specific choices is essential. (shrink)

The debate around age-based healthcare rationing was precipitated by two books in the late 1980s, one by Daniel Callahan and the other by Norman Daniels. These books ignited a firestorm of criticism, best captured in the claim that any form of age-based healthcare rationing was fundamentally ageist, discriminatory in a morally objectionable sense. That is, the elderly had equal moral worth and an equal right to life as the nonelderly. If an elderly and nonelderly person each had essentially the same (...) medical problem requiring the same medical treatment, then they had an equal right to receive that treatment no matter what the cost of that treatment. Alternatively, if cost was an issue because the benefits of the treatment were too marginal, then both the elderly and nonelderly patients requiring that treatment ought to be denied it. If there were something absolutely scarce about the treatment, then some fair process would have to be used to make an allocation decision. (shrink)

Galasso calls for “the actualization of the public health potential of precision medicine….as the best realistic contribution to health equity” (Galasso 2024, 83). Unfortunately, this is wishful th...

This chapter commences with an account on the Zillo Beasts. The reawakening of extinct species, or "de‐extinction," has gained massive popular appeal. The chapter explains some facts before delving into the philosophical debate over de‐extinction. Philosophers sometimes use far‐fetched examples to answer the questions that are left after we agree on all the facts. These “thought experiments” are meant to show us what we really believe. What makes a duck a duck, a mammoth a mammoth, or a Zillo Beast a (...) Zillo Beast? This is called the species problem, and it is one of the oldest in the philosophy of biology. Essentialism is the view that permits us to say that the Zillo Beast's clone would be a member of the Zillo Beast species. The New Essentialists argue that essentialism can be compatible with natural selection if one looks beyond organisms' traits for species essences. (shrink)

In this article, I show that attending to Nietzsche's views about breeding and human enhancement reveals two important ways in which Ken Gemes's account of Nietzsche's uses of the rhetoric of degeneration and Verjüdung must be modified. First, attending to Nietzsche's views about breeding reveals that methods like isolation, quarantine, excision, and extermination are not merely for the weak, as Gemes claims. In fact, for Nietzsche such methods are crucial for producing and maintaining healthy, strong people and societies. More generally, (...) such methods play a vital role in Nietzsche's philosophy, including with respect to his conception of health. Second, contrary to Gemes's claim that Nietzsche was not interested in the actual Jews of his time, I show that Nietzsche was very interested in them, and thought they were important precisely for their relevance to his interest in breeding a new European aristocracy. (shrink)

Now I continue the investigation, begun in Homo Quaerens: The Seeker and the Sought, into the generic traits of persons from a philosophic point of view. I treat such special topics of my method, set forth in that book, as bear upon the person's intrapersonal aspects: namely, his body and such of its functions as contribute to his preconscious acts. In particular, I deal with those aspects insofar as they may be construed as straining, so to speak, toward that self-transcendence (...) which culminates in the veridical person - in effect, strands of subpersonal events which contribute to and converge upon his consummate personhood. In consequence, I explore the ontology of the person under the perspective of his naturalistically interpreted makeup; and I conceive my enterprise as propaedeutic to more generalized ontologic topics which I shall take up in subsequent books. (shrink)

Political authority is not eliminable, even if in a globalizing world order the particulars of its exercise might be undergoing a transformation. What matters to political philosophy is whether or not its existence and exercise can be justified. In this paper I begin by contrasting two paradigmatic approaches to justifications of political authority and political obligation: political naturalism and political voluntarism. Having set the stage for the debate, I connect Aquinas’s account of political authority with the former—though one will not (...) find a full-fledged version of that account in this paper. More importantly, I connect Aquinas’s naturalist defense of political obligation to a non-instrumental account of the common good, though the bulk of the paper deals with what I argue are failed attempts to offer non-naturalist accounts of the common good as alternative natural law defenses of political authority. (shrink)

This essay challenges a growing consensus among Aquinas scholars who attribute to him a pro-passion attitude, linking his virtue theory to accounts of emotion that see the emotions in a primarily positive light. There are good reasons for thinking Aquinas far more skeptical of the role to be played by emotion in the virtuous life—indeed, one can safely argue, in agreement with Aquinas, that the emotions are often threats to and so in need of control by the virtues. I focus (...) on the ideal of reason’s control over the emotions in the essay in contrast with the work of Robert Miner whose understanding of Aquinas on the passions and virtues tends to downplay the dominating role that reason plays in the moral theory of Aquinas. For Aquinas IRC is central to the normativity of the virtues that relate to the emotions. In contrast, Miner appears to minimize the need for the emotions to be controlled, which entails a certain elevation of the emotions to a nearly co-equal status with reason in Aquinas’s moral theory. Miner adopts two argumentative strategies to achieve this valorization of emotion in Aquinas, but I find both exegetically inaccurate and experientially deficient. (shrink)

The Dobbs decision has precipitated renewed medical, political, and professional interest in the issue of abortion. Because this decision handed responsibility for regulation of abortion back to the states, and because the states are enacting or have enacted policies that tend to be very permissive or very restrictive, the result has been legal and professional confusion for physicians and their patients. Medical education cannot resolve either the legal or ethical issues regarding abortion. However, medical education must prepare future physicians for (...) caring for patients seeking abortion-related services. Physicians must be prepared to interact appropriately (sensitively and with integrity) with patients or colleagues whose views on abortion differ significantly from their own. This essay describes our educational effort to achieve that objective. The motto that governed this exercise was “No Easy Answers.”. (shrink)

What exactly is a “wicked problem”? It is a social or economic problem that is so complex and so interconnected with other issues that it is extraordinarily difficult or impossible to resolve. This is because all proposed resolutions generate equally complex, equally wicked problems. In this essay, I argue that precision medicine, especially in the context of the U.S. healthcare system, generates numerous wicked problems related to distributive justice. Further, I argue that there are no easy solutions to these wicked (...) problems. The need for trade-offs is inescapable. Rough justice is the best outcome we can hope for, and that outcome requires a commitment to processes of public reason that are fair and inclusive. (shrink)

In this paper, I argue for the following points. First, all of us have a presumptive moral obligation to be organ donors if we are in the relevant medical circumstances at the time of death. Second, family members should not have the right to interfere with the fulfillment of that obligation. Third, the ethical basis for that obligation is reciprocity. If we want a sufficient number of organs available for transplantation, then all must be willing donors. Fourth, that likelihood is (...) diminished if individuals are entirely free to refuse to be organ donors but still would demand to be organ recipients. Fifth, although individuals would be ethically obligated to be organ donors, we still need to permit them to refuse to be organ donors. Sixth, to encourage individuals to stay within the organ donation system, we should have as a just and ethically justified policy denying individuals an organ transplant in the relevant medical circumstances if they have chosen to exit the organ donation system. Individuals would not be permitted to be organ recipients if they were unwilling to be organ donors. This is what it means to be part of what Rawls in Political liberalism (15-22) would refer to as a “fair system of social cooperation.” We refer to this as the “reciprocity requirement.”. (shrink)