Children’s preferences about medical treatment—like the preferences of other patients—hold moral weight in decision-making that is independent of considerations of autonomy or best interests. In light of this understanding of the moral value of patient preferences, the American Academy of Pediatrics could strengthen the ethical foundation for its formal guidance on pediatric assent.

Oppression can be unjust from a luck egalitarian point of view even when it is the consequence of choices for which it is reasonable to hold persons responsible. This is for two reasons. First, people who have not been oppressed are unlikely to anticipate the ways in which their choices may lead them into oppressive conditions. Facts about systematic phenomena (like oppression) are often beyond the epistemic reach of persons who are not currently subject to such conditions, even when they (...) possess adequate information about the particular consequences of their choices. Second, people may be (much) less responsible for remaining in oppressive conditions, even if they are responsible for entering circumstances of oppression. Oppression that results from a person’s choice may cause or contribute to dramatic changes in that person, and these changes may be sufficient to undermine the person’s responsibility for the results of her earlier choice. (shrink)

According to a standard account of patient decision-making capacity, patients can provide ethically valid consent or refusal only if they are able to understand and appreciate their medical c...

In this rigorous investigation into the logic of truth Anil Gupta and Nuel Belnap explain how the concept of truth works in both ordinary and pathological..

In a recent paper published in this journal, Giubilini, Douglas and Savulescu argue that we have given insufficient weight to the moral importance of fairness in our account of the best policies for non-medical exemptions to childhood immunization requirements. They advocate for a type of policy they call Contribution, according to which parents must contribute to important public health goods before their children can receive NMEs to immunization requirements. In this response, we argue that Giubilini, Douglas and Savulescu give insufficient (...) weight to the moral importance parental liberty in ways that count against their preferred type of NMEs policy and threaten public support for mandatory vaccination laws and public health initiatives generally. (shrink)

We write and for the cardinalities of the set of finite sequences and the set of finite subsets, respectively, of a set which is of cardinality. With the axiom of choice (), for every infinite cardinal but, without, any relationship between and for an arbitrary infinite cardinal cannot be proved. In this paper, we give conditions that make and comparable for an infinite cardinal. Among our results, we show that, if we assume the axiom of choice for sets of finite (...) sets, then for every Dedekind‐infinite cardinal and the condition that is Dedekind‐infinite cannot be weakened to weakly Dedekind‐infinite. (shrink)

Recent increases in the rates of parental refusal of routine childhood vaccination have eroded many countries’ “herd immunity” to communicable diseases. Some parents who refuse routine childhood vaccines do so because they deny the mainstream medical consensus that vaccines are safe and effective. I argue that one reason these vaccine denialists disagree with vaccine proponents about the reasons in favor of vaccination is because they also disagree about the sorts of practices that are conducive to good reasoning about healthcare choices. (...) Vaccine denialists allocate epistemic authority more democratically than do mainstream medical professionals. They also sometimes make truth ascriptions for nonepistemic reasons, fail to recognize legitimate differences in expertiseand competence, and seek uncritical affirmation of their existing beliefs. By focusing on the different epistemic values and practices of vaccine denialists and mainstream medical professionals, I locate my discussion of vaccine denialism within broader debates about rationality. Furthermore, I argue that gender inequality and gendered conceptions of reason are important parts of the explanation of vaccine denialism. Accordingly, I draw upon feminist work—primarily feminist social epistemology—to help explain and evaluate this form of vaccine refusal. (shrink)

Volume 24, Issue 8, August 2024, Page 93-95.

Leaders of the world’s largest food sovereignty movement, La Vía Campesina, have argued that gender justice is a core component of food justice. On their view, food justice requires an end to violence against women and a guarantee of women’s equal social and political status. However, some have wondered what gender justice has to do with food. In particular, they have worried that La Vía Campesina’s embrace of radical gender egalitarianism cannot be grounded in food-related concerns. My goal in this (...) paper is to respond to these objections, and to show that La Vía Campesina’s efforts to promote gender justice may be grounded in its broader food justice goals. (shrink)

The capacity to designate a surrogate (CDS) is not simply another kind of medical decision-making capacity (DMC). A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who (...) lack DMC for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases (eg, Alzheimer’s disease). That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions. (shrink)

Conscientious objectors to military service are either general objectors or selective objectors. The former object to all wars; the latter object to only some wars. There is widespread popular and political support in western liberal democracies for exemptions for general objectors, but currently there is little support for exemptions for selective objectors. Many who advocate exemptions for selective objectors attempt to build upon the strength of support that is enjoyed by exemptions for general objectors. They argue that selective objectors ? (...) like general objectors ? sincerely believe that it would be deeply morally wrong for them to fight in the wars to which they object. I argue that a stronger moral case for exemptions for selective objectors relies upon a different claim: selective objections are often accurate. It is often immoral to fight in the wars to which selective objectors object. While some advocates of exemptions for selective objectors have identified accuracy as a reason for offering exemptions, they have usually not adequately distinguished sincerity from accuracy. However, keeping these two moral reasons for exemptions distinct clarifies and strengthens the moral case for exemptions for selective conscientious objectors. (shrink)

Techniques from behavioral economics—nudges—may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate. This article rejects a principle to which parties on both sides of this debate sometimes seem (...) committed: that nudges are morally permissible only if they are consistent with autonomy. Instead, I argue that, at least in the case of pediatric vaccination, some autonomy-undermining nudges may be morally justified. This is because parental autonomy in pediatric decision-making is not as morally valuable as the autonomy of adult patients, and because the interests of both the vaccinated child and other members of the community can sometimes be weighty enough to justify autonomy-infringing pediatric vaccination nudges. This article concludes with a set of worries about the effect of pediatric vaccination nudges on parent-physician relationships, and it calls on the American Academy of Pediatrics to draw on scientific and bioethics research to develop guidelines for the use of nudges in pediatric practice and, in particular, for the use of pediatric vaccination nudges. (shrink)

We show that in the [Formula: see text] extension of a certain Chang-type model of determinacy, if [Formula: see text], then the restriction of the club filter on [Formula: see text] Cof[Formula: see text] to HOD is an ultrafilter in HOD. This answers Question 4.11 of [O. Ben-Neria and Y. Hayut, On [Formula: see text]-strongly measurable cardinals, Forum Math. Sigma 11 (2023) e19].

Parents in the US and other societies are increasingly refusing to vaccinate their children, even though popular anti-vaccine myths – e.g. ‘vaccines cause autism’ – have been debunked. This book explains the epistemic and moral failures that lead some parents to refuse to vaccinate their children. First, some parents have good reasons not to defer to the expertise of physicians, and to rely instead upon their own judgments about how to care for their children. Unfortunately, epistemic self-reliance systematically distorts beliefs (...) in areas of inquiry in which expertise is required. Second, vaccine refusers and mainstream medical authorities are often committed to different values surrounding health and safety. For example, while vaccine advocates stress that vaccines have low rates of serious complications, vaccine refusers often resist vaccination because it is ‘unnatural’ and because they view vaccine-preventable diseases as a ‘natural’ part of childhood. Finally, parents who refuse vaccines rightly resist the utilitarian moral arguments – ‘for the greater good’ – that vaccine advocates sometimes make. Unfortunately, vaccine refusers also sometimes embrace a pernicious hyper-individualism that sanctions free-riding on herd immunity and that cultivates indifference to the interpersonal and social harms that unvaccinated persons may cause. (shrink)

Many advocate practices of ‘local food’ or ‘locavorism’ as a partial solution to the injustices and unsustainability of contemporary food systems. I think that there is much to be said in favor of local food movements, but these virtues are insufficient to immunize locavorism from criticism. In particular, three duties of international ethics—beneficence, repair and fairness—may provide reasons for constraining the developed world’s permissible pursuit of local food. A complete account of why (and how) the fulfillment of these duties constrains (...) locavorism will require extensive empirical evidence about the relationship between agricultural demand-led industrialization, international trade (rules), and local food practices. In this paper I can only gesture at some of this evidence and, for that reason, my policy prescriptions are merely provisional. Instead, the upshot of this paper is that advocates of locavorism ought to be attentive to the empirical-dependence of the moral permissibility of their projects. As local food ‘scales up’—and comes to be embraced as a goal of political communities—these concerns should receive even greater attention. (shrink)

Two new documents from the Committee on Bioethics of the American Academy of Pediatrics expand the terrain for parental decision making, suggesting that pediatricians may override only those parental requests that cross a harm threshold. These new documents introduce a broader set of considerations in favor of parental authority in pediatric care than previous AAP documents have embraced. While we find this to be a positive move, we argue that the 2016 AAP positions actually understate the importance of informed and (...) voluntary parental involvement in pediatric decision making. This article provides a more expansive account of the value of parental permission. In particular, we suggest that an expansive role for parental permission may reveal facts and values relevant to their child's treatment, encourage resistance to suboptimal default practices, improve adherence to treatment, nurture children's autonomy, and promote the interests of other family members. (shrink)

The paper attempts to explore the implications of Kant's moral criticism of suicide in the case of euthanasia. The paper argues that since Kant's criticism of suicide is essentially directed towards rational beings who are in full control of their rational faculty. It would hence not be applicable in case of individuals who are suffering from dementia and who have expressed a prior desire to be euthanized in such a scenario.

I argue that a parental prerogative to sometimes prioritize the interests of one’s children over the interests of others is insufficient to make the parental refusal of routine childhood vaccines morally permissible. This is because the moral permissibility of vaccine refusal follows from such a parental prerogative only if the only (weighty) moral reason in favor of vaccination is that vaccination is a means for promoting the interests of others. However, there are two additional weighty moral reasons in favor of (...) routine vaccination: fairness and concern for the vulnerable. These moral reasons in favor of vaccination are not defeated by a parental prerogative to prioritize the interests of one’s children over the interests of others. (shrink)

Journal of Mathematical Logic, Ahead of Print.

This book offers a novel account of the relationship of experience to knowledge. The account builds on the intuitive idea that our ordinary perceptual judgments are not autonomous, that an interdependence obtains between our view of the world and our perceptual judgments. Anil Gupta shows in this important study that this interdependence is the key to a satisfactory account of experience. He uses tools from logic and the philosophy of language to argue that his account of experience makes available (...) an attractive and feasible empiricism. (shrink)

Journal of Mathematical Logic, Ahead of Print. We show that in the [math] extension of a certain Chang-type model of determinacy, if [math], then the restriction of the club filter on [math] Cof[math] to HOD is an ultrafilter in HOD. This answers Question 4.11 of [O. Ben-Neria and Y. Hayut, On [math]-strongly measurable cardinals, Forum Math. Sigma 11 (2023) e19].

Political communities across the world have recently sought to tackle rising rates of vaccine hesitancy and refusal, by implementing coercive immunization programs, or by making existing immunization programs more coercive. Many academics and advocates of public health have applauded these policy developments, and they have invoked ethical reasons for implementing or strengthening vaccine mandates. Others have criticized these policies on ethical grounds, for undermining liberty, and as symptoms of broader government overreach. But such arguments often obscure or abstract away from (...) the diverse values that are relevant to the ethical justifications of particular political communities’ vaccine‐mandate policies. We argue for an expansive conception of the normative issues relevant to deciding whether and how to establish or reform vaccine mandates, and we propose a schema by which to organize our thoughts about the ways in which different kinds of vaccine‐mandate policies implicate various values. (shrink)

Pediatric intervention principles help clinicians and health-care institutions determine appropriate responses when parents’ medical decisions place children at risk. Several intervention principles have been proposed and defended in the pediatric ethics literature. These principles may appear to provide conflicting guidance, but much of that conflict is superficial. First, seemingly different pediatric intervention principles sometimes converge on the same guidance. Second, these principles often aim to solve different problems in pediatrics or to operate in different background conditions. The potential for convergence (...) between intervention principles—or at least an absence of conflict between them—matters for both the theory and practice of pediatric ethics. This article builds on the recent work of a diverse group of pediatric ethicists tasked with identifying consensus guidelines for pediatric decision-making. (shrink)

This book aims to offer an account of conscious experience and of concepts that help us understand empirical reasoning and empirical dialectic. The account offered possesses, it is claimed, two virtues. First, it provides great theoretical freedom. It allows the theoretician freedom to radically reconceive the world. The theoretician may, for example, begin with the conception that colors are genuine qualities of physical bodies and may, in light of empirical findings, shift to the conception that colors are not genuine qualities (...) at all. Second, the account grants empirical reason a great power to constrain: empirical reason can force a particular conception of the self and the world on the rational inquirer. These seemingly contrary virtues are reconciled through a novel treatment of presentation and appearances in the account offered of conscious experience and a novel treatment of ostensive definitions in the account offered of concepts. The argument of the book is buttressed by a critical study of the principal approaches to experience and reason found in the philosophical literature.--. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 93-96 [Access article in PDF] Phenomenological Methods in Psychiatry:A Necessary First Step M. Gupta and L. Rex Kay Keywords: behavior, empathy, human science, methodology, natural science, phenomenology. WE ARE GRATEFUL to the journal for prviding the opportunity for exchange and discussion of some of the themes raised in our paper, "The impact of phenomenology on North American psychiatric assessment" and we are (...) pleased to be able to reply to the two excellent commentaries by McMillan and Morley. Both McMillan and Morley question the prospect of employing phenomenology and its methods in psychiatric assessment, and in psychiatric practice more generally. McMillan questions the utility of such a step, and Morley is pessimistic about its feasibility. We shall address each author's concerns in turn.Initially, let us restate the aims of our paper to contextualize our arguments and those made in the commentaries. First, we sought an understanding of what is meant by North American psychiatrists, working within the DSM framework, when they refer to the phenomenological approach to psychiatric assessment. To elucidate this meaning, we compared the contemporary North American usage to a small number of definitions of phenomenology, particularly those definitions that were, and are now, applied to clinical psychiatric work. Contrary to McMillan's suggestion, we did not intend to state definitively what should or should not count as phenomenological, but rather to compare North American psychiatric assessment to what typically has counted as phenomenological. Second, we sought to examine phenomenology's influence on North American psychiatric practice, particularly psychotherapy.Morley argues that such influences usually exemplify the inappropriate appending of phenomenology to psychiatric practice rather than true integration of different paradigms. Although we do not disagree with this general contention, we will argue that the deployment of phenomenological methods in psychiatric assessment is a necessary first step toward the kind of integration he proposes.McMillan makes two related but unintegrated points. First, he argues that objective, behavioral data are phenomenological, according to his broad definition of the term. Second, he proposes that, if the behavioral and the phenomenological are different, we are better off staying with the behavioral when it comes to psychiatric nosology. Let us consider these two points in succession.McMillan seeks to broaden Jasper's definition of phenomenology to include objective observations [End Page 93] as phenomenological. To this end, he distinguishes methods from aims. He summarizes Jasper's definition of phenomenology as "an empirical method for investigating 'individual psychic experience (p 55)" and claims that this is a statement of aim or objectives. He then urges us to "consider the merits of different phenomenological methodologies in terms of their success in achieving this objective" whether or not they utilize "all the methods" of phenomenology. This is much like saying that if we treat waving one's hand as a method for greeting someone, we are then free to treat the objective of the wave as one of greeting someone, and then say that anything that serves as a greeting is, by definition, a "wave." Whatever else McMillan's objective observations are, he has not convinced us that they are phenomenological, anymore than we are likely to convince you that a kiss on the lips is really just a wave.Nonetheless, it is worthwhile seeing what McMillan does with this argument. He tells us that we can "read the first-person experience from behavior in a fairly accurate and informative way." He uses the example of a father gazing at his young child and notes that it is not unreasonable to infer that he is experiencing loving and nurturing feelings. It is, indeed, not unreasonable to draw such an inference. But it is far more reasonable to infer that the father is experiencing a cacophony of feelings, including, but not limited to, love, concern, anxiety, pride, envy, hope, and sadness (Stern 1995, 18-58). If we are able to distinguish which of these feelings is dominant at any given moment—which we are—and if we are also able to track subtle shifts in such feelings... (shrink)

In this paper, I draw attention to various doctrines common to different Vedāntic traditions. In particular, I pay close attention to the doctrine of beginningless _karman_. I also note that this doctrine seems to stand in tension with Leibnizian Cosmological Arguments (LCAs) and Kalām Cosmological Arguments (KCAs). This tension arises because defenders of these arguments argue that an infinite causal regress or an actual infinite cannot be physically instantiated and because the doctrine of beginningless _karman_ seems to imply that such (...) a regress or actual infinite can be physically instantiated. I address this tension by showing that not all interpretations of beginningless _karman_ involve an infinite causal regress or an actual infinite. I close this paper by highlighting a few features that Vedāntic traditions have that make them more resistant to some objections to LCAs and KCAs. (shrink)

This volume reprints eight of Anil Gupta's essays, some with additional material. The essays bring a refreshing new perspective to central issues in philosophical logic, philosophy of language, and epistemology.

Alternative Food Networks (AFNs), which include local food and Fair Trade, work to mitigate some of the many shortcomings of mainstream food systems. If AFNs have the potential to make the world’s food systems more just and sustainable (and otherwise virtuous) then we may have good reasons to scale them up. Unfortunately, it may not be possible to increase the market share of AFNs while preserving their current forms. Among other reasons, this is because there are limits to both the (...) productive capacities of small owner-operated farms and to the distribution capacities of Farmers Markets and Community Supported Agriculture (CSA). These limits tell in favor of AFN partnerships with larger producers and distributors. But some advocates of AFNs have worried that these partnerships would sacrifice too much. (shrink)

Background: Previous research shows that pediatricians inconsistently utilize the ethics consultation service (ECS). Methods: Pediatricians in two suburban, Midwestern academic hospitals were asked to reflect on their ethics training and utilization of ECS via an anonymous, electronic survey distributed in 2017 and 2018, and analyzed in 2018. Participants reported their clinical experience, exposure to formal and informal ethics training, use of formal and informal ethics consultations, and potential barriers to formal consultation. Results: Less experienced pediatricians were more likely to utilize (...) formal ethics consultation and more likely to have formal ethics training. The most commonly reported reasons not to pursue formal ECS consultation were inconvenience and self-reported expertise in pediatric ethics. Conclusions: These results inform ongoing discussions about ethics consultation among pediatricians and the role of formal ethics training in both undergraduate and graduate medical education. (shrink)

Political debate regarding trans youth’s access to gender-affirming care (GAC) has pushed many to advocate for GAC by pointing to tragic, pathological outcomes of non-treatment, namely suicide. However, these pathologized arguments are a harmful ethical “shortcut” which should be replaced by a meaningful engagement with the ethics of providing GAC to youth.

The three of us work as academics and clinical ethicists. In our clinical ethics work, we often encounter patients who lack decision-making capacity, but who nonetheless have strong preferences abo...

Este ensayo relaciona, por una parte, el pensamiento inclusivo con la cuestión moral del reconocimiento y, por otra, con el problema existencial del resentimiento y la técnica en la globalización híper-industrial. Se contrastan e integran perspectivas como las de Anne Phillips, Axel Honneth, María Pía Lara, Bernard Stiegler y Cynthia Fleury, para argumentar que los desarrollos tecnoeconómicos y sociales de la última década obligan a recuperar el problema del reconocimiento, para replantearlo por fuera de una racionalidad normativa, esto es, a (...) la luz de sus dimensiones psíquicas y existenciales. Dado que las condiciones tecnoeconómicas actuales parecen eliminar la posibilidad de un reconocimiento genuino —o una igualdad sin condición—, el problema del pensamiento inclusivo se revela, en el fondo, como el del resentimiento ante el descrédito de las promesas morales y políticas de la modernidad. El ensayo termina con una reflexión sobre las implicaciones de este argumento para una consideración responsable del pensamiento inclusivo, en tanto fenómeno cultural situado. El libro Desde los zulos (2023), de la escritora feminista Dahlia de la Cerda, nos permite mostrar que no hay determinismo tecnoeconómico o metafísico total, sino agujereado, y que de los agujeros brota, a veces, algo así como el reconocimiento. Al mismo tiempo, deja abierta la cuestión de si eso que emerge le pertenece a un nuevo sujeto estético-político, o si sucede, sin más, como la diferencia absoluta entre vida y política. (shrink)

Privacy is widely valued, especially in individualistic cultures, because people want to control access to their bodies and to information about their personal choices. Privacy can promote a variety of goods. It can protect intimacy among friends and colleagues and create trusting relations of tolerance among strangers. Privacy can promote dignity, since it can be embarrassing to disclose secret or unconsidered thoughts or opinions, or to reveal one’s naked body or other private spaces. Privacy can also contribute to our individuality, (...) self-respect, and autonomy; and privacy can protect us from a wide array of emotional or psychological harms associated with unwanted publicity. Privacy can also further important political and legal goods, including property rights, fraud prevention, and non-discrimination. (shrink)

This paper builds on previous research about the potential downsides of food sovereignty activism in relatively wealthy societies by developing a three-part taxonomy of harms that may arise in such contexts. These are direct opposition, false equivalence, and diluted goals and methods. While this paper provides reasons to resist complacency about wealthy-world food sovereignty, we are optimistic about the potential for food sovereignty in wealthy societies, and we conclude by describing how wealthy-world food sovereignty can be a location of either (...) transnational solidarity or nonharmful forms of cooptation. (shrink)

This essay builds on various critiques of the relationship between the voice and autonomous individual subjectivity, briefly tracking the specific history through which the voice transformed into an ideal object representing the liberal subject of post-Enlightenment thought. This paper asks: what are we to make of those enfleshed voices that do not conform to the ideal voice of the self-possessed liberal subject? What are we to make of those voices that refuse the imperative of improvement that underpins social and economic (...) contractualism? How might we attend to the sonicity of those voices that refuse to individuate, possess, and accumulate? And what fugitive modes of speech might be transmitted by such un-formed and un-organized voices? Against the idealized voice of liberalism, and the gendered and racialized exclusions that this voice implies, I propose a mode of fugitive listening that allows us to open our ears to the noisy voices and modes of speech that sound outside the locus of politics proper. Indebted to the Black radical tradition, fugitive listening attends to sonic practices that refuse the given grounds of representation. I argue that fugitive listening is a practice that can be situated in what Stefano Harney and Fred Moten call ‘the undercommons’. The essay concludes by turning to gossip, figuring this noisy modality of speech as central to undercommon spaces shaped by Black performance. (shrink)

Abstract:In this work, we consider the essence of human freedom as a living link among the forces of the individuation process thought aesthetically; that is, because human understanding is synthetic, imagination can elaborate a whole world that is not linked to conceptual knowledge. Precisely because of that, we can find a way of relationship between ourselves and the environment that is not binary, such as when we ask ourselves whether the emission of carbon gas resulting from our human intervention is (...) harmful to the environment or not. To do so, we will initially outline the meaning of the symbolic (Sinnbild) in Schelling. Then, we will see how Schelling reaches the material conditions of objectification for an extra-theoretical synthesis by which, in a single move, the universe is immediately given. Finally, we turn to the specificity of human freedom and the dual nature of the I, which allows us to understand that the possibility of our human freedom does not consist in being able to choose between good and evil; rather, its possibility consists in a capacity (Vermögen) for good and evil. (shrink)