As the demand for healthcare rises, so does the need for priority setting in healthcare. In this paper, I consider a prominent priority-setting principle: proportional shortfall. My purpose is to argue that proportional shortfall, as a principle, should not be adopted. My key criticism is that proportional shortfall fails to consider past health.Proportional shortfall is justified as it supposedly balances concern for prospective health while still accounting for lifetime health, even though past health is deemed irrelevant. (...) Accounting for this lifetime perspective means that the principle may indirectly consider past health by accounting for how far an individual is from achieving a complete, healthy life. I argue that proportional shortfall does not account for this lifetime perspective as it fails to incorporate the fair innings argument as originally claimed, undermining its purported justification.I go on to demonstrate that the case for ignoring past health is weak, and argue that past health is at least sometimes relevant for priority-setting decisions. Specifically, when an individual’s past health has a direct impact on current or future health, and when one individual has enjoyed significantly more healthy life years than another.Finally, I demonstrate that by ignoring past illnesses, even those entirely unrelated to their current illness, proportional shortfall can lead to instances of double jeopardy, a highly problematic implication. These arguments give us reason to reject proportional shortfall. (shrink)

In his “Games and the Art of Agency,” C. Thi Nguyen makes an intriguing and very plausible suggestion: games, or at any rate a great many of them, are artworks whose medium is, roughly, how one goes about doing what one does. In assigning an objective, laying down the constraints under which it has to be achieved, and specifying the terrain on which it will be played out, a game sculpts the decision-making processes of its players, the ways they see (...) their environment and option space, their motivations, and much else. Thus our by now quite extensive repertoire of games constitutes a library of agency. This library allows us to try on different modes of agency before deciding which is best for us—for a given type of occasion, or generally. It can help educate us into unfamiliar forms of agency, by providing the sort of controlled exercises that allow beginners the practice they need, which is to say that games are exercise and preparation for autonomous agency. And it promises to broaden and enrich our philosophical treatments of the topic, in part by serving as a testbed for competing theories of practical rationality; if we want to get a realistic sense of what it would be like to decide what to do, in the way that one or another theory of practical deliberation says, we can experiment with it in an appropriately designed game. (shrink)

Many countries project that they will have difficulty to meet their demand for primary care based on an inadequate supply of primary care doctors. There are many reasons for this, and they tend to vary by country. The policy options available to these countries are to increase the number of local primary care doctors, recruit doctors from other countries, ration primary care, shift more primary care to specialists, or authorize other disciplines to provide primary care. This article examines lessons learned (...) in the United States over the past 50 years and proposes that expanding the use of nurse practitioners is the best solution when measured by feasibility, costs, ethics, and scope of the care delivered. Using nurse practitioners trained in country meets the World Health Organization global code of practice regarding the international recruitment of health personnel. (shrink)

In this article, I will argue that early post-Apartheid South Africa adopted certain neoliberal principles which compromised the efforts to combat economic inequality. In particular, I will show that the economic policies that South Africa adopted during its early democracy reflect core neoliberal principles which promote a neoliberal political rationality. These economic policies indicate a pivotal approach from the African National Congress government in addressing economic inequality in South Africa. The dramatic shift from traditional Marxist policies to neoliberal policies reveals (...) the significant influence of a neoliberal global market system during South Africa’s early democracy. However, the neoliberal policies failed to address the problem of economic inequality in South Africa. Instead, these policies seem to have deepened the existing economic inequality in contemporary South African society. (shrink)

The past decade has witnessed a shift in the ambitions of pharmacists away from the core role of dispensing medicines towards more interesting and rewarding relationships and responsibilities with other healthcare providers and patients. The patient-centred role of pharmacists has allowed ethical issues experienced in medical practice to surface in pharmacy practice, resulting in an increase in the number and variety of ethical dilemmas that pharmacists face in their routine pharmacy practice. Pharmacy education prepares pharmacy students for practice and must (...) be in tune with the professional dynamics. Many countries that provide patient-centered pharmacy services have redesigned pharmacy ethics education while others are in various stages of revision of their curriculum in order to adequately equip future pharmacists with the rudiments required to handle ethical issues in clinical pharmacy practice. In contrast, in Nigeria, little or no pharmacy ethics is taught to pharmacy students and the challenge lies with the curriculum design and method of teaching. (shrink)

Derek Parfit held that in evaluating the future, we should ignore the difference between necessary persons and merely possible persons. In this article, I look at one of the most prominent alternatives to Parfit's view, namely Michael Otsuka and Larry Temkin ‘shortfall complaints’ view. In that view, we aggregate future persons’ well-being and deduct intrapersonal shortfall complaints, giving extra weight to the complaints of necessary persons. I offer here a third view. I reject Parfit's no difference view in (...) that I register a difference between necessary and possible persons. But I also reject the Shortfall View and replace its intra-personal complaints with an inter-personal complaints mechanism. I argue that the value of a population is its aggregate prioritarian value minus the egalitarian complaints that necessary persons hold. I show that the egalitarian view has all the explanatory power of the Shortfall view in easy cases, while significantly improving on it in three sorts of tough cases. (shrink)

The Expected Shortfall or Conditional Value-at-Risk (CVaR) has been playing the role of main risk measure in the recent years and paving the way for an enormous number of applications in risk management due to its very intuitive form and important coherence properties. This work aims to explore this measure as a probability-dependent utility functional, introducing an alternative view point for its Choquet Expected Utility representation. Within this point of view, its main preference properties will be characterized and its (...) utility representation provided through local utilities with an explicit dependence on the assessed revenue’s distribution (quantile) function. Then, an intuitive interpretation for the related probability dependence and the piecewise form of such utility will be introduced on an investment pricing context, in which a CVaR maximizer agent will behave in a relativistic way based on his previous estimates of the probability function. Finally, such functional will be extended to incorporate a larger range of risk-averse attitudes and its main properties and implications will be illustrated through examples, such as the so-called Allais Paradox. (shrink)

The organ donor shortfall in the UK has prompted calls to introduce legislation to allow for presumed consent: if there is no explicit objection to donation of an organ, consent should be presumed. The current debate has not taken in account accepted meanings of presumption in law and science and the consequences for rights of ownership that would arise should presumed consent become law. In addition, arguments revolve around the rights of the competent autonomous adult but do not always (...) consider the more serious implications for children or the disabled. (shrink)

Canada has a marked shortfall between the supply and demand for kidneys for transplantation. Median wait times for deceased donor kidney transplantation vary from 5.8 years in British Columbia, 5.2 years in Manitoba and 4.5 years in Ontario to a little over 2 years in Quebec and Nova Scotia. Living donation provides a viable option for some, but not all people. Consequently, a small number of people travel abroad to undergo kidney transplantation by commercial means. The extent to which (...) they are aware of the potential risks to their health and the health of the kidney vendors is unclear. Travel abroad to obtain a kidney commercially i.e. transplant tourism (TT), raises ethical issues which include the exploitation of the poor, uncertainty of donor informed consent to nephrectomy, poor clinical care and lack of follow up for the donor, commodification of the body and inequity of access to medical care for donors. Also, TT widens socioeconomic disparities in access to transplantation, differing from the Canadian system of universal coverage for healthcare. The Canadian transplant community has discussed how to respond to patients who plan to travel abroad for TT or return with a purchased kidney. Unease rests in the tension between the duty to care for legitimate Canadian residents and the unwillingness to enable TT. This paper discusses three anonymized cases and the Canadian responses to TT as recorded in academic literature and a formal statement by relevant professional bodies. (shrink)

The problem addressed in this paper is “the main epistemic problem concerning science”, viz. “the explication of how we compare and evaluate theories [...] in the light of the available evidence” (van Fraassen, BC, 1983, Theory comparison and relevant Evidence. In J. Earman (Ed.), Testing scientific theories (pp. 27–42). Minneapolis: University of Minnesota Press). Sections 1– 3 contain the general plausibility-informativeness theory of theory assessment. In a nutshell, the message is (1) that there are two values a theory should exhibit: (...) truth and informativeness—measured respectively by a truth indicator and a strength indicator; (2) that these two values are conflicting in the sense that the former is a decreasing and the latter an increasing function of the logical strength of the theory to be assessed; and (3) that in assessing a given theory by the available data one should weigh between these two conflicting aspects in such a way that any surplus in informativeness succeeds, if the shortfall in plausibility is small enough. Particular accounts of this general theory arise by inserting particular strength indicators and truth indicators. In Section 4 the theory is spelt out for the Bayesian paradigm of subjective probabilities. It is then compared to incremental Bayesian confirmation theory. Section 4 closes by asking whether it is likely to be lovely. Section 5 discusses a few problems of confirmation theory in the light of the present approach. In particular, it is briefly indicated how the present account gives rise to a new analysis of Hempel’s conditions of adequacy for any relation of confirmation (Hempel, CG, 1945, Studies in the logic of comfirmation. Mind, 54, 1–26, 97–121.), differing from the one Carnap gave in § 87 of his Logical foundations of probability (1962, Chicago: University of Chicago Press). Section 6 adresses the question of justification any theory of theory assessment has to face: why should one stick to theories given high assessment values rather than to any other theories? The answer given by the Bayesian version of the account presented in section 4 is that one should accept theories given high assessment values, because, in the medium run, theory assessment almost surely takes one to the most informative among all true theories when presented separating data. The concluding section 7 continues the comparison between the present account and incremental Bayesian confirmation theory. (shrink)

Recent methodological debates regarding the place of feasibility considerations in normative political theory are hindered for want of a rigorous model of the feasibility frontier. To address this shortfall, I present an analysis of feasibility that generalizes the economic concept of a production possibility frontier and then develop a rigorous model of the feasibility frontier using the familiar possible worlds technology. I then show that this model has significant methodological implications for political philosophy. On the Target View, a political (...) ideal presents a long-term goal for morally progressive reform efforts and, thus, serves as an important reference point for our specification of normative political principles. I use the model to show that we can- not reasonably expect that adopting political ideals as long-term reform objectives will guide us toward the realization of morally optimal feasible states of affairs. I conclude by proposing that political philosophers turn their attention to the analysis of actual social failures rather than political ideals. (shrink)

The individualist nature of much contemporary just war theory means that we often discuss cases with single attackers. But even if war is best understood in this individualist way, in war combatants often have to make decisions about how to distribute harms among a plurality of aggressors: they must decide whom and how many to harm, and how much to harm them. In this paper, I look at simultaneous multiple aggressor cases in which more than one distribution of harm among (...) aggressors is available. I show how such cases pose deep questions concerning the nature, role, and scope of the necessity principle, and its relationship to both liability and narrow proportionality. I argue that a hitherto unrecognised measure – ‘narrow proportionality shortfall’ – and its distribution is relevant in choosing how to distribute harms across aggressors. I then extend this analysis to show how this may help us with a puzzle concerning sequential attacks. (shrink)

What are the respective roles and responsibilities of global, national, and local communities as well as individuals themselves to address health deprivations and avert health threats? This article offers the beginnings of a theory of global health justice, arguing for universal ethical norms (general duty) with shared global and domestic responsibility (specific duties) for health. It offers a global minimalist view I call ‘ provincial globalism ’ as a mean between nationalism and cosmopolitanism, in which a provincial consensus must accompany (...) a global consensus on health morality. This minimalist account asserts global and national duties to promote human flourishing and, more specifically, individuals’ central health capabilities. In this view, justice requires prioritizing responsibilities through shared health governance to reduce shortfall inequalities in central health capabilities — a general duty to reduce premature mortality and escapable morbidity. It examines the difficulties presented by the philosophical principles of connectedness, causality, remediation, partiality, and capacity in the allocation of responsibility for global health. It offers a theory of responsibility allocation based on a functional, health agency centered and homeostatic balanced understanding of the analytical components required to solve global health problems and parcels out roles and responsibilities at the global, national, local, and individual levels accordingly. Allocations of responsibility rest on the effectiveness and special obligations of different actors, respecting self-determination by groups and individuals and seeking voluntary commitments . This view understands that the remedy for global health problems must be sustainable to take nations and the global health community to a new global health equilibrium that remedies current problems and prepares for new health threats to come. (shrink)

In this article by way of reply, the author responds to the challenging comments on The Democratic Horizon provided by Michelman, Benhabib, White, Scheuerman and Laden. In response to Michelman, some reflections are propounded (1) on the function of judicial review, in order to alleviate the tension between two understandings of the mandate of the highest interpreter of the constitution as aimed at remedying either an occlusion of democratic authorship or a shortfall of agreement, and (2) on the need (...) to rethink how the authority of the supreme interpreter relates to the will of the people in a deeply changed historical context. In response to Benhabib, the author discusses the new limits of the accommodation of diversity in Fairburg, a fictional polity that expands the Rawlsian standard of ‘ reasonable disagreement’, and defends the normative relevance and democratic credentials of his notion of ‘ multivariate polity’. In response to White, after recalling the importance of putting the ‘democratic ethos’ at the center of a reflection on the democratic quality of complex societies where formal procedures often mask elitist substance, the author defends the ‘political, not metaphysical’ credentials of ‘openness’ (as well as of ‘exemplarity’ as the ‘upstream source’ of openness) and accepts a complementarity of ‘openness’ and ‘presumptive generosity’. In response to Scheuerman, the author restates his focus on the democratic ethos as a supplement to, not a replacement of, the reflection on democratic procedures and defends the conceptual diversity of governance from government. In response to Laden, the author highlights the diversity of contexts to which his own and Laden’s versions of ‘democratic justification’ are responding and defends a more moderate version of ‘openness’, which still keeps constitutional essentials and political values shielded from ongoing questioning. Finally, the author interprets the debate aroused by The Democratic Horizon as indicative of the persistent vitality of the Rawlsian legacy in the 21st century. (shrink)

Abstract Normative criteria for evaluations of economic and social outcomes are often formulated in terms of social welfare functions which are essentially and importantly non-satiable. However, there are good reasons to consider certain normative criteria and many policy objectives to be capped, i.e. bounded, and thus satiable provided sufficient resources are made available for their satisfaction. Inspired by the Foster–Greer–Thorbecke class of indicators, this paper uses an interdisciplinary approach to develop a model for assessing outcomes in terms of capped objectives (...) based on an understanding of individual shortfalls from the objective, denoted needs. We present an indicator to measure need satisfaction in a population of individuals with heterogeneous needs and highlight an aggregation problem under scarcity. For such situations, we develop three ways in which the indicator can be weighted that reflect respectively concerns over the frequency, depth and severity of the need shortfalls and show that normative evaluations based on these weighting schemes can conflict, yielding mutually inconsistent outcome rankings. The indicator can be adapted to measure a wide variety of phenomena, e.g. health needs, education shortfalls, deprivation, etc., and it is suited for targeting exercises and other policy implementations. In particular, it allows for exogenous weighting schemes, i.e. weights that can incorporate non-shortfall characteristics relevant for the evaluation, e.g. age, gender, ethnicity, etc. The indicator thus enables new ways for researchers to promote and study satiable objectives in a wide variety of contexts relevant to economic and social policy, e.g. human development programs, poverty reduction, healthcare policies, etc. (shrink)

Research based on the behavioral theory of the firm (BTOF) argues that firms will actively adopt strategic actions to respond to performance that falls below aspirations, that is performance shortfalls. However, most previous studies have focused on market-related strategic actions, paying less attention to the impact of performance shortfalls on non-market-related strategic actions, especially corporate social responsibility (CSR) and corporate social irresponsibility (CSI). In this study, we propose that firms facing performance shortfalls are likely to reduce CSR levels and increase (...) CSI levels. In addition, we also propose that board characteristics (board size, board age and board tenure) have a significant moderating effect on the above relationship. Empirical analyses based on an unbalanced panel data of China's listed firms from 2010 to 2018 show that our arguments are largely supported. (shrink)

This brief report presents the global problem of the shortfall of donor corneal tissue for transplantation, a potential root cause (‘ick factor’ language), and a potential solution (modification of ‘ick factor’ language). Specifically, use of the term ‘eye donation’ is a potential hurdle to ocular tissue donation as it can stimulate the ‘ick factor.’ Verbiage such as ‘ocular (eye tissue)’ could be a method of providing terminology that is less emotive than ‘eye donor’ or ‘eye donation.’ The field of (...) transplantation has experienced terminology shifts over time; for example, ‘cadaver’ has been replaced with ‘deceased donor,’ ‘harvest’ has been replaced with ‘recover,’ and ‘life support’ has been replaced with ‘ventilated.’ Notably, only a small number of regions worldwide are using ‘ocular’ terminology, yet it could be an important step to enhancing the informed consent process and improving donation rates, potentially increasing transplant and optimising patient quality of life for those with treatable blindness. (shrink)

Soccer, or football, attracts vast numbers of passionate fans from all over the world; yet clinical psychology is yet to study it in depth. In this book, David Huw Burston, a consultant football psychology and performance coach, uses a phenomenological research method inspired by Amedeo Giorgi to consider what we can learn from the spirit of the game, and how this can be used positively in the consulting room and on the field of play. By examining detailed qualitative research with (...) professional soccer players of both sexes, Burston identifies and considers nine particular themes, including the family, god, heroes and dreams, and discusses how what we can learn from the game of football and team culture can be applied to Jungian analysis today. This book bridges the gap between clinical psychology and sport, outlining potential shortfalls in current youth development in sport, as well as discussing how traditional Jungian archetypes can be identified in everyday settings. It will be of key interest to researchers from both the fields of analytical psychology and sports studies. (shrink)

It is well known that there is a shortage of human ova for in vitro fertilization (IVF) purposes, but little attention has been paid to the way in which the demand for ova in stem-cell technologies is likely to exacerbate that shortfall and create a trade in human eggs. Because the 'Dolly' technology relies on enucleated ova in large quantities, allowing for considerable wastage, there is a serious threat that commercial and research demands for human eggs will grow exponentially (...) from the combination of these two pressures. In the absence of legal regulation in the United Kingdom, and in the context of a globalized trade in human organs, we face a 'Wild West' situation in genetic and biotechnological research that involves human ova -/- . (shrink)

Japan is the world’s largest producer of love simulation games, revealing a curious feature: these games, in theory, assign female players to the unique task of seducing a male character, but, in reality, they promote the establishment of a network of friendship between women. Love cannot be achieved if this network is not carefully woven both in play and in real life. Based on the analysis of this double dynamics, outwardly contradictory, I would like to advance the following hypothesis: that (...) such games enable their users to ‘outsmart’ gender expectations. These games, called otome games, became popular in the context of a national panic related to the declining birthrate: they target the market of women who – living alone or with their parents – are held responsible for the future shortfall of the system. These new generations of women don’t start a family. They have no children. How do they manage to ward off exclusion and stigma? The study will focus on the strategies collectively devised to turn otome games into an identity-building tool, promoting friendship between players as a means of resistance against social norms. (shrink)

Recognizing the influence crises have in shaping global governance nowadays, the present work explores the possible contribution of human development thinking countering the perverse effects of shock-driven responses to major emergencies. This is done by focusing on contributions by Sen, Dreze, Haq and Stewart related to famines, violent conflict and the idea of human security, analyzed using a selection of four criteria, namely, describing the position of crisis inside human development thinking, issues of modeling and measurement, the stance toward agency, (...) and the actors gathered around the discourse. After strengths and weaknesses are considered, the article suggests a tangential involvement through other human concepts, so human development ideas do not get muddled by the logic of shocks and fulfill the great responsibility of helping us avoid the many shortfalls of a security-obsessed view of humanity. (shrink)

Political culture theory enjoyed a revival during the 1980s despite its alleged inability to account for change, values, conflict, and differences within nations. A new school of thought attempts to remedy the shortfalls of Almond and Verba's The Civic Culture. The grid-group cultural theory, propounded by Thompson, Ellis and Wildavsky, proposes a typology of ways of life as the missing link in a cultural-functional analysis of the formation of preferences. This essay assesses cultural theory as a methodology and a substantive (...) theory or sociology of knowledge. Cultural theory claims that there are only five possible ways of life: Hierarchy, egalitarianism, fatalism, individualism, and autonomy. Yet it fails to address questions of universal values, ethics, power, or human rights and freedoms. There are inherent problems in applying cultural theory as a mode of political analysis. In the absence of exogenous, non-systemic ethical criteria, cultural theory as a social construction of reality begs the question of ethical conduct. (shrink)

Because youths are particularly vulnerable to social problems, philosophers since Plato to date have continued to show interest in developing, empowering, and protecting the youths. African youths are particularly far more than ordinarily vulnerable to various social problems including racism especially from outside the continent, mainly because of the shortfall in youth development and empowerment strategies in most African countries. Consequently, young people are pulled to countries with resources and infrastructures that provide them with opportunities to enlarge their capabilities (...) and improve their quality of life, where they are also faced with discriminatory, prejudicial, and antagonistic treatments simply because of their skin colour. So, one way to look at racism and reduce its effects is to examine those socio-political as well as economic structures that constitute obstacles to youth development and empowerment, and which push and expose the young in Africa to the ill-treatments emanating from racism. (shrink)

In this paper I point out main shortfalls of the three main families of theories of perception and I propose a sort of inferential realism. In addition, I argue that there cannot be a scientific variant of direct realism and illustrate this point with reference to P.F.Strawson's attempt to reconcile, not naïve realism and the scientific variant as he amounts to, but rather, direct and indirect realism. I draw the distinction between four cases of illusion, and I refer to one (...) of these, namely to the case of veridical illusion, to show that Strawson's view, put in terms of the Fregean sense-reference distinction, fails. As regards indirect realism, I argue against the representationalist account and the Lockean picture of primary and secondary qualities. Phenomenalism is rejected in terms of the impossibility to identify an object throughout different contexts and I suggest that what is for x to be that x in different contexts can be given only by a realist analysis of a material object. Finally, I provide an account of what it is for A to perceive that x with respect to different contexts and I conclude with what conditions should veridical perception meet and therefore propose the framework of a new theory of perception. (shrink)

Cell therapy means treating diseases with the body's own cells. One of the cell types most in demand for therapeutic purposes is the pancreatic β‐cell. This is because diabetes is one of the major healthcare problems in the world. Diabetes can be treated by islet transplantation but the major limitation is the shortage of organ donors. To overcome the shortfall in donors, alternative sources of pancreatic β‐cells must be found. Potential sources include embryonic or adult stem cells or, from (...) existing β‐cells. There is now a startling new addition to this list of therapies: the pancreatic α‐cell. Thorel and colleagues recently showed that under circumstances of extreme pancreatic β‐cell loss, α‐cells may serve to replenish the insulin‐producing compartment. This conversion of α‐cells to β‐cells represents an example of transdifferentiation. Understanding the molecular basis for transdifferentiation may help to enhance the generation of β‐cells for the treatment of diabetes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"A Mark ofthe Growing Mind is Veneration of Objects" (Ludwig Wittgenstein) Fay Horton Sawyier Introduction In book 1 of the Treatise,1 Hume directs his attention to two sets of concepts; one of these sets is what I think of as the "basic epistemological set" and the other as the "basic metaphysical or ontological set." Except for the idea of personal identity, the First Inquiry2 addresses the same arrays of (...) concerns. Within the "epistemological set" we find discussions ofknowledge, belief, origin of ideas, etc.; within the "metaphysical set"are seen space, time, identity, cause and effect, uniformity ofnature, external objects and so on.3 For the first (epistemological) set, Hume constructs a mode of analysis which depends crucially on the provenance of an idea or concept. Thatis, asit does forarthistorians today, authenticityortruth depends on how the thingin question came intoyour possession. Hume announces not only that every simple idea depends on and comes from its simple impression, but that the full understandingofa complexidea requires first factoring it into its simple components and then tracing them back to their impressions. Understanding is, so to speak, like displaying the family tree. It turns out that all of the members of the "metaphysical" set have dubious parentage. Even if one grants the accuracy and adequacy of Hume's factoring, we are left facing his demonstrations that for each metaphysical concept there are at least some elements with no clear ancestry from single impressions. In this wayHume directs our attention tohis questforhow suchideas(or such elements withinideas) are ever come by. Why do we attribute identity? Howcanwe assume thereisanecessary connection and apower? What can possibly bring us to imagine, even, that anything can be independent ofour perceptions? And so on. All ofthis is not only at the heart ofthe Humean enterprise inbook 1 ofthe Treatise ami theFirstInquiry butis well-known to anyone even modestly familiar with Hume's writings. The result of his powerful analyses is that these mysterious, illegitimate elements in the metaphysical concepts are generated within subjects exposed to repeated instances of, for example, pairings in time or place, similar sightings after temporal lapses and so on. The processes by which we Volume XVIII Number 2 315 FAY HORTON SAWYIER construct our categories as well as the elements out ofwhich we make them areimportantandin these cases were shown tobe developmental or time-dependent.4 Furthermore, since these processes and these resultant conceptshavebeen shown tohave been generated by us, they are uniquely quaUfied to demonstrate the nature of human nature, which was, after all, the subject ofthe Treatise? Having reminded ourselves ofthese extremely general features of Hume's exposition, I want now to isolate and to highlight some particular and peculiar features. 1.The subject upon whose mind or sensibilities paired and repeated events are presumed to impinge and by whose consequent conditioning these otherwise inexplicable concepts can be understood is always an adult male.6 2.The presentingsituation which is presumed to arise and repeatfor this adult male is always hypothetical and never observed. 3.Thisman'sconstructionofanyoneofthese concepts (like necessary connection) is always as his solution to a logical problem, his way-out ofa mental awkwardness or unease. 4.These adult male concept generators and logical problem solvers neverseem to doanything but sitstill and look around themselves.7 The fundamental character ofmy inquiry can be understood as a search for the (presumably deleterious) consequences of the four particular features noted above. Since the lives and experiences of young children are neglected and since acquisition of the basic metaphysical set is always initiated in early childhood, one may well hypothesize that Hume's results will be damaged or skewed. Intuitively, this would seem to be an obvious inference, but proof is needed that in some cases Hume did indeed misconstrue certain basic concepts and that the central factor in his shortfall was his neglect of the child's experience of concept development and acquisition. By contrast, his contemporary, Thomas Reid, remarked, "Could we obtain a distinct and full history of all that hath passed in the mind ofa child from thebeginning ofUfe and sensation, till it grows to the use ofreason... this would be a treasury of natural history, which would probably give... (shrink)

Objectives: To characterise UK undergraduate medical ethics curricula and to identify opportunities and threats to teaching and learning.Design: Postal questionnaire survey of UK medical schools enquiring about teaching and assessment, including future perspectives.Participants: The lead for teaching and learning at each medical school was invited to complete a questionnaire.Results: Completed responses were received from 22/28 schools . Seventeen respondents deemed their aims for ethics teaching to be successful. Twenty felt ethics should be learnt throughout the course and 13 said ethics (...) teaching and learning should be fully integrated horizontally. Twenty felt variety in assessment was important and three tools was the preferred number. A shortfall in ethics core competencies did not preclude graduation in 15 schools. The most successful aspects of courses were perceived to be their integrated nature and the small group teaching; weaknesses were described as a need for still greater integration and the heavily theoretical aspects of ethics. The major concerns about how ethics would be taught in the future related to staffing and staff development.Conclusions: This study describes how ethics was taught and assessed in 2004. The findings show that, although ethics now has an accepted place in the curriculum, more can be done to ensure that the recommended content is taught and assessed optimally. (shrink)

This paper considers the relation of corrective to distributive justice. I discuss the shortfalls of one sort of account that holds these are independent domains of justice. To support a more modest claim that these are sometimes independent domains of justice, I focus instead on the case of apologies. Apologies are sometimes among the measures specified by corrective justice. I argue that the sorts of injustices that apologies can help to correct need not always be departures from ideals specified by (...) distributive justice. Apologies and the moral relations they engage might thus be parts of a domain of justice that is neither distributive nor dependent on distributive justice. (shrink)

Simon May has argued that the notion of a principled compromise is incoherent. Reasons to compromise are always in his view strategic: though we think that the position we defend is still the right one, we compromise on this view in order to avoid the undesirable consequences that might flow from not compromising. I argue against May that there are indeed often principled reasons to compromise, and that these reasons are in fact multiple. First, compromises evince respect for persons that (...) we have reason to think of as our epistemic peers, and acknowledgement of our own finitudes as moral reasoners. Second, compromises are often made morally necessary by the shortfalls that unavoidably separate democratic institutions from democratic ideals. Third, compromises express a desirable form of democratic community. And fourth, compromises are often justified from a consequentialist point of view, in that they allow for the realization of values that would not be realized as well by the failure to compromise. (shrink)

There is a global shortage of organs for transplantation and despite many governments making significant changes to their organ donation systems, there are not enough kidneys available to meet the demand. This has led scientists and clinicians to explore alternative means of meeting this organ shortfall. One of the alternatives to human organ transplantation is xenotransplantation, which is the transplantation of organs, tissues, or cells between different species. The resurgence of interest in xenotransplantation and recent scientific breakthroughs suggest that (...) genetically-engineered pigs may soon present a realistic alternative as sources of kidneys for clinical transplantation. It is therefore important for nurses and allied health professionals to understand what is involved in xenotransplantation and its future implications for their clinical practices. First, we explore the insufficiency of different organ donation systems to meet the kidney shortage. Second, we provide a background and a summary of the progress made so far in xenotransplantation research. Third, we discuss some of the scientific, technological, ethical, and economic issues associated with xenotransplantation. Finally, we summarise the literature on the attitudes of healthcare professionals toward xenotransplantation. (shrink)

Is equality a distributive value or does it rather point to the quality of social relationships? This article criticizes the distributive character of luck egalitarian theories of justice and fleshes out the central characteristics of an alternative, relational approach to equality. It examines a central objection to distributive theories: that such theories cannot account for the significance of how institutions treat people (as opposed to the outcomes they bring about). I discuss two variants of this objection: first, that distributive theories (...) fail to account for the importance of how institutions cause good shortfalls and, second, that they fail to account for the normative attitude of social and political institutions expressed in different ways of treating people. The article argues that the causal variant of the objection has only very limited reach, and endorses the expressive variant: the attitudes expressed by institutions in their treatment of persons, such as contempt or neglect, generate potentially unjust social relationships and hierarchies. This should be the focus of a relational egalitarian approach to social justice. The article proceeds to explain how it is possible that artificial agents such as institutions have attitudes and how these attitudes are not reducible to those of the individuals that sustain them, and argues that distributive theories cannot be so modified as to account for such attitudes. It concludes by indicating several directions for the development of more worked-out conceptions of relational equality on this basis. (shrink)

The long-standing overarching policy governing research with human subjects conducted and supported by most federal agencies and departments in the United States, known as the Common Rule, has recently been revised, with most requirements slated to become effective in 2018. Although there are multiple alterations to the current regulations, some of the most significant changes aim to enhance consent for research. While some of the particular provisions in this regard will be easy to apply and promise to help meet this (...) goal, others may be more challenging to implement despite their intuitive appeal. In this article, I examine some of the provisions in the revised Common Rule that relate to consent: new required consent elements; the goal of comprehension in the consent process; consent forms; and broad consent. By raising issues about these provisions now and suggesting possible ways to overcome their potential shortfalls, the hope is that future efforts can be taken to help clarify and appropriately implement them. (shrink)

Advocates of “Mendelism” early on stressed the usefulness of Mendelian principles for breeders. Ever since, that usefulness—and the favourable opinion of Mendelism it supposedly engendered among breeders—has featured in explanations of the rapid rise of Mendelian genetics. An important counter-tradition of commentary, however, has emphasized the ways in which early Mendelian theory in fact fell short of breeders’ needs. Attention to intellectual property, narrowly and broadly construed, makes possible an approach that takes both the tradition and the counter-tradition seriously, by (...) enabling a more complete description of the theory-reality shortfall and a better understanding of how changing practices, on and off the Mendelians’ experimental farms, functioned to render that shortfall unproblematic. In the case of plant breeding in Britain, a perennial source of lost profits and disputes over ownership was the appearance of individual plants departing from their varietal types—so-called “rogues.” Mendelian plant varieties acquired a reputation for being rogue-free, and so for demonstrating the correctness of Mendelian principles , at a time when Mendelians were gradually taking control of the means for distributing their varieties. Mendelian breeders protected their products physically from rogue-inducing contamination in such a way that when rogues did appear, the default explanation—that contamination had somehow occurred—ensured that there was no threat to Mendelian principles. (shrink)

While classifications of mental disorders have existed for over one hundred years, it still remains unspecified what terms such as 'mental disorder', 'disease' and 'illness' might actually denote. While ontologies have been called in aid to address this shortfall since the GALEN project of the early 1990s, most attempts thus far have sought to provide a formal description of the structure of some pre-existing terminology or classification, rather than of the corresponding structures and processes on the side of the (...) patient. We here present a view of mental disease that is based on ontological realism and which follows the principles embodied in Basic Formal Ontology and in the application of BFO in the Ontology of General Medical Science. We analyzed statements about what counts as a mental disease provided in the research agenda for the DSM-V, and in Pies' model. The results were used to assess whether the representational units of BFO and OGMS were adequate as foundations for a formal representation of the entities in reality that these statements attempt to describe. We then analyzed the representational units specific to mental disease and provided corresponding definitions. Our key contributions lie in the identification of confusions and conflations in the existing terminology of mental disease and in providing what we believe is a framework for the sort of clear and unambiguous reference to entities on the side of the patient that is needed in order to avoid these confusions in the future. (shrink)

It is not uncommon for multiple clinical trials at the same institution to recruit concurrently from the same patient population. When the relevant pool of patients is limited, as it often is, trials essentially compete for participants. There is evidence that such a competition is a predictor of low study accrual, with increased competition tied to increased recruitment shortfalls. But there is no consensus on what steps, if any, institutions should take to approach this issue. In this article, we argue (...) that an institutional policy that prioritises some trials for recruitment ahead of others is ethically permissible and indeed prima facie preferable to alternative means of addressing recruitment competition. We motivate this view by appeal to the ethical importance of minimising the number of studies that begin but do not complete, thereby exposing their participants to unnecessary risks and burdens in the process. We then argue that a policy of prioritisation can be fair to relevant stakeholders, including participants, investigators and funders. Finally, by way of encouraging and helping to frame future debate, we propose some questions that would need to be addressed when identifying substantive ethical criteria for prioritising between studies. (shrink)

In this paper, we introduce the Societal Readiness Thinking Tool to aid researchers and innovators in developing research projects with greater responsiveness to societal values, needs, and expectations. The need for societally-focused approaches to research and innovation—complementary to Technology Readiness frameworks—is presented. Insights from responsible research and innovation concepts and practice, organized across critical stages of project-life cycles are discussed with reference to the development of the SR Thinking Tool. The tool is designed to complement not only shortfalls in TR (...) approaches, but also improve upon other efforts to integrate RRI, sustainability, and design thinking in research and innovation cycles. Operationalization and early-stage user tests of the Tool are reported, along with discussion of potential future iterations and applications. (shrink)

Helen Steward accepts what I call the Separation Thesis, the main tenet of which is that the movements one’s body makes when one acts are the causal results of one’s actions. I claim that this threatens to generate a pair of epistemic shortfalls: first, our perception of others’ bodily movements may not reach to their actions themselves; and, second, our own ‘knowledge in intention’ may not reach to the actual bodily movements in which the efficacy of our actions consists. I (...) suggest we should adopt a slogan that Anscombe considered, and say ‘I do what happens’ when I am acting. Then the movements one’s body makes when one acts are seen simply to be one’s actions. (shrink)

The principle of need—the idea that resources should be allocated according to need—is often invoked in priority setting in the health care sector. In this article, I argue that a reasonable principle of need must be indeterminate, and examine three different ways that this can be dealt with: appendicizing the principle with further principles, imposing determinacy, or empowering decision makers. I argue that need must be conceptualized as a composite property composed of at least two factors: health shortfall and (...) capacity to benefit. When one examines how the different factors relate to each other, one discovers that this is sometimes indeterminate. I illustrate this indeterminacy in this article by applying the small improvement argument. If the relation between the factors are always determinate, the comparative relation changes by a small adjustment. Yet, if two needs are dissimilar but of seemingly equal magnitude, the comparative relation does not change by a small adjustment of one of the factors. I then outline arguments in favor of each of the three strategies for dealing with indeterminacy, but also point out that all strategies have significant shortcomings. More research is needed concerning how to deal with this indeterminacy, and the most promising path seems to be to scrutinize the position of the principle of need among a plurality of relevant principles for priority setting in the health care sector. (shrink)

Discussions of where the costs of climate change adaptation and mitigation should fall often focus on the 'polluter pays principle' or the 'ability to pay principle'. Simon Caney has recently defended a 'hybrid view', which includes versions of both of these principles. This article argues that Caney's view succeeds in overcoming several shortfalls of both principles, but is nevertheless subject to three important objections: first, it does not distinguish between those emissions which are hard to avoid and those which are (...) easy to avoid; second, its only partial reference to all-things-considered justice means it cannot provide a full account even of climate justice; and third, it assigns to the poor very limited duties to meet climate change costs, even where they have created those costs, which may incentivise them to increase emissions. An alternative pluralistic account which avoids these objections is presented. (shrink)

In non-ideal theory, the political philosopher seeks to identify an injustice, synthesize social scientific work to diagnose its underlying causes, and propose morally permissible and potentially efficacious remedies. This paper explores the role in non-ideal theory of the identification of a plausible agent of change who might bring about the proposed remedies. I argue that the question of the agent of change is connected with the other core tasks of diagnosing injustice and proposing practical remedies. In this connection, I criticize (...) two linked postures that nonideal theorists sometimes adopt: a technocratic mode of neutral policy recommendation, whereby philosophers say what “we” must do to address some problem, without attending to the way agency enters the problem and its possible resolution; and the tendency to treat non-ideal theory as primarily consisting int eh enumeration of duties we are failing to fulfill, and specification of who is under what additional duties in light of this shortfall. My argument is that these tendencies fail to register in a coherent way the practical character of political philosophy. (shrink)

In this article, I offer an analysis of what it is to take offense and what doing so is like, on which a more nuanced and positive appraisal of this emotion becomes possible as compared to its popular reputation. First, I survey the shortfalls of the limited discussion of offense by philosophers, before proposing an alternative analysis. Second, I distinguish offense from nearby emotions, like anger, disgust, and pride. Third, I examine the implications not only for how we conceptualize offense (...) but also how we regard those who take it. On my account, offense tends to be a smaller-scale, more everyday emotion than those making claims about its threats to society suppose, and one ripe for a moral reassessment. While offense sometimes appears excessive, that is likely only in limited cases: namely, those requiring symbolic withdrawal or proxy forms of estrangement. Even there, the appearance of excess may be illusory, with the grander gestures of offense appropriate given the distance between the offended and offending parties. Furthermore, on my account, to take offense is to resist affronts to one's standing, rather than merely a reflection of hurt feelings. Concluding, I sketch a defense of this resistance as a sometimes valuable response to injustice. (shrink)

Climate change and other harmful large-scale processes challenge our understandings of individual responsibility. People throughout the world suffer harms—severe shortfalls in health, civic status, or standard of living relative to the vital needs of human beings—as a result of physical processes to which many people appear to contribute. Climate change, polluted air and water, and the erosion of grasslands, for example, occur because a great many people emit carbon and pollutants, build excessively, enable their flocks to overgraze, or otherwise stress (...) the environment. If a much smaller number of people engaged in these types of conduct, the harms in question would not occur, or would be substantially lessened. However, the conduct of any particular person (and, in the case of climate change, of even quite large numbers of people) could make no apparent difference to their occurrence. My carbon emissions (and quite possibly the carbon emissions of much larger groups of people dispersed throughout the world) may not make a difference to what happens to anyone. When the conduct of some agent does not make any apparent difference to the occurrence of harm, but this conduct is of a type that brings about harm because many people engage in it, we can call this agent an overdeterminer of that harm, and their conduct overdetermining conduct. In this essay we explore the moral status of overdetermining harm. (shrink)

Given any proposition, is it possible to have rationally acceptable attitudes towards it? Absent reasons to the contrary, one would probably think that this should be possible. In this paper I provide a reason to the contrary. There is a proposition such that, if one has any opinions about it at all, one will have a rationally unacceptable set of propositional attitudes—or if one doesn’t, one will end up being cognitively imperfect in some other manner. The proposition I am concerned (...) with is a self-referential propositional attitude ascription involving the propositional attitude of rejection. Given a basic assumption about what constitutes irrationality, and a few assumptions about the nature of cognitively ideal agents, a paradox results. This paradox is superficially like the Liar, but it is importantly different in that no alethic notions are involved at all. As such, it stands independent of the Liar and is not a ‘revenge’ version of it. After setting out the paradox I discuss possible responses. After considering several I argue that one is best off simply accepting that the paradox shows us something surprising and interesting about rationality: that some cognitive shortfall is unavoidable even for ideal agents. I argue that nothing disastrous follows from accepting this conclusion. (shrink)

This article discusses the relationship between two theories about the badness of death, the Life-Comparative Account and the Gradualist Account, and two methods of operationalizing severity in health care priority setting, Absolute Shortfall and Proportional Shortfall. The aim is that theories about the badness of death can influence and inform the idea of the basis of severity as a priority setting criterion. I argue that there are strong similarities between the Life-Comparative Account and Absolute Shortfall, and since (...) the Life-Comparative Account is one of the most reasonable accounts of the badness of death, this provides some support for using Absolute Shortfall. I also argue that it is difficult to find support for Proportional Shortfall from theories about the badness of death, and also, that it is difficult to find support for Gradualist Account from theories about severity. (shrink)

In Being and Time, Heidegger affirms that being-with or Mitsein is an essential constitution of Dasein but he does not submit this existential to the same rigorous analyses as other existentials. In this essay, Jean-Luc Nancy points to the different places where Heidegger erased the possibility of thinking an essential with that he himself opened. This erasure is due, according to Nancy, to the subordination of Mitsein to a thinking of the proper and the improper. The polarization of Being-with between (...) an improper face, the Anyone, and a proper one, the people, which is also, as Nancy shows, a polarization between everydayness and historicity, between a being-together in exteriority (indifference and anonymity) and a being-together in interiority (union through destiny), between a solitary dying and the sacrificial death in combat, leaves the essential with unthought. This essay shows not only the tensions that arise out of Heidegger’s own analyses of Mitsein and affect the whole of Being and Time but also underlines in the end a “shortfall in thinking” inherent not only to Heidegger’s work but, as Nancy claims, to our Western tradition, a shortfall which Nancy has attempted to remedy in his Being Singular Plural. (shrink)

Many approaches to addressing labour injustices—shortfalls from minimally decent wages and working conditions— focus on how governments should orient themselves toward other states in which such phenomena take place, or to the firms that are involved with such practices. But of course the question of how to regard such labour practices must also be faced by individuals, and individual consumers of the goods that are produced through these practices in particular. Consumers have become increasingly aware of their connections to complex (...) global production processes that often involve such injustice. For example, activist campaigns have exposed wrongful harm in factories producing clothes, shoes and mobile phones and farms producing coffee, tea and cocoa. These campaigns have promoted the message to ordinary people that by becoming connected to unjust labour practices through their purchasing behaviour, they acquire special additional moral responsibilities to contribute to reforming such practices, or to address the hardships suffered by the victims of the wrongdoing that result from them. The moral significance of the responsibilities of individual consumers has not, however, received much analytical scrutiny. Why should we believe that there are such responsibilities? And if there are such responsibilities, what are their grounds? How stringent are the responsibilities triggered by such connections? Finally, what are the implications of such responsibilities—the courses of action that they prescribe or proscribe? The activists who assert special ethical responsibilities for consumers have promoted many particular courses of action, but have seldom articulated the grounds of these responsibilities or explained why they should be taken to be stringent. And moral and political theorists have not devoted much focussed attention to this issue. For the consumer who is concerned to act in a morally permissible way, this presents a troubling practical challenge regarding the goods they may (or may not) purchase, and the moral relevance of their consumption choices more generally. While we cannot address all of these pressing questions in this chapter, we try to make some headway with them by discussing two general approaches to the question of how individuals should conceive of their responsibilities with respect to such practices, taking as our starting point the recent work of the late Iris Marion Young—the most sustained treatment of this topic by a prominent political theorist. In a series of influential articles and a posthumously published book, Young articulated an approach to conceiving of individual responsibilities to address labour injustices—the social connection model—at home and abroad. She also argued that an alternative model—the liability model—which she claimed had dominated discourse on this topic, suffered from very serious flaws. In a critical vein, we will argue that Young’s arguments against the liability model are not convincing, and that the alternative she proposes is itself vulnerable to some damaging objections. We also find, however, that the liability model would need to be extended in various ways to provide an adequate account of individual responsibility to address shortfalls from minimally decent wages and working conditions, and we begin the task of sketching an extended framework. (shrink)

Recent work in formal philosophy has concentrated over-whelmingly on the logical problems pertaining to epistemic shortfall - which is to say on the various ways in which partial and sometimes incorrect information may be stored and processed. A directly depicting language, in contrast, would reflect a condition of epistemic perfection. It would enable us to construct representations not of our knowledge but of the structures of reality itself, in much the way that chemical diagrams allow the representation (at a (...) certain level of abstractness) of the structures of molecules of different sorts. A diagram of such a language would be true if that which it sets out to depict exists in reality, i.e. if the structural relations between the names (and other bits and pieces in the diagram) map structural relations among the corresponding objects in the world. Otherwise it would be false. All of this should, of course, be perfectly familiar. (See, for example, Aristotle, Metaphysics, 1027 b 22, 1051 b 32ff.) The present paper seeks to go further than its predecessors, however, in offering a detailed account of the syntax of a working universal characteristic and of the ways in which it might be used. (shrink)

Future population growth is uncertain and matters for climate policy: higher growth entails more emissions and means more people will be vulnerable to climate-related impacts. We show that how future population is valued importantly determines mitigation decisions. Using the Dynamic Integrated Climate-Economy model, we explore two approaches to valuing population: a discounted version of total utilitarianism (TU), which considers total wellbeing and is standard in social cost of carbon dioxide (SCC) models, and of average utilitarianism (AU), which ignores population size (...) and sums only each time period’s discounted average wellbeing. Under both approaches, as population increases the SCC increases, but optimal peak temperature decreases. The effect is larger under TU, because it responds to the fact that a larger population means climate change hurts more people: for example, in 2025, assuming the United Nations (UN)-high rather than UN-low population scenario entails an increase in the SCC of 85% under TU vs. 5% under AU. The difference in the SCC between the two population scenarios under TU is comparable to commonly debated decisions regarding time discounting. Additionally, we estimate the avoided mitigation costs implied by plausible reductions in population growth, finding that large near-term savings ($billions annually) occur under TU; savings under AU emerge in the more distant future. These savings are larger than spending shortfalls for human development policies that may lower fertility. Finally, we show that whether lowering population growth entails overall improvements in wellbeing—rather than merely cost savings—again depends on the ethical approach to valuing population. (shrink)

Resurgent interest in both mechanistic and counterfactual theories of explanation has led to a fair amount of discussion regarding the relative merits of these two approaches. James Woodward is currently the pre-eminent counterfactual theorist, and he criticizes the mechanists on the following grounds: Unless mechanists about explanation invoke counterfactuals, they cannot make sense of claims about causal interactions between mechanism parts or of causal explanations put forward absent knowledge of productive mechanisms. He claims that these shortfalls can be offset if (...) mechanists will just borrow key tenets of his counterfactual theory of causal claims. What mechanists must bear in mind, however, is that by pursuing this course they risk both the assimilation of the mechanistic theories of explanation into Woodward’s own favored counterfactual theory, and they risk the marginalization of mechanistic explanations to a proper subset of all explanations. An outcome more favorable to mechanists might be had by pursuing an actualist-mechanist theory of the contents of causal claims. While it may not seem obvious at first blush that such an approach is workable, even in principle, recent empirical research into causal perception, causal belief, and mechanical reasoning provides some grounds for optimism. (shrink)