In this book, Christopher Evan Franklin develops and defends a novel version of event-causal libertarianism. This view is a combination of libertarianism--the view that humans sometimes act freely and that those actions are the causal upshots of nondeterministic processes--and agency reductionism--the view that the causal role of the agent in exercises of free will is exhausted by the causal role of mental states and events (e.g., desires and beliefs) involving the agent. Franklin boldly counteracts a dominant theory that has (...) similar aims, put forth by well-known philosopher Robert Kane. -/- Many philosophers contend that event-causal libertarians have no advantage over compatibilists when it comes to securing a distinctively valuable kind of freedom and responsibility. To Franklin, this position is mistaken. Assuming agency reductionism is true, event-causal libertarians need only adopt the most plausible compatibilist theory and add indeterminism at the proper juncture in the genesis of human action. The result is minimal event-causal libertarianism: a model of free will with the metaphysical simplicity of compatibilism and the intuitive power of libertarianism. And yet a worry remains: toward the end of the book, Franklin reconsiders his assumption of agency reductionism, arguing that this picture faces a hitherto unsolved problem. This problem, however, has nothing to do with indeterminism or determinism, or even libertarianism or compatibilism, but with how to understand the nature of the self and its role in the genesis of action. Crucially, if this problem proves unsolvable, then not only is event-causal libertarianism untenable, so also is event-causal compatibilism. (shrink)

Photo ID 222412412 © US Navy Medicine | Dreamstime.com ABSTRACT In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. INTRODUCTION Medical resources in an austere environment without quick recourse for resupply or casualty evacuation are often (...) limited. The shortage extends not only to supplies like blood products and drugs, but physicians and other medical personnel. In the midst of a mass casualty scenario, such as a battle that includes intense ground fighting, the medical staff will stretch scarce resources and triage casualties according to specific criteria. Typically, they proceed by providing care for the most severely wounded first, referred to here as conventional triage. At times, though, the staff may reverse the triage so that soldiers with minor wounds can return to the fight. In a mass casualty situation, when medical personnel apply conventional triage and treat casualties from opposing forces, a dilemma may arise. We argue that it can be permissible for military physicians to prioritize their own soldiers over enemy combatants in a mass casualty triage, where reverse triage does not apply. The case we will focus on is as follows: Battlefield Triage: During combat operations on a remote island in the Pacific Ocean, a compatriot soldier and an enemy combatant arrive at the compatriot soldier country’s medical treatment facility. Both have similar gunshot wounds to the abdomen, and they arrive with similar conditions. Both have low oxygen saturation and excessive blood loss. The sole physician only has enough time to stabilize one person. The scenario is brief, and we are aware that medical rules of eligibility will most often dictate how the physician proceeds,[1] but this scenario is useful in setting up the question we focus on in this paper: would it be wrong to favor the stabilization of a soldier just because the soldier is the physician’s compatriot? In other words, can nationality serve as an ethically justified tiebreaker in a situation such as Battlefield Triage?[2] In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. The AMA’s Code of Medical Ethics asserts that physicians have “ethical obligations to place patients’ welfare above their self-interest and above obligations to other groups.”[3] The World Medical Association’s Declaration of Tokyo affirms that “no motive, whether personal, collective or political, shall prevail against this higher purpose” of alleviating distress.[4] Physicians are taught early on that triage decisions must be medically indicated and made without consideration of factors such as race, ethnicity, religion, social status, and nationality. They are taught that public trust and obligations of justice grounded in equality demand that only medical indications be considered. But military physicians in a military setting are beholden to obligations, duties, and responsibilities as members of the military, and when these obligations, duties, and responsibilities conflict, as they do in Battlefield Triage, which loyalties win out and why?[5] Critics of partiality on national grounds argue that partiality undermines public trust in medicine and justice because everyone should be treated equally regardless of nationality.[6] Proponents of partiality argue that military obligations supersede equality and that justice requires partiality in such cases.[7] Despite the critics’ disagreement, both agree that there is a morally right, perhaps even blameless, course of action. Drawing on insights from virtue ethics, we argue that Battlefield Triage is a moral tragedy in which justice is unattainable and there is no action without moral cost. The assumption that there is a morally right choice is flawed. We argue that while no decision in this scenario is free from moral blame, there are reasons to favor treating one’s soldiers over enemy combatants. I. The Case Against Partiality There is a common assumption that there is a morally right or just decision in Battlefield Triage. A number of organizations and scholars claim that it is wrong for military physicians to favor their own soldiers on the grounds of nationality or some form of ‘group membership.’ (In a conflict involving service members from multiple nations working as a coalition, a soldier from an allied country may receive the same priority as the US service member due to ‘group membership.’) The World Medical Association’s WMA Declaration of Lisbon on the Rights of the Patient, which was reaffirmed in 2015, posits that, “[i]n circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.”[8] This echoes what was set forth in Article 12 of the Geneva Conventions, which states that “[o]nly urgent medical reasons will authorize priority in the order of treatment to be administered.”[9] The argument for impartiality in Battlefield Triage is that every person is morally equal, and equality entails that medical distribution is, “based on a combination of medical need and urgency.”[10] This is in keeping with the bioethical principles that are generally applied.[11] II. The Case for Partiality On the other side, there are arguments that favoritism is the ethically right decision in Battlefield Triage.[12] The argument asserts that members of the military form a morally significant community of friends and participation in these relationships demands partiality. Just as parents have strong ethical duties to their children and not just any children, military personnel have ethical duties to their group, a group that involves an affirmation of mutual aid and support. Some have termed these ‘associative duties. According to Michael Gross, obligations of friendship, care, and solidarity “leave very little room for generally applicable principles of justice that would obligate a medic to treat enemy or non-compatriot wounded ahead of their compatriots.”[13] This is true in Battlefield Triage, but it may also be true even if the enemy’s soldier were more seriously wounded: “the ethics of small group cohesion, largely an ethics of care, mostly replaces the demands of impartial justice.”[14] In a more recent article, Gross explains that preferential treatment is ethically justified based on fighting capability and “the special obligations people owe friends, family, and, no less, comrades-in-arms.”[15] To not show partiality to the US soldier would be morally wrong on the grounds of friendship and mutual care.[16] III. The Moral Tragedy of Battlefield Triage Defenders and critics of Battlefield Triage favoritism based on nationality both frame their position as just or fair. For example, Justin List argues that physicians are “bound to practice medical neutrality,”[17] Marcus Adams denies that physicians “possess special ethical obligations” to enemy combatants because of their profession.[18] These perspectives assume that there is a morally right decision and that justice is attainable. The assumption that there is or can be a morally right Battlefield Triage decision, and we need to put our heads together to figure it out, remains strongly entrenched. However, the facts of the situation should give us pause; there are too many people and too few resources, and this demands a decision-making process that determines who will receive scarce resources. By its very nature, a battlefield triage decision has to be made based on some characteristic or value, a characteristic or value that will inevitably favor some at the expense of others. This is precisely why competing analyses “in the military context struggle to resolve these conflicts satisfactorily.”[19] Drawing on the insights of virtue ethics, we suggest that Battlefield Triage is a moral tragedy. Virtue ethics suggests that morality is about acting virtuously, which is to say that we should do what a virtuous person would do in the situation. Ethics is about figuring out how a just, wise, compassionate, loving, and fair person would act, and then doing that, as one grows in virtue. But life is not always clear cut, and it is possible that virtuous people may find themselves in a moral tragedy, a situation in which, through no fault of one’s own, a person must make a morally objectionable decision. After the action the virtuous person “emerges having done a terrible thing, the very sort of thing that the callous, dishonest, unjust, or in general vicious agent would characteristically do.”[20] Stated differently, a moral tragedy presents a virtuous person with two or more courses of action, all of which have a moral cost.[21] In Battlefield Triage, no matter how the physician goes about deciding, there is going to be defensible concern from those not saved. The fact that there are more people than can be helped fosters competing values in battlefield triage: maximize lives saved, treat people equally, treat the worse off, and support the war effort. Treating people equally may create tension between treating the worse off, maximizing lives saved, and supporting the war effort. Reverse triage is a case in point, as supporting the war effort conflicts with treating the worse off first, as is a fair lottery system since deploying a lottery may not maximize lives saved or support the war effort. There can be reasons why one person is selected over another, to be sure. Yet, there are reasons for making a decision, and that the decision is subject to legitimate moral concern is another. To recognize the moral tragedy of Battlefield Triage is to recognize the impossibility of acting blamelessly in the situation. In this situation, the virtuous military physician is going to have to sacrifice important values such as justice, compassion, and respect for others, even with a defensible criterion in hand. The physician will grieve this sacrifice accordingly. The physician may find her decision difficult or stressful, and rightly so, because of what her circumstances require of her. This kind of moral tragedy results “in actions which betray and violate the rights of persons to whom there may be a strong duty of care. When this happens, it properly triggers an appropriate moral emotion since our moral integrity has been violated and this affects how we think of ourselves and what we have become.”[22] Rather than view her triage decision as the morally superior choice, the virtuous military physician will view her decisions in these circumstances in a different light: it is the least bad option in a terrible situation, and she did something ethically problematic, something that is contrary to her moral character. She deeply regrets the circumstances in which she had to act. IV. Virtue Ethics A virtue ethicist has insight into how one should go about deciding what to do in a moral tragedy, although virtue ethics may not be as helpful as one may hope. The goal of the virtuous military physician in Battlefield Triage is to adopt the best course of action or the action that she feels she ought to do, all things considered. This does not make her choice devoid of serious wrongdoing—a decision must be made, but that does not make it just. The virtuous military physician will approach the situation with courage, responsibility, and insight. She will think about the decision carefully, wisely, and conscientiously; she will weigh the goods and harms of the choices before her, in conjunction with a proper conception of the good life, human worth, and understanding of her obligations to others—including chain of command, fellow soldiers, and the medical community. She is attuned to the value of human life and has a reasonable idea of the various ways her decisions will affect others. She recognizes that she is in this non-ideal situation through no fault of her own: she is not the one fighting in battles; she is serving her country as a physician, whose job it is to save lives, treat everyone justly, and promote military objectives. She regrets the decision she is forced to make in battlefield triage, acting “with immense regret and pain,” Hursthouse explains, “instead of indifferently or gladly.”[23] This is because, no matter what decision is made, the virtuous military physician “does something terrible or horrible,” something she otherwise would not do and is contrary to her values.[24] V. A Resolvable Moral Tragedy Instead of asking whether there is a morally right decision, in which a decision is morally blameless and above reproach, the virtue ethicist asks whether there is a decision with a convincing rationale, knowing that a decision can have a clear rationale but still be morally tragic. It is perfectly reasonable to think that different virtuous persons will arrive at different courses of action: “two virtuous agents, in the same situation,” Hursthouse writes, “may act differently” in irresolvable moral tragedies, in cases in which there is no clear course of action.[25] Because a person must act in a moral tragedy, one goal is to identify reasons for choosing the chosen action. Some decisions are clearly indefensible—treating neither the compatriot soldier nor the enemy combatant in Battlefield Triage would be wrong—and some decisions are more problematic than others. If the military physician selects to treat the soldier because she does not like the enemy combatant’s skin color, such a reason would be deeply problematic. But much of the debate over how to act in a moral tragedy is not over clearly indefensible or problematic criteria. Instead, the literature is largely about different standards or implementations of justice. Some scholars defend nation-impartial triage as right, while others defend nation-aware triage as right, and each argues that the other side is promoting an unjust or otherwise wrong solution to Battlefield Triage. We suggest that Battlefield Triage is a resolvable moral tragedy and that virtue ethics offers convincing reasons to prefer the treatment of the compatriot soldier rather than the enemy combatant on the grounds of national identity. Virtues are integral to living a good life, a flourishing life, but as Aristotle observed long ago, human beings are inherently social, interdependent and interconnected in profound ways.[26] This goes beyond the obvious fact that we need each other to survive day to day (one person makes clothes, another farms, and another makes tools); the claim is that a good or flourishing life depends in large part on one’s social network or community. This is why many of Aristotle’s moral virtues are other facing: justice, friendship, generosity, and magnanimity, to name a few. Courage, a typically self-facing virtue, is understood by Aristotle to be the virtue that regards one’s fear of death in battle, a battle fought on behalf of one’s city.[27] All of this remains true today. Namely, there is an important sense in which our community matters to our lives: it is easier to live a good, flourishing life if one is part of a good, flourishing community. Our community is made up of smaller groups, and it is more accurate to say that we are simultaneous members of different groups within a broader community. A person may be part of a family, friend group, research team, large state university, city, state, and nation. Groups can function well or not, as we all have experienced, and this suggests that there are virtues or excellences that groups can instantiate. Good groups are unified in purpose, with each member doing their duty alongside others for the attainment of that purpose. Good groups manifest solidarity among their members. Although Aristotle does not list solidarity as a virtue, a number of modern-day virtue ethicists have begun examining how group solidarity can be a virtue that contributes to a good or flourishing life.[28] Solidarity is not conceptualized as an individual virtue, a virtue possessed by a person in isolation of others; instead, it is a collective virtue, a virtue that is shared among members of a defined group with particular ends.[29] “A group has solidarity to the extent that its members are disposed to: (1) share values, aims, or goals; (2) care about those values, aims, or goals; (3) act in accordance with those values, aims, or goals; (4) trust the testimony of other group members with respect to those values, aims, and goals; and (5) feel a sense of belonging to the group.”[30] The virtue of collective or group solidarity involves individuals having special concern for each other, shared aims and values, trust, loyalty, and a sense of belonging with these specific others. There is a oneness to the group in the pursuit of a definite goal or purpose, involving mutual support and affirmation of each member. As such, the group has ends and goods above and beyond the good of each individual person. Sometimes solidarity requires personal sacrifice for the collective (for example, a father sacrificing food so his child can eat). The virtue of collective or group solidarity is important to the military and medical community at every level, and for clear reasons. In the military, there is a clear hierarchy of command, unity of purpose and end, mutual trust and support in complex settings, and so on. Soldiers need to know they can count on one another, and solidarity grounds a soldier’s ability to trust others and be assured of mutual aid. In medicine, solidarity maintains self-regulation of the profession, shared values and goals, as well as public support, not to mention that day-to-day operations require physician trust, engagement, and effort toward the ends of clinical care. Physicians need to work together, along with others, in pursuit of health, and disunity is sowed when there is mistrust, selfishness, or disengagement among the healthcare team and organization. Importantly, just as we are all members of various groups and hence may manifest group solidarity in different settings, the virtuous military physician instantiates collective solidarity with both the medical profession and the military. Her dual loyalty contributes to the moral difficulty of acting in Battlefield Triage. The military physician has competing obligations to distinct groups and cannot satisfy all obligations in Battlefield Triage. Solidarity with the military supports the consideration of favoring the soldier for reasons of national identity, whereas solidarity with the medical community does not. Something has to give, which is why it is a moral tragedy. The virtuous military physician, therefore, must weigh the costs of each course of action. To fulfill her obligations to the medical community would require that she does not use nationality and other non-medical considerations in Battlefield Triage. Since the soldier and enemy combatant are equally injured, justice would demand a random process, perhaps a flip of the coin. Although this may satisfy obligations the military physician has to the medical community, this would be costly to the physician’s military group. If word gets out that the physician decides who to treat based on a coin toss, soldiers, families, and citizens may become frustrated and angry. Soldier morale may go down if it becomes known that a coin flip led to the preventable death of a soldier and the saving of an enemy combatant who had killed (or attempted to kill) other soldiers. As Gross highlights, military solidarity involves a mutual aid promise that military personnel promise to help one another.[31] A military physician is part of the military and, as such, is part of the mutual aid promise, which would appear to be violated if the physician flips a coin. Treating a member of one’s own team may be psychologically more beneficial than treating an enemy combatant and may lead to less moral distress.[32] Finally, treating soldiers rather than enemy combatants promotes broader military and social aims, including returning soldiers to health, maintaining unity of purpose, and minimizing community suffering from a soldier’s death. Favoring members of one’s group, that is, triage based on nationality in Battlefield Triage, would fulfill obligations of military group loyalty, which is contrary to the values and duties of medicine. It does not seem as though showing favoritism in this particular situation is very costly to the medical community or general public, but this is because there is recognition that the physician is in the military. Medicine is impartial to non-medical indications partly because of fairness and to promote public trust in medicine. However, Battlefield Triage is unique, as medicine is being practiced in a non-public, wartime setting. In ordinary circumstances, a patient’s identity is irrelevant, and physicians ought not play favorites. Since Battlefield Triage is not an ordinary circumstance, decisions based on patient identity may not undermine public trust in medicine. In addition, it is contestable that fairness in Battlefield Triage requires that no consideration be paid to one’s nationality. Fairness is about giving each person their due, what is owed to them, and the case can be made that soldiers who place themselves in danger for the sake of the common good or a just cause are owed special attention when they suffer harm in the line of duty. In other words, soldiers voluntarily undergo risk to themselves for the greater good, and society owes them for this sacrifice. This plausibly includes preferential treatment in a situation such as Battlefield Triage. So, while the medical community affirms justice demands non-preferential treatment, the military community can affirm the opposite. The demands of fairness are unclear at best or in conflict in this situation: demands of physician justice decry favoritism, while demands of military justice support favoritism. Triage not based on nationality is arguably unfair and triage based on nationality may not undermine public trust, after all. All things considered, there is a clear rationale for favoring nationality-based preferential treatment in Battlefield Triage. Adopting a nationality-based preference in this situation is more defensible than not. This does not make such a decision ethically right or just. Preference based on nationality is the least bad decision, but it is not morally blameless. It involves one in a serious moral wrong, a wrong otherwise avoided and contrary to one’s character. The virtuous military physician is in a situation in which obligations conflict, and we disagree with Gross, who posits that care of fellow soldiers “is important to the near exclusion of all else.”[33] Gross fails to appreciate the collective virtue of solidarity as applied to those in medicine. The military physician has duties to fellow soldiers but also to fellow physicians, to the medical community, and humanity. To favor a soldier on grounds of nationality violates her duties and responsibilities to this latter group. She is involved in a moral tragedy and can only seek the most just action given the circumstances, yet, at least in virtue ethics, the action remains far from blameless. CONCLUSION We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. As such, the virtuous military physician incurs a moral cost to acting as she does—there is a moral residue. However, despite being a moral tragedy, there are clear reasons to act in favor of treating one’s own, considering group solidarity. As such, these kinds of tragedies are resolvable: virtuous military physicians should favor treatment of their own, although they would do so with sorrow. - [1] Militaries set forth medical rules of eligibility or guidelines used to determine whether a person qualifies for specific medical interventions or treatments in certain circumstances, and these guidelines are binding for a military physician. For example, despite opposition from medical organizations, militaries have adopted reverse triage guidelines for military physicians to follow. For ethical discussion, see Falzone, Elisabeth, P. Pasquier, C. Hoffmann, O. Barbier, M. Boutonnet, A. Salvadori, A. Jarrassier, J. Renner, B. Malgras, and S. Mérat. "Triage in military settings." Anaesthesia Critical Care & Pain Medicine 36, no. 1 (2017): 43-51. https://doi.org/10.1016/j.accpm.2016.05.004 [2] There are issues that are related to this, including the triage of civilians and allied soldiers. We set related issues aside for purposes of this paper [3] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [4] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [5] This is termed the “dual loyalty” dilemma in military medicine and has been described at length elsewhere: Institute of Medicine (US) Board on Health Sciences Policy. Military Medical Ethics: Issues regarding Dual Loyalties: Workshop Summary. Washington (DC): National Academies Press (US); 2008. Toward a Framework for Resolving Dual Loyalties. Available from: https://www.ncbi.nlm.nih.gov/books/NBK214853/ [6] See Kenneth G. Swan and K.G. Swan, Jr., “Triage: The Past Revisited,” Military Medicine 161:8 (1996): 448–452. https://doi.org/10.1093/milmed/161.8.448; Jerome A. Singh, “American Physicians and dual loyalty obligations in the ‘war on terror,’” BMC Medical Ethics 4.4 (2003): 1–10. https://doi.org/10.1186/1472-6939-4-4; Beam, Thomas E. "Medical Ethics on the Battlefield." Military Medical Ethics: Sect. IV. Medical ethics in the military. Medical ethics on the battlefield: the crucible of military medical ethics 2 (2003): 369-402; Hereth, Blake. "Health justice for unjust combatants." Journal of Military Ethics 20, no. 1 (2021): 67-81. https://doi.org/10.1080/15027570.2021.1949782. [7] See Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. Gross, Michael L. "Comradery, community, and care in military medical ethics." Theoretical medicine and bioethics 32 (2011): 337-350. https://doi.org/10.1007/s11017-011-9189-6. Gross, Michael L. "The limits of impartial medical treatment during armed conflict." In Military medical ethics for the 21st century, pp. 71-84. Routledge, 2016. [8] World Medical Association, WMA Declaration of Lisbon on the Rights of the Patient. 5 December 2022, https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ [9] Geneva Convention for the Amelioration of the Condition of Wounded, Sick in Armed Forces in the Field. 12 August 1949. https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.30_GC-I-EN.pdf. [10] List, Justin M. "Medical neutrality and political activism: physicians' roles in conflict situations." In Physicians at war: The dual-loyalties challenge, pp. 237-253. Dordrecht: Springer Netherlands, 2008. 240 [11] Beauchamp, T., and J. Childress. 2013. Principles of Biomedical Ethics, 7th ed. Oxford, United Kingdom: Oxford University Press. [12] Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. [13] Gross, "Comradery, community, and care in military medical ethics," 347. [14] Gross, “Comradery, community, and care in military medical ethics,” 349. [15] Gross, Michael L. "When medical ethics and military ethics collide." Narrative inquiry in bioethics 13, no. 3 (2023): 199-204. 202 https://dx.doi.org/10.1353/nib.2023.a924191 [16] Our argument draws on virtue ethics, from which care ethics derives, and it is worth clarifying how our argument relates to Gross’s. We do not think that the virtue of friendship grounds triage decisions, for we think it is unlikely that the physician and wounded soldier are friends. Instead, as explained below, we think the collective virtue of group solidarity better captures the moral significance of group loyalty and that Gross would agree with us. But since military physicians are part of distinct groups, with competing obligations, the military physician will be forced to sacrifice a value in battlefield triage cases. In other words, we think Gross downplays the dual group membership of a military physician. [17] List,”Medical neutrality and political activism,” 250. [18] Adams,”Triage priorities and military physicians,” 235. [19] London, Leslie, Leonard S. Rubenstein, Laurel Baldwin-Ragaven, and Adriaan Van Es. "Dual loyalty among military health professionals: human rights and ethics in times of armed conflict." Cambridge Quarterly of Healthcare Ethics 15, no. 4 (2006): 381-391. 383. [20] Hursthouse, R. On Virtue Ethics. OUP 1999. 74 [21] Nussbaum, Martha C. "The costs of tragedy: Some moral limits of cost-benefit analysis." The Journal of Legal Studies 29, no. S2 (2000): 1005-1036, 1007. [22] De Wijze, S. (2005). Tragic-remorse–the anguish of dirty hands. Ethical theory and moral practice, 7(5), 453-471, 457. https://doi.org/10.1007/s10677-005-6836-x [23] Hursthouse, 73 [24] Hursthouse, 81 [25] Hursthouse, 72 [26] Aristotle, Politics 1253a8. Reeve, C. D. C., Indianapolis: Hackett Publishing Co., 2017 [27] Aristotle, Nicomachean Ethics. III.6.114a, 34-35. 2002, Nicomachean Ethics, Christopher Rowe (trans.), Oxford: Oxford University Press [28] Byerly, T. Ryan, and Meghan Byerly. "Collective virtue." The Journal of Value Inquiry 50, no. 1 (2016): 33-50. https://doi.org/10.1007/s10790-015-9484-y; Federico, Veronica. "Conclusion: solidarity as a public virtue." Solidarity as a Public Virtue (2018): 495-542. https://doi.org/10.5771/9783845290058. Rehg, William. "Solidarity and the common good: An analytic framework." Journal of Social Philosophy 38, no. 1 (2007): 7-21. https://doi.org/10.1111/j.1467-9833.2007.00363.x [29] Byerly and Byerly. "Collective virtue." 43 [30] Battaly, Heather. "Solidarity: Virtue or vice?." In Social virtue epistemology, pp. 303-324. Routledge, 2022. 304 [31] Ibid., 2011: 341 [32] It might be thought that displaying altruism by helping an enemy combatant at the expense of one’s fellow soldier may be psychologically satisfiying. For evidence that military physicians find it difficult to treat enemy combatants, see Lundberg, Kristina, Sofia Kjellström, Anders Jonsson, and Lars Sandman. "Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties." Military medicine 179, no. 8 (2014): 821-826. https://doi.org/10.7205/MILMED-D-14-00038. Lamblin, Antoine, Clément Derkenne, Marion Trousselard, and Marie-Ange Einaudi. "Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study." BMC Medical Ethics 22 (2021): 1-13. https://doi.org/10.1186/s12910-021-00723-2 [33] Ibid., 2011: 344. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vice and Naturalistic OntologyChristopher R. Williams (bio)Keywordscausality, criminality, determinism, medical model, positivismThese questions have been posed: Is vice (encompassing criminal and other wrongful conduct) best regarded as “sick” behavior, “immoral” behavior, or some other type altogether? Are we to understand vice in natural-medical terms, or are we better served by utilizing a moral framework? Is criminality reducible to and best categorized as a metaphysical type the essential features of (...) which are neurological or otherwise biological in nature? Or, perhaps, is criminality closer to a (non-natural) sociological type, the essential features of which can be understood only through reference to social norms and cultural conventions? These are torturously involved philosophical and theoretical questions that have given rise to an equally torturous volume of literature. Without pretending to do justice to these questions or their corresponding literature, several key considerations that must be inserted into and accounted for within the discursive pursuit of these inquiries are worth noting.Where a naturalistic ontology is employed within the study of vice, we reduce the intricacies of deviant behavioral phenomena to what we presume to be their underlying medical/biological properties. It is worth remembering that behavior itself cannot rightfully be said to be “sick”; rather, what we mean to say is that the behavior in question—in our case, various forms of “vice”—is symptomatic of some underlying illness or medical/biological condition. The presumed underlying sickness and the behavior itself are distinct, ontologically linked only through their theorized relationship to one another. This, then, is a key assumption of the medical approach to vice and its ontological classification as a natural-medical kind: that there exists a relationship between the behavior (a symptom) and the underlying illness or medical condition, and that the relationship is of the causal kind. Vice, it is suggested, is a change in state that is caused by (or, at the very least, is a direct consequence of) sickness or illness. Second, to legitimate such attributions, the illness supplying the requisite causal force must be identifiable and its causal connection to the behavior must be or be capable of being sufficiently explicated. In other words, once we have identified the relevant medical/biological properties and the behavior to which they stand in causal relatedness, we must be prepared to characterize this dynamic—we must be able to show exactly how and why such and such a condition gives rise to such and such a behavior.Problematically, causation itself is and has always been a contentious metaphysical specimen. Hume (1955) reminded us of the troubling reality [End Page 39] that we cannot ever “see” one thing cause or necessitate another. We are left, rather, to merely presume the existence of causal relationships between things. How is it, exactly, that disorder in neurodevelopment can necessitate certain behavioral outcomes? Even if we can “see” (in the empirical sense) the disorder and equally “see” the behavior, we cannot of course witness the precise causal action of the former upon the latter. Even if we are content inferring causal action in such cases, we still need to demonstrate the basic conditions of causality. To show that Condition X is causally related Behavior Y, we need to show that they are regularly associated with one another, that Condition X temporally preceded Behavior Y and, most challengingly, that no other conditions or factors have an intervening (e.g., additive, synergistic) influence. Hypothetically, if we were to posit a causal relationship between schizotypal personality traits and violent behavior, we would need to establish: (1) that schizotypal traits and violent behavior regularly coexist; (2) that those traits presented before the manifestation of the violent behavior; and (3) that no other factors (biological, psychological, and/or sociological) contributed in any meaningful way to those manifestations. We would thus need to systematically rule out family dynamics, income, education, intelligence, substance use, and so forth, as contributing factors. If, in turn, we were to determine that the presence of schizotypal traits alone is not sufficient—even if a necessary condition—to produce violent behavior but, rather, that those traits act in concert with other variables to produce the behavior, then we would not truly be... (shrink)

_Critical Heidegger_ brings together a selection of the best work on Martin Heidegger from a number of key commentators working in Europe. These new and classic essays, for the most part translated from German and French originals, are an essential guide to the current European reception of Heidegger and make available essays that have had considerable impact on English-language Heidegger studies. Essays in this collection: * Marlene Zarader, `The mirror with the triple reflection' * Franco Volpi, `Dasein and Praxis: Aristotle' (...) * Jean-Luc Marion, `Heidegger on Descartes' * Christopher Macann, `Heidegger's Kant Interpretation' * Michel Haar, `Critical Remarks on the Heideggerian Reading of Nietzsche' * Maria Villela-Petit, `Heidegger's Conception of Space' * Francoise Dastur, `The ekstatico-horizontal constitution of temporality' * F-W von Herrmann, `Way and Method in Philosophy' * Samuel Ijsseling, `The End of Philosophy as the Commencement of Thinking' * Otto Poggler, `Does the saving power also grow? Heidegger's last paths' * Ernst Tugendhat, `Heidegger's Idea of Truth' * Karl-Otto Apel, `Wittgenstein and Heidegger'. (shrink)

I. EXECUTIVE SUMMARY The MRCT Center Post-trial Responsibilities: Continued Access to an Investigational Medicine Framework outlines a case-based, principled, stakeholder approach to evaluate and guide ethical responsibilities to provide continued access to an investigational medicine at the conclusion of a patient’s participation in a clinical trial. The Post-trial Responsibilities (PTR) Framework includes this Guidance Document as well as the accompanying Toolkit. A 41-member international multi-stakeholder Workgroup convened by the Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard University (...) (MRCT Center) developed this Guidance and Toolkit. Project Motivation A number of international organizations have discussed the responsibilities stakeholders have to provide continued access to investigational medicines. The World Medical Association, for example, addressed post-trial access to medicines in Paragraph 34 of the Declaration of Helsinki (WMA, 2013): “In advance of a clinical trial, sponsors, researchers and host country governments should make provisions for post-trial access for all participants who still need an intervention identified as beneficial in the trial. This information must also be disclosed to participants during the informed consent process.” This paragraph and other international guidance documents converge on several consensus points: • Post-trial access (hereafter referred to as “continued access” in this Framework [for terminology clarification – see definitions]) is the responsibility of sponsors, researchers, and host country governments; • The plan for continued access should be determined before the trial begins, and before any individual gives their informed consent; • The protocol should delineate continued access plans; and • The plan should be transparent to potential participants and explained during the informed consent process. -/- However, there is no guidance on how to fulfill these responsibilities (i.e., linking specific responsibilities with specific stakeholders, conditions, and duration). To fill this gap, the MRCT Center convened a working group in September of 2014 to develop a framework to guide stakeholders with identified responsibilities. This resultant Framework sets forth applicable principles, approaches, recommendations and ethical rationales for PTR regarding continued access to investigational medicines for research participants. (shrink)

Advertising and other forms of promotional activity have proliferated to such an extent that they may constitute a form of social pollution (Kitchen, 1994). The quantity and tone of communications to which consumers are exposed may have a subtle but pervasive effect on the social ecology of the developed world. Not only are Marketing Communications delivered in unprecedented quantities (Kitchen, 1994); but their tone is increasingly difficult to categorise in the Postmodern Marketing era (Brown, 1994). Notably, there has been very (...) little research conducted on this seeming "Leviathan" (Kitchen, 1994, after Hobbes, 1651) effect. Ethical concerns of professional marketing bodies such as the MRS and CIM are focussed on the conduct of professionals with regard to law and notions of moral decency in human exchange relationships (see MRS code of conduct, ASA and IBA guidelines). There is less emphasis on the ethical implications for society of the totality of Marketing Communication activities. This paper examines the distinctively Postmodern concept of the Communications Leviathan and discusses contemporary ethical issues, drawing perspectives where possible from Postmodern critical theory, Enlightenment philosophy, cognitive psychology and classical ethical works of Plato and Aristotle. (shrink)

This groundbreaking handbook of character strengths and virtues is the first progress report from a prestigious group of researchers who have undertaken the systematic classification and measurement of widely valued positive traits. Character Strengths and Virtues classifies twenty-four specific strengths under six broad virtues that consistently emerge across history and culture. This book demands the attention of anyone interested in psychology and what it can teach about the good life.

Macann guides the student through the major texts of the four great thinkers of the phenomenological movement.

Paxillin is a recently identified member of the complex of cytoskeletal proteins that is found concentrated in cultured cells and in vivo at the cytoplasmic face of regions of cell attachment to the extracellular matrix. These sites, in view of their close proximity to the extracellular matrix, are well positioned to act as signal‐transducing centers to ‘report on’ changes in the cells, immediate environment. Recent findings indicate that such signals are in part mediated through the activation of tyrosine kinases concentrated (...) at the sites of adhesion. Changes in the phosphotyrosine content of paxillin accompanying this elevation in kinase activity suggest that paxillin may be an important intermediary in these pathways. (shrink)

This Companion offers a state-of-the-art survey of the work of John Stuart Mill – one which covers the historical influences on Mill, his theoretical, moral and social philosophy, as well as his relation to contemporary movements. Its contributors include both senior scholars with established expertise in Mill’s thought and new emerging interpreters. Each essay acts as a ‘go-to’ resource for those seeking to understand an aspect of Mill’s thought or to familiarise themselves with the contours of a debate within the (...) scholarship. The Companion is a key reference on Mill’s theory of liberty and utilitarianism, but also provides a valuable resource on lesser-known aspects of his work, including his epistemology, metaphysics, and philosophy of language. The volume is divided into six sections. Part I covers Mill’s life, his immediate posthumous reputation, and his own telling of his life-story. Part II brings together an accessible and comprehensive summary of the various influences on Mill’s thought. Part III offers an account of the foundations of Mill’s philosophy and his thought on key philosophic topics. Parts IV and V tackle issues from Mill’s moral and social philosophy. Part VI concludes with a treatment of the broader aspects of Mill’s thought, tracing his relation to major movements in philosophy. (shrink)

A tendency of auditory cortical neurons to respond at the beginning of major transitions in sounds rather than providing a continuously updated spectral-temporal profile may impede the generation of combination-sensitivity for certain classes of stimuli. Potential consequences of the cortical encoding of voiced stop-consonants on representational principles derived from orderly output constraints are discussed.

I aim to show that the practice of reading excellent literature is an excellent form of moral education. I offer a two-stage defense. First, I call attention to central features of the human self (especially the emotions) involved in moral growth. I argue that the central components of emotions are construals (or ways of seeing) and loves. Second, I show that literature has distinctive resources both to train our construals by affording us practice in seeing the world in new ways (...) and to cultivate our loves by affording us practice in imitating the loves of others. (shrink)

We know from experience that a stable feature of the human predicament is internal alienation: our various psychic states are often in conflict with one another. We are divided selves. In this paper, I delineate the nature and argue for the importance of a spiritual discipline of reading literature as a way of addressing this division. My argument comes in two stages. First, I offer a diagnosis of why we fail to be wholehearted that develops Aristotle’s idea that a fundamental (...) source of internal division within the soul is between what we know and how we see or construe our present situation. Second, I show how a spiritual discipline of reading literature is the right prescription for retraining our habits of construal so as to bring them into harmony with our knowledge. I conclude with a few remarks about how to put this discipline into practice. (shrink)

ABSTRACT:This article examines the place of Machiavelli’sPrincein the history of ethics and the history of leadership philosophy. Close scrutiny indicates that Machiavelli advances an ethical system for leadership that involves uprooting corruption and establishing rule of law. He draws on history and current affairs in order to obtain a realistic understanding of human behavior that forms a basis for a consequentialist ethics. While he claims a good leader might do bad things, this is in situations where necessity constrains a prince (...) to choosing the “least bad” course of action. Furthermore, Machiavelli advocates winning the goodwill of followers through leadership as a source of power. Machiavelli’s leadership ethics has a sophistication not fully enjoyed by his reputation in management scholarship. He would not score as especially “Machiavellian” on the Mach IV. Many of his ideas contain seeds for theories that are now considered important for leadership today. (shrink)

Martin Heidegger (1899-1976), born in Baden, Germany, is one of the most important philosophers of the twentieth century. The one-time assistant of Edmund Husserl, the founder of the phenomenological movement, Heidegger established himself as an independent and original thinker with the publication of his major work Being and Time in 1927. This collection of papers is the most comprehensive and international examination of Heidegger's work available. It contains established classic articles, some appearing in English for the first time, and many (...) original pieces provided especially for this collection. The cross-cultural and political aspects of Heidegger's thought are examined, including his relationship to the Nazi party. The purpose of this collection is to provide a critical examination of Heidegger's work which evaluates its limits as well as its strengths, and to assess the prospects for the future development of his thought. Since many of the leading themes of contemporary philosophy such as hermeneutics, phenomenology, existentialism, postmodernism and deconstructivism trace their intellectual heritage back to Heidegger, this collection will be an indispensable guide to the issues which are currently being disputed in the field of philosophy. (shrink)

This article outlines in details specific experiments that Galen performed. It explores how his methodology for experimentation was a sophisticated response to the rationalist-empirist debate as it occurred in ancient medicine. -/- .

This paper explores the anatomical foundations of Aristotle's natural philosophy. Rather than simply looking at the body, he contrives specific procedures for revealing unmanifest phenomena. In some cases, these interventions seem extensive enough to qualify as experiments. At the work bench, one can observe the parts of animals in the manner Aristotle describes, even if his descriptions seem at odds with 20th century textbooks. Manipulating animals allows us to recover his teleological thought more fully. This consideration of Aristotle as a (...) sophisticated biologist helps our reading of his writings in other areas of philosophy. (shrink)

Many of the most virulent and problematic eukaryotic pathogens have evolved from photosynthetic ancestors, such as apicomplexans, which are responsible for a wide range of diseases including malaria and toxoplasmosis. The primary barrier to understanding the early stages of evolution of these parasites has been the difficulty in finding parasites with closely related free‐living lineages with which to make comparisons. Parasites found throughout the florideophyte red algal lineage, however, provide a unique and powerful model to investigate the genetic origins of (...) a parasitic lifestyle. This is because they share a recent common ancestor with an extant free‐living red algal species and parasitism has independently arisen over 100 times within this group. Here, we synthesize the relevant hypotheses with respect to how these parasites have proliferated. We also place red algal research in the context of recent developments in understanding the genome evolution of other eukaryotic photosynthesizers turned parasites. (shrink)

Deciphering how DCAFs (DDB1‐CUL4 Associated Factors) modulate a broad spectrum of cellular processes, including cell cycle progression and maintenance of genomic integrity is critical to better understand cellular homeostasis and diseases. Cells contain more than 100 DCAFs that associate with the Cullin‐Ring Ubiquitin Ligase 4 (CRL4) complex that target specific protein substrates for degradation. DCAFs are thought to act as substrate receptors that dictate the specificity of the ubiquitination machinery (“catalytic DCAFs”). However, recent studies have suggested that some DCAFs might (...) play a different role by targeting CRL4 complexes to distinct cellular compartments (“structural DCAFs”). Once localized to their correct cellular domains, these CRLs dissociate from the structural DCAFs prior to their association with other, substrate‐specific catalytic DCAFs. Thus, we propose that DCAF switches can provide a mechanistic basis for the degradation of proteins that regulate cell growth and proliferation at precise points in space and time. (shrink)

Although in fundamental agreement with Carpendale & Lewis 's position, we discuss a potential source of confusion regarding the socially constituted nature of mental states. Drawing from recent work by Kusch, we argue, more specifically, that mental states are instances of “artificial kinds,” and so, stand between the more common classificatory extremes of “the natural” and “the social.”.

BackgroundLow-stakes crimes related to alcohol and/or drugs are common around the world, but research is lacking on police–suspect interactions of such crimes. A large proportion of these suspects are intoxicated during interrogations, and many may have substance use disorder, making them potentially vulnerable to interrogative pressure.MethodsTo address this lack of knowledge, the taxonomy of interrogation methods framework and a common classification of question types were applied in the coding of written police interrogations. Two archival studies, one pilot and one main (...) study analyzed police interrogations with suspects of alcohol- and drug-related crimes in Sweden.ResultsFor both Study 1 and 2, suspects showed signs of alcohol and/or drug intoxication, hangover or withdrawal in more than 50% of all interrogations. In Study 2, additional coding indicated that suspects displayed signs of substance use disorder in 57% of the interrogations. The main results from both studies revealed a large number of direct questions asked by the police across all interrogations, and relatively little use of the strategic interrogation techniques from the taxonomy of interrogation methods framework. In fact, when it came to interrogation techniques, law enforcement used more confrontational techniques in their interactions with intoxicated suspects compared to sober suspects. Furthermore, suspects displaying signs of substance use disorder were significantly more cooperative and prone to confess than suspects without indicators of substance use disorder.ConclusionAs the first novel study on low-stakes crime interrogations related to alcohol and/or drugs, the present study provides useful information about current Swedish interrogation practices and areas for improvement. The study results indicate that suspects displaying signs of intoxication or substance use disorder may be more vulnerable during police interrogations. This may in turn have the potential to inform the development of new interrogation policies. Due to the novelty of this research, more studies are needed, both on a national and international level, to examine interrogations in low-stakes crimes further. (shrink)

Machine learning algorithms may radically improve our ability to diagnose and treat disease. For moral, legal, and scientific reasons, it is essential that doctors and patients be able to understand and explain the predictions of these models. Scalable, customisable, and ethical solutions can be achieved by working together with relevant stakeholders, including patients, data scientists, and policy makers.

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide.Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines (...) for the procedure before it was introduced in the United States. We used a process of research ethics consultation that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery. (shrink)

Mounting ambitions and capabilities for public and private, non-government sector crewed space exploration bring with them an increasingly diverse set of space travelers, raising new and nontrivial ethical, legal, and medical policy and practice concerns which are still relatively underexplored. In this piece, we lay out several pressing issues related to ethical considerations for selecting space travelers and conducting human subject research on them, especially in the context of non-governmental and commercial/private space operations.

The pervasiveness of unethical actions paired with the rising demand for creativity in organizations has contributed to an increased interest in how ethicality and creativity relate. However, there are mixed findings on whether these two fundamental pillars of the workplace relate positively, negatively, or not at all. To provide an empirical consensus to this debate, we study the directional effects of ethicality on creativity by employing meta-analytic techniques. Specifically, a series of meta-regressions, moderated meta-regressions, and individual subgroup analyses of moderators (...) investigated the nuances of the ethicality-creativity relationship. Using a random-effects model, a quantitative review of 278 effects across 23 articles revealed that ethicality positively related to creativity. We further probed how each domain of ethicality (i.e., ethical decision-making, ethical leadership, ethical culture, ethical thought) related to creativity; the effect of ethicality on creativity remained positive, but was no longer significant. Additionally, to expand our understanding of this relationship, we offer theoretical and empirical accounts of five factors that moderate the positive association between ethicality and creativity: ethicality and creativity domains and measurement, sample culture, study characteristics, and sample characteristics. Theoretical and practical insights regarding these relationships are discussed. (shrink)