Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for metastatic (...) cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve “rough justice” and “supple solidarity.” The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity. (shrink)

Untruthfulness is surprisingly common in the U.S. military even though members of the profession are loath to admit it. Further, much of the deception and dishonesty that occurs in the profession of arms is actually encouraged and sanctioned by the military institution. The end result is a profession whose members often hold and propagate a false sense of integrity that prevents the profession from addressing -- or even acknowledging -- the duplicity and deceit throughout the formation. It takes remarkable courage (...) and candor for leaders to admit the gritty shortcomings and embarrassing frailties of the military as an organization in order to better the military as a profession. Such a discussion, however, is both essential and necessary for the health of the military profession"--Publisher's web site. (shrink)

Abstract:Because the demand for intensive care unit (ICU) beds exceeds the supply in general, and because of the formidable costs of that level of care, clinicians face ethical issues when rationing this kind of care not only at the point of admission to the ICU, but also after the fact. Under what conditions—if any—may patients be denied admission to the ICU or removed after admission? One professional medical group has defended a rule of “first come, first served” in ICU admissions, (...) and this approach has numerous moral considerations in its favor. We show, however, that admission to the ICU is not in and of itself guaranteed; we also show that as a matter of principle, it can be morally permissible to remove certain patients from the ICU, contrary to the idea that because they were admitted first, they are entitled to stay indefinitely through the point of recovery, death, or voluntary withdrawal. What remains necessary to help guide these kinds of decisions is the articulation of clear standards for discontinuing intensive care, and the articulation of these standards in a way consistent with not only fiduciary and legal duties that attach to clinical care but also with democratic decision making processes. (shrink)

As such, this volume represents the transition from one era of social cognition research to the next.

I fundamentally agree with Childress et al. (2023) in the scenario they have constructed with Mr. J. None of the arguments they critically assess are ethically persuasive enough to justify removing...

We consider a proportional-prize contest to forecast future events, and show that, in equilibrium, this mechanism possesses perfect forecasting ability for any group size when the contestants share common knowledge about the probabilities by which future events realize. Data gathered in a laboratory experiment confirm the performance invariance to group size. By contrast, when realization probabilities are not common knowledge, there are some differences across group sizes. The mechanism operates marginally better with three or four compared to two players. However, (...) this effect is mainly driven by players’ behavior rather than by differences in the beliefs they form about the realization probabilities. (shrink)

This article probes the relationship among constitutionalism, extra-legal prerogative power, and citizen judgment. While much has been written about the nature of Lockean prerogative, and while his theory serves as a direct inspiration for contemporary "normative extra-legalists," key participants in the debate over emergency powers, less attention has been paid to how the people judge prerogative. Attention to this issue is useful because an examination of the process of political judgment of extra-legalism in Locke leads to a complication of the (...) current extra-legalist vision of democratic mechanisms of accountability. The author argues that the extra-legal approach is right to consider the role of democratic publics in potentially constraining the exercise of emergency powers but wrong to formulate that role as one extra-constitutional power checking another extra-constitutional power. The author situates both prerogative power and citizen judgment of it at the threshold of the constitutional order. (shrink)

Abstract:The American College of Physicians in its ethics manual endorsed the idea that physicians ought to improve their ability to provide care to their patients more parsimoniously. This elicited a critical backlash; critics essentially claimed that what was being endorsed was a renamed form of rationing. In a recent article, Tilburt and Cassel argued that parsimonious care and rationing are ethically distinct practices. In this essay I critically assess that claim. I argue that in practice there is considerable overlap between (...) what they term parsimonious care and what they define as rationing. The same is true of the Choosing Wisely campaign endorsed by the American Board of Internal Medicine. In both cases, if the goal is to control healthcare costs by reducing the use of marginally beneficial care that is not cost effective, then a public conversation about the justness of specific choices is essential. (shrink)

I saggi di questo testo gravitano attorno a due fuochi: una diagnosi della soggettività contemporanea e il tentativo di sviluppare una critica all'altezza della sua vocazione emancipativa. Ciò che viene descritto è un processo di tendenziale emersione in superficie della relazione tra soggettività e politica; nessuna utopia col torcicollo, nessun nostalgismo, nessuna lamentela sulla superficialità della politica o paternale sulla superficialità dei soggetti. La scommessa, piuttosto, è quella di prendere le apparenze sul serio e quindi rinunciare a ogni forma di (...) ventriloquismo teorico, restituendo ai soggetti la parola senza per questo rinunciare alle ambizioni emancipative di una teoria sociale capace di fotografare, tracciare, scandagliare le trasformazioni della soggettività contemporanea e contemporaneamente le sue potenzialità e le sue contraddizioni. (shrink)

The debate around age-based healthcare rationing was precipitated by two books in the late 1980s, one by Daniel Callahan and the other by Norman Daniels. These books ignited a firestorm of criticism, best captured in the claim that any form of age-based healthcare rationing was fundamentally ageist, discriminatory in a morally objectionable sense. That is, the elderly had equal moral worth and an equal right to life as the nonelderly. If an elderly and nonelderly person each had essentially the same (...) medical problem requiring the same medical treatment, then they had an equal right to receive that treatment no matter what the cost of that treatment. Alternatively, if cost was an issue because the benefits of the treatment were too marginal, then both the elderly and nonelderly patients requiring that treatment ought to be denied it. If there were something absolutely scarce about the treatment, then some fair process would have to be used to make an allocation decision. (shrink)

Organisms leave a variety of traces in the fossil record. Among these traces, vertebrate and invertebrate paleontologists conventionally recognize a distinction between the remains of an organism’s phenotype and the remains of an organism’s life activities. The same convention recognizes body fossils as biological structures and trace fossils as geological objects. This convention explains some curious practices in the classification, as with the distinction between taxa for trace fossils and for tracemakers. I consider the distinction between “parallel taxonomies,” or parataxonomies, (...) which privileges some kinds of fossil taxa as “natural” and others as “artificial.” The motivations for and consequences of this practice are inconsistent. By comparison, I examine an alternative system of classification used by paleobotanists that regards all fossil taxa as “artificially” split. While this system has the potential to inflate the number of taxa with which paleontologists work, the system offers greater consistency than conventional practices. Weighing the strengths and weaknesses of each system, I recommend that paleontologists should adopt the paleobotanical system more broadly. (shrink)

Recently, there has been renewed interest in the search for low-mass magnetic monopoles. At the University of Oklahoma we are performing an experiment (Fermilab E882) using material from the old D0 and CDF detectors to set limits on the existence of Dirac monopoles of masses of the order of 500 GeV. To set such limits, estimates must be made of the production rate of such monopoles at the Tevatron collider, and of the binding strength of any such produced monopoles to (...) matter. Here we sketch the still primitive theory of such interactions, and indicate why we believe a credible limit may still be obtained. On the other hand, there have been proposals that the classic Euler–Heisenberg Lagrangian together with duality could be employed to set limits on magnetic monopoles having masses less than 1 TeV, based on virtual, rather than real processes. The D0 collaboration at Fermilab has used such a proposal to set mass limits based on the nonobservation of pairs of photons each with high transverse momentum. We critique the underlying theory, by showing that the cross section violates unitarity at the quoted limits and is unstable with respect to radiative corrections. We therefore believe that no significant limit can be obtained from the current experiments, based on virtual monopole processes. (shrink)

In this essay we explore whether and how we should use bibliometrics in hiring, promoting, and granting in the academy. We suggest a Deweyan-Hickmanian pragmatist approach to reflecting on the technology of bibliometrics as a resource for inherently qualitative judgements in these deliberations. We begin with a literature review of current work evaluating the role and use of bibliometrics in the academy, from advocating for them to questioning their construct validity and assessing their limitations and/or dangerous consequences. In the next (...) section, we take a step back and provide a Deweyan philosophical analysis of the validity and practical use of qualitative assessment. In our conclusion we reflect on what pragmatism can teach about recent algorithmic tools used for faculty evaluation. (shrink)

The STS education movement is identified and related to the critique of technology of the 1960s–1970s. The critics of technology included the system of education in their critiques. There is a practical tension or contradiction in attempting to develop their insights within the curriculum routines of the schools and colleges. This tension is explored under six categories: reductive knowledge, socialization of technical modes of thinking, technicalized processes of learning, the loss of meaning, radical monopoly over learning, and the socialization of (...) secular values. (shrink)

The development of Web 2.0 has opened new opportunities for teaching and learning - an entire ecology of online learning. This ecology has not previously been systematically investigated. This book offers the first comprehensive conceptual map for this territory.

Globalization of markets and expanding communication technology networks affect all dimensions of education: curriculum, instructional method, learning environments, and administration. In this article, the author anticipates the impacts upon education in science, technology, and society (STS).

The author offers perspectives that can assist healthcare managers in achieving the highest ethical standards as they face their roles as healthcare providers, employers, and community service organizations. He also examines how to comply with relevant laws and regulations, provide high quality patient care with limited resources, and more.