BackgroundThe state of the world is one with scarce medical resources where longevity is not equally distributed. Given such facts, setting priorities in health entails making difficult yet unavoidable decisions about which lives to save. The business of saving lives works on the assumption that longevity is valuable and that an early death is worse than a late death. There is a vast literature on health priorities and badness of death, separately. Surprisingly, there has been little cross-fertilisation between the academic (...) fields of priority setting and badness of death. Our aim is to connect philosophical discussions on the badness of death to contemporary debates in health priorities.DiscussionTwo questions regarding death are especially relevant to health priorities. The first question is why death is bad. Death is clearly bad for others, such as family, friends and society. Many philosophers also argue that death can be bad for those who die. This distinction is important for health priorities, because it concerns our fundamental reasons for saving lives. The second question is, ‘When is the worst time to die?’ A premature death is commonly considered worse than a late death. Thus, the number of good life years lost seems to matter to the badness of death. Concerning young individuals, some think the death of infants is worse than the death of adolescents, while others have contrary intuitions. Our claim is that to prioritise between age groups, we must consider the question of when it is worst to die.ConclusionsDeprivationism provides a more plausible approach to health priorities than Epicureanism. If Deprivationism is accepted, we will have a firmer basis for claiming that individuals, in addition to having a health loss caused by morbidity, will have a loss of good life years due to mortality. Additionally, Deprivationism highlights the importance of age and values for health priorities. Regarding age, both variants of Deprivationism imply that stillbirths are included in the Global Burden of Disease. Finally, we suggest that the Time-Relative Interest Account may serve as an alternative to the discounting and age weighting previously applied in the Global Burden of Disease. (shrink)

This paper develops a theory of how democratic governance is possible. It analyses democracy as a laminated system consisting of three interdependent levels – the political/institutional, the social/interactional, and the psychological/intrapsychic – each of which is necessary for the others to exist. Each level is subject to a regulatory principle that is necessary for it to function appropriately. At the political/institutional level, competing political parties must be governed by the regulatory principle of ‘loser’s consent,’ in which the losing party must (...) agree to cede power to the winning party. At the social/interactional level individuals from opposing political parties must be governed by the regulatory principle of a superordinate identity as citizen, which allows them to transcend their partisan political identities. At the psychological/intrapsychic level individuals must be governed by the regulatory principle of mutuality/thirdness which allows the possibility of an alternative to the binary identities that result from the doer/done-to position. (shrink)

We study the degrees of unsolvability of sets which are cohesive . We answer a question raised by the first author in 1972 by showing that there is a cohesive set A whose degree a satisfies a' = 0″ and hence is not high. We characterize the jumps of the degrees of r-cohesive sets, and we show that the degrees of r-cohesive sets coincide with those of the cohesive sets. We obtain analogous results for strongly hyperimmune and strongly hyperhyperimmune sets (...) in place of r-cohesive and cohesive sets, respectively. We show that every strongly hyperimmune set whose degree contains either a Boolean combination of ∑2 sets or a 1-generic set is of high degree. We also study primitive recursive analogues of these notions and in this case we characterize the corresponding degrees exactly. MSC: 03D30, 03D55. (shrink)

In a recent issue of The Lancet, the historian Roger Cooter predicted that the field of bioethics will soon die of self-inflicted wounds. “Conspiring against it,” he wrote, “is exposure of the funding of some of its US centres by pharmaceutical companies; exclusion of alternative perspectives from the social sciences; retention of narrow analytical notions of ethics in the face of popular expression and academic respect for the place of emotions; divisions within the discipline ; and collusion with, and appropriation (...) by, clinical medicine.” Cooter's prognosis? “Hardly wet behind the ears, bioethics seems destined for a short lifespan.”. (shrink)

A hyperintensional semantics for natural language is proposed which is agnostic about the question of whether propositions are sets of worlds or worlds are sets of propositions. Montague’s theory of intensional senses is replaced by a weaker theory, written in standard classical higher-order logic, of fine-grained senses which are in a many-to-one correspondence with intensions; Montague’s theory can then be recovered from the proposed theory by identifying the type of propositions with the type of sets of worlds and adding an (...) axiom to the effect that each world is the set of propositions which are true there. Senses are compositionally assigned to linguistic expressions by a categorial grammar with only two rule schemas, based on the implicative fragment of intuitionistic linear propositional logic, and a fully explicit grammar fragment is provided that illustrates the compositional assignment of sense to a variety of constructions, including dummy-subject constructions, infinitive complements, predicative adjectives and nominals, raising to subject, ‘tough-movement’, and quantifier scope ambiguities. Notably, the grammar and the derivations that it licenses never make reference to either worlds or to the extensions of senses. (shrink)

This article investigates what notions of “just health care” are found at three Swedish hospitals among health care personnel and whether these notions are relevant to what priorities are actually made. Fieldwork at all three hospitals and 114 in-depth interviews were conducted. Data have been subject to conceptual and ethical analysis and categorisation. According to our findings, justice is an important idea to health care personnel at the studied hospitals. Two main notions of just health care were found. The main (...) idea was the notion of “equal treatment according to need”, the basic idea being that differences in treatment should be justified by differences in needs. The competing idea that merit should affect the treatment received is occasionally encountered, the idea here being that patients, by acting irresponsibly, may no longer deserve to be treated strictly according to needs. In practice, priorities are made on grounds that only partly comply with the basic idea of justice in health care, as it is understood by staff at the studied hospitals. Exceptions are made due to regional differences, considerations of cost-effectiveness, economic incentives, tradition, the daily patient flow, research, private alternatives, patient influence and favouritism of health care personnel. (shrink)

In the face of land confiscations and other forms of imperialism characteristic of the 19th century in Aotearoa/new Zealand, the second Maori King Tawhiao devised a number of sayings that seem at first glance to be entirely mythical. Highly metaphorical and poetic, they appear to refer, as Bakhtin would have it in his discussion of the epic, to a language that is emotional, innately tied to a static mooring of pre-rational thought. Yet, in this paper we argue that a Maori (...) metaphysics complicates the delineations between primordial and novelistic language. Indeed, there is in a Maori worldview the notion that a term contains to it both postcolonial and mythical traces at once. Thus each apparently primordial term is tinged with the realities of colonised experience, even if they seem concrete and self-referential. In this paper we address those multiple voices in light of Bakhtin’s philosophies on heteroglossia, and argue that the accusation of ‘myth’ in relation to Tawhiao’s sayings is possible yet does not accommodate the metaphysics founding the sayings. We speculate that there is a form of freedom in Tawhiao’s words that exists regardless of our interpretation but that calls to be unearthed through an open reading. Sir Robert Mahuta, prominent Tainui leader, is one who has already indicated the need for a heteroglossic reading of Tawhiao. We then move to a description of the Waikato-Tainui College for Research and Development as it attempts to carry out this heteroglossic reading of Maori political and metaphysical text and utterance. (shrink)