This paper defends the view, put roughly, that to think that p is to guess that p is the answer to the question at hand, and that to think that p rationally is for one’s guess to that question to be in a certain sense non-arbitrary. Some theses that will be argued for along the way include: that thinking is question-sensitive and, correspondingly, that ‘thinks’ is context-sensitive; that it can be rational to think that p while having arbitrarily low credence (...) that p; that, nonetheless, rational thinking is closed under entailment; that thinking does not supervene on credence; and that in many cases what one thinks on certain matters is, in a very literal sense, a choice. Finally, since there are strong reasons to believe that thinking just is believing, there are strong reasons to think that all this goes for belief as well. (shrink)

An action is agentially perfect if and only if, if a person tries to perform it, they succeed, and, if a person performs it, they try to. We argue that trying itself is agentially perfect: if a person tries to try to do something, they try to do it; and, if a person tries to do something, they try to try to do it. We show how this claim sheds new light on questions about basic action, the logical structure of (...) intentional action, and the notion of "options" in decision theory. On the way to these central ideas, we argue that a person can try to do something even if they believe it is impossible that they will succeed, that a person can try to do something even if they do not want to succeed, and that a person can try to do something even if they do not intend to succeed. (shrink)

Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patient contribution to costs, (...) and lower priority treatment, but not typically full exclusion from the healthcare system. We also note two important restrictions on this argument. First, failures of solidary obligations can only be assumed under conditions that are conducive to sufficiently autonomous choice, which occur when patients are given ‘Golden Opportunities’ to improve their health. Second, because poor health does not occur in a social vacuum, an insistence on solidarity as part of healthcare is legitimate only if all members of society are held to similar standards of solidarity. We cannot insist upon, and penalise failures of, solidarity only for those who are unwell, and who cannot afford to evade the terms of public health. (shrink)

This paper defends the simple view that in asserting that p, one lies iff one knows that p is false. Along the way it draws some morals about deception, knowledge, Gettier cases, belief, assertion, and the relationship between first- and higher-order norms.

Virtue epistemology is among the dominant influences in mainstream epistemology today. An important commitment of one strand of virtue epistemology – responsibilist virtue epistemology (e.g., Montmarquet 1993; Zagzebski 1996; Battaly 2006; Baehr 2011) – is that it must provide regulative normative guidance for good thinking. Recently, a number of virtue epistemologists (most notably Baehr, 2013) have held that virtue epistemology not only can provide regulative normative guidance, but moreover that we should reconceive the primary epistemic aim of all education as (...) the inculcation of the intellectual virtues. Baehr’s picture contrasts with another well-known position – that the primary aim of education is the promotion of critical thinking (Scheffler 1989; Siegel 1988; 1997; 2017). In this paper – that we hold makes a contribution to both philosophy of education and epistemology and, a fortiori, epistemology of education – we challenge this picture. We outline three criteria that any putative aim of education must meet and hold that it is the aim of critical thinking, rather than the aim of instilling intellectual virtue, that best meets these criteria. On this basis, we propose a new challenge for intellectual virtue epistemology, next to the well-known empirically-driven ‘situationist challenge’. What we call the ‘pedagogical challenge’ maintains that the intellectual virtues approach does not have available a suitably effective pedagogy to qualify the acquisition of intellectual virtue as the primary aim of education. This is because the pedagogic model of the intellectual virtues approach (borrowed largely from exemplarist thinking) is not properly action-guiding. Instead, we hold that, without much further development in virtue-based theory, logic and critical thinking must still play the primary role in the epistemology of education. (shrink)

This paper considers some puzzling knowledge ascriptions and argues that they present prima facie counterexamples to credence, belief, and justification conditions on knowledge, as well as to many of the standard meta-semantic assumptions about the context-sensitivity of ‘know’. It argues that these ascriptions provide new evidence in favor of contextualist theories of knowledge—in particular those that take the interpretation of ‘know’ to be sensitive to the mechanisms of constraint.

There is significant controversy over whether patients have a ‘right not to know’ information relevant to their health. Some arguments for limiting such a right appeal to potential burdens on others that a patient’s avoidable ignorance might generate. This paper develops this argument by extending it to cases where refusal of relevant information may generate greater demands on a publicly funded healthcare system. In such cases, patients may have an ‘obligation to know’. However, we cannot infer from the fact that (...) a patient has an obligation to know that she does not also have a right not to know. The right not to know is held against medical professionals at a formal institutional level. We have reason to protect patients’ control over the information that they receive, even if in individual instances patients exercise this control in ways that violate obligations. (shrink)

There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth might seem to enable us (...) to overcome—fairness of burdens and reliance on self-reporting—I note that these problems would only really be solved by unacceptably comprehensive forms of personal health surveillance which applies to all of us at all times. A more plausible model is to use personal health surveillance as a last resort for patients who would otherwise independently qualify for responsibility-based penalties. However, I note that there are still a number of ethical and practical problems that such a policy would need to overcome. The prospects of mHealth enabling a fair, genuinely cost-saving policy of patient responsibility are slim. (shrink)

A plausible principle about the felicitous use of indicative conditionals says that there is something strange about asserting an indicative conditional when you know whether its antecedent is true. But in most contexts there is nothing strange at all about asserting indicative conditionals like ‘If Oswald didn’t shoot Kennedy, then someone else did’. This paper argues that the only compelling explanation of these facts requires the resources of contextualism about knowledge.

A considerable literature has emerged around the idea of using ‘personal responsibility’ as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as ‘responsibilisation’. This discussion focuses most prominently, but not exclusively, on ‘luck egalitarianism’, the view that deviations from equality are justified only by suitably free choices. A superficially separate issue in distributive justice concerns the two–way relationship (...) between health and other social goods: deficits in health typically undermine one's abilities to secure advantage in other areas, which in turn often have further negative effects on health. This paper outlines the degree to which this latter relationship between health and other social goods exacerbates an existing problem for proponents of responsibilisation (the ‘harshness objection’) in ways that standard responses to this objection cannot address. Placing significant conditions on healthcare access because of a person's prior responsibility risks trapping them in, or worsening, negative cycles where poor health and associated lack of opportunity reinforce one another, making further poor yet ultimately responsible choices more likely. It ends by considering three possible solutions to this problem. (shrink)

The idea of using responsibility in the allocation of healthcare resources has been criticized for, among other things, too readily abandoning people who are responsible for being very badly off. One response to this problem is that while responsibility can play a role in resource allocation, it cannot do so if it will leave those who are responsible below a “sufficiency” threshold. This paper considers first whether a view can be both distinctively sufficientarian and allow responsibility to play a role (...) even for those who will be left with very poor health. It then draws several further distinctions that may affect the application of responsibility at this level. We conclude that a more plausible version of the sufficientarian view is to allow a role for responsibility where failure to do so will leave someone else who is not responsible below the sufficiency threshold. However, we suggest that individuals must exhibit “sufficient responsibility” in order for this to apply, involving both a sufficient level of control and an avoidable failure to respond adequately to reasons for action. (shrink)

Defenses of political obligation—the pro tanto obligation to obey the law because the state commands it—often operate at or near the level of ideal theory. Critics, though, increasingly question that approach’s relevance for the imperfect states that exist. This article develops a lesser evil framework to evaluate political obligation with several advantages over more ideal approaches: (1) avoids the questionable assumption that some actual states are reasonably just, (2) recognizes that context matters for political obligation, (3) captures the complicity involved (...) in obeying the state, and (4) identifies a basis—varying intuitions on lesser evil justifications—to distinguish philosophical anarchism from conceptions of political obligation without the former collapsing into the latter. We remain agnostic on whether this framework establishes political obligation to any state but argue that it offers a compelling account of the moral dilemma of obeying the state under nonideal conditions. (shrink)

This paper argues that two widely accepted principles about the indicative conditional jointly presuppose the falsity of one of the most prominent arguments against epistemological iteration principles. The first principle about the indicative conditional, which has close ties both to the Ramsey test and the “or‐to‐if” inference, says that knowing a material conditional suffices for knowing the corresponding indicative. The second principle says that conditional contradictions cannot be true when their antecedents are epistemically possible. Taken together, these principles entail that (...) it is impossible to be in a certain kind of epistemic state: namely, a state of ignorance about which of two partially overlapping bodies of knowledge corresponds to one's actual one. However, some of the more popular “margin for error” style arguments against epistemological iteration principles suggest that such states are not only possible, but commonplace. I argue that the tension between these views runs deep, arising just as much for non‐factive attitudes like belief, presupposition, and certainty. I also argue that this is worse news for those who accept the principles about the indicative conditional than it is for those who reject epistemological iteration principles. (shrink)

Greg Bognar has recently offered a prioritarian justification for ‘fair innings’ distributive principles that would ration access to healthcare on the basis of patients' age. In this article, I agree that Bognar's principle is among the strongest arguments for age-based rationing. However, I argue that this position is incomplete because of the possibility of ‘time-relative' egalitarian principles that could complement the kind of lifetime egalitarianism that Bognar adopts. After outlining Bognar's position, and explaining the attraction of time-relative egalitarianism, I suggest (...) various ways in which these two kinds of principle could interact. Since various options have very different implications for age-based rationing, proponents of such a rationing scheme must take a position on time-relative egalitarianism to complement a lifetime prioritarian view like Bognar's. (shrink)

This article offers a normative analysis of some of the most controversial incidents involving police—what I call police-generated killings. In these cases, bad police tactics create a situation where deadly force becomes necessary, becomes perceived as necessary, or occurs unintentionally. Police deserve blame for such killings because they choose tactics that unnecessarily raise the risk of deadly force, thus violating their obligation to prioritize the protection of life. Since current law in the United States fails to ban many bad tactics, (...) police- generated killings often are treated as “lawful but awful.” To address these killings, some call on changes to departmental policies or voluntary reparations by local governments, yet such measures leave in place a troubling gap between ethics and law. I argue that police-generated killings merit legal sanctions by appealing to a relevant analogy: self-generated self-defense, where the person who engages in self-defense started the trouble. The persistent lack of accountability for police-generated killings threatens life, police legitimacy, and trust in democratic institutions. The article closes by identifying tools in law and policy to address this challenge. (shrink)

I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly (...) strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort. (shrink)

This interview with Michal Ben-Naftali from March 2004 is one of Derrida's last. It begins with the question of the relationship between love, law, and justice and then moves on to discuss everything from the secret, hospitality, friendship, sacrifice, pardon and psychoanalysis to the relationship between deconstruction and melancholy.

Sufficientarians face a problem of arbitrariness: why place a sufficiency threshold at any particular point? One response is to seek universal goods to justify a threshold. However, this faces difficulties (despite sincere efforts) by either being too low, or failing to accommodate individuals with significant cognitive disabilities. Some sufficientarians have appealed to individuals’ subjective evaluations of their lives. I build on this idea, considering another individualized threshold: ‘tolerability’. I respond to some traditional challenges to individualistic approaches to justice: ‘expensive’ tastes, (...) and adaptive preferences. Finally, I end by offering some suggestions about how this relates to policymaking. (shrink)

Hun Chung argues for a theory of distributive justice – ‘prospect utilitarianism’ – that overcomes two central problems purportedly faced by sufficientarianism: giving implausible answers in ‘lifeboat cases’, where we can save the lives of some but not all of a group, and failing to respect the axiom of continuity. Chung claims that prospect utilitarianism overcomes these problems, and receives empirical support from work in economics on prospect theory. This article responds to Chung's criticisms of sufficientarianism, showing that they are (...) misplaced. It then shows that prospect utilitarianism faces independent problems, since it too requires a threshold, which Chung bases on the idea of ‘adequate functioning’. The article shows that there are problems with this as a threshold, and that it is not empirically supported by prospect theory. (shrink)

Healthcare practitioners have access to a range of ethical guidance. However, the normative role of this guidance in ethical decision-making is underexplored. This paper considers two ways that healthcare practitioners could approach ethics guidance. We first outline the idea of deference to ethics guidance, showing how an attitude of deference raises three key problems: moral value; moral understanding; and moral error. Drawing on philosophical literature, we then advocate an alternative framing of ethics guidance as a form of moral testimony by (...) colleagues and suggest that a more promising attitude to ethics guidance is to approach it in the spirit of ‘critical engagement’ rather than deference. (shrink)

This introductory chapter offers an overview of the various ways that responsibility may be relevant to health care, in order to situate the chapters in this volume in their broader context. The chapter begins by outlining relevant concepts, and explaining why it is worth considering the role of responsibility in health care. The chapter then turns to various ways in which patients might be held responsible in a health care system, before considering objections to these practices. Finally, the chapter considers (...) the role of responsibility in health care beyond holding patients responsible, by considering the responsibility of medical professionals, and of institutions. (shrink)

On 26 January 2021, while announcing that the country had reached the mark of 100,000 deaths within 28 days of COVID-19, UK Prime Minister Boris Johnson said that he took “full responsibility for everything that the Government has done” as part of British efforts to tackle the pandemic. The force of this statement was undermined, however, by what followed: -/- What I can tell you is that we truly did everything we could, and continue to do everything that we can, (...) to minimise loss of life and to minimise suffering... -/- Taking these sentiments together, it was hard to avoid the conclusion that the government took responsibility only for doing everything right. Such an admission of responsibility, accommodating no admission of error or wrongdoing, is not really about responsibility at all. Indeed, the UK’s pandemic response has been marked from its earliest days by a shifting of focus from institutional responsibility to personal responsibility for individual UK residents. -/- This paper explores the relationship between these two sites of responsibility—the institutional and the personal—in the context of the sort of pandemic that is ongoing as we write. Section 2 offers some initial definitions and discussions of key terms. Section 3 outlines how these two ideas interact in principle during such emergencies. Section 4 turns to the ‘non-ideal’ implications for personal responsibility of failures of institutional responsibility. While our focus is on the specific context with which we are most familiar, the UK governmental approach, where appropriate we also include examples from other states. (shrink)

This article considers attempts to include the issues of ageing and ill health in a Rawlsian framework. It first considers Norman Daniels’ Prudential Lifespan Account, which reduces intergenerational questions to issues of intrapersonal prudence from behind a Rawslian veil of ignorance. This approach faces several problems of idealisation, including those raised by Hugh Lazenby, because it must assume that everyone will live to the same age, undermining its status as a prudential calculation. I then assess Lazenby's account, which applies Rawls’ (...) general theory of justice more directly to healthcare. Lazenby suggests that we should apply Rawls’ difference principle – which claims that any inequalities in social goods must benefit the worst off – to conclude that we should significantly prioritise treatment of young patients. I argue first that the existence of young terminally ill patients undermines a number of Rawlsian arguments for the difference principle. I then argue that the structure of ageing undermines the Rawlsian decision mechanism of the ‘veil of ignorance’ on which Lazenby relies. I conclude that age and terminal illness present significant problems for any comprehensive Rawlsian account of justice. (shrink)

This chapter contains sections titled: Property‐Owning Democracy Before Socialism: The Rise of Commercial Republicanism Property‐Owning Democracy at the Socialist High Tide (i): Progressive Conservative Origins Property‐Owning Democracy at the Socialist High Tide (ii): Liberals and Labour Revisionists Property‐Owning Democracy at the Socialist High Tide (iii): James Meade Property‐Owning Democracy After Socialism? Rawlsian and Neoliberal Lineages References.

How should we respond to patients who do not wish to take on the responsibility and burdens of making decisions about their own care? In this paper, we argue that existing models of decision-making in modern healthcare are ill-equipped to cope with such patients and should be supplemented by an “appointed fiduciary” model where decision-making authority is formally transferred to a medical professional. Healthcare decisions are often complex and for patients can come at time of vulnerability. While this does not (...) undermine their capacity, it can be excessively burdensome. Most existing models of decision-making mandate that patients with capacity must retain ultimate responsibility for decisions. An appointed fiduciary model provides a formalized mechanism through which those few patients who wish to defer responsibility can hand over decision-making authority. By providing a formal structure for deferring to an appointed fiduciary, the confusions and risks of the informal transfers that can occur in practice are avoided. Finally, we note how appropriate governance and law can provide safeguards against risks to the welfare of patients and medical professionals. -/- . (shrink)

This paper outlines a novel framing of the normative significance of health by considering the idea of ‘health capital’. Health capital is a set of health-related assets of individuals that enable them to pursue their interests and to collaborate with others. The specific contribution of this paper is to establish the notion of health capital beyond a metaphorical idea and to initially explore the repercussions of it for theories of health justice. We propose a sufficientarian approach to health capital justice. (...) Our theory claims that social justice requires enabling people to achieve enough health capital to meet threats to health. This is a dynamic ideal, establishing claims of justice over time. The overarching goal is to avoid disadvantageous tipping points of health depletion. (shrink)

ABSTRACTIn Leviathan, Hobbes outlines the concept of the ‘Kingdome of God by Nature’ or ‘Naturall Kingdome of God’, terms rarely found in English texts at the time. This article traces the concept back to the Catechism of the Council of Trent, which sets forth a threefold understanding of God’s kingdom – the kingdoms of nature, grace, and glory – none of which refer to civil commonwealths on earth. Hobbes abandons this Catholic typology and transforms the concept of the natural kingdom (...) of God to advance a claim often missed by his interpreters: Leviathan-states are the manifestation of a real, not metaphorical, kingdom of God. This argument plays a key role in Leviathan, which identifies the kingdom of God as the Christian doctrine most subject to abuse. Hobbes harshly criticizes Catholic and Presbyterian clergy for claiming to represent God’s kingdom. This claim, he argues, comes with the subversive implication that the church possesses spiritual and temporal authority, and caused great turmoil during the English Civil War. As an alternative, Hobbes points to civil commonwealths as the manifestation of God’s natural kingdom, which is the only form his kingdom currently takes. (shrink)

Abstract The distinction between thick and thin concepts has been a central part of recent discussion in metaethics. Whilst there is a debate regarding how best to characterise the distinction, it is commonly accepted that ethical theorising traditionally focuses on the thin, leading some to contend that moving from considering thin to thick concepts leads to a very different, and preferable, conception of ethics. Not only does a similar distinction between thick and thin concepts suggest itself within epistemology, traditional discussion (...) within epistemology also seems to focus on the thin in a similar manner. The question of a possible parallel beckons: Is there a comparable distinction between thick and thin epistemic concepts? Would a move from thin to thick lead to an alternative and/or preferable epistemology? (shrink)

John Rawls’s ‘just savings’ principle is among the better-known attempts to outline how we should balance the claims of the present with the claims of the future generations on resources. A central element of Rawls’s approach involves endorsing a sufficientarian approach, where our central obligation is to ensure ‘the conditions needed to establish and to preserve a just basic structure’.1 This engaging paper by Christian Munthe, Davide Fumagalli and Erik Malmqvist (‘the authors’) does not explicitly mention Rawls’s work on this (...) issue.2 Still, there are parallels in their aim to generate a ‘sustainability principle’ for healthcare systems. The authors defend the broadening of our focus to the relations between rounds—particularly, how decisions in one period can affect our choice range in the next, whereas current principles for allocating healthcare resources operate within ‘allocation rounds’. Where Rawls is concerned about future generations, the authors’ concern is with future sets of patients. Our present decisions may generate system ‘dynamics’ which are either positive—where ‘more resources per health need’ become available—or negative—where (otherwise justified) decisions taken now leave us with less bang for our buck in the future. The paper’s important and compelling central claim is that we have an obligation …. (shrink)

Originally written as a lecture-presentation for the 2021 South African Society for Research in Music (SASRIM) conference, this text shares our ongoing collaborative study of Born Under the Heat, an album by Johnny Mbizo Dyani. Our research tracks the record(ings) to mark potential pathways for thinking about networks of sociality and solidarity that underpin the production of such politicised cultural work, as well as how we listen to and/or may read it. We trace how the album, recorded in 1983, was (...) born out of festival-gatherings in Lagos, Gaborone and Amsterdam as well as Dyani's memories/remembering of home (from Duncan Village to Dorkay House, perhaps) when exiled in Scandinavia. By reiterating literal and symbolic modes of travel which Born Under the Heat took, as an object and as a concept/project, we aim to explore multiple routes and forms archival, repatriation and restitution projects continue to find in the postapartheid present. (shrink)

This book stems from an examination of how Western philosophy has accounted for the foundations of law. In this tradition, the character of the “sovereign” or “lawgiver” has provided the solution to this problem. But how does the sovereign acquire the right to found law? As soon as we ask this question we are immediately confronted with a convoluted combination of jurisprudence and theology. The author begins by tracing a lengthy and deeply nuanced exchange between Derrida and Nancy on the (...) question of community and fraternity and then moves on to engage with a diverse set of texts from the Marquis de Sade, Saint Augustine, Kant, Hegel, and Kafka. These texts—which range from the canonical to the apocryphal—all struggle in their own manner with the question of the foundations of law. Each offers a path to the law. If a reader accepts any path as it is and follows without question, the law is set and determined and the possibility of dialogue is closed. The aim of this book is to approach the foundations of law from a series of different angles so that we can begin to see that those foundations are always in question and open to the possibility of dialogue. (shrink)

Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to pluralism about justice, where theorizing about just (...) principles demands paying attention to the role particular goods play in our lives. This means that different approaches to the temporal subject—as well as other relevant issues—may be appropriate for different goods, including different goods within healthcare. In particular, the paper discusses two central goods targeted by healthcare: life-saving and pain relief. The view is offered as complementary to, rather than competitive with, lifetime approaches. As such, the paper finishes by considering how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives. (shrink)

Those who care about and engage in politics frequently fall victim to cognitive bias. Concerns that such bias impacts scholarship recently have prompted debates—notably, in philosophy and psychology—on the proper relationship between research and politics. One proposal emerging from these debates is that researchers studying politics have a professional duty to avoid political activism because it risks biasing their work. While sympathetic to the motivations behind this proposal, I suggest several reasons to reject a blanket duty to avoid activism: (1) (...) even if it reduced bias, this duty would make unreasonable demands on researchers; (2) this duty could hinder research by limiting viewpoint diversity; (3) this duty wrongly implies that academia offers a relative haven from bias compared to politics; and (4) not all forms of political activism pose an equal risk of bias. None of these points suggest that researchers should ignore the risk of bias. Rather, researchers should focus on stronger evidence-based strategies for reducing bias than a blanket recommendation to avoid politics. (shrink)

There is an ongoing debate in medicine about whether patients have a ‘right not to know’ pertinent medical information, such as diagnoses of life-altering diseases. While this debate has employed various ethical concepts, probably the most widely-used by both defenders and detractors of the right is autonomy. Whereas defenders of the right not to know typically employ a ‘liberty’ conception of autonomy, according to which to be autonomous involves doing what one wants to do, opponents of the right not to (...) know often employ a ‘duty’ understanding, viewing autonomy as involving an obligation to be self-governing. The central contribution of this paper is in showing that neither view of autonomy can reasonably be said to support the extreme stances on the right not to know that they are sometimes taken to. That is, neither can a liberty view properly defend a right not to know without limits, nor can a duty view form the basis of an absolute rejection of the right not to know. While there is still theoretical distance between these two approaches, we conclude that the views are considerably closer on this issue than they first appear, opening the way for a possible compromise. (shrink)