Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...) Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. (shrink)

In a recent extended essay, philosopher Daniel Hausman goes a long way towards dismissing severity as a morally relevant attribute in the context of priority setting in healthcare. In this response, we argue that although Hausman certainly points to real problems with how severity is often interpreted and operationalised within the priority setting context, the conclusion that severity does not contain plausible ethical content is too hasty. Rather than abandonment, our proposal is to take severity seriously by carefully mapping the (...) possibly multiple underlying accounts to well-established ethical theories, in a way that is both morally defensible and aligned with the term’s colloquial uses. (shrink)

Adolescence, defined in the US as 11–21 years of age, is a critical period for prevention, as it marks the onset of risk behaviors. Minor (<18 years) self-consent and inclusion in biomedical resear...

Just Life reorients ethics and politics around the generativity of mothers and daughters rather than the right to property and the sexual proprieties of the Oedipal drama. Invoking two concrete universals – everyone is born of a woman and everyone needs to eat – Rawlinson rethinks labor and food as relationships that make ethical claims and sustain agency. Just Life counters the capitalization of bodies under biopower with the solidarity of sovereign bodies.

From the title, Interpreting Duns Scotus, one would expect to find in this volume a type of meta-study. By this I mean that each article would reveal as much about the author as about the subject,...

This paper challenges contemporary portrayals in the nursing literature of the spaces within which care of patients in hospital settings is conducted. Within the wider discourse of fiscal restraint on health care spending, professional nursing has cast its disciplined eyes on details of the nurse‐patient relationship for the ostensible purpose of repairing that which is treated as individual failings of nurses to practise in ways prescribed by nursing theories. Set aside in this approach to the so‐called ‘problems’ of nursing practice (...) has been an examination of the conditions within which nurses come in contact with patients, and a critical recognition that such contacts represent skilled accomplishments of social action. In this paper, these conditions are treated as resources available to both nurses and patients to generate accounts for the nurse's presence as well as the nurse's absence. Examples from an ethnographic study of nursing practice are used to illustrate how the spaces operating between nurses and patients are not empty voids but aresocialspaces through which particular meanings about nursing care can be conveyed. (shrink)

Meaningful participant engagement has been identified as a key contributor to the success of efforts to share data via a “Medical Information Commons”. We present findings from expert stakeholder interviews aimed at understanding barriers to engagement and the appropriate role of MIC participants. Although most interviewees supported engagement, they distinguished between individual versus collective forms. They also noted challenges including representation and perceived inefficiency, prompting reflection on political aspects of engagement and efficiency concerns.

If Kant's account of rights had continued the "early modern Natural Law tradition", basing rights on some notion of human flourishing, there would be no difficulty about including socio-economic rights for the needy in his theory. However, his division of moral philosophy into Rechtslehre and Tugendlehre limits Rechtspflichten to duties that a moral agent can be coerced to fulfill. If a state is to give the needy statutory rights, the justification for using coercion on its citizens cannot be that they (...) have a duty of virtue to assist the needy. In order to determine whether such a justification can be found, the one innate socio-economic right Kant admits, a child's right to be cared for and educated, is examined and found to be a right against its parents, not against the state. Kant does, however, hold that a state should establish institutions to provide for abandoned children and for the poor in general. His justification for a state's use of coercion with regard to such statutory rights is considered and a criterion is suggested for the possible consent of its non-virtuous citizens to proposed measures for assistance to the needy. It is suggested that if advocates of aid to the needy cannot justify their proposals by such a criterion they will have to provide a very different account of rights than Kant gives in his Rechtslehre , which is concerned with the moral permissibility of using coercion. Wenn Kants Lehre von den subjektiven Rechten nichts anderes wäre als eine Fortsetzung der "ihr vorangehenden modernen Naturrechtstradition" und die subjektiven Rechte infolgedessen auf das eine oder andere Konzept von menschlichem Wohlergehen gestützt hätte, dann wäre es nicht sonderlich schwierig, sozio-ökonomische Rechte für die Bedürftigen in diese Lehre einzubauen. Nun schränkt Kants Einteilung der Moralphilosophie in Rechtslehre und Tugendlehre den Begriff der Rechtspflicht allerdings auf diejenigen Pflichten ein, zu deren Erfüllung ein Mensch gezwungen werden kann. Deshalb kann, wenn ein Staat den Bedürftigen durch ein positives Gesetz irgendwelche Rechte auf Hilfe gewährt, die Rechtfertigung der Anwendung von staatlichem Zwang nicht darin gesucht werden, daß die dadurch in Anspruch genommenen Personen die Tugendpflicht haben, die Bedürftigen zu unterstützen. Um festzustellen, ob sich staatlicher Zwang in bezug auf solche Hilfspflichten überhaupt rechtfertigen läßt, erörtert der Beitrag das Recht des Kindes auf Fürsorge und Ausbildung als das eine und einzige angeborene sozio-ökonomische Recht, das Kant akzeptiert. Freilich ist das Recht des Kindes ein Recht gegen seine Eltern und nicht gegen den Staat. Gleichwohl nimmt Kant an, daß der Staat Einrichtungen schaffen sollte, die für verlassene Kinder und für die Armen im allgemeinen zu sorgen haben. Der Beitrag untersucht die Rechtfertigung, die Kant für die Anwendung von staatlichem Zwang zur Durchsetzung solcher positiv-gesetzlicher Rechte gibt, und arbeitet die Gründe dafür heraus, warum der nicht tugendhafte Staatsbürger in die vorgesehenen Hilfsmaßnahmen für die Bedürftigen einwilligen könnte. Wenn sich die Verfechter von Hilfsmaßnahmen für die Bedürftigen außerstande sehen, ihre Vorschläge auf Gründe dieser Art zu stützen, dann werden sie mit einem Konzept von subjektivem Recht aufwarten müssen, das sich von dem Konzept Kants von Recht und Rechtslehre , bei dem es allein um die moralische Erlaubtheit von Zwangsmaßnahmen geht, ganz erheblich unterscheidet. (shrink)

Introduction -- The problem of Socrates : Kierkegaard and Nietzsche -- Kierkegaard : Socrates vs. the God -- Nietzsche : call for an artistic Socrates -- Plato's Socrates -- Love, generation, and political community (the Symposium) -- The prologue -- Phaedrus' praise of nobility -- Pausanias' praise of law -- Eryximachus' praise of art -- Aristophanic comedy -- Tragic victory -- Socrates' turn -- Socrates' prophetess and the daemonic -- Love as generative -- Alcibiades' dramatic entrance -- Alcibiades' images of (...) socrates -- Alcibiades' praise of Socrates' virtues -- Aftermath -- The incompleteness of the Symposium -- Self-knowledge, love, and rhetoric (Plato's Phaedrus) -- The setting -- Non-lovers (Lysias' speech and Socrates' first speech) -- Souls and their fall -- Lovers and their ascent -- Prayer to love -- Contemporary rhetoric and politics -- A genuine art of rhetoric -- Writing -- Prayer to Pan -- Who is the friend? (the Lysis) -- Joining the group -- Getting acquainted -- Seeking a friend -- Are friends the ones loving, the ones loved, or both? -- Are likes friends? -- Are unlikes friends? -- Are those who are neither good nor bad friends to the good? -- Are the kindred friends? -- Who might friends be? -- Friendly communities -- Socratic philosophizing -- Socrates' youthful search for cause -- Socrates' second sailing and the ideas -- Piety, poetry, and friendship. (shrink)

Companies that contribute to charitable organizations rightly hope that their philanthropic work will also be good for the bottom line. Marketers of good corporate conduct must be especially careful, however, to market such conduct in a morally acceptable fashion. Although marketers typically engage in mild deception or take artistic license when marketing goods and services, these sorts of practices are far more morally troublesome when used to market good corporate conduct. I argue that although mild deception is not substantially worrisome (...) with respect to the marketing of most goods and services, it is a far greater moral blunder to use such methods in the marketing of good corporate character. These erode trust and demonstrate alack of adequate respect for the moral good. In light of these concerns, I suggest that such practices must be re-examined when applied to the marketing of corporate character and good conduct. Finally, I develop a revised set of ethical guidelines that are needed in order to address the problems peculiar to the marketing of morally praiseworthy behavior. (shrink)

"Multiverse" cosmologies imagine our universe as just one of a vast number of others. While this idea has captivated philosophy, religion, and literature for millennia, it is now being considered as a scientific hypothesis--with different models emerging from cosmology, quantum mechanics, and string theory. Beginning with ancient Atomist and Stoic philosophies, Mary-Jane Rubenstein links contemporary models of the multiverse to their forerunners and explores the reasons for their recent appearance. One concerns the so-called fine-tuning of the universe: nature's constants (...) are so delicately calibrated that it seems they have been set just right to allow life to emerge. For some thinkers, these "fine-tunings" are evidence of the existence of God; for others, however, and for most physicists, "God" is an insufficient scientific explanation. Hence the allure of the multiverse: if all possible worlds exist somewhere, then like monkeys hammering out Shakespeare, one universe is bound to be suitable for life. Of course, this hypothesis replaces God with an equally baffling article of faith: the existence of universes beyond, before, or after our own, eternally generated yet forever inaccessible to observation or experiment. In their very efforts to sidestep metaphysics, theoretical physicists propose multiverse scenarios that collide with it and even produce counter-theological narratives. Far from invalidating multiverse hypotheses, Rubenstein argues, this interdisciplinary collision actually secures their scientific viability. We may therefore be witnessing a radical reconfiguration of physics, philosophy, and religion in the modern turn to the multiverse. (shrink)

This paper examines potential ethical and legal issues arising during the research, develop- ment and clinical use of a proposed strategy in personalized medicine (PM): using human induced pluripotent stem cell (iPSC)-derived tissue cultures as predictive models of individ- ual patients to inform treatment decisions. We focus on epilepsy treatment as a likely early application of this strategy, for which early-stage stage research is underway. In relation to the research process, we examine issues associated with biological samples; data; health; vulnerable (...) populations; neural organoids; and what level of accuracy justifies using the iPSC-derived neural tissue system. In relation to clinical use, we examine potential uses in pre-natal screening, and effects on clinical decision-making. Although our focus is providing recommendations for researchers developing work in this area, we identify the novel issue of deciding on an acceptable accuracy level for the system. We also emphasize an issue thus far neglected in the ethics of PM: PM tends to represent treatment decisions as though they should be directed solely by biomedical information, but this in itself could be detri- mental to best personalizing treatment decisions in the clinic. (shrink)

This paper investigates the exemplarity of medicine in Foucault's analyses of knowledge generally. By tracing the development of his concept of power and its relation to knowledge, it offers an account of Foucault's unconventional philosophical project. Finally, it specifies Foucault's strategy for undermining processes of normalisation.

The French botanist Michel Adanson spent five years in precolonial Senegal in the 1750s, under the auspices of the Compagnie des Indes. This essay follows the archival traces of Adanson’s engagement with African indigo, including experiments conducted in an ad hoc “laboratory” near the French fort of Saint Louis. A reconstruction of these experiments exposes the multifarious connections to and from the island garden-laboratory, mediated by materials and different kinds of indigo knowledge, including that of local Wolof informants. A microhistory (...) of encounters in and around a tiny island off the West African coast merges with a transatlantic story connecting Senegal to Paris and to French colonies in the Caribbean (Saint-Domingue and Guyana). The essay explores geographies of knowledge and French imperial ambitions through close attention to the material properties of indigo, the practices associated with its cultivation and transformation from plant to dye, and the material remnants of Adanson’s engagement with it in Africa. These remnants—herbarium sheets, experimental notes, color samples on paper strips, dyed fabric swatches, sketched maps, correspondence, collection catalogues, and plant taxonomies—put various kinds of African knowledge and Caribbean plantation experience into dialogue with European botany and dye chemistry. (shrink)

This paper is primarily an attempt to study the Homeric evidence on houses, particularly on the , in relation to the relevant remains. The reverse procedure, illuminating the archaeological evidence by references to Homer, is a hazardous one, as we shall see. It is often unclear just what is represented by the descriptions in the poems, and what period, if any, the things described belong to. I shall be concerned with these questions here. Are the houses in the poems Mycenaean: (...) genuine traditions from the period in which the stories are set? Or are they Geometric: contemporary? Or a memory of some time in between? Or a mixture? We know so little about the development of the epic tradition that any possible source of information is worth pursuing. (shrink)

Existentialism, by A. Macintyre.--Sartre the philosopher, by S. Hampshire.--The phenomenological philosophy in France, by I.W. Alexander.--Imagination, by H. Ishiguro.--Authenticity and obligation, by F.A. Olafson.--Pessimism and optimism in Sartre's thought, by F. Jeanson.--Sartre as critic, by H. Wardman.--Sartre's literary criticism, by O. Hahn.--Sartre as a playwright: The flies and Dirty hands, by W. Kaufmann.--Sartre as dramatist, by D. Bradby.--The existentialist rediscovery of Hegel and Marx, by G.L. Kline.--Sartre's ideal of social unity, by H.R. Burkel.--Praxis and dialectic in Sartre's critique, by A. (...) Manser.--Sartre and the humanist tradition in sociology, by M.A. and D. Weinstein.--Bibliography (p. [387]-390). (shrink)

In this paper, Professor Wiggins explores the relationship between conservative economic theories and major bankruptcy reforms recently enacted by the United States Congress. First, she describes three key components of conservative economic theory as advanced by the Bush Administration and conservative scholars. These include: a strong preference for private ordering over public ordering, the promotion of private property as a means to expand personal freedom and liberty, and the encouragement of individual risk internalization. Next, she describes two theoretical components of (...) the new bankruptcy reforms. These include: a preference for creditor collection over debt relief and the promotion of individual risk internalization. Then Professor Wiggins examines two questions: First, is there meaningful theoretical symmetry between conservative economics and the new bankruptcy law? Second, is there significant operational symmetry between the two? The paper suggests theoretical convergence for two reasons: First, both conservative economics and the new bankruptcy law aim to promote private bargains over administratively adjusted ones. Second, both seek to force individuals to absorb more of the risks of financial decision-making. The paper suggests, however, that at the operational level there exists significant divergence between the aims of conservative economics and the predicted consequences of the new law. Professor Wiggins concludes, among other things, that economic conservatives should pay more rigorous attention to personal bankruptcy policy because operational asymmetry between their theories and the new legislation could blunt their ambitious economic agenda for American consumers. (shrink)