Certain health care services and goods, although legal and often generally accepted in a society, are by some considered morally problematic. Debates on conscientious objection in health care try to resolve whether and when physicians, nurses and pharmacists should be allowed to refuse to provide medical services and goods because of their ethical or religious beliefs. These debates have most often focused on issues such as how to balance the interests of patients and health care professionals, and the compatibility of (...) conscientious objection with professional obligations, but it is also possible to think about conscientious objection in terms of how to respond to moral disagreement and the requirements of liberal neutrality. (shrink)

Several philosophers have proposed Knowledge-Based Decision Theories (KDTs)—theories that require agents to maximize expected utility as yielded by utility and probability functions that depend on the agent’s knowledge. Proponents of KDTs argue that such theories are motivated by Knowledge-Reasons norms that require agents to act only on reasons that they know. However, no formal derivation of KDTs from Knowledge-Reasons norms has been suggested, and it is not clear how such norms justify the particular ways in which KDTs relate knowledge and (...) rational action. In this paper, I suggest a new axiomatic method for justifying KDTs and providing them with stronger normative foundations. I argue that such theories may be derived from constraints on the relation between knowledge and preference, and that these constraints may be evaluated relative to intuitions regarding practical reasoning. To demonstrate this, I offer a representation theorem for a KDT proposed by Hawthorne and Stanley (2008) and briefly evaluate it through its underlying axioms. -/- In section 1, I present knowledge-based decision theories generally and the versions of such theories suggested in the literature. In section 2, I argue that KDTs and theories of practical reasoning conjoined with Knowledge-Reasons norms generate constraints on the same relation—the relation between knowledge and preference. In section 3, I present a formal framework in which constraints on this relation may be expressed and from which KDTs may be derived. In section 4, I present a representation theorem for a specific KDT. In section 5, I briefly evaluate the axioms of the theory, and in section 6, I conclude. (shrink)

The unfairness of health inequalities depends on the more fundamental question of the relationship between justice in health and distributive justice more generally. In this article, I discuss some constraints on how health should be incorporated in a theory of justice and their implications for when health inequalities can be considered to be unfair. I argue against adopting separate distributive principles for health, and in favour of conceiving justice in health as interrelated with, and contingent on, justice in the distribution (...) of other important social goods and resources, in particular income. Accordingly, health inequalities are unfair when they are the result of an unfair distribution of resources. (shrink)

We study the representation of attitudes to risk in Jeffrey’s decision-theoretic framework suggested by Stefánsson and Bradley :602–625, 2015; Br J Philos Sci 70:77–102, 2017) and Bradley :231–248, 2016; Decisions theory with a human face, Cambridge University Press, Cambridge, 2017). We show that on this representation, the value of any prospect may be expressed as a sum of two components, the prospect’s instrumental value and the prospect’s intrinsic value. Both components have an expectational form. We also make a distinction between (...) a prospect’s overall intrinsic value and a prospect’s conditional intrinsic value given each one of its possible outcomes and argue that this distinction has great explanatory power. We explore the relation between these two types of intrinsic values and show that they are determined at the level of preferences. Finally, we explore the relation between the intrinsic values of different prospects and point to a strong restriction on this relation that is implicit in Jeffrey’s axioms. We suggest a natural interpretation to this restriction. (shrink)

Research on ethical, legal and social aspects of life sciences and new technologies has mainly been focused on impacts and consequences, while the emerging framework of Responsible Research and Innovation focuses rather on increased involvement and reflexivity in research processes to foster science and technology that better answers the needs of society. I argue that philosophy of science should be a central feature of RRI and demonstrate how the philosophy of science can contribute in this sense. I show how investigating (...) basic assumptions in research, here exemplified by reductive assumptions in causal modeling, can have important ethical and societal implications. (shrink)

Reducing inequalities in health and the determinants of health is a widely acknowledged health policy goal, and methods for measuring inequalities and inequities in health are well developed. Yet, the evidence base is weak for how to achieve these goals. There is a lack of high-quality randomised controlled trials reporting impact on the distribution of health and non-health benefits and lack of methodological rigour in how to design, power, measure, analyse and interpret distributional impact in RCTs. Our overarching aim in (...) this paper is to contribute to the emerging effort to improve transparency and coherence in the theoretical and conceptual basis for RCTs on effective interventions to reduce health inequity. We endeavour to achieve this aim by pursuing two more specific objectives. First, we propose an overview of three broader health equity frameworks and clarify their implications for the measurement of health inequality in RCTs. Second, we seek to clarify the relationship between theory and translational challenges that researchers would need to attend to, in order to ensure that equity-relevant RCTs are coherently grounded in theory. (shrink)

A grandfather clause is a provision whereby an old rule continues to apply to some existing situation while a new rule applies to all future cases. This paper focuses on the use of grandfather clauses in health technology appraisals (HTAs) issued by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. NICE provides evidence‐based guidance on healthcare technologies and public health interventions that influence resource allocation decisions in the National Health Service (NHS) and the broader public (...) sector in England and Wales. In this context, a grandfather clause is included when NICE does not recommend treatment with a given technology. The grandfather clause provides an exemption from the general recommendation for patients who have already started treatment with the technology in question, before the publication of the NICE guidance. In this paper we first lay out the contexts in which grandfather clauses occur in NICE guidance, and then consider ethical arguments against and in support of grandfather clauses and the continuation of treatment. We argue that NICE’s current practice of automatic inclusion of a grandfather clause is ethically problematic and unfair. While the inclusion of a grandfather clause may be appropriate and justified in specific cases, we argue that inclusion of such a clause should be considered as part and parcel of the decision making process on a case by case basis, rather than adopted as the default. (shrink)

A wide range of gene knockout experiments shows that functional stability is an important feature of biological systems. On this backdrop, we present an argument for higher‐level causation based on counterfactual dependence. Furthermore, we sketch a metaphysical picture providing resources to explain the metaphysical nature of functional stability, higher‐level causation, and the relevant notion of levels. Our account aims to clarify the role empirical results and philosophical assumptions should play in debates about reductionism and higher‐level causation. It thereby contributes to (...) the development of a philosophical foundation for systems biology. †To contact the authors, please write to: CSMN/IFIKK, University of Oslo, Box 1020 Blindern, N‐0315, Oslo, Norway; e‐mail: [email protected] , [email protected]. (shrink)

In this masterful work of historical scholarship, Zeev Sternhell, an internationally renowned Israeli political scientist and historian, presents a controversial new view of the fall of democracy and the rise of radical nationalism in the twentieth century. Sternhell locates their origins in the eighteenth century with the advent of the Anti-Enlightenment, far earlier than most historians. The thinkers belonging to the Anti-Enlightenment represent a perspective that is antirational and that rejects the principles of natural law and the rights of (...) man. Sternhell asserts that the Anti-Enlightenment was a development separate from the Enlightenment and sees the two traditions as evolving parallel to one another over time. He contends that J. G. Herder and Edmund Burke are among the real founders of the Anti-Enlightenment and shows how that school undermined the very foundations of modern liberalism, finally contributing to the development of fascism that culminated in the European catastrophes of the twentieth century. (shrink)

Humboldt Revisited offers a fresh perspective on the contemporary discourse surrounding reform of European universities. Arguing that contemporary reform derives its basis from pre-constructed truths about the so-called 'Humboldt-university,' this monograph traces the historical descent of these truths to the American reception of Humboldt's ideas from the mid-19th century up until the 1960s. Drawing from a rich selection of historical sources, this volume offers an alternative to conventional explanations of the forces behind the ongoing reform of European universities. It also (...) challenges the conventional historical narrative on the Humboldt University, providing new insight into the American reception of the German ideas. (shrink)

ABSTRACTThe aim of this paper is to bring a phenomenological perspective to bear on a specific problem: how to understand the diminished sense of reality that is often reported by persons who have suffered severe and prolonged interpersonal trauma. For this purpose I turn to resources from two traditions. First, I present a phenomenological account of the intersubjective constitution of objective experience, which is then complemented by a developmental account of how the very small child comes to inhabit a world (...) of shared mind-independent things. On this basis, I aim to show how the sense of reality, as the clear and dependable sense of the difference in experience between inner life and external reality, is an interpersonal developmental achievement that goes hand in hand with the development of the sense of self. I will in particular draw on Husserlian phenomenology and Winnicott’s psychoanalytic perspective on developmental psychology. (shrink)

Much recent work in Cognitive Linguistics and neighbouring disciplines has adopted a so-called usage-based perspective in which generalizations are based on the analysis of authentic usage data provided by computerized corpora. However, the analysis of such data does not always utilize methodological findings from other disciplines to avoid analytical pitfalls and, at the same time, generate robust results. A case in point is the strategy of using corpus frequencies. In this paper, we take up a recently much debated issue from (...) construction grammar concerning the association between verbs and argument-structure constructions, and investigate a construction, the English as-predicative, in order to test the predictive power of different kinds of frequency data against that of a recent, more refined corpus-based approach, the so-called collexeme analysis. To that end, the results of the application of these corpus-based approaches to an analysis of the as predicative are compared with the results of a sentence-completion experiment. Concerning the topic under consideration, collexeme analysis is not only shown to be superior on a variety of theoretical and methodological grounds, it also significantly outperforms frequency as a predictor of subjects’ production preferences. We conclude by pointing out some implications for usage-based approaches. (shrink)

Lynch et al. (Biol Philos 34:62, 2019) employ stability, specificity, and proportionality as criteria for evaluating microbiome causal explanations. Although these causal characteristics signify relevant differences between causal roles, I suggest that they should not be used as general criteria for strong or good causal explanations.

A model of a spatio-cultural sub-context (enfolded in a wider scope context) is presented in the form of a blue print of a Complex System with a two-stage decision engine at its core. The engine first attaches a meaning to analyzable datum, and then decides whether to keep or change it. It does not alter already stored meanings but is designed to search for data to be converted into additional stored meanings and improve the accuracy of correspondence of their spatial (...) and cultural range of relevance. Meaning is reduced to the choice of a strategy—a future continuum of events; a choice dependent on a unique Evolutionary Path, a past continuum of events specific enough to lead to the current temporarily stable state of a spatio-cultural category. It is a blue print for a program that can emulate decisions to initiate changes in the environment in which a collective of culture partners resides; changes consisting of movements from one location to another or in the layout of its current location. The model is proposed at a low cultural resolution and is applicable, after suitable modifications, to a majority of city/period pairs. However, any such model has to be city/period specific. It is illustrated with a design for analyzing changes in the Israeli city, in particular in Tel Aviv. (shrink)

The method in human genetics of ascribing causal responsibility to genotype by the use of heritability estimates has been heavily criticized over the years. It has been argued that these estimates are rarely valid and do not serve the purpose of tracing genetic causes. Recent contributions strike back at this criticism. I present and discuss two opposing views on these matters represented by Richard Lewontin and Neven Sesardic, and I suggest that some of the disagreement is based on differing concepts (...) of genetic causation. I use the distinction of structuring and triggering causes to help clarifying the basis for the opposing views. (shrink)

Synthetic biology research is often described in terms of programming cells through the introduction of synthetic genes. Genetic material is seemingly attributed with a high level of causal responsibility. We discuss genetic causation in synthetic biology and distinguish three gene concepts differing in their assumptions of genetic control. We argue that synthetic biology generally employs a difference-making approach to establishing genetic causes, and that this approach does not commit to a specific notion of genetic program or genetic control. Still, we (...) suggest that a strong program concept of genetic material can be used as a successful heuristic in certain areas of synthetic biology. Its application requires control of causal context, and may stand in need of a modular decomposition of the target system. We relate different modularity concepts to the discussion of genetic causation and point to possible advantages of and important limitations to seeking modularity in synthetic biology systems. (shrink)

This article discusses what arguments best support universal health care (UHC), with a focus on Norman Daniels’ equality of opportunity account. This justification for UHC hinges on the assumption of a close relationship between health care and health. But in light of empirical research that suggests that health outcomes are shaped to a large extent by factors other than health care, such as income, education, housing, and working conditions, the question arises to what extent health care is really necessary to (...) protect and promote health, and thereby opportunity. The author argues that, although this challenge to the equality of opportunity rationale is legitimate, it is not sufficiently specified to allow us to adequately assess the extent to which universal health succeeds in protecting equality of opportunity. The article concludes by outlining a more promising strategy for developing a viable rationale for UHC. (shrink)

Under the post-metaphysical sky “old” humanistic-oriented education is possible solely at the cost of its transformation into its negative, into a power that is determined to diminish human potentials for self-exaltation. Nothing less than total metamorphosis is needed to rescue the core of humanistic genesis: the quest for edifying Life and resistance to the call for “home-returning” into the total harmony that is promised to us within nothingness.

This paper investigates the process of moral agency development as a community-supported process. Based on a multimethod qualitative inquiry, including diaries, focus groups, and documentary analysis, we analyze the experiences of middle managers in two Norwegian hospitals during the first year of the COVID-19 pandemic. We find that moral agency is developed through a community-embedded value inquiry, emerging in three partially overlapping steps. The first step is marked by moral reflex, an intuitive, value-driven, pre-reflective response to a crisis situation. In (...) the second step, the managers involved the community in value calibration, a collective-ethical sensemaking. In the third step, they took active stances to translate values into actions, with an increased awareness of values and an ability to explain and justify their actions. We label the steps, respectively: value inquiry-in-action, value inquiry-on-action and reflective enactment of value. An analysis of the process reveals two aspects critical for moral agency development: it happens through confrontation with uncertainty, and it is relational, that is, embedded in a community. While uncertainty forces an intuitive moral response, dialogical reflection in the community develops value awareness and relationships of mutual care and support. (shrink)

This article presents results from a nationally representative survey conducted in Taiwan in November 2011 that explores Taiwanese attitudes toward China and the world. It demonstrates that while (KMT) and (DPP) supporters maintained different attitudes towards China, few Taiwanese supported reunification. Taiwanese attitudes towards other countries, the sources of Taiwanese party identification, and policy implications for cross–Strait relations are also explored.

Aristotle in Physics I,1 says some strange-sounding things about how we come to know wholes and parts, universals and particulars. In explicating these, Simplicius distinguishes an initial rough cognition of a thing as a whole, an intermediate “cognition according to the definition and through the elements,” and a final cognition of how the thing's many elements are united: only this last is πιστήμη. Simplicius refers to the Theaetetus for the point about what is needed for πιστήμη and the ways that (...) cognition according to the definition and through the elements falls short. By unpacking this reference I try to reconstruct Simplicius' reading of “Socrates' Dream,” its place in the Theaetetus ' larger argument, and its harmony with other Platonic and Aristotelian texts. But this reconstruction depends on undoing some catastrophic emendations in Diels's text of Simplicius. Diels's emendations arise from his assumptions about definitions and elements, in Socrates' Dream and elsewhere, and rethinking the Simplicius passage may help us rethink those assumptions. (shrink)

At the beginning of Posterior Analytics 2.19 Aristotle reminds us that we cannot claim demonstrative knowledge unless we know immediate premisses, the archai of demonstrations. By the end of the chapter he explains why the cognitive state whereby we get to know archai must be Nous. In between, however, Aristotle describes the process of the acquisition of concepts, not immediate premisses. How should we understand this? There is a general agreement that it is Nous by means of which we acquire (...) both premisses and concepts. I argue that this cannot be the case. Since concepts are simples while premisses are composites , the two cannot be objects of the same cognitive state. I further argue that, whereas Nous is responsible for our grasp of concepts, the state Aristotle elsewhere calls non-demonstrable knowledge is the one whereby we get to know the premisses of demonstrations. (shrink)

The sensation-perception distinction did not appear before the seventeenth century, but since then various formulations of it have gained wide acceptance. This is not an historical accident and the article suggests an explanation for its appearance. Section 1 describes a basic assumption underlying the sensation-perception distinction, to wit, the postulation of a pure sensory stage--viz. sensation--devoid of active influence of the agent's cognitive, emotional, and evaluative frameworks. These frameworks are passive in that stage. I call this postulation the passivity assumption. (...) Section 2 suggests three major reasons for the emergence of this assumption in the seventeenth century: the mental-physical gap, the causal theory of perception, and epistemological considerations regarding the status of the sensory given. In the last section a critical discussion is presented. The passivity assumption is found to have serious empirical and theoretical flaws. (shrink)

How and why could some stories be construed as sacred in organizations, and what functions does the sacred have in organizational values work? Research has shown how values can be made formative of a range of organizational purposes and forms but has underscored their performative, situated, and agentic nature. We address that void by studying the sacred as a potentially salient yet under-researched realm of values work. Drawing on an ethnographic case study of a faith-based health care organization and the (...) ethical philosophy of Paul Ricoeur, we describe how the sacred is figured in two sets of tales that were lived and told with surprising intensity and consistency: the parable of the Good Samaritan and the tale of the legacy bestowed by the organization’s founder. We theorize how this figuring of the sacred in story and in action recasts values work from a centralized and unitary process to a two-way learning dialectic between the ongoing creative imitation of action and narrative. Values in the shape of stories of the sacred do not achieve their meaning as unchangeable cores or sanctioned beliefs. Rather, they come to life in a process of ongoing moral inquiry that co-evolves with moral agencies. In the latter regard, the sacred primarily becomes manifest in everyday work in the form of questioning and creative acts of care. People become moral agents when they feel and respond to the sacred in the call of the other. (shrink)