BackgroundWhen rationing health care, a commonly held view among ethicists is that there is no ethical difference between withdrawing or withholding medical treatments. In reality, this view does not generally seem to be supported by practicians nor in legislation practices, by for example adding a ‘grandfather clause’ when rejecting a new treatment for lacking cost-effectiveness. Due to this discrepancy, our objective was to explore physicians’ and patient organization representatives’ experiences- and perceptions of withdrawing and withholding treatments in rationing situations of (...) relative scarcity.MethodsFourteen semi-structured interviews were conducted in Sweden with physicians and patient organization representatives, thematic analysis was used.ResultsParticipants commonly express internally inconsistent views regarding if withdrawing or withholding medical treatments should be deemed as ethically equivalent. Participants express that in terms of patients’ need for treatment withholding and withdrawing should be deemed ethically equivalent. However, in terms of prognostic differences, and the patient-physician relation and communication, there is a clear discrepancy which carry a moral significance and ultimately makes withdrawing psychologically difficult for both physicians and patients, and politically difficult for policy makers.ConclusionsWe conclude that the distinction between withdrawing and withholding treatment as unified concepts is a simplification of a more complex situation, where different factors related differently to these two concepts. Following this, possible policy solutions are discussed for how to resolve this experienced moral difference by practitioners and ease withdrawing treatments due to health care rationing. Such solutions could be to have agreements between the physician and patient about potential future treatment withdrawals, to evaluate the treatment’s effect, and to provide guidelines on a national level. (shrink)

In a recent paper, Andy Clark (2008) has argued that the literature on embodied cognition reveals a tension between two prominent strands within this movement. On the one hand, there are those who endorse what Clark refers to as body-centrism, a view which emphasizes the special contribution made by the body to a creature’s mental life. Among other things, body centrism implies that significant differences in embodiment translate into significant differences in cognition and consciousness. On the other hand, there are (...) those who endorse what Clark calls extended functionalism, a view which sees the mind as the joint product of the computational resources presented by (i) intracranial processing, (ii) bodily input, and (iii) environmental scaffolding. As such, extended functionalism allows for the possibility that any contribution of the body to cognition and consciousness can be compensated for by the other two contributing factors. While Clark’s sympathies lie with the latter approach, we argue in favour of the former. In particular, we focus on consciousness and argue that the unique contribution the body makes to a creature’s manifold of phenomenal experience cannot be compensated for, in the manner, and on the scale, that Clark envisages. (shrink)

I discuss the peculiar optimism present in an influential strand of analytic philosophy, and compare it with the more morose philosophical anthropology one might naturally pick up from other fields.

In the first sentence of the first section of A Theory of Justice Rawls writes that “justice is the first virtue of social institutions.” He soon elaborates.

Liam Shields systematically clarifies and defends the political philosophy of Sufficientarianism, which insists that securing enough of some things, such as food, healthcare and education, is a crucial demand of justice. By engaging in practical debates about critical issues such as child-rearing and global justice, the author sheds light on the potential implications of suffientarianism on the social policies that affect our daily lives.

Is there a limit to the legitimate demands of morality? In particular, is there a limit to people's responsibility to promote the well-being of others, either directly or via social institutions? Utilitarianism admits no such limit, and is for that reason often said to be an unacceptably demanding moral and political view. In this original new study, Murphy argues that the charge of excessive demands amounts to little more than an affirmation of the status quo. The real problem with utilitarianism (...) is that it makes unfair demands on people who comply with it in our world of nonideal compliance. Murphy shows that this unfairness does not arise on a collective understanding of our responsibility for others' well being. Thus, according to Murphy, while there is no general problem to be raised about the extent of moral demands, there is a pressing need to acknowledge the collective nature of the demands of beneficence. (shrink)

Almost everyone accepts that parents must provide a good enough upbringing in order to retain custodial rights over children, but little has been said about how that level should be set. In this paper, I examine ways of specifying a good enough upbringing. I argue that the two dominant ways of setting this level, the Best Interests and Abuse and Neglect Views, are mistaken. I defend the Dual Comparative View, which holds that an upbringing is good enough when shortfalls from (...) the best alternative upbringing in terms of the child's interests are no more significant than the parents' interest. (shrink)

A contract theory is an attempt both to make normative sense of contract law as an institutional type and to come up with criteria for the evaluation of the law of any particular place. There is no precise rule telling us how far the prescriptions of a theory can deviate from actually existing contract law and still be a theory of contract — rather than a political proposal to replace contract law with something else. But we can say roughly that (...) contract theory aims to provide normative foundations for the type of legal institution that enforces (some) agreements and unilateral commitments. Having provided an account of the point of having an institution of that general kind, the theory can then be used to evaluate existing examples. (shrink)

In a capitalist economy, taxes are the most important instrument by which the political system puts into practice a conception of economic and distributive justice. Taxes arouse strong passions, fueled not only by conflicts of economic self-interest, but by conflicting ideas of fairness. Taking as a guiding principle the conventional nature of private property, Murphy and Nagel show how taxes can only be evaluated as part of the overall system of property rights that they help to create. Justice or injustice (...) in taxation, they argue, can only mean justice or injustice in the system of property rights and entitlements that result from a particular regime. Taking up ethical issues about individual liberty, interpersonal obligation, and both collective and personal responsibility, Murphy and Nagel force us to reconsider how our tax policy shapes our system of property rights. (shrink)

Principles of sufficiency are widely discussed in debates about distributive ethics. However, critics have argued that sufficiency principles are vulnerable to important objections. This paper seeks to clarify the main claims of sufficiency principles and to examine whether they have something distinctive and plausible to offer. The paper argues that sufficiency principles must claim that we have weighty reasons to secure enough and that once enough is secured the nature of our reasons to secure further benefits shifts. Having characterized sufficientarianism (...) in this way, the paper shows that the main objections to the view can be avoided; that we can examine the plausibility of sufficiency principles by appealing to certain reasons that support a shift; and that we should be optimistic about the prospects for sufficientarianism because many of our strongest reasons seem to be of this sort. This shift, I claim, is the overlooked grain of truth in sufficientarianism. (shrink)

Principles of bcnciiccnce require us to promote the good. If we believe that a plausible mom] conception will contain some such principle, we must address the issue of the demands it imposes on agents. Some writers have defended extremely demanding principles, while others have argued that only principles with limited demands are acceptable. In this paper I su ggest that we 100k at the demands 0f beneficencc in a different way; 0ur concern should not just be with the extent of (...) the demands faced by individual agents. Instead, we should consider how the demands imposed Ol'] an agent by a principle of beneiiccncc are affected by the level of compliance with the principle by others. Act—[email protected], for example, in effect requires each complying agent to shoulder her share of the demands of bcncficcnce plus as many of the shares of noncomplying agents as would be optimal. I suggest that we focus OH this feature ofconsequentialism, and not just on the very high demands it can impose Ol'] individual agents. Thus I defend the View that principles of beneiicence should not demand more of agents as expected compliance by othcr agents decreases, and formulate a principle of bencficcnce that meets this condition. This View about beneiicence and compliance is supported by a particular conception 0f beneiiccnce. Rather than as an aim we each have as individuals, benciicence could be understood as a cooperative project, where each of us aims to promote the good together with others. If s0, it would be natural t.. (shrink)

Sufficientarianism is a position in debates about distributive justice. Sufficientarianism states that whether individuals have secured enough of some goods is a question that is central to determining whether a society is just. In this paper I provide an overview of this work, and highlight what I think are the most interesting recent contributions to it. Towards the end, I describe a way forward for sufficientarians and argue, in stark contrast to Frankfurt, that sufficientarian accounts of distributive justice should be (...) pluralist and are more plausible when they accommodate, rather than reject, other distributive values, such as equality. (shrink)

This book offers an advanced introduction to central questions in legal philosophy. What factors determine the content of the law in force? What makes a normative system a legal system? How does law beyond the state differ from domestic law? What kind of moral force does law have? The most important existing views are introduced, but the aim is not to survey the existing literature. Rather, this book introduces the subject by stepping back from the fray to sketch the big (...) picture, to show just what is at stake in these old debates. Legal philosophy has become somewhat arid and inward looking. In part this is because the disagreement between the main camps on the important questions is apparently intractable. The main aim of the book is to suggest both a diagnosis and a proper practical response to this situation of intractable disagreement about questions that do matter. (shrink)

Objective: To examine the role of explainability in machine learning for healthcare (MLHC), and its necessity and significance with respect to effective and ethical MLHC application. Study Design and Setting: This commentary engages with the growing and dynamic corpus of literature on the use of MLHC and artificial intelligence (AI) in medicine, which provide the context for a focused narrative review of arguments presented in favour of and opposition to explainability in MLHC. Results: We find that concerns regarding explainability are (...) not limited to MLHC, but rather extend to numerous well-validated treatment interventions as well as to human clinical judgment itself. We examine the role of evidence-based medicine in evaluating unexplainable treatments and technologies, and highlight the analogy between the concept of explainability in MLHC and the related concept of mechanistic reasoning in evidence-based medicine. Conclusion: Ultimately, we conclude that the value of explainability in MLHC is not intrinsic, but is instead instrumental to achieving greater imperatives such as performance and trust. We caution against the uncompromising pursuit of explainability, and advocate instead for the development of robust empirical methods to successfully evaluate increasingly inexplicable algorithmic systems. (shrink)

Sufficient doubt surrounds electroconvulsive therapy (ECT) to warrant nurses opting out of its administration and/or advising patients that it may be only one of a range of treatments open to them. In the latter respect, this discussion touches on aspects of the concept of advocacy. Relationships with the medical profession are also considered, as is the indefatigable attention given to issues of 'professional status' by nurses; this preoccupation facilitates an avoidance of therapeutic/advocacy issues.

The issue of what constitutes a person is examined in relation to whether or not the fetus or newborn has qualities of personhood. The discussion also dwells on birth and viability as determining factors in decisions concerning terminations. Such decisions are stated to be constrained by both biological and social factors, particularly in the way in which the fetus can possess personhood only through the ‘absorption’ of such froni its mother; both mother and fetus together are ‘the person’. This article (...) also considers whether, on Piagetian grounds, one can make personhood comparisons between infants and adults and suggests that such comparisons are a mistake. A social critique of Piagetian principles shifts the emphasis from individualism towards consideration of school, family and environmental factors. Equally, it is not feasible to view the fetus as an entity that is separate from its mother's perceptions of its social as well as its physical status. Finally, because termination decisions occur against ‘real life’ (and highly charged) backgrounds, we must reject any notion that such decisions are only an intel-lectual exercise. It is assumed that nurses would implicitly understand this and some attempt is made to state why this is so. (shrink)

Is there more to Buddhism than sitting in silent meditation? Is modern Buddhism relevant to the problems of daily life? Does it empower individuals to transform their lives? Or has Buddhism become too detached, so still and quiet that the Buddha has fallen asleep? Waking the Buddha tells the story of the Soka Gakkai International, the largest, most dynamic Buddhist movement in the world today--and one that is waking up and shaking up Buddhism so it can truly work in ordinary (...) people's lives. Drawing on his long personal experience as a Buddhist teacher, journalist, and editor, Clark Strand offers broad insight into how and why the Soka Gakkai, with its commitment to social justice and its egalitarian approach, has become a role model, not only for other schools of Buddhism, but for other religions as well. Readers will be inspired by the struggles and triumphs of the Soka Gakkai's three founding presidents--individuals who staked their lives on the teachings of the Lotus Sutra and the extraordinary power of those teachings to help people become happy. (shrink)

Philosophers of science debate the proper role of non-epistemic value judgements in scientific reasoning. Many modern authors oppose the value free ideal, claiming that we should not even try to get scientists to eliminate all such non-epistemic value judgements from their reasoning. W. E. B. Du Bois, on the other hand, has a defence of the value free ideal in science that is rooted in a conception of the proper place of science in a democracy. In particular, Du Bois argues (...) that the value free ideal must be upheld in order to, first, retain public trust in science and, second, ensure that those best placed to make use of scientifically acquired information are able to do so. This latter argument turns out to relate Du Bois’ position on the value free ideal in science to his defence of epistemic democracy. In this essay I elaborate, motivate, and relate to the modern debate, Du Bois’ under-appreciated defence of the value free ideal. (shrink)

Should parental rights be allocated to the best available parent? Anca Gheaus has argued that they should and that the interests of those who might rear them are strictly irrelevant to their allocation. This discussion article defends the view that parents’ interests are relevant to parental rights, against this latest argument. I show that the Best Available Parent View, as stated, conflicts with the exclusion of parental interests, on which it allegedly rests. I show that by including parental interests we (...) better explain how parental rights should be distributed and over a wider range of cases. (shrink)

Jennifer Lackey makes the case that non-summativist accounts of group belief cannot adequately account for an important difference between group lies and group belief. Since non-summativist accounts fail to do this, she argues that they ought be rejected and that we should seek an account of group belief which can do better by this standard. I briefly summarize Lackey’s argument, to give a sense of the role I see the central desideratum playing, and outline her arguments for that desideratum. I (...) then critique one of the positive arguments she offers for the desideratum, briefly outlining the notion of explication and why I think it would not license the appeal to the Group Lie Desideratum that Lackey’s argument depends upon. This leads me to reflections on the broader project of analysing notions of group belief, and the role I think such endeavours can or ought to play in social epistemology more broadly. (shrink)

Some philosophers argue that mental properties are ontologically distinct from physical properties and that, therefore, physicalism ought to be rejected. There are philosophers who feel the force of this challenge but who wish to maintain their physicalism. They suggest that mentality is grounded in inscrutable properties or ‘incrutables’: properties that are not revealed through physical enquiry but that do not violate physicalism. Our analysis reveals that appealing to inscrutables is not a successful strategy for these physicalists, for the following reasons: (...) first, inscrutables likely do violate the conditions of physicalism; second, inscrutables lend greater support to panpsychism than physicalism; third, there is good reason to be agnostic as to whether or not inscrutables count as physical properties. Each of these reasons undermines the physicalist’s purpose in positing inscrutables. If one wishes to remain a physicalist, they ought to direct their philosophical analysis and energies toward revisiting and defeasing the arguments that purport to show that mental properties are ontologically distinct from physical properties. (shrink)

This paper addresses the problem of judgment aggregation in science. How should scientists decide which propositions to assert in a collaborative document? We distinguish the question of what to write in a collaborative document from the question of collective belief. We argue that recent objections to the application of the formal literature on judgment aggregation to the problem of judgment aggregation in science apply to the latter, not the former question. The formal literature has introduced various desiderata for an aggregation (...) procedure. Proposition-wise majority voting emerges as a procedure that satisfies all desiderata which represent norms of science. An interesting consequence is that not all collaborating scientists need to endorse every proposition asserted in a collaborative document. (shrink)

Does religious belief differ in any interesting way from other kinds of belief? For now, take ‘belief’ to mean how one takes the world to be, on the basis of which they act. Call beliefs like this ‘ordinary beliefs’. There are also more complicated, or abstract, beliefs. Call such beliefs ‘non-ordinary beliefs’. Are religious beliefs different in any significant or interesting way from what we call ‘standard belief’? Our analysis shows that they are not. Although the content of religious belief (...) is different, and sometimes so is the function, religious beliefs are still mental, dispositional attitudes that aim to provide a correct representation of the world. Therefore, religious beliefs are best understood as a sub-category of standard beliefs, alongside ordinary and non-ordinary beliefs. This account of religious belief provides further insight into the meaning of belief and supports a revision of a strict demarcation between standard and non-standard beliefs. (shrink)

Equality of Opportunity is widely thought of as the normative ideal most relevant to the design of educational institutions. One widely discussed interpretation of this ideal is Rawls' principle of Fair Equality of Opportunity. In this paper I argue that theories, like Rawls, that give priority to the achievement of individual autonomy, are committed to giving that same priority to a principle of sufficient opportunity. Thus, the Rawlsian's primary focus when designing educational institutions should be on sufficiency and not equality. (...) The paper then argues this commitment has at least three attractive implications. Firstly, it enables defenders of Fair Equality of Opportunity to overcome Richard Arneson's powerful objections. Secondly, it suggests a revised version of the principle of Fair Equality of Opportunity that is more plausible. Thirdly, it has attractive practical implications for educational provision. (shrink)

I analyse the political, economic, and cultural circumstances that have given rise to persistent political disputes about race (known colloquially as “the culture war”) among a subset of Americans. I argue that they point to a deep tension between widely held normative aspirations and pervasive and readily observable material facts about our society. The characterological pathologies this gives rise to are discussed, and a normatively preferable path forward for an individual attempting to reconcile themselves to the current social order is (...) suggested. (shrink)

Giovanni Arrighi was a leading figure in the development of world-systems theory and also contributed to a range of debates in Marxist thought. This symposium engages with Arrighi’s last book, Adam Smith in Beijing, which was the final instalment in his ‘trilogy’, following The Long Twentieth Century and Chaos and Governance in the Modern World System. This Editorial Introduction traces the broad trajectory of Arrighi’s ‘trilogy’ and its concern with systemic cycles of accumulation, highlights additional major contributions by Arrighi, and (...) sketches some of the central arguments of the five symposium articles. *. (shrink)

Modern information technology allows academics many new ways to enhance their research activities. This article suggests that one of the most important changes in recent years has been the overwhelming proliferation of academic research. It proposes that many new developments in online publishing have been, and will continue to be, in response to this proliferation of research. It also offers some general principles based on six years' working for a series of innovative online journals, including examples of where new technologies (...) have been used successfully to enrich a journal's content without adding substantively to the workloads of authors and editors. (shrink)

This article explores the process by which intelligent transport system technologies have further advanced a data-driven culture in public transport and traffic control. Based on 12 interviews with transport engineers and fieldwork visits to three control rooms, it follows the implementation of Real-Time Passenger Information in Dublin and the various technologies on which it is dependent. It uses the concept of ‘data ratcheting’ to describe how a new data-driven rational order supplants a gradualist, conservative ethos, creating technological dependencies that pressure (...) organisations to take control of their own data and curate accessibility to outside organisations. It is argued that the implementation of Real-Time Passenger Information forms part of a changing landscape of urban technologies as cities move from a phase of opening data silos and expanded communication across departments and with citizens towards one in which new streams of digital data are recognised for their value in stabilising novel forms of city administration. (shrink)

In his paper, ‘Patients, doctors and risk attitudes,’ Nicholas Makins1 argues that healthcare professionals should defer to a patient’s higher-order risk attitudes (ie, the risk attitudes they desire to have or endorse within themselves upon reflection) when making medical decisions. We argue against Makins’ deference to higher-order risk attitudes on the basis that (1) there are significant practical concerns regarding our ability to easily and consistently access and verify the higher-order risk attitudes of patients, (2) there is a lack of (...) a theoretical limit on higher-order risk attitudes (eg, second, third, fourth order), and (3) the consideration of higher-order risk attitudes is actually more paternalistic than Makins suggests because it narrows what counts as an autonomous preference to the limited occasions in which an individual actually reflects on his or her own risk attitude. On the issue of practicality, we can reasonably expect that healthcare professionals would find difficulty eliciting the higher-order risk attitudes of their patients. Take for example the patient who has never expressed his higher-order desire to be more risk adverse and who is not willing nor comfortable expressing this desire. What is the healthcare professional expected to do in this situation? This is even more of a concern for the incapacitated patient, to which Makins seems to imply that …. (shrink)

Reference to security and intelligence in education today will undoubtedly elicit concerns over terrorism, radicalisation and, in the UK, counter-terrorism measures such as Channel and Prevent (UK...

This essay explores histories of common salt, sodium chloride, using concepts and methods from media theory. It contributes to research on media and environment and the general ‘material turn’ taken across the Humanities. I conceive of salt as what Peters calls an ‘elemental’ medium so as to show, first, the imbrication of naturally-occurring substances in the operations and supply chains of digital culture. Second, the many lives salt has lived materially, in techniques of survival and exchange, and metaphorically, in cultural (...) expression, complicate conventional understandings of media. In showing how salt performs three functions, processing, storage, and transfer, which Kittler ascribed to technical and symbolic media, I argue for a more expansive use of ‘mediation’ as a bridge concept that speaks to matters of nature and culture, Arts and Science, and to account for deep histories of extraction and economy that shape digital culture and global supply chains. (shrink)

Addressing the complex and longstanding relationship between universities and security and intelligence agencies, this article provides a tentative, working conceptual framework for research ethics in a global higher education environment. The article does so in the light of intensified threats of international terrorism which have brought this historic relationship to the contemporary foreground of academic life. Seeing higher education environments as part of a broader process of enhanced security in societies worldwide, we use securitization theory to provide an analytical framework (...) specifically for understanding a complex of historical-contemporary relationships between universities and security and intelligence agencies. As the basis for framing the ethical issues which arise for researchers across all disciplines, the intention is to raise awareness of a relationship which by its very, especially historical, nature, has been secret. The article suggests identify a three-fold analytical framework were structural, operational and ethical considerations are interwoven in complex ways. At the structural level we identify three modus operandi ; and four academic ethical principles. While the conceptual framework presented makes no pretence of offering a complete or comprehensive picture of a complex and still evolving relationship, the intention is provide some critical balance and coherence to a contentious not to say often divisive aspect of research ethics in the securitised university. (shrink)