Background Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral. Method The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. The (...) primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral. Results Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one's practice (multivariable ORs, 1.6–2.4). Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. (shrink)

Starry Nights: Critical Structural Realism in Anthropology offers nothing less than a reinventing of the discipline of anthropology. In these six essays – four published here for the first time – Stephen Reyna critiques the postmodern tenets of anthropology, while devising a new strategy for conducting research. Combative and clear, Starry Nights provides an important critique of mainstream anthropology as represented by Geertz and the postmodern legacy, and envisions a mode of anthropological research that addresses social, cultural and biological questions (...) with techniques that are theoretically rigorous and practically useful. (shrink)

At De Principiis II, p. 75.10-11 Westerink, Damascius states that ‘Being will be that which provides being itself to each thing, καὶ καθ’ ὅ τι ὄν ἐστι’. The modern reference translation of the De Principiis, that of Joseph Combès for the Collection des Universités de France, renders the phrase left here in Greek as ‘et selon ce qu’elle est comme être’. Combès interprets it by stating that being is here conceived of as the constitutive unity of each form, at once (...) responsible for both its essence and existence. I argue that both a translation and an interpretation of καθ’ ὅ τι ὄν ἐστι of the type suggested by Combès are untenable and I defend an alternative construal. The two other main modern translations, those of Ahbel-Rappe and Galpérine, are also critically assessed. The translation of the relevant phrase I propose is: ‘and in virtue of which something is a being’. I argue that being – that is the property bestowed by the Kind or Form of Being, a notion that Damascius draws from Plato’s Sophist – is here conceived of as that which is metaphysically responsible only for the fact that something is (or is a being), not also for what something is. This construal does justice to the grammar of Damascius’ text and fits better with the argument of De Principiis II, pp. 56-99 Westerink. (shrink)

With the publication of these two volumes the ground has now been prepared for a long awaited event, the critical edition of the works of Henry of Ghent. Henry was one of the outstanding philosophizing-theologians at the University of Paris in the second half of the thirteenth century and, during the period between the death of Thomas Aquinas in 1274 and the ascendancy of John Duns Scotus near the beginning of the fourteenth century, no other Master surpassed him in terms (...) of influence or importance. During his tenure there as Master in the theology faculty, Henry conducted fifteen Quodlibetal disputes. His written versions of these, along with his Summa of ordinary Disputed Questions, constitute his most important surviving works. And of these, his Quodlibets rank first. Henry's philosophical and theological views were highly original and drew considerable reaction from other leading Masters of the time, especially from Giles of Rome, Godfrey of Fontaines, and somewhat later, from Duns Scotus. While his personal thought cannot be reduced to that of any earlier thinker or tradition, his views were heavily influenced by Augustine, by Avicenna, and by various other Neoplatonic currents. At the same time, while he was quite familiar with the texts and thought of Aristotle, he reacted strongly against the more radical form of Aristotelianism developed by Siger of Brabant, Boethius of Dacia, and other Masters in the Arts Faculty at Paris in the 1260s and 1270s. Aquinas's incorporation of many Aristotelian positions into his own thought was also suspect in Henry's eyes. Given this background, Henry himself may be regarded as an outstanding representative of the Neo-Augustinian philosophical current which surfaced at Paris around 1270, which triumphed with the condemnation of 219 propositions by Stephen Tempier, Bishop of Paris, in 1277, and which would continue to be a dominant philosophical force until the end of the century. The need for a critical edition of his Quodlibets and his Summa has long been recognized, since the only printed versions date from the sixteenth and seventeenth centuries. In these first two volumes of Henry's Opera omnia Macken has prepared the way for the critical edition of Henry's works and especially of his Quodlibets. Here one finds a valuable catalog, based on first-hand inspection, of the widely scattered manuscripts of Henry's works. The catalog also contains expert codicological descriptions of the contents of these manuscripts, including works whose authenticity remains doubtful. Manuscripts are also considered which contain works that treat ex professo of Henry's doctrine. This is followed by an appendix which surveys ancient references to other manuscripts allegedly containing Henry's works, which manuscripts have not yet been found. Then there is a Répertoire, not of manuscripts but of Henry's works themselves, including certainly authentic works, works of doubtful authenticity, and finally, in another short appendix, works which have been falsely ascribed to him. A third part of this survey of Henry's works is devoted to manuscripts of other writers who discuss Henry's doctrine ex professo. The two volumes conclude with all the necessary indices. One must congratulate Macken for the care, the industry, and the meticulous scholarship with which he has prepared these two volumes. Not only are they of great value to anyone interested in the manuscript tradition of Henry's works and doctrine; they also include helpful descriptions of the writings of many other medieval authors which are contained in many of these same manuscripts. They will undoubtedly be carefully combed for decades to come by other scholars interested in these same authors and manuscripts. These volumes will be indispensable for libraries of institutions making any serious claim to expertise in the history of medieval philosophical and theological thought. One can only wish Macken and his international team of collaborators every success in their next immediate task, the actual edition of Henry's most important works, his fifteen Quodlibetal Questions.--J.F.W. (shrink)

O artigo se insere no debate acerca do caráter político-ideológico da atuação da Igreja Católica brasileira na segunda metade do século XX, elegendo como foco de estudo a parcela mais combativa do episcopado brasileiro, a Igreja nordestina, mais especificamente um grupo de treze bispos que, por sua intensa participação política, foi objeto central de fervorosas polêmicas, sendo igualmente classificados das mais díspares formas, de comunistas a santos, de pastores a políticos, de verdadeiros a falsos profetas. Signatários do documento “Eu ouvi (...) os clamores do meu povo”, de maio de 1973, talvez as mais radicais declarações publicadas por um grupo de bispos em qualquer parte do mundo, testemunharam em suas vidas, seja pela pregação, pela ação e mesmo pela perseguição, o caráter crítico-utópico do profetismo. Para analisar suas trajetórias, adotamos uma abordagem histórico-teológica, mediante o conceito de “episcopalismo profético” que visa incluir tanto a dimensão sócio- histórica como a ético-teológica, uma vez que, para eles, a responsabilidade evangélica tem prioridade absoluta sobre a diplomacia eclesiástica e, apesar da apreciação que fazem da sociedade ser política, seus objetivos não o são, posto que motivados pela fé que os anima. Palavras-chave: Cristianismo de Libertação. Igreja Católica Nordestina. Bispos Proféticos.The article is part of the debate about the political-ideological character of the Brazilian Catholic Church performance in the second half of the twentieth century, having as the focus of study the portion of the more combative Brazilian episcopate, the Northeastern Church, more specifically a group of thirteen bishops who, by their intense political participation, was the central object of fervent controversy, being also ranked in different ways: communists and saints, pastors and politicians, true and false prophets. Signatories of the document “I heard the cries of my people” (may 1973), perhaps the most radical statements ever published, a group of bishops witnessed in their lives, either by preaching, by the action and even persecution, the critical-utopian character of prophecy. To analyze their trajectories, we adopted a historical-theological approach, by the concept of “prophetic episcopate”, which aims to include both the socio-historical as the theological-ethical dimension, since, for them, the evangelic responsibility has absolute priority over the ecclesiastical diplomacy, and, despite making a political appreciation of society, their goals are not, since they are motivated by faith that animates them. Key Words: Christianity Liberation. Northeastern Catholic Church. Prophetic Bishops. (shrink)

Fabienne Blaise- F. Blaise, P. Judet de La Combe et Ph. Rousseau (éds.) : Le Métier du mythe. Lectures d'Hésiode (Villeneuve d'Ascq, PUS, 1996) - traduction chinoise à paraître aux éditions Huaxia Publishing House of China, Pékin, en 2005. Jean Bollack- La Muerte de Antigona. La tragedia de Creonte. Traduction en espagnol de La Mort d'Antigone (Paris, PUF, 1999) par Arnaud Pons et de Xavier Riu, Arena Libros, coll. Tempo al Tempo, Madrid 2004, 144 p. - Sentido contra sentido. (...) ¿ Como se lee.. (shrink)

Psychopathy fascinates. Modernist writers construct out of it an image of alienated individualism pursuing the moment, killing they know not why, exploiting in passing, troubled, if troubled at all, not by guilt, but by perplexity (Camus 1989; Gide 1995; Mailer 1957; Musil 1996). Psychiatrists and psychologists—even those who should know better—are drawn by it to take off into philosophical speculation about morality, evil, and the beast in man (Mullen 1992; Simon 1996). Philosophers succumb to the temptation of attempting to ground (...) speculation in the supposed facticity of psychopathy. -/- Psychopathy is a cultural construct with roots going back to the eighteenth century, but which only came to full flower over the last fifty years (Hare 1998; Lewis 1974). The currently fashionable constructions of psychopathy find wide acceptance among clinicians and academics. The problem is, however, whether the concept has connections that have been established to the behavior, psychopathology, or the structure and function of brain worthy of according even a modest level of scientific status. There is little point in basing an argument on some supposed scientific gold standard if what glitters is iron pyrites (fools' gold). -/- Neil Levy's opening paragraph contains the statement "Yet in other respects they seem quite irrational; so much so that the term moral insanity has sometimes been applied to them" (p. 129). This both asserts that there is a category "them," namely the psychopaths, and connects them to "moral insanity." Moral insanity entered the language of psychiatry when Pritchard chose to use the term to translate Pinel's category of mania sans deliré (Pritchard 1836). Pinel was attempting to conceptualize a range of disorders that bordered on insanity in the sense of severe disturbances of affect, judgment, and behavior, but that were not accompanied by hallucinations or delusions (Pinel 1798/1964). In today's terminology, the cases he described would probably fall into diagnostic groups, including major depression, bipolar disorder, epilepsy, and a range of personality disorders. A number of his more striking case histories involved antisocial and even murderous behavior, which probably reflected Pinel's role in assessing offenders for the criminal courts of Paris. Pritchard's use of the English word "moral" reflected an appeal first to its use at the time to designate something which was like or similar, but not identical (a usage the OED labels "vulgar"), and second moral in the sense of ethical, conforming to virtuous behavior. Anglophones seized on the latter meaning, although Pinel emphasized the former. Forty years later, Henry Maudsley, the most widely read psychiatrist of his generation, could assert that moral insanity was as real as Colour blindness, some people being Colour blind and some moral blind (Maudsley 1879). Moral insanity became connected variously to phrenology with its own bump over the underlying moral cortex, with the twisted genetics of degeneration, with atavistic theories of criminality, and with a range of disorders of brain from epilepsy to frontal lobe damage (Combed 1853; Ellis 1890; Pick 1989). Although it is anachronistic to use the terms "psychopathy" and "moral insanity" together, it is clear they occupied a similar social and psychiatric space, albeit in different era. This should caution against too ready acceptance of psychopathy which may turn out to be as empty and dangerous a conceptualization as moral insanity. Why dangerous? Dangerous to those labeled, because the morally insane and the moral imbeciles were placed in preventive detention in asylums and prisons, and even sterilized in some jurisdictions. Dangerous to society, because it gave a spurious scientific justification for viewing crime not as reflecting the social evils of deprivation, ignorance, and inequality but as the ravages of the born criminals. -/- Psychopaths are not, as Levy asserts, "(causally) responsible for … more than fifty percent of violent crime" (p. 129). A proportion of violent offenders, which varies widely between observers, are labeled psychopaths. This is often on the basis of Hare's psychopathy checklist, which is a subjective, albeit through training aspiring to be reproducible, and to some extent self-sustaining, evaluation system (Hare 1980, 2003). Part of the checklist gathers data on prior antisocial behavior; part constrains the examiner to subjectively estimate such matters as glibness and callousness, part requires judgments about whether the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:464 Feminist Studies 44, no. 2. © 2018 by Feminist Studies, Inc. Claire Raymond and Sarah Corse A Distorting Mirror: Educational Trajectory After College Sexual Assault This article focuses on the broad and specific impacts of college sexual assault on student-survivors’ academic performance, academic trajectory, and their sense of self in relation to the university community. We frame this study with, and relate our findings to, the historic and (...) theoretical literatures that provide the context for this essay, including the large and burgeoning literature on the sexual assault of women college students and recent studies analyzing the role of fraternities in sexual assault, students’ fears and perceptions about college assault, bystander intervention training, and survivors’ grade-point averages after assault.1 Our study also builds on the history of feminist resistance to rape, feminist writings about rape, and campus activism against rape, with the 1. Cortney Franklin, Leana Allen Bouffard, and Travis C. Pratt, “Sexual Assault on the College Campus: Fraternity Affiliation, Male Peer Support, and Low Self-Control,” Criminal Justice and Behavior 39, no. 11 (2012): 1457– 80; Christine A. Gidycz, John R. McNamara, and Katie M. Edwards, “Women ’s Risk Perception and Sexual Victimization: A Review of the Literature,” Aggression and Violent Behavior 11, no. 5 (2006): 441–56; Jennifer Katz and Jessica Moore, “Bystander Education Training for Campus Sexual Assault Prevention: An Initial Meta-Analysis,” Violence and Victims 28, no. 6 (2013): 1054–67; Douglas W. Pryor and Marion R. Hughes, “Fear of Rape among College Women: A Social Psychological Analysis,” Violence and Victims 28, no. 3 (2013): 443–65; Carol E. Jordan, Jessica L. Combs, and Gregory T. Smith, “An Exploration of Sexual Victimization and Academic Performance among College Women,” Trauma, Violence, & Abuse 15, no. 3 (2014): 191–200. Claire Raymond and Sarah Corse 465 goal of shedding light on one aspect of the problem. Groundbreaking (and in some cases controversial) works analyzing the cultures of rape, such as Susan Brownmiller’s Against Our Will and Peggy Sanday’s “The Socio-Cultural Context of Rape” (in which Sanday creates the concept of the rape-producing culture—a concept that is central to our argument in this essay), found immediate reception with feminist activists of the 1970s and early 1980s.2 Mary Koss’s work regarding the scope of rape in college settings is also foundational to our study of campus rape.3 Susan Estrich, Catharine MacKinnon, and other feminist theorists in the mid-1980s developed critical apparatuses to shift the understanding of rape, providing a feminist framework wherein rape is interpreted as violence committed against a woman—in opposition to the patriarchal argument that rape is caused by a woman’s actions or is the product of her distortion of events after the fact.4 Angela Davis and bell hooks were deeply influential in framing understandings of the racial and racist aspects of feminist discussions of rape, while legal scholar Sarah Deer has more recently broadened understandings of the racialized discourse of rape, and Lisa Wade has written on twenty-first century hookup culture and the ways that this social landscape promulgates rates of maleon -female rape that are significantly higher on college campuses than in the general population.5 2. Peggy Reeves Sanday, “The Socio-Cultural Context of Rape: A Cross-Cultural Study,” Journal of Social Issues 37, no. 4 (1981): 5–27; Susan Brownmiller, Against Our Will: Men, Women and Rape (New York: Penguin Books, 1976). 3. Mary P. Koss, Christine A. Gidycz, and Nadine Wisniewski, “The Scope of Rape: Incidence and Prevalence of Sexual Aggression and Victimization in a National Sample of Higher Education Students,” Journal of Consulting and Clinical Psychology 55, no. 2 (1987): 162–70. 4. Susan Estrich, Real Rape: How the Legal System Victimizes Women Who Say No (Cambridge, MA: Harvard University Press, 1988); Duncan Chappell, Robley Geis, and Gilbert Geis, eds., Forcible Rape: The Crime, the Victim and the Offender (New York: Columbia University Press, 1977). 5. Angela Davis, “Rape, Racism, and the Myth of the Black Rapist,” in her Women, Race, and Class (New York: Vintage Books, 1983), 172–201; bell hooks, Feminist Theory: From Margin to Center (Boston: South End Press, 1984); Sarah Deer, The Beginning and End... (shrink)

We define the notion of a combinatorics of a first order structure, and a relation of covering between first order structures and propositional proof systems. Namely, a first order structure M combinatorially satisfies an L-sentence Φ iff Φ holds in all L-structures definable in M. The combinatorics Comb(M) of M is the set of all sentences combinatorially satisfied in M. Structure M covers a propositional proof system P iff M combinatorially satisfies all Φ for which the associated sequence of propositional (...) formulas 〈Φ〉 n , encoding that Φ holds in L-structures of size n, have polynomial size P-proofs. That is, Comb(M) contains all Φ feasibly verifiable in P. Finding M that covers P but does not combinatorially satisfy Φ thus gives a super polynomial lower bound for the size of P-proofs of 〈Φ〉 n . We show that any proof system admits a class of structures covering it; these structures are expansions of models of bounded arithmetic. We also give, using structures covering proof systems R * (log) and PC, new lower bounds for these systems that are not apparently amenable to other known methods. We define new type of propositional proof systems based on a combinatorics of (a class of) structures. (shrink)

"No other work treating Indian philosophy on a comparable scale contains the illuminating comparisons between doctrines of Indian schools and the thought of Western philosophy ranging from Plato to Sartre and Wittgenstein...It will, moreover, contribute to the understanding of Western philosophy by Indian thinkers and vice versa...Raju has an intimate acquaintance with a remarkable range of Western thinkers and this distinguishes his work from most of what has gone before...Raju, moreover, is himself a critical thinker and consequently, although he has (...) written a history, he treats the ideas and doctrines in a philosophical mode and his assessments of positions are often original and illuminating." -- John E. Smith, Clark Professor of Philosophy, Yale University "Purpose: To deal with Indian philosophy in a fashion reflecting the way the best German historians of philosophy deal with Western philosophy...The book is remarkable for its comprehensiveness in combination with extensive critical discussions...Raju's book...is more critical than Radhakrishnan's and more philosophical than Dasgupta's. Radhakrishnan's comments are far less philosophically sophisticated and interesting than Raju's....a monument to a senior Indian philosopher's lifelong study and thoughtful critical consideration of the great classical systems of his tradition." -- Karl H. Potter, Professor of Philosophy, University of Washington "Raju's credentials are impeccable. He is one of the few scholars in the world who could presume to write a major work on Indian thought. Accordingly, his knowledge of the Indian schools is accurate and impressive. To the extent that one of his intentions is to cast those schools in terms which make them more intelligible to western readers, his work measures up very well." -- Harold H. Oliver, Professor of Philosophy, Boston University. (shrink)

This article on the early history of phenomenological psychological research in the academic context in America focuses on the four approaches of the following respective psychologists: 1) Donald Snygg, Arthur W. Combs, and Anne C. Richards and Fred Richards; 2) Robert B. MacLeod; 3) Adrian L. van Kaam; and 4) Amedeo P. Giorgi. It begins by first addressing the "context" for this early history namely, the European origin of philosophical phenomenology and the connection of it with the psychology of its (...) times in Europe, and then the American background for the development of a sensibility for phenomenology and an eventual connection of phenomenology with psychology. Each of the four positions was examined in terms of basic approach to the study of human experience and behavior. That is, examination was directed toward whether the respective position was under the aegis of psychology as a human science or as a natural science. Also examined were the research postures and the methodologies of the four positions in terms of their respective degrees of reflecting either the human science or the natural science approach, and in terms of their approximation to a phenomenological psychology. It was found that syncretism characterized the approaches of the first three positions, and that there was either an absence of phenomenological psychological method in the psychologies of those positions or, in the case of MacLeod, an undeveloped and non-worked-out method. Only the work of Amedeo Giorgi presented 1) a human science approach that was radical and not compromised by natural science syncretions, and 2) an articulated phenomenological psychological method based on Husserl's concept of intentionality and on mediation of Merleau-Ponty's philosophical phenomenological method. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

This paper uses the framework of Formal Darwinism (FD) to evaluate organism-centric critiques of the Modern Synthesis (MS). The first section argues that the FD project reconciles two kinds of selective explanations in biology. Thus it is not correct to say that the MS neglects organisms—instead, it explains organisms’ design, as argued in the second section. In the third section I employ a concept of the organism derived from Kant that has two aspects: the parts presupposing the whole, and the (...) productivity of the parts in relation to the whole. The first aspect corresponds to the “design” that FD explains, whereas the second aspect is something about which the MS is largely silent. (shrink)

The logical positivists’ critical attitude towards metaphysics is sketched. Strawson’s conception of descriptive and revisionary metaphysics is described. Revisionary metaphysics is argued to be chimerical, and descriptive metaphysics is argued not to be a form of metaphysics at all. Strawson’s failure to account for the status of propositions of descriptive metaphysics is held to be remediable by reference to Wittgenstein’s conception of grammatical propositions that express norms of representation.

This chapter defines nontheistic conceptions of the divine as those that depart significantly in vocabulary and conceptuality from the ways of naming the divine characteristic of the Abrahamic traditions. It treats three examples: the Mimamsa understanding of the Vedic text; the nondual philosophy of Advaita Vedanta with special attention to Sankara; and a particular Buddhist understanding of the Buddha’s person.

We report a series of experiments in which subjects were required to make spatial discriminations about naturally obtained images, as follows. Subjects were shown two natural images on a computer screen, side by side and for a period of 500 ms. Subjects were then shown, on a separate part of the computer screen, a small patch of one of the images selected at random. Subjects were required to decide which of the two full images the patch comes from, and whereabouts (...) in that image it is taken from. They indicated their response by clicking the mouse cursor at the appropriate point on the screen. -/- The proportion of trials on which the subjects selected the correct image and the accuracy of the spatial position of their correct responses were calculated. These two measures independently indicate the general discriminability of the two image sets, and the extent to which the spatial layout of the image has been perceived. By comparing response accuracy for images that are from different sets (such as mountain or town scenes) with response accuracy when the two images are from the same set it is possible to establish the image properties that underlie coarse scene apprehension. By using sets of images that are perhaps best described as being natural textures (such as patterns of foliage or rock surface) it is possible to measure the extent to which texture is processed spatially. Our results are interpreted in the light of statistical differences between the image sets that we have used. (shrink)