An international legal agreement governing the global antimicrobial commons would represent the strongest commitment mechanism for achieving collective action on antimicrobial resistance (AMR). Since AMR has important similarities to climate change—both are common pool resource challenges that require massive, long-term political commitments—the first article in this special issue draws lessons from various climate agreements that could be applicable for developing a grand bargain on AMR. We consider the similarities and differences between the Paris Climate Agreement and current governance structures for (...) AMR, and identify the merits and challenges associated with different international forums for developing a long-term international agreement on AMR. To be effective, fair, and feasible, an enduring legal agreement on AMR will require a combination of universal, differentiated, and individualized requirements, nationally determined contributions that are regularly reviewed and ratcheted up in level of ambition, a regular independent scientific stocktake to support evidence informed policymaking, and a concrete global goal to rally support. (shrink)

That being than which a greater cannot be conceived.' This was the way in which the living God of biblical tradition was described by the great Medieval philosophers such as Augustine, Anselm and Aquinas.Contemporary philosophers find much to question, criticise and reject in the traditional analysis of that description. Some hold that the attributes traditionally ascribed to God - simplicity, necessity, immutability, eternity, omniscience, omnipotence, creativity and goodness - are inherently incoherent individually, or mutually inconsistent. Others argue that the divinity (...) described by philosophers cannot be the same as the providential God of revelation.In Perfect Being Theology Katherin A. Rogers defends the traditional approach, considering contemporary criticisms but concluding that the most adequate account of the nature of God should build upon the foundation laid by the Medieval philosophers.Written in a lively and accessible style and offering an important historical perspective, this book covers key areas of contention and many of the major ideas and thinkers from all sides of the debate are included. (shrink)

Friedrich Nietzsche and Albert Schweitzer end up defending radically similar, yet critically opposed conclusions about the human animal and its place in nature, particularly with regard to the ethical awareness that does or does not follow from this situatedness. Arthur Schopenhauer’s notion of the will accounts for their similar foundational assumptions. But what accounts for the fact that their shared desire to affirm the will to life leads to fundamentally opposed ethical conclusions? What keeps Schweitzer’s ascetic ethic of reverence for (...) life from evolving into Nietzsche’s anti-ascetic vision of a second innocence beyond good and evil? We argue that situating the notion of reverence for life within an environmental virtue ethics, as one environmental virtue among many, aiming at ecological conversion, better articulates and motivates the disposition demanded by the ethics of reverence for life. (shrink)

Synthetic biology (synbio) involves designing and creating new living systems to serve human ends, using techniques including molecular biology, genomics, and engineering. Existing bioethical analyses of synbio focus largely on balancing benefits against harms, the dual-use dilemma, and metaphysical questions about creating and commercializing synthetic organisms. We argue that these approaches fail to consider key feminist concerns. We ground our normative claims in two case studies, focusing on the public good, who holds and wields power, and synbio research projects’ particularity (...) and context. Attention to feminist concerns is essential for synbio to realize its potential in ethically justifiable ways. (shrink)

Concern for human vulnerability seems to be at the heart of bioethical inquiry, but the concept of vulnerability is under-theorized in the bioethical literature. The aim of this article is to show why bioethics needs an adequately theorized and nuanced conception of vulnerability. We first review approaches to vulnerability in research ethics and public health ethics, and show that the bioethical literature associates vulnerability with risk of harm and exploitation, and limited capacity for autonomy. We identify some of the challenges (...) emerging from this literature: in particular, how to reconcile universal human vulnerability with a context-sensitive analysis of specific kinds and sources of vulnerability; and how to reconcile obligations to protect vulnerable persons with obligations to respect autonomy. We then briefly survey some of the theoretical resources available within the philosophical literature to address these challenges, and to assist in understanding the conceptual connections between vulnerability and related concepts such as harm, exploitation, needs, and autonomy. We also sketch out a taxonomy of sources and kinds of vulnerability. Finally, we consider the implications for policy evaluation of making vulnerability an explicit and central focus of bioethics. Our investigation is in the form of a broad survey motivating a research agenda rather than a detailed analysis. (shrink)

Antimicrobial resistance (AMR) is an urgent threat to global public health and development. Mitigating this threat requires substantial short-term action on key AMR priorities. While international legal agreements are the strongest mechanism for ensuring collaboration among countries, negotiating new international agreements can be a slow process. In the second article in this special issue, we consider whether harnessing existing international legal agreements offers an opportunity to increase collective action on AMR goals in the short-term. We highlight ten AMR priorities and (...) several strategies for achieving these goals using existing “legal hooks” that draw on elements of international environmental, trade and health laws governing related matters that could be used as they exist or revised to include AMR. We also consider the institutional mandates of international authorities to highlight areas where additional steps could be taken on AMR without constitutional changes. Overall, we identify 37 possible mechanisms to strengthen AMR governance using the International Health Regulations, the Agreement on the Application of Sanitary and Phytosanitary Measures, the Agreement on Trade-Related Aspects of Intellectual Property Rights, the Agreement on Technical Barriers to Trade, the International Convention on the Harmonized Commodity Description and Coding System, and the Basel, Rotterdam, and Stockholm conventions. Although we identify many shorter-term opportunities for addressing AMR using existing legal hooks, none of these options are capable of comprehensively addressing all global governance challenges related to AMR, such that they should be pursued simultaneously with longer-term approaches including a dedicated international legal agreement on AMR. (shrink)

Michael Bergmann claims that all versions of epistemic internalism face an irresolvable dilemma. We show that there are many plausible versions of internalism that falsify this claim. First, we demonstrate that there are versions of ‘‘weak awareness internalism’’ that, contra Bergmann, do not succumb to the ‘‘Subject’s Perspective Objection’’ horn of the dilemma. Second, we show that there are versions of ‘‘strong awareness internalism’’ that do not fall prey to the dilemma’s ‘‘vicious regress’’ horn. We note along the way that (...) these versions of internalism do not, in avoiding one horn of the dilemma, succumb to the dilemma’s other horn. The upshot is that internalists have many available strategies for avoiding dilemmatic defeat. (shrink)

This paper argues that, in addition to humanitarian concerns, policies toward immigrants should also be shaped by recognition of special responsibilities toward some populations of noncitizens. National governments acquire such responsibilities in part through their histories of coercive impositions on those populations. Former imperial powers, in particular, often possess special obligations toward the inhabitants of their foreign colonies that go beyond their general humanitarian responsibilities. Those obligations might be met in various ways; but if national governments of wealthy, formerly imperial (...) states granted greater access for immigration to the poor of their former colonies, migration flows might significantly contribute to reductions in global levels of inequality. (shrink)

Traditionally, physicians and parents made decisions about children’s health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children — of diverse levels of cognitive development — are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning (...) children’s ‘best interest’. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families. (shrink)

Spinoza’s attitude toward nonhuman animals is uncharacteristically cruel. This essay elaborates upon this ostensible idiosyncrasy in reference to Hasana Sharp’s commendable desire to revitalize a basis for animal ethics from within the bounds of his system. Despite our favoring an ethics beginning from animal affect, this essay argues that an animal ethic adequate to the demands of our historical moment cannot be developed from within the confines of strict adherence to Spinoza’s system—and this is not yet to speak of a (...) more robust animal ethics which would advocate actual care and compassion for the animals themselves. We argue that on the assumption of Spinoza’s ontological biocentrism, in the presence of Spinozist determinism and the absence of an axiological biocentrism, an anthropocentric axiology necessarily follows. Any Spinozist animal ethic must fall back, therefore, upon appeals to the maximization of human pleasure and power; hence Spinoza’s ruthless injunction to “use (the animals) at our pleasure.” These are the very ontological and ethical assumptions which have incited human self-exaltation in the modern period, in pursuit of power and pleasure even despite the destructive long-term consequences for all the living. We suggest that an adequate animal ethic would require either an abandonment of Spinoza’s ontological biocentrism or the adoption of an axiological biocentrism. (shrink)

Some analytic philosophers of religion argue that theists should embrace the hypothesis of the multiverse to address the problem of evil and make the concept of a “best possible creation” plausible. I discuss what classical theists, such as Augustine, Anselm, and Aquinas, might make of the multiverse hypothesis including issues such as: the principle of plenitude, what a classical theist multiverse could look like, and how a classical theist multiverse could deal with the problem of evil and the question of (...) a best possible creation. (shrink)

It is a commonplace to observe that we have been living through an extraordinary pan-European and trans-Atlantic populist moment. But do the heterogeneous phenomena lumped under the rubric “populist” in fact belong together? Or is “populism” just a journalistic cliché and political epithet? In the first part of the article, I defend the use of “populism” as an analytic category and the characterization of the last few years as a “populist moment,” and I propose an account of populism as a (...) discursive and stylistic repertoire. In the second part, I specify the structural trends and the conjunctural convergence of a series of crises that jointly explain the clustering in space and time that constitutes the populist moment. The question in my title is thus twofold: it is a question about populism as a term or concept and a question about populism as a phenomenon in the world. The article addresses both the conceptual and the explanatory question, limiting the scope of the explanatory argument to the pan-European and trans-Atlantic populist conjuncture of the last few years. (shrink)

Michael Sandel's Democracy's Discontent traces America's woes to an erosion of community and a loss of a sense of collective self‐governance. He recommends a more communitarian, republican public philosophy as the cure. His book illuminates many important historical and contemporary issues, particularly the link between systems of political economy and visions of citizenship. His methods are, however, too impressionistic to support his empirical claims. He particularly neglects the role of civic republicanism in America's history of racial, gender, and religious discrimination. (...) Hence his call for Americans to minimize liberal doctrines of individual rights in favor of communally minded republicanism is not fully persuasive. (shrink)

Digital hyperconnectivity is a defining fact of our time. In addition to recasting social interaction, culture, economics, and politics, it has profoundly transformed the self. It has created new ways of being and constructing a self, but also new ways of being constructed as a self from the outside, new ways of being configured, represented, and governed as a self by sociotechnical systems. Rather than analyze theories of the self, I focus on practices of the self, using this expression in (...) a looser, more general sense than that used by Foucault. I begin by considering and reformulating two early lines of argument about the web as a medium for exploring and emancipating the self. Subsequent sections show how digital hyperconnectivity has engendered new ways of objectifying, quantifying, producing, and regulating the self—considered both as active, reflexive practices and as systemic, data- and algorithm-driven processes. I conclude by reflecting on the broader implications of contemporary modes of governing the self and by underscoring the ways in which hyperconnectivity has colonized the territories of the self, conscripting the self into the service of techno-social systems. (shrink)

This paper introduces a special issue of Cognitive Science initiated on the 25th anniversary of the publication of Parallel Distributed Processing (PDP), a two-volume work that introduced the use of neural network models as vehicles for understanding cognition. The collection surveys the core commitments of the PDP framework, the key issues the framework has addressed, and the debates the framework has spawned, and presents viewpoints on the current status of these issues. The articles focus on both historical roots and contemporary (...) developments in learning, optimality theory, perception, memory, language, conceptual knowledge, cognitive control, and consciousness. Here we consider the approach more generally, reviewing the original motivations, the resulting framework, and the central tenets of the underlying theory. We then evaluate the impact of PDP both on the field at large and within specific subdomains of cognitive science and consider the current role of PDP models within the broader landscape of contemporary theoretical frameworks in cognitive science. Looking to the future, we consider the implications for cognitive science of the recent success of machine learning systems called “deep networks”—systems that build on key ideas presented in the PDP volumes. (shrink)

The doctrine of divine simplicity (DDS) is an important aspect of the classical theism of philosophers like Augustine, Anselm, and Thomas Aquinas. Recently the doctrine has been defended in a Thomist mode using the intrinsic/extrinsic distinction. I argue that this approach entails problems which can be avoided by taking Anselm’s more Neoplatonic line. This does involve accepting some controversial claims: for example, that time is isotemporal and that God inevitably does the best. The most difficult problem involves trying to reconcile (...) created libertarian free will with the Anselmian DDS. But for those attracted to DDS the Anselmian approach is worth considering. (shrink)

ABSTRACT Few denials of tolerance are more severe than rejection of the moral worth of another’s way of life. In the U.S. today, many traditional religious believers, especially fundamentalist Christians, and many LGBQT+ persons see each other’s ways of life as deeply evil in important respects. These gulfs probably cannot be bridged; but public policies can and should seek to accommodate all claims of conscience as far as this can be done without denying anyone meaningful possession of basic rights. By (...) placing religious and moral consciences equally in a constitutionally “preferred position,” governments can foster a wider sense that citizens are engaged in a shared enterprise of helping everyone to pursue their distinctive forms of happiness. (shrink)

Why do we labour so hard to sustain relationships that are fundamentally harmful to our wellbeing? That is the question which lies at the heart of Maja Borg’s poetic and alternatively distributed documentary film, Future My Love. The detrimental bonds on which the film focuses are those that maintain our connection to an economic system that has thrown us into an acute state of crisis and the stillborn emotions that keep us hopefully attached to a romantic partnership that we have (...) already outgrown; this elision imbricates and implicates the personal in the political. Through a prism of painful and, at times, unbearable emotion, and by blurring the boundaries between the public and the private, the real and the fictional, this film urges us to imagine ourselves into a future in which it might be possible to live otherwise; but this requires us to abandon the future we have already imagined and, as the film evinces through archival imagery from the 1950s or golden age of capitalism, imaged ourselves into. By drawing on the work of Lauren Berlant and Sara Ahmed on the cultural politics of emotion, Judith Butler’s work on the act of mourning, and the writing of Eva Illouz, Luce Irigaray and Alain Badiou on love in the age of late capitalism, this article contends that Future My Love pleads with us to abandon, in Ahmed’s words, ‘happiness for life’, to forsake an ideology that is invested in a highly specific notion of what it means to flourish and to thrive, to mourn and name our losses, and to think about the future creatively and without cynicism. (shrink)

Authoritarian nationalism is on the rise in many countries around the world, threatening liberal democracies. Many on the left rightly fear that any and all celebrations of national identities risk heightening these dangers. It is questionable, however, whether illiberal nationalism can be defeated politically without some reliance on progressive stories of national identity that advance themes of equality, freedom, and inclusion in ways that resonate with many of the traditions in which those whom progressives seek to mobilize have been raised.

Biological dysfunction is regarded, in many accounts, as necessary and perhaps sufficient for disease. But although disease is conceptualized as all-or-nothing, biological functions often differ by degree. A tension is created by attempting to use a continuous variable as the basis for a categorical definition, raising questions about how we are to pinpoint the boundary between health and disease. This is the line-drawing problem. In this paper, we show how the line-drawing problem arises within “dysfunction-requiring” accounts of disease, such as (...) those of Christopher Boorse and Jerome Wakefield. We then provide several detailed examples to establish that biological dysfunction cannot provide a boundary. We examine potential ways of resolving the line-drawing problem, either by dropping one of the claims that generates it, or by appealing to additional criteria. We argue that two of these options are plausible, and that each of these can be applied with regard to different diseases. (shrink)

Human uterus transplantation is currently under investigation as a treatment for uterine infertility. Without a uterus transplant, the options available to women with uterine infertility are adoption or surrogacy; only the latter has the potential for a genetically related child. UTx will offer recipients the chance of having their own pregnancy. This procedure occurs at the intersection of two ethically contentious areas: assisted reproductive technologies and organ transplantation. In relation to organ transplantation, UTx lies with composite tissue transplants such as (...) face and limb grafts, and shares some of the ethical concerns raised by these non-life saving procedures. In relation to ART, UTx represents one more avenue by which a woman may seek to meet her reproductive goals, and as with other ART procedures, raises questions about the limits of reproductive autonomy. This paper explores the ethical issues raised by UTx with a focus on the potential gap between women's desires and aspirations about pregnancy and the likely functional outcomes of successful UTx. (shrink)

In this paper, we explore the concept of bearing witness in nursing practice. We examine the description of bearing witness in the nursing literature, particularly that offered by William Cody who suggests that bearing witness results in the limited moral obligation of “true presence.” We then turn to Lorraine Code's work on testimony, drawing parallels between the concepts of testimony and bearing witness. Code suggests that receiving testimony results in a responsibility to respond, and that this is an ethico‐political (...) obligation. We discuss these ideas in relation to a Canadian exemplar of witnessing the Truth and Reconciliation Commission of Canada's work to understand and address the historical injustices done to Indigenous peoples in Canada. Here, we focus on the Commission's definition of witnessing and highlight the experience of Shelagh Rogers who served as an honorary witness. As an outcome of our analysis, we suggest that bearing witness in nursing practice is most usefully conceptualized as both a moral and a political obligation. Implications for nursing practice are suggested, including first, the need to critically examine our own understandings of power and privilege in order to authentically bear witness and avoid being complicit in injustice, and second, the concomitant responsibility to take action to challenge injustice once we have borne witness to it. (shrink)

Objective We reviewed human–robot interaction (HRI) participatory design (PD) research with older adults. The goal was to identify methods used, determine their value for design of robots with older adults, and provide guidance for best practices. Background Assistive robots may promote aging-in-place and quality of life for older adults. However, the robots must be designed to meet older adults’ specific needs and preferences. PD and other user-centered methods may be used to engage older adults in the robot development process to (...) accommodate their needs and preferences and to assure usability of emergent assistive robots. Method This targeted review of HRI PD studies with older adults draws on a detailed review of 26 articles. Our assessment focused on the HRI methods and their utility for use with older adults who have a range of needs and capabilities. Results Our review highlighted the importance of using mixed methods and including multiple stakeholders throughout the design process. These approaches can encourage mutual learning (to improve design by developers and to increase acceptance by users). We identified key phases used in HRI PD workshops (e.g., initial interview phase, series of focus groups phase, and presentation phase). These approaches can provide inspiration for future efforts. Conclusion HRI PD strategies can support designers in developing assistive robots that meet older adults’ needs, capabilities, and preferences to promote acceptance. More HRI research is needed to understand potential implications for aging-in-place. PD methods provide a promising approach. (shrink)

Many healthcare practices expose people to risks of harmful outcomes. However, the major theories of moral philosophy struggle to assess whether, when and why it is ethically justifiable to expose individuals to risks, as opposed to actually harming them. Sven Ove Hansson has proposed an approach to the ethical assessment of risk imposition that encourages attention to factors including questions of justice in the distribution of advantage and risk, people’s acceptance or otherwise of risks, and the scope individuals have to (...) influence the practices that generate risk. This paper investigates the ethical justifiability of preventive healthcare practices that expose people to risks including overdiagnosis. We applied Hansson’s framework to three such practices: an ‘ideal’ breast screening service, a commercial personal genome testing service, and a guideline that lowers the diagnostic threshold for hypertension. The framework was challenging to apply, not least because healthcare has unclear boundaries and involves highly complex practices. Nonetheless, the framework encouraged attention to issues that would be widely recognised as morally pertinent. Our assessment supports the view that at least some preventive healthcare practices that impose risks including that of overdiagnosis are not ethically justifiable. Further work is however needed to develop and/or test refined assessment criteria and guidance for applying them. (shrink)

In this paper we consider the use of cases in medical ethics research and teaching. To date, there has been little discussion about the consent or confidentiality requirements that ought to govern the use of cases in these areas. This is in marked contrast to the requirements for consent to publish cases in clinical journals, or to use personal information in research. There are a number of reasons why it might be difficult to obtain consent to use cases in ethics. (...) Many cases concern people who are incompetent, and thus unable to give consent. Often the material is of a sensitive nature, it is not clear who should give consent, or the ethicist has no access to those involved. We argue that the use of cases in ethics research and teaching can be justified by appeal to the public interest argument, and suggest a number of areas for discussion and clarification. (shrink)

This article describes the development of a computerized version of a measure of ethical sensitivity to racial and gender intolerance, the Racial Ethical Sensitivity Test. The REST was based on James Rest's 4-component model of moral development and the professional codes of ethics from school-based professions. The new version, Racial and Ethical Sensitivity Test-Compact Disk, consists of 5 videotaped scenarios followed by an interactive "interview" presented on compact discs. Data from a study with 58 students provides initial validation of the (...) REST-CD. Ethical sensitivity to racial and gender intolerance in schools, as measured by the REST-CD, was moderately related to attitudes toward racial and gender equity issues in society as measured by the Quick Discrimination Index. The results provide evidence for both interrater and internal reliability of the REST-CD scores. This study also tests the hypothesized relationship between REST-CD scores and previous multicultural and ethics course work. Students with multicultural and ethics course experience have scored significantly higher on the REST-CD than students without course work. The paper-and-pencil tests are not significantly related to previous ethics/multicultural course work. In this article, we discuss the implications of the results and directions for future research. (shrink)

Overdiagnosis refers to diagnosis that does not benefit patients because the diagnosed condition is not a harmful disease in those individuals. Overdiagnosis has been identified as a problem in cancer screening, diseases such as chronic kidney disease and diabetes, and a range of mental illnesses including depression and attention deficit hyperactivity disorder. In this paper, we describe overdiagnosis, investigate reasons why it occurs, and propose two different types. Misclassification overdiagnosis arises because the diagnostic threshold for the disease in question has (...) been set at a level where many people without harmful disease are nonetheless diagnosed. We illustrate misclassification overdiagnosis using the example of chronic kidney disease. Misclassification occurs in diseases diagnosed using biomarkers or based on patient reported phenomena. Maldetection overdiagnosis arises because, at the time the diagnosis is made and despite the presence of a 'gold standard' diagnostic test, it is not possible to discriminate between harmful and non-harmful cases of the index disease. We illustrate maldetection overdiagnosis using the example of thyroid cancer. While there is some overlap between misclassification and maldetection overdiagnosis, this conceptual analysis helps to clarify the phenomenon of overdiagnosis and is a necessary first step in developing strategies to address the problem. (shrink)

Anselm holds that God is timeless, time is tenseless, and humans have libertarian freedom. This combination of commitments is largely undefended incontemporary philosophy of religion. Here I explain Anselmian eternalism with its entailment of tenseless time, offer reasons for accepting it, and defend it against criticisms from William Hasker and other Open Theists. I argue that the tenseless view is coherent, that God’s eternal omniscience is consistent with libertarian freedom, that being eternal greatly enhances divine sovereignty, and that the Anselmian (...) view supports the contention that the Bible is relevant today far better than does Open Theism. (shrink)