The paper proposes a new method of researching public opinion for the purposes of valuing the outcomes of healthcare interventions. The issue I address is that, under the quality-adjusted life-year system, disabled patients face a higher cost-effectiveness hurdle than able-bodied patients. This seems inequitable. The author considers the alternative approaches to valuing healthcare interventions that have been proposed, and shows that all of them face the same problem. It is proposed that to value an outcome, instead of researching the general (...) public, the population that is to be targeted with the intervention should be researched. (shrink)

Happy people often fail to elaborate on persuasive arguments, while people in sad moods tend to scrutinise messages in greater detail. According to some motivational accounts, however, happy people will elaborate a message if they believe it might maintain their positive mood. The present research extends this reasoning by demonstrating that happy people will elaborate arguments from message presenters that convey positive hedonic attributes (i.e., source likeability). In a pilot study, we show that happy people believe persuasive messages from a (...) likeable source will be mood maintaining. The results of Study 1 demonstrate that these expectancies have important message-processing implications. In Study 1, sad participants elaborated arguments from both likeable and dislikeable sources, while happy participants only elaborated arguments from a likeable source. Consistent with motivational explanation of these effects, in Study 2, happy participants elaborated arguments from a likeable source when not distracted, but used likeability as a heuristic when distracted with a cognitive-load manipulation. Implications of these results for understanding the effects of mood on processing strategy, limitations, and directions for future research are discussed. (shrink)

I consider various principles which might explain our intuitive obligation to rescue people from imminent death at great cost, even when the same resources could produce more benefit elsewhere. Our obligation to rescue is commonly explained in terms of the identifiability of the rescuee, but I reject this account. Instead, I offer two considerations which may come into play. Firstly, I explain the seeming importance of identifiability in terms of an intuitive obligation to prioritise life-extending interventions for people who face (...) a high risk of an early death, and I explain this in turn with a fair innings-style principle which prioritises life-extending interventions for people expected to die young. However, this account is incomplete. It does not explain why we would devote the same resources to rescuing miners stuck down a mine even if they are elderly. We are averse to letting people die suddenly, or separated from friends and family. And so, secondly, I give a new account that explains this in terms of narrative considerations. We value life stories that follow certain patterns, classic patterns which are reflected in many popular myths and stories. We are particularly averse to depriving people of the opportunity to follow some such pattern as they approach death. This means allowing them to sort out their affairs, say goodbyes to family and friends, review their life, or come to terms with death itself. Such activities carry a lot of meaning as ways of closing our life story in the right way. So, for someone who has not been given much notice of their death, an extra month is worth much more than for other patients. Finally, I review the UK National Health Service's end of life premium, which gives priority to patients with short life expectancy. I suggest it falls short in terms of such considerations. For example, the NHS defines its timings in terms of how long the patient can expect to live as at the time of the treatment decision, whereas the timings should be specified in terms of time from diagnosis. (shrink)

I would like to thank Whitehurst et al for their comments on my paper.1 Although I will argue their approach will not eliminate the potential for disability discrimination from quality-adjusted life year -based assessment, their comments were very thought provoking. Whitehurst et al argue that, to the extent that allocating healthcare by QALYs discriminates against disabled patients, the fault is not with the QALY framework, but with ‘the descriptive systems of preference-based health-related quality of life instruments’.1 Specifically, they argue that (...) some HRQoL survey instruments do not characterise health impairments adequately. For example, Whitehurst et al mention an earlier study of HRQoL survey instruments that had different ways of asking about mobility. Some instruments asked specifically about the respondent’s ability to walk, while others asked about mobility. The study found that, in relation to individuals with spinal cord injuries, survey instruments focused on ability to walk produced lower quality of life scores than instruments focused on mobility. Whitehurst et al argue from this that survey instruments should include ‘adequate’ health state descriptions. This seems eminently sensible. However, contrary to their view, there is no guarantee that this will avoid discrimination. In fact, …. (shrink)

Significant differences in perceptions between teachers in primary and secondary grant-maintained schools are reported and analysed. Parents were more frequently involved in promoting opting-out in primary schools, primary teachers had more favourable attitudes to the grant-maintained school policy and, in primary schools, grant-maintained status delivered improvements in classroom conditions, most notably reduced class size and increased para-professional support in classrooms. The findings are discussed in terms of the management of primary schools, of theorising about reputation management in grant-maintained schools, and (...) of the explicit objectives of the grant-maintained policy. It is further suggested that the evidence provided about grant-maintained primary schools could be used to inject new life into a policy faltering in secondary schools. (shrink)

We bear witness to a sweeping social movement for change—fostered and driven by a powerful group of Black nurses and nursing students determined to call out and dismantle anti‐Black racism and discrimination within the profession of nursing. The Black Nurses Task Force, launched by the Registered Nurses' Association of Ontario (RNAO) in July 2020, is building momentum for long‐standing change in the profession by critically examining the racist and discriminatory history of nursing, listening to and learning from the lived experiences (...) of the Black nursing community, and shaping concrete, actionable steps to confront anti‐Black racism and discrimination in academic settings, workplaces, and nursing organizations. The Black Nurses Task Force and the RNAO are standing up and speaking out in acknowledgment of the magnitude of anti‐Black racism and discrimination that exist in our profession, health system, justice system, and economic system. This social movement is demonstrating, in actions, how individuals and a collective act as change agents to drive meaningful and widespread change for our present and future Black nurses. We also acknowledge the Black nurses who have gone before us. (shrink)

Racism against Black people, Indigenous and other racialized people continues to exist in healthcare and academic settings. Racism produces profound harm to racialized people. Strategies to address systemic racism must be implemented to bring about sustainable changes in healthcare and academic settings. This quality improvement initiative provides strategies to address systemic racism and discrimination against Black nurses and nursing students in Ontario, Canada. It is part of a broader initiative showcasing Black nurses in action to end racism and discrimination. We (...) have found that people who have experienced racism need healing, support and protection including trauma-related services to facilitate their healing. Implementing multi-level, multi-pronged interventions in workplaces will create healthy work environments for all members of society, especially Black nurses who are both clients/patients and providers of healthcare. (shrink)

Critical Review of The Philosophical Project of Carnap and Quine, edited by Sean Morris, Cambridge University Press, 2023.Scholarly opinion concerning the Carnap–Quine relationship and their centra...

Our team at the Centre for Clinical Ethics has long been engaged in internal discussion about the purpose and value of ethics debriefs and their purported role in reducing moral distress (Morley an...

I am very much in sympathy with the overall approach of John Campbell’s paper, “Reference as Attention”. My sympathy extends to a variety of its features. I think he is right to suppose, for instance, that neuropsychological cases provide important clues about how we should treat some traditional philosophical problems concerning perception and reference. I also think he is right to suppose that there are subtle but important relations between the phenomena of perception, action, consciousness, attention, and reference. I (...) even think that there is probably something importantly right about the main claim of the paper. I take this to be the claim that there is a tight connection – of some sort at any rate – between our capacity to refer demonstratively to perceptually presented objects and our capacity to attend to those objects in our conscious awareness of them. What precisely this connection consists in, however, remains a mystery to me. My goal in these comments is to clarify this result. I will begin, in section 2, with a fairly general statement of the problem I take Campbell to have set himself. Following this, in section 3, I will focus more particularly on what kind of relation Campbell takes to exist, or does exist, or perhaps could exist between attention and demonstrative reference. I examine four options, the first three of which seem to admit of clear counterexamples, and the fourth of which is too weak to be of any real interest. (shrink)

Why work? Most people say that they work only as a means to earn a living. This is also implied by the hedonist account of human nature which underlies utilitarianism and classical economics. It is argued in this paper that Marx’s concept of alienation involves a more satisfactory theory of human nature which is rooted in Hegel’s philosophy. According to this, we are productive beings and work is potentially a fulfilling activity. The fact that it is not experienced as such (...) is shown to be at the basis of Marx’s critique of capitalist society. (shrink)

This paper outlines a new metasemantic theory of moral reason statements, focused on explaining how the reasons thus stated can be inescapable. The motivation for the theory is in part that it can explain this and other phenomena concerning moral reasons. The account also suggests a general recipe for explanations of conceptual features of moral reason statements. (Published with Open Access.).

Reichenbach’s ‘principle of the common cause’ is a foundational assumption of some important recent contributions to quantitative social science methodology but no similar principle appears in econometrics. Angrist et al. has argued that the principle is necessary for instrumental variables methods in econometrics, and Angrist Krueger builds a framework using it that he proposes as a means of resolving an important methodological dispute among econometricians. Through analysis of instrumental variables methods and the issue of multicollinearity, we aim to show that (...) the relationship of the principle to econometric methods is more nuanced than implied by previous work but nevertheless may make a valuable contribution to the coherence and validity of existing methods. (shrink)

Despite emerging attention to Indigenous philosophies both within and outside of feminism, Indigenous logics remain relatively underexplored and underappreciated. By amplifying the voices of recent Indigenous philosophies and literatures, I seek to demonstrate that Indigenous logic is a crucial aspect of Indigenous resurgence as well as political and ethical resistance. Indigenous philosophies provide alternatives to the colonial, masculinist tendencies of classical logic in the form of paraconsistent—many-valued—logics. Specifically, when Indigenous logics embrace the possibility of true contradictions, they highlight aspects of (...) the world rejected and ignored by classical logic and inspire a relational, decolonial imaginary. To demonstrate this, I look to biology, from which Indigenous logics are often explicitly excluded, and consider one problem that would benefit from an Indigenous, paraconsistent analysis: that of the biological individual. This article is an effort to expand the arenas in which allied feminists can responsibly take up and deploy these decolonial logics. (shrink)

From the publisher: "This book is a lucid and accessible companion to Plato’s Republic, throwing light upon the text’s arguments and main themes, placing them in the wider context of the text’s structure. In its illumination of the philosophical ideas underpinning the work, it provides readers with an understanding and appreciation of the complexity and literary artistry of Plato’s Republic. McAleer not only unpacks the key overarching questions of the text – What is justice? And Is a just life happier (...) than an unjust life? – but also highlights some fascinating, overlooked passages which contribute to our understanding of Plato’s philosophical thought.". (shrink)

The author explores different views of the significance of the human body and contrasts those which regard it as a commodity or personal possession with those which stress its moral value as integral to the personal identity of individuals. This study provides background to many of the controversies in medical ethics.

Rudolf Carnap is well known for his attack on metaphysics, and W. V. Quine is equally well known for his attack on Carnap’s analytic/synthetic distinction. Receiving far less attention is their basic agreement that a properly scientific approach to philosophy should eliminate the metaphysical excesses of the past. This paper aims to remedy this. It focuses initially on the development of Carnap’s rejection of metaphysics from 1932 to 1950 and the role that analyticity plays. It then turns to Quine, emphasizing (...) his basic agreement with Carnap over the elimination of metaphysics and what this looks like without the analytic/synthetic distinction. (shrink)

Many commentators now view Quine's ‘Truth by Convention’ as a flawed criticism of Carnap. Gary Ebbs argued recently that Quine never intended Carnap as his target. Quine's criticisms were part of his attempt to work out his own scientific naturalism. I agree that Carnap was not Quine's target but object that Quine's criticisms were wholly internal to his own philosophy. Instead, I argue that C.I. Lewis held the kind of truth‐by‐convention thesis that Quine rejects. This, however, leaves Carnap out of (...) the picture. I then show how Quine came to see the earlier criticisms as also having force against Carnap. (shrink)

In this essay, I explore John Stuart Mill’s theory of government and its application to the issue of health care reform. In particular, I ask whether Mill’s theory of government would justify or condemn the creation of a public health-insurance option. Although Mill’s deep distrust of governmental authority would seem to align him with Republicans, Tea Partiers, libertarians, and others, who cast the public option as a “government takeover” of “our” health care system, I argue that Mill offers good reasons (...) for seriously considering some form of government-operated health insurance. For Mill theorizes government as having a positive as well as a negative role to play in people’s lives, and he explicitly endorses “public options” in different areas of life. According to his theory of government, a public health-insurance option would be just as long as it would meet the following two conditions: (1) it would not invade the “reserved territory” of individual liberty; and (2) “the case of expediency is strong.” I argue that a public option would in fact meet both of these conditions, and that Mill would have likely endorsed it as an effective solution to the current health care crisis in the United States. (shrink)

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six (...) interviews were undertaken with fifty-seven participants across three states in Australia. Interpretative Phenomenological Analysis was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants’ experiences with decision-making: “the person in relationship over time” and “maintaining involvement.” Participant views on the practical issues associated with supported decision-making are addressed under the themes of “facilitating decision-making,” “supported decision-making arrangements,” “constraints on decision-making,” and “safeguarding decision-making.” While participants endorsed the principles of supported decision-making as part of their overarching strategy of “maintaining involvement” in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual “constraints on decision-making” also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a “spectrum approach” to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population. (shrink)

The premises that a four foot man is short and that a man one tenth of an inch taller than a short man is also short entail by universal instantiation and "modus ponens" that a seven foot man is short. The negation of the second premise seems to entail there are virtually no borderline cases of short men, While to deny the second premise and its negation conflicts with the principle of bivalence, If not excluded middle. But the paradox can (...) be dissolved without resort to degrees of truth or any non-Classical system of logic. If some true predications can be semantically uncertain in a sense suitable for defining borderline cases, The second premise can be denied without denying the vagueness of "short" or reintroducing a sorites paradox along with higher order borderline cases. (shrink)

This article asks whether personal ventilators should be redistributed to maximize lives saved in emergency condition, like the COVID-19 pandemic. It begins by examining extant claims that items like ventilators are literally parts of their user’s bodies. Arguments in favor of incorporation for ventilators fail to show that they meet valid sufficient conditions to be body parts, but arguments against incorporation also fail to show that they fail to meet clearly valid necessary conditions. Further progress on this issue awaits clarification (...) of difficult normative, conceptual, and metaphysical questions about the possible boundaries of a person’s body. Rather than relying solely on incorporation arguments, we propose an argument against reallocation from widely accepted anti-discrimination principles. Possession of a personal ventilator is an obvious marker of disability identity; thus, reallocating ventilators from those that already possess them discriminates on the basis of a stigmatized trait – a paradigm case of presumptively wrongful discrimination. This discrimination claim, taken together with uncertainty about the bodily status of ventilators, yields a strong presumption against personal ventilator reallocation. (shrink)

Since 2007, capitalism has been going through its greatest crisis since the 1930s or before. In 2008, the banking system was saved from meltdown (at least for the time being) only by extensive government intervention in the USA, Britain, and a number of other countries. Stock markets all over the world plummeted. Then the crisis spread to the ‘real’ economy. A long and deep recession followed. Only now are we perhaps beginning to see what may – or may not – (...) be fragile signs of recovery. Capitalism, it is sometimes said, has been on the verge of collapse. (shrink)

A collection of essays by nine prominent thinkers on the compatibility of socialism and democracy and its future.