The rule of rescue describes the moral impulse to save identifiable lives in immediate danger at any expense. Think of the extremes taken to rescue a small child who has fallen down a well, a woman pinned beneath the rubble of an earthquake, or a submarine crew trapped on the ocean floor. No effort is deemed too great. Yet should this same moral instinct to rescue, regardless of cost, be applied in the emergency room, the hospital, or the community clinic? (...) -/- In health care, the desire to save lives at any cost must be reconciled with the reality of resource scarcity. As one example, the estimated cost for prophylactic Factor VIII to treat one patient with hemophilia for one year is $300,000. Costs of this magnitude have been accepted by public and private insurers in the developed world, even though, in principle, these sums could provide greater overall health benefit if allocated to pay for the unmet health care needs of many other patients. Looking forward, however, broad application of the rule of rescue will be increasingly untenable. But the moral instinct will remain: the desire to help those weakest among us, especially when their small numbers allow us to see them as unique individuals. What, then, is the ethical framework that can guide coverage and reimbursement decisions for orphan drugs into the future? (shrink)

In cognitive science, there is a tacit norm that phenomena such as cultural variation or synaesthesia are worthy examples of cognitive diversity that contribute to a better understanding of cognition, but that other forms of cognitive diversity (e.g., autism, attention deficit hyperactivity disorder/ADHD, and dyslexia) are primarily interesting only as examples of deficit, dysfunction, or impairment. This status quo is dehumanizing and holds back much-needed research. In contrast, the neurodiversity paradigm argues that such experiences are not necessarily deficits but rather (...) are natural reflections of biodiversity. Here, we propose that neurodiversity is an important topic for future research in cognitive science. We discuss why cognitive science has thus far failed to engage with neurodiversity, why this gap presents both ethical and scientific challenges for the field, and, crucially, why cognitive science will produce better theories of human cognition if the field engages with neurodiversity in the same way that it values other forms of cognitive diversity. Doing so will not only empower marginalized researchers but will also present an opportunity for cognitive science to benefit from the unique contributions of neurodivergent researchers and communities. (shrink)

Two recent articles in this journal – one by Morris, the other by Pfleegor & Rosenberg – have revived the philosophical discussion of the ethics of deception in sport which had largely laid dormant since the 1973 publication of Pearson’s ‘Deception, Sportsmanship, and Ethics’. Morris and Pfleegor & Rosenberg both share with Pearson the view that ethical deceptive sport acts are those that relate to sport-specific skills. However, whereas Pearson ultimately grounds this view in the agreement she (...) takes to obtain amongst sport participants, both recent treatments overlook this fundamental aspect of her account and offer alternative justifications for that view. I argue, though, that in both cases the arguments offered are incomplete precisely because they require an appeal to the agreement amongst participants that lies at the foundation of Pearson’s account. On all three treatments, I argue, what ultimately determines an action’s ethical status is not its relation to sport-specific skills, but its conformit... (shrink)

Background: Dignity is a multidimensional construct that includes perception, knowledge, and emotions related to competence or respect. Attitudes to aging are a comprehensive personal view of the experience of aging over the course of life, which can be influenced by various factors, such as the levels of health and self-sufficiency and social, psychological, or demographic factors. Aim: The purpose of this study was to explore the attitudes to aging of home-dwelling and inpatient older adults, and whether dignity and other selected (...) factors belong among the predictors influencing attitudes to aging in these two different groups of older adults. Research design: Cross-sectional study using a set of questionnaires: Patient Dignity Inventory, Attitudes to Aging Questionnaire, and Barthel Index. Pearson and Spearman correlation analyses and multivariable linear regression were used for statistical processing. Participants and research context: 233 inpatients and 237 home-dwelling older adults participated in the research in two regions of the Czech Republic. Ethical considerations: Institutional Review Board approval was received from the authors’ university. Findings: The inpatients had more negative attitudes to aging (M = 74.9±10.9; P <0.0001). The predictors of their attitudes to aging were gender and dignity. Women ( β = −2.969, P = 0.045) and inpatients with poor dignity ratings ( β = −0.332, P <0.0001) had more negative attitudes to aging. The predictors for home-dwelling older adults were education, living arrangement, and dignity. More negative attitudes to aging were found in older adults with lower levels of education ( β = 2.716, P = 0.007) who lived alone ( β = 2.163, P = 0.046) and rated their dignity as low ( β = −0.325, P <0.0001). Discussion and Conclusions: The results of this study add to the understanding that a sense of dignity is an important predictor of attitudes to aging for both home-dwelling older adults and inpatients. (shrink)

When health budgets are insufficient to provide care for all, allocating resources to treat a person with a rare and expensive disorder entails that we cannot treat at least one person with a more common, less expensive disorder. Since any allocation scheme will entail such trade‐offs, how should prudent policy‐makers, concerned about justice and fairness, allocate their community's health resources? In their article in this issue of the Hastings Center Report, Emily Largent and Steven Pearson frame this problem (...) as a conflict between the “rule of rescue” and utilitarian allocation schemes that try to maximize the benefits produced by a given budget. In his article, Norman Daniels discusses the related problem of the “identified victim bias.” I doubt that the problem of crafting an equitable health policy regarding orphan diseases maps onto either of these factors in a way that sheds light on the key moral issues. (shrink)

The young women had survived the car crash, after a fashion. In the five months since parts of her brain had been crushed, she could open her eyes but didn't respond to sights, sounds or jabs. In the jargon of neurology, she was judged to be in a persistent vegetative state. In crueler everyday language, she was a vegetable.

The increasing attention which has been given to social history of science and to the sociological analysis of scientific activity has resulted in a renewed interest in scientific controversies. Furthermore, the rejection of the presentist view of history, according to which those contestants who took what we can identify, with the benefit of modern knowledge, as the ‘right’ stand in a controversy, were right and their opponents were ‘wrong’, left the subject of scientific controversies with many questions. What determines their (...) emergence, course and resolution? When Froggatt and Nevin wrote on the Bio-metric-Mendelian controversy in 1971 they called their article ‘descriptive rather than interpretative’, so they avoided the very questions we would like to ask. Provine, in the same year, concentrated on the strong personalities of the contestants, their clashes, and the scientific arguments in play. But in 1975 Mackenzie and Barnes argued that the controversy could not be accounted for unless recourse was had to sociological factors. Their view has become widely known and figured prominently in 1982 in Steven Shapin's recital of the empirical achievements of the application of the sociological approach. I have returned to this subject because I do not yet feel altogether convinced by Mackenzie and Barnes' analysis. Even if their analysis of the controversy between Pearson and Bateson be accepted, it is not so obvious how effectively it can be used to explain the controversy between Weldon and Bateson, and I am not confident that it is adequate for an understanding of the evolution of their differing views of the mechanism of evolution. (shrink)

Although Darwin insisted that human intelligence could be fully explained by the theory of evolution, the codiscoverer of natural selection, Alfred Russel Wallace, claimed that abstract intelligence was of no use to ancestral humans and could only be explained by intelligent design. Wallace’s apparent paradox can be dissolved with two hypotheses about human cognition. One is that intelligence is an adaptation to a knowledge-using, socially interdependent lifestyle, the “cognitive niche.” This embraces the ability to overcome the evolutionary fixed defenses of (...) plants and animals by applications of reasoning, including weapons, traps, coordinated driving of game, and detoxification of plants. Such reasoning exploits intuitive theories about different aspects of the world, such as objects, forces, paths, places, states, substances, and other people’s beliefs and desires. The theory explains many zoologically unusual traits in Homo sapiens, including our complex toolkit, wide range of habitats and diets, extended childhoods and long lives, hypersociality, complex mating, division into cultures, and language (which multiplies the benefit of knowledge because know-how is useful not only for its practical benefits but as a trade good with others, enhancing the evolution.. (shrink)

Contributors to the 2016 Special Issue of Discourse Studies on the ‘Epistemics of Epistemics’ claim that studies of epistemics in interaction have lost the ‘radical’ character of groundbreaking work in ethnomethodology and conversation analysis. We suggest that the critiques and related writings are a kind of mandarin EM, lacking an adequate definition of ‘radical’, other than to invoke brief and by now familiar statements from Garfinkel and Sacks regarding the pursuit of ‘ordinary everyday activities’ and the avoidance of ‘formal analysis’. (...) Drawing on Egon Bittner’s work, we further suggest that the EoE group shares properties and problems common to social movements claiming the mantle of radicalism. Because of their particular focus on CA and Harvey Sacks’ early work, we also demonstrate that Sacks was not, as asserted, preoccupied with the singularity of occasions. Rather, from his earliest available work, Sacks pursued trans-situational aspects of sequential organization, and documented these not only through single cases but also through the comparative analysis of specimen collections. We conclude by considering how EM and CA are compatible endeavors, both in their engagement with traditional research topics – or what Garfinkel called ‘asymmetric alternates’ – and in their appreciation of generic features implicated in the assembly of social actions and social worlds. This implies a relationship of mutual interchange between EM and CA. (shrink)

The story of one of the most important—and incendiary—books in Western history When it appeared in 1670, Baruch Spinoza's Theological-Political Treatise was denounced as the most dangerous book ever published—"godless," "full of abominations," "a book forged in hell... by the devil himself." Religious and secular authorities saw it as a threat to faith, social and political harmony, and everyday morality, and its author was almost universally regarded as a religious subversive and political radical who sought to spread atheism throughout Europe. (...) Yet Spinoza's book has contributed as much as the Declaration of Independence or Thomas Paine's Common Sense to modern liberal, secular, and democratic thinking. In A Book Forged in Hell, Steven Nadler tells the fascinating story of this extraordinary book: its radical claims and their background in the philosophical, religious, and political tensions of the Dutch Golden Age, as well as the vitriolic reaction these ideas inspired. It is not hard to see why Spinoza's Treatise was so important or so controversial, or why the uproar it caused is one of the most significant events in European intellectual history. In the book, Spinoza became the first to argue that the Bible is not literally the word of God but rather a work of human literature; that true religion has nothing to do with theology, liturgical ceremonies, or sectarian dogma; and that religious authorities should have no role in governing a modern state. He also denied the reality of miracles and divine providence, reinterpreted the nature of prophecy, and made an eloquent plea for toleration and democracy. A vivid story of incendiary ideas and vicious backlash, A Book Forged in Hell will interest anyone who is curious about the origin of some of our most cherished modern beliefs. (shrink)

Editors provide a substantive introduction to the history and theories of perfectionism and neutrality, expertly contextualizing the essays and making the collection accessible.

In broadcast news interviews, interviewees will occasionally address the interviewer by name. As a method of establishing the directionality of talk, address terms are redundant in this institutional context because the normative question/answer activity structure and associated participation framework make the direction of address transparent and knowable in advance. But address terms can be deployed in the service of a variety of actions beyond addressing per se. Some of these involve disaligning actions such as topic shifts, non-conforming responses, and disagreements. (...) Others involve the presentation of views as particularly significant or sincere. Address terms are thus a resource for managing certain expressive properties of talk, as well as its disalignment from prior talk. (shrink)

Philosophy & Social Criticism, Volume 48, Issue 5, Page 655-673, June 2022. The standard account of the relation between democracy and the rule of law focuses on law’s liberty-enhancing role in constraining official action. This is a faint echo of the complex, constitutive relation between the two. The Greeks used one word – isonomia – to describe both. If democracy is the system in which people have an equal say in determining the rules that govern social life, then the rule (...) of law is simultaneously before, after, concurrent and synonymous with democracy: It contributes to the formation of citizens with the capacity for self-governance, serves as the instrument through which democratic decisions are implemented, functions as one of the central social practices that constitute citizens as equals and addresses the question of how to ensure that government by the people operates for the people. The rule of law has many independently valuable qualities, including impartiality and predictability. But, to valorise the rule of law for its own sake is to fetishize authority. The fundamental values of the rule of law are as the instrument of democratic self-governance and the expression of the equal dignity of all persons. Democracy thus entails the rule of law, but both implicate the yet more comprehensive ideal of equality. Core rule-of-law values require political norms and conditions of equality, generality and comprehensiveness. In a modern, differentiated society, however, the constitutive relation between democracy and the rule of law is fractured and law becomes the agent of authority. Courts in the modern constitutional state have contributed to the decline of rule-of-law values, supporting role specialization through judge-made immunity doctrines that protect officials at all levels. The crisis of police violence against minorities is a symptom of this breakdown. Greater accountability can ameliorate the problem. But an effective solution requires the fair and equal distribution of political power. (shrink)

Under what conditions do you have a reason to perform some action? Do you only have reason to do what you want to do? Reasons-motives internalism is the appealingly simple view that unless an agent is, or could be, motivated to act in a certain way, he has no normative reason to act in that way. Thus, according to reasons-motives internalism, facts about an individual’s motivational psychology constrain what is rational for that agent to do. This article canvasses several ways (...) of formulating the view and considers some advantages and disadvantages of each. (shrink)

Frigg and Reiss (2009) argue that philosophical problems in simulation bear enough resemblance to recognized issues in the philosophy of modeling that they only pose challenges analogous to those found in standard analytic models used to represent natural systems. They suggest that there are no new philosophical problems in computer simulation modeling beyond those found in traditional mathematical modeling. Winsberg (2009) has countered that there appear to be genuinely new epistemological problems in simulation modeling because the knowledge obtained from them (...) is ‘downward, motley, and autonomous.’ Here I draw out some specific ways that these epistemological problems are manifest in complex ecological simulation, especially in agent-based models. These models contain novel features that were impossible to anticipate prior to the computer revolution, and continue to present difficulties and challenges of both a practical and philosophical nature (Humphreys 2002). (shrink)

I examine an argument that appears to take us from Parfit’s [Reasons and Persons, Oxford: Clarendon Press (1984)] thesis that we have no reason to fulfil desires we no longer care about to the conclusion that the effect of posthumous events on our desires is a matter of indifference (the post-mortem thesis). I suspect that many of Parfit’s readers, including Vorobej [Philosophical Studies 90 (1998) 305], think that he is committed to (something like) this reasoning, and that Parfit must therefore (...) give up the post-mortem thesis. However, as it turns out, the argument is subtly equivocal and does not commit Parfit to the post-mortem thesis. I close with some doubts about Parfit’s case for his indifference thesis. (shrink)

The object of the present essay is to establish the possibility of “theology without anathemas.” First, an argument is given for the conclusion that infallible knowledge in matters of theology is not now possible. Both the Protestant doctrine of claritas scripturae and the Roman Catholic understanding of the Magisterium of the Church are rejected. Then, an alternative, “fallibilist” ecclesiology is proposed, according to which to belong to the Church is a matter of having been claimed by Christ as His own. (...) When combined with a universal doctrine of election and a highly objective and actualized doctrine of the Atonement, such a conception of the Church makes it possible to understand theology as a collaborative and cooperative effort on the part of all to understand better this Christ to whom they all always already belong. (shrink)

In this article I critically discuss Michael Steven Green's Nietzsche and the Transcendental Tradition and R. Kevin Hill's Nietzsche's Critiques: The Kantian Foundations of his Thought. Firstly, I raise textual doubts about Hill's interpretation of the early Nietsche as a Kantian critic of Schopenhaur. Secondly, I argue that Hill fails to establish that Nietzsche's later theoretical philosophy developed through a direct engagement with Kant's. Thirdly, I raise broader criticisms of Hill's 'Kantian' approach, and argue that Green's alternative account identifies (...) an underappreciated Kantian theme in Nietzsche's theoretical philosophy, although Green misrepresents Nietzsche's ultimate conclusions. Finally, I argue that while Hill rehearses prevailing misinterpretations of Kant's and Nietzsche's moral philosophies, Green's accoung also illuminates Nietzsche's developing criticism of Kantian notions of moral agency.In diesem Artikel werden die Bücher Michael Steven Greens Nietzsche and the Transcendental Tradition un R. Kevin Hill's Nietzsche's Critiques: The Kantian Foundations of his Thought kritisch diskutiert. Erstens bezwifle ich aus textualen Gründen, dass Hills Interpretation richtig ist, der frühe Nietzsche habe mit Kant Schopenhaur kritisiert. Zweitens, so mein Argumentation gelingt es Hill nicht nachzuweisen, dass Nietzsches spätere theoretische Philosophie direkt aus seiner Auseinandersetzung mit Kant hervorgeht. Drittens kritisiere ich den Kantischen Ansatz Hills umfassender und ziehe die alternative Deutung Greens heran, die ein wenig beachteres Kantisches Thema in Nietzsches theoretischer Philosophie ausmacht, wenngleich Green Nietzsches letze Schlussforlgerungen falsch interpretiert. Schließlich zeige ich, dass hill die vorherrschenden Missdeutungen der Moralphilosophie von Kant und Nietzsche wiederholt, während Green Nietzsches wachsende Kritik an den Kantischen Vorstellungen vom moralisch handelnden Subjekt beleuchtet. (shrink)

This is an examination of the nature and extent of Cordemoy's commitment to the doctrine of occasionalism.