Perhaps the two main contemporary formulations of ethical naturalism – Synthetic Ethical Naturalism (SEN) and Analytical Descriptivism – seem to conflict with plausible views about cases where moral debate and disagreement is possible. Both lack safeguards to avoid divergence of reference across different communities, which can scupper the prospects for genuine moral disagreement. I explore the prospects for supplementing both views with Lewis's notion of eligibility, arguing that this can solve the problem for a modified form of analytical descriptivism, (...) and for a modified form of SEN too (though perhaps more controversially). I close by considering the appropriateness of using the notions of eligibility and joint-carving in ethics. (shrink)

Inscrutability arguments threaten to reduce interpretationist metasemantic theories to absurdity. Can we find some way to block the arguments? A highly influential proposal in this regard is David Lewis’ ‘ eligibility ’ response: some theories are better than others, not because they fit the data better, but because they are framed in terms of more natural properties. The purposes of this paper are to outline the nature of the eligibility proposal, making the case that it is not ad (...) hoc, but instead flows naturally from three independently motivated elements; and to show that severe limitations afflict the proposal. In conclusion, I pick out the element of the eligibility response that is responsible for the limitations: future work in this area should therefore concentrate on amending this aspect of the overall theory. (shrink)

When a belief set is contracted only some beliefs are eligible for removal. By introducing eligibility for removal as a new semantic primitive for contraction and combining it with epistemic entrenchment we get a contraction operator with a number of interesting properties. By placing some minimal constraint upon eligibility we get an explicit contraction recipe that exactly characterises the so called interpolation thesis, a thesis that states upper and lower bounds for the amount of information to be given (...) up in contraction. As a result we drop the controversial property of recovery. By placing additional constraints on eligibility we get representation theorems for a number of contraction operators of varying strength. In addition it is shown that recovery contraction is a special case that we get if eligibility is explicitly constructed in terms of logical relevance. (shrink)

In their analysis of the eligibility criteria for assisted dying in Canada, Downie and Schuklenk put forward a strong argument for the ethical defensibility of including mental illnesses and disabilities as underlying conditions driving a person’s request for assisted dying.1 In this commentary, we add a view on these debates from our home state of Victoria, Australia, where voluntary assisted dying has been legal since June 2019. We highlight the more conservative approach to eligibility in our setting compared (...) with Canada, and argue for debates about eligibility criteria to be conceptualised as part of a broader discussion about access to assisted dying that includes clinicians’ roles and perspectives. In our view, clinicians’ perspectives may have a significant impact on individuals’ ability to access assisted dying, regardless of legislative or other changes made to any system. ‘Voluntary assisted dying’ is the terminology used in our context, rather than Medical Assistance in Dying, so we will use that term when referring to the Victorian system. There are several key differences between the Canadian and Victorian approaches that are important in relation to the debates addressed by Downie and Schuklenk. First, the emphasis in Victoria is on patient self-administration of the VAD …. (shrink)

According to the eligibility theory of meaning, often attributed to David Lewis, the referent of a predicate is the property that best balances the twin constraints of charity and eligibility, where eligibility is a function of metaphysical naturalness. This sort of metasemantics, which is motivated by its ability to resolve problems of indeterminacy and secure shared reference between disputing parties, can be somewhat friendly towards revisionary theories, since highly natural properties can act as “reference magnets,” securing our (...) reference despite some mismatch with usage. In this paper, I apply these considerations to normative ethics and argue that the theory of rule utilitarianism achieves a high balance of charity and eligibility. I proceed by comparing rule utilitarianism to two of its well-known rivals, act utilitarianism and Rossian pluralism. I show how the former achieves a high degree of eligibility but only at a significant cost of charity, while the latter does the opposite, fitting very nicely with our considered judgments but at the price of very low eligibility. Rule utilitarianism, on the other hand, strikes a good balance between these extremes; it assigns to our core moral term a relatively natural property without doing too much damage to our moral convictions. Thus, rule utilitarianism should be regarded as a promising moral theory by any philosopher who takes seriously considerations of eligibility and naturalness. (shrink)

Downie and Schuklenk1 provide a clear narrative of the development of Canadian policy on medically assisted dying. This is very helpful for considering specific aspects of the continuing deliberations in Canada. This commentary presents an alternative perspective on the authors’ argument that narrow eligibility criteria for medical assistance in dying are discriminatory and unjustified. I argue that disability or mental illness as sole reason for accessing MAiD removes protections for all people who have times in their life when they (...) have mental illness or disability combined with intolerable suffering. I claim that individuals do not make their best, self-actualising decisions at those times and the supposed protections of vague terms such as incurable, advanced and decline are not clinically useful for evaluating eligibility for individuals with chronic health conditions. Within discussion of the impact of social determinants of health on access to MAiD, the authors present the argument that decisionally capable people with mental illness or disabilities as their sole underlying condition should be allowed to access MAiD. The authors state that opposing this access sacrifices patient rights and strips people of their agency. To support their argument, they embrace the idea that people with mental illness or disabilities belong to an identifiable cohort. They claim that …. (shrink)

The scarcity of human organs requires the transplant community to make difficult allocation decisions. This process begins at individual medical centers, where transplant teams decide which patients to place on the transplant waiting list. Each transplant center utilizes its own listing criteria to determine if a patient is eligible for transplantation. These criteria have historically considered preexisting affective and psychotic disorders to be relative or absolute contraindications to transplantation. While attitudes within the field appear to be moving away from this (...) practice, there is no data to confirm that eligibility criteria have changed. There are no nationwide guidelines detailing the manner in which affective and psychotic disorders should impact transplant eligibility. Individual transplant centers thus form their own transplant eligibility criteria, resulting in significant inter-institution variability. Data from the 1990s indicates that the majority of transplant programs considered certain psychiatric illnesses, such as active schizophrenia, to be absolute contraindications to transplantation. A review of literature reveals that no comprehensive data has been collected on the topic since that time. Furthermore, the limited data available about current practices suggests that psychiatric illness continues to be viewed as a contraindication to transplantation at some transplant centers. In light of this finding, we review psychiatric literature that examines the impact of affective and psychotic disorders on transplant outcomes and conclude that the presence of these disorders is not an accurate predictor of transplant success. We then discuss the requirements of justice as they relate to the creation of a just organ allocation system. We conclude that transplant eligibility criteria that exclude patients with affective and psychotic disorders on the basis of their psychiatric diagnosis alone are unjust. Just listing criteria must incorporate only those factors that have a causative effect on posttransplant morbidity and mortality. Justice also demands that we eliminate current inter-institution practice variations in favor of national transplant eligibility criteria. Given the limited data available about current practices, we call for an updated study investigating the manner in which affect and psychotic disorders impact transplant eligibility determinations. (shrink)

Moral perception has made something of a comeback in recent work on moral epistemology. Many traditional objections to the view have been argued to fail upon closer inspection. But it remains an open question just how far moral perception might extend. In this paper, I provide the beginnings of an answer to this question by assessing the relationship between the metaphysical structure of different normative properties and a plausible constraint on which properties are eligible for perceptual awareness which I call (...) the Counterfactual Strengthening Test. Along the way I consider and reject a few other possible constraints on perceptual awareness. I defend the view that moral perception is restricted to the perception of evaluative and pro tanto deontic properties. I conclude with a few gestures toward what this limitation on moral perception may mean for broader moral epistemology. (shrink)

In emergency situations and while medical resources are sufficient, doctors are expected to prioritize and treat patients according to medical criteria only. In MASSCAL situations and when medical resources become insufficient, patient selection and prioritization changes. Rules of triage are applied with the aim of getting the best result possible under the circumstances, e.g., saving the largest number; collective health outweighs individual health. Still, according to the standard ethical principles, non-medical criteria should never influence the doctors’ decision of who will (...) be treated. In military contexts, so-called medical rules of eligibility (MROE) provide rules that include non-medical criteria. This chapter aims to analyze if, why, and under what circumstances it may be ethically acceptable to prioritize patients according to non-medical criteria. (shrink)

Deciding whether to grant an expanded access request for a child whose sibling is enrolled in a gene therapy trial involves a number of complex factors: considering the best interests of the child, the psychosocial and economic impact on the family, and the concerns and obligations of researchers. Despite the challenges in coming to a substantively fair outcome in cases of discordant eligibility, creating a procedurally fair decision-making process to adjudicate requests is essential.

We studied changes in eligibility criteria--the largest impediment to patient accrual--in two samples of clinical trials. Trials from the NSABP (National Surgical Adjuvant Breast and Bowel Program) and POG (Pediatric Oncology Group) were analyzed. After eliminating duplications, the criteria in each protocol were enumerated and classified according to a novel schema. NSABP trials contained significantly more criteria than POG trials, and added precision criteria (making study populations homogeneous) at a faster rate than POG studies. The difference between NSABP studies (...) (explanatory trials) and POG studies (pragmatic trials) suggest that large numbers of eligibility criteria are not necessary for quality studies. We recommend that: (1) the inclusion/exclusion criteria distinction be abandoned; (2) eligibility criteria be explicitly justified; (3) the need for each criterion be assessed when new trials are planned; (4) criteria in phase III trials restricting patient accrual be minimized; and (5) further research be done to assess the impact of criteria on generalizability. (shrink)

El objetivo de este capítulo es analizar el presunto despliegue de la «democracia sin alternativas» en Europa y sus consecuencias para la calidad de las democracias nacionales, especialmente las de la periferia de la zona euro –giips: Grecia, Irlanda, Italia, Portugal y España. El argumento principal es que la falta de receptividad de los gobiernos nacionales de los países giips hacia los deseos de sus ciudadanos constituye el reverso de la moneda de un exceso de atención de los gobiernos de (...) los países núcleo del euro, en especial de Alemania, a las preferencias de su ciudadanía. En todas las democracias representativas los políticos se enfrentan a un dilema fundamental entre receptividad a las demandas ciudadanas y responsabilidad ante terceros. Enfrentados a este dilema, los países núcleo del euro han optado claramente por lo primero –la receptividad ante las demandas de los electorados nacionales–, mientras que los países de la periferia de la zona euro se han visto forzados a ser responsables –ante sus socios de la ue y ante la ue en su totalidad. Como resultado, la crisis financiera de 2008 ha conducido a una ruptura en tres frentes dentro de la Unión Europea entre el núcleo y la periferia: con relación al ritmo de la recuperación económica, a los grados de autonomía gubernamental y, lo más importante, a la legitimidad democrática. Los países de la periferia de la eurozona se encuentran en el bando perdedor en los tres frentes.The objective of this article is to analyze the alleged unfolding of ‘democracy without choices’ in Europe and its consequences for the quality of national democracies, particularly those of the Eurozone periphery –giips: Greece, Ireland, Italy, Portugal and Spain. The argument is, in a nutshell, that the lack of responsiveness of giips national Governments to their respective national constituencies is the reverse of the medal of an excess of responsiveness in core Euro countries, particularly Germany. Governments are trapped between the pressure to be responsive at home and the need to be responsible to their European partners and the European project. If the trade-off of all democratic politics is between responsiveness and responsibility, Euro core countries have clearly opted for responsiveness –to domestic constituencies– and Eurozone peripheral countries have been forced to be responsible –towards their eu partners and the eu as a whole. As a result, the 2008 financial crisis has led to a three-fold breach inside the eu between core and periphery concerning the pace of economic recovery, the degrees of governmental autonomy and, most important of all, democratic legitimacy. Eurozone peripheral countries are at the losing side of this three-fold breach. (shrink)

This paper outlines Lewis’s favoured foundational account of linguistic representation, and outlines and briefly evaluates variations and modifications. Section 1 gives an opinionated exegesis of Lewis’ work on the foundations of reference—his interpretationism. I look at the way that the metaphysical distinction between natural and non-natural properties came to play a central role in his thinking about language. Lewis’s own deployment of this notion has implausible commitments, so in section 2 I consider variations and alternatives. Section 3 briefly considers a (...) buck-passing strategy involving fine-grained linguistic conventions. (shrink)

This paper continues the discussion of three values of sport (safety, fairness, inclusion) that has developed around the theme of inclusion of transwomen in the female category in World Rugby, as discussed by Pike, Burke and Imbrišević. In contrast to their discussion, in which these three values have been seen from the limited perspective of the inclusion of one group of athletes into a specific category of one sport, they are here discussed in the context of the categorization in sport (...) in general, with a focus on constitutive and eligibility rules. Constitutive rules give a strong foundation for eligibility rules. From the perspective of eligibility rules, the value of inclusion is identified as the underlying main value, while fairness and safety are its functions. This view rehabilitates the value of inclusion and has implications for how we think about the inclusion of athletes in sport, and for the creation of categories. (shrink)

This chapter outlines David Lewis's favored foundational account of linguistic representation, and outlines and briefly evaluates variations and modifications. It gives an opinionated exegesis of Lewis's work on the foundations of reference: his interpretationism. The author looks at the way that the metaphysical distinction between natural and non‐natural properties came to play a central role in his thinking about language. Lewis's own deployment of this notion has implausible commitments. The chapter briefly considers a buck‐passing strategy involving fine‐grained linguistic conventions. Lewis (...) was no fan of primitive intentionality. Much of the Lewisian framework remains attractive. The overall select‐and‐project method, with its promise to deal even‐handedly with all linguistic intentionality, and its epistemic tractability, should be retained. Post‐Lewisian interpretationism results from emphasizing and retaining some of the virtues of Lewis's original proposal promises (e.g. universality and epistemic tractability), while compromising on others (e.g. metaphysical principle). (shrink)

The subject of gender discrimination in language and the relation between language and social structures is well known and widely debated. Nevertheless, everyday experiences show, over and over, the linguistic hierarchy at work when men and women are concerned. This paper has two main parts. The first one concerns the image of women in language and the other one treats the manner in which women usually use the language. Despite the fact that these social unwritten rules and deep rooted preconceptions (...) are, in my opinion, difficult to ignore, the initiative of analyzing such facts represents an important first step in reducing the negative effects of the phenomenon. Obviously, we are aware of the fact that the problem is extremely profound and the imposed usage of certain nondiscriminatory terms represents not a very efficient solution, but, all in all, this analysis is the first phase of a much profound change that hopefully will occur. (shrink)

Medical rules of eligibility permit severely injured Iraqi and Afghan nationals to receive care in Coalition medical facilities only if bed space is available and their injuries result directly from Coalition fire. The first rule favors Coalition soldiers over host-nation nationals and contradicts the principle of impartial, needs-based medical care. To justify preferential care for compatriots, wartime medicine invokes associative obligations of care that favor friends, family, and comrades-in-arms. Associative obligations have little place in peacetime medical care but significantly (...) affect wartime medicine. The second rule suggests liability for collateral harm that is unsupported by international law and military ethics. Absent liability, there are pragmatic reasons to offer medical care to injured local civilians if it quells resentment and cements support for Coalition forces. In contrast to peacetime medicine, military necessity and associative obligations outweigh distributive principles based on medical need during war. (shrink)

With the world's population aging, hospitals are facing pressure to adequately meet the needs of a growing number of frail older patients. For this population, comorbidities combined with a limited ability to face stressful situations contribute to frailty whereby a small injury or illness can lead to significant loss of function. It is widely recognized that hospitalized older patients are more vulnerable to physical or cognitive functional decline and require increased assistance in activities of daily living (Creditor 1993; Sager et (...) al. 1996; Mahoney, Sager, and Jalaluddin 1998; Kortebein et al. 2008; English and PaddonJones 2010; Covinsky, Pierluissi, and Johnston 2011; Zisberg et al. 2011;... (shrink)

The Caster Semenya debacle touched off by the 2009 Berlin World Athletics Championships resulted finally in IOC and IAAF abandonment of sex testing, which gave way to procedures that make female competition eligibility dependent upon the level of serum testosterone, which must be below the male range or instrumentally countered by androgen resistance. We argue that the new policy is unsustainable because (i) the testosterone-performance connection it posits is uncompelling; (ii) testosterone-induced female advantage is not ipso facto unfair advantage; (...) (iii) the new policy reflects the gender policing impulses endemic to sport as well as the broader cultural impulses to monstrify women and to doctor women who have nothing wrong with them; (iv) female?male performance disparities are not the only reason for sex-segregated sport, but co-exist with respectable cultural and practical reasons, which (v) provide a powerful case for allowing athletes to compete in the sex category congruent with their gender identity. (shrink)

Open peer commentary on the article “Investigating Extended Embodiment Using a Computational Model and Human Experimentation” by Yuki Sato, Hiroyuki Iizuka & Takashi Ikegami. Upshot: The target article’s findings on the focus of attention in extending an agent’s body schema are consistent with those in developmental psychology and neuroscience on goal-directed action. The consequences of these findings are that embodiment can be extended in a variety of ways, not all of which require direct physical manipulation.

According to the “discrimination argument,” it would be discriminatory and hence impermissible to categorically exclude people with mental illness (PMI) from access to assisted suicide (AS) if AS is accessible to people with somatic illnesses. In objection to this, it could be argued that excluding PMI is not discriminatory, but rather based on their inability to meet certain eligibility criteria for AS. Which criteria are deemed necessary depends on the approach taken to justifying AS. In this article, we describe (...) two distinct ethical approaches to justifying AS and the eligibility criteria they entail and examine whether PMI can fulfill these criteria. A widespread “joint” approach based on beneficence and autonomy assumes that AS is justified when it alleviates the severe and irremediable suffering of a person who autonomously requests AS. An alternative, exclusively autonomy‐based approach assumes that providing AS is justified when a person's request is autonomous, regardless of whether AS is in her best interests. The latter approach underlies an important judgment of the German Federal Constitutional Court from 2020. We argue that PMI can in principle fulfill both beneficence‐ and autonomy‐based eligibility criteria for AS, and that a blanket exclusion of all PMI from AS is thus discriminatory on either approach. However, depending on which approach is taken, there are differences regarding the subgroups of PMI that would be eligible for AS. Whether the exclusion of specific PMI is discriminatory therefore depends on how we understand and justify AS. (shrink)

Priority setting in healthcare is a highly contentious area of public decision making, in which different values often support incompatible policy options and compromise can be elusive. One promising approach to resolving priority-setting conflicts divides the decision-making process into two steps. In the first, a set of eligible options is identified; in the second, one of those options is chosen by a deliberative process. This paper considers the first step, examining proposals for identifying a set of options eligible for deliberation. (...) It focuses on the approach proposed by Anders Herlitz, which limits deliberation to options that are on a par; neither better or worse than, nor strictly equal to the alternatives. Once these “maximal” options are identified, the choice among them is made though a deliberative process that acknowledges the difficult tradeoffs which must be made. While parity and kindred notions are clearly useful in resolving some priority-setting conflicts, this paper argues that the conflicts that arise in setting priorities make it as difficult to decide which options are on a par as it is to decide among those options. The paper draws on priority-setting debates that occurred during the recent pandemic to illustrate the challenges in identifying eligible options: There may be sharp disagreement about how to understand and individuate relevant values; about whether certain values are relevant in a priority-setting context; about how to establish parity between “consequential” and “deontic” options, and about whether one option remains on a par with others after it is modified in various ways. (shrink)

Clear guidelines addressing the ethically appropriate use of anti-infectives in the setting of hospice care do not exist. There is lack of understanding about key treatment decisions related to infection treatment for patients who are eligible for hospice care. Ethical concerns about anti-infective use at the end of life include: (1) delaying transition to hospice, (2) prolonging a dying process, (3) prescribing regimens incongruent with a short life expectancy and goals of care, (4) increasing the reservoir of potential resistant pathogens, (...) (5) placing unreasonable costs on a capitated hospice system. Although anti-infectives are thought to be relatively safe, they can place a burden on patients and be inconsistent to particular care plans. The current complex, and at times fragmented, medical care often fails to address these issues in decision-making. In many ways, the ethics governing the end of life decisions related to dialysis, hydration/nutrition, and hypercalcemia parallel those of anti-infectives. In this article we articulate important elements in ethical decision-making in the application of anti-infectives for patients who are eligible for hospice care, and we point to the need for prospective studies to help refine particular guidelines in these cases. (shrink)

ABSTRACT Clear guidelines addressing the ethically appropriate use of anti‐infectives in the setting of hospice care do not exist. There is lack of understanding about key treatment decisions related to infection treatment for patients who are eligible for hospice care. Ethical concerns about anti‐infective use at the end of life include: (1) delaying transition to hospice, (2) prolonging a dying process, (3) prescribing regimens incongruent with a short life expectancy and goals of care, (4) increasing the reservoir of potential resistant (...) pathogens, (5) placing unreasonable costs on a capitated hospice system. Although anti‐infectives are thought to be relatively safe, they can place a burden on patients and be inconsistent to particular care plans. The current complex, and at times fragmented, medical care often fails to address these issues in decision‐making. In many ways, the ethics governing the end of life decisions related to dialysis, hydration/nutrition, and hypercalcemia parallel those of anti‐infectives. In this article we articulate important elements in ethical decision‐making in the application of anti‐infectives for patients who are eligible for hospice care, and we point to the need for prospective studies to help refine particular guidelines in these cases. (shrink)

The topic of this paper is the general thesis that the death of the human organism is what constitutes the death of a person. All admit that when the death of a human organism occurs, in some form or another, this normally does result in the death of a person. But, some maintain, organismic death is not the same thing as personal death. Why? Because, they maintain, despite the fact that persons are associated with a human organism (‘their organism’), they (...) are not identical with their organism, and so they can, at least in principle and perhaps in actuality, die before or after their organism dies. The thesis described above I shall call ‘the two-deaths thesis’ in virtue of the fact that its proponents believe that there are two kinds of death, viz. organismic death and personal death. The opposing thesis, according to which the death of a human organism does constitute the death of a person, I call the ‘one death thesis’. After giving some background remarks in section 2 of this paper, in section 3 I argue that, if we take linguistic usage seriously, neither the two-deaths thesis nor the one-death thesis is true. I argue, rather, that so far as linguistic usage goes it is indeterminate which of them is true. In section 4 I go further and argue that if one accepts a widely held metaphysical view, viz. that the world itself partially determines reference and the extensions of our concepts, then it is plausible that the one-death thesis is true despite the facts about linguistic usage. (shrink)

Parker’s article is a welcome attempt to address the importance of environmental sustainability in the realm of clinical ethics.1 We support the recent movement to seriously consider the environmental impact of healthcare institutions in bioethics.2 3 Still, we find two partly linked weaknesses of Parker’s analysis and guideline suggestion. These relate to a need in ‘green’ bioethics to see beyond the normal healthcare ethical focus on health-related values related to individual patients, and to primarily adopt institutional ways of framing central (...) decision problems. Traditional bioethics applies a restricted scope of values to assess clinical decisions: primarily health-related patient well-being (including life) and patient autonomy. If a decision improves (or, as in Parker’s inhaler case, maintains) a patient’s health-related well-being, this supports it. However, if a decision improves a patient’s non health-related well-being, say, winning a beauty contest or securing a job by having cosmetic surgery, it is not supported. And so on. This idea of healthcare as, in Michael Walzer’s classic terminology, a separate ‘sphere of justice’ has two interrelated limitations: it reflects a bias towards individual patients over other people, and it restricts the scope of values allowed to influence healthcare ethical judgements. These limitations appear once we see that the issue addressed by Parker can be framed either as prescription decisions taken by individual doctors against the background of …. (shrink)

Ki Su Kim; J. S. Mill's Concept of Maturity as the Criterion in Determining Children's Eligibility for Rights, Journal of Philosophy of Education, Volume 24, Is.

A key challenge in conducting paid internet-based studies is that individuals may feign eligibility to participate. This case series describes three examples where people attempted to fake being locals with health vulnerabilities to participate in paid internet-mediated studies. In two cases, individuals pretended to have serious cancer diagnoses to participate in a randomized controlled trial. In the third case, an individual pretended to be nine restaurant workers at high risk of occupational COVID-19 exposure to participate in an online survey. (...) Key red flags among individuals feigning eligibility are noted. Ethical and practical methodologic implications are discussed. (shrink)

This book focuses on resource allocation in military and humanitarian medicine during times of scarcity and austerity. It is in these times that health systems bend, break, and even collapse and where resource allocation becomes a paramount concern and directly impacts clinical decision-making. Such times are challenging and this book covers this very important, yet, scarcely researched topic within the field of bioethics. This work brings together experts and practitioners in the fields of military health care, philosophy, ethics, and other (...) disciplines to provide analysis on a variety of related topics ranging from case studies and first-hand experiences to policy and philosophical analysis. It is of great interest to to academics, practitioners, policy makers and students who are looking for analyses and guidance regarding the fair provision of medical care and the use of medical rules of eligibility under adverse conditions. (shrink)

The Toulmin model has been proved useful in law and argumentation theory. This model describes the basic process in justifying a claim, which comprises six elements, i.e., claim (C), data (D), warrant (W), backing (B), qualifier (Q), and rebuttal (R). Specifically, in justifying a claim, one must put forward ‘data’ and a ‘warrant’, whereas the latter is authorized by ‘backing’. The force of the ‘claim’ being justified is represented by the ‘qualifier’, and the condition under which the claim cannot be (...) justified is represented as the ‘rebuttal’. To further improve the model, (Goodnight, Informal Logic 15:41–52, 1993) points out that the selection of a backing needs justification, which he calls legitimation justification. However, how such justification is constituted has not yet been clarified. To identify legitimation justification, we separate it into two parts. One justifies a backing’s eligibility (legitimation justification 1 ; LJ 1 ); the other justifies its superiority over other eligible backings (legitimation justification 2 ; LJ 2 ). In this paper, we focus on LJ 1 and apply it to the legal justification (of judgements) in hard cases for illustration purposes. We submit that LJ 1 refers to the justification of the legal interpretation of a norm by its backing, which can be further separated into several orderable subjustifications. Taking the subjustification of a norm’s existence as an example, we show how it would be influenced by different positions in the philosophy of law. Taking the position of the theory of natural law, such subjustification is presented and evaluated. This paper aims not only to inform ongoing theoretical efforts to apply the Toulmin model in the legal field, but it also seeks to clarify the process in the justification of legal judgments in hard cases. It also offers background information for the possible construction of related AI systems. In our future work, LJ 2 and other subjustifications of LJ 1 will be discussed. (shrink)

OBJECTIVE: To investigate whether eligibility criteria that exclude the elderly, persons with psychiatric disease, and persons with substance abuse problems from participation in randomized controlled trials (RCTs) are subjective and hence a source of variability in enrolment decisions and investigator uncertainty. DESIGN: Survey questionnaire. PARTICIPANTS: Cancer investigators from the United States and Canada. INTERVENTIONS: Investigators were presented with clinical vignettes from 3 patient categories--eligible, ineligible and uncertain--for each of 5 eligibility criteria--3 subjective and 2 objective--and were asked whether (...) they would enrol the patient in a trial and how sure they were of this decision. Demographic characteristics of the investigators were also collected. OUTCOME MEASURES: The difference in enrolment decisions between subjective and objective criteria, and the difference in the certainty associated with these decisions. RESULTS: Of 365 questionnaires sent out, 224 usable ones were returned. Compared with the objective criteria, the subjective criteria were associated with more variable enrolment decisions (p = 0.07 for the "eligible" scenario and p = 0.0001 for the "ineligible" and "uncertain" scenarios), and investigators were less sure about the decisions they made (p = 0.0001 for all scenarios). Demographic characteristics of the investigators failed to explain the observed differences. CONCLUSIONS: Subjective eligibility criteria may interfere with the conduct and interpretation of RCTs and, therefore, their use ought to be justified explicitly in the study protocol. RCT designers, funding agencies and research ethics boards have an important role in reviewing eligibility criteria for their necessity. (shrink)

Medical aid in dying (MAiD), despite being legal in many jurisdictions, remains controversial ethically. Existing surveys of physicians’ perceptions of MAiD tend to focus on the legal or moral permissibility of MAiD in general. Using a novel sampling strategy, we surveyed physicians likely to have engaged in MAiD-related activities in Colorado to assess their attitudes toward contemporary ethical issues in MAiD.

Current strategies to address global inequities in access to life-saving vaccines use averaged national income data to determine eligibility. While largely successful in the lowest income countries, we argue that this approach could lead to significant inefficiencies from the standpoint of justice if applied to middle-income countries, where income inequalities are large and lead to national averages that obscure truly needy populations. Instead, we suggest alternative indicators more sensitive to social justice concerns that merit consideration by policy-makers developing new (...) initiatives to redress health inequities in middle-income countries. (shrink)

Based on conversation analysis, this study investigates central practices in what is defined as a caring interview, in the context of welfare administration. Caring refers to a helpful interviewing in reformulations of questions, taking interviewees’ difficulties to answer into consideration; a caring attitude in the framing of questions, showing understanding of clients’ circumstances and professional’s enactment of expertise in assessments of clients’ disabilities and care needs. Data include a corpus of 43 recorded interviews in which officials at the Swedish Social (...) Insurance Agency interview clients who have applied for benefits. The study adds to research on interactional sensitivity, polar questions and epistemic stance in institutional interaction. The study shows how the interviewer prioritizes confirming polar questions, takes responsibilities of knowing into account and reduces the epistemic gap to the interviewee in practices of a caring interview. This makes the interviewing markedly different from standardized and bureaucratic interviewing. (shrink)