This paper compares and contrasts three different substantive principles of justice for making health care priority-setting or “rationing” decisions: need principles, maximising principles and egalitarian principles. The principles are compared by tracing out their implications for a hypothetical rationing decision involving four identified patients. This decision has been the subject of an empirical study of public opinion based on small-group discussions, which found that the public seem to support a pluralistic combination of all three kinds of rationing principle. In conclusion, (...) it is suggested that there is room for further work by philosophers and others on the development of a coherent and pluralistic theory of health care rationing which accords with public opinions. (shrink)

We present the Welleye – a novel and conceptually clear framework that shows how attention links the objective circumstances of people’s lives and selves to how they spend their time and feel day to day. While existing wellbeing frameworks in policy contain many of the factors included in the Welleye, they all lack attention as the “lens” that determines the impact of these factors on how people feel. Policymakers and organizations can use the Welleye to better understand how people are (...) faring and design and evaluate interventions aimed at making people better off. (shrink)

Scarce healthcare resources can be allocated in many ways. The National Institute for Health and Clinical Excellence in the UK focuses on the size of the benefit relative to costs, yet we know that there is support among clinicians and the general public for reducing inequalities in health. This paper shows how the UK general public trade-off these sometimes competing objectives, and the data we gather allow us to show the weight given to different population groups, for example, 1 extra (...) year of life in full health to someone who would otherwise die at the age of 60 years is worth more than twice as much as an additional year of life to someone who would otherwise die at the age of 70 years. Such data can help inform the rationing decisions faced by all healthcare systems around the world. (shrink)

It is widely accepted that one of the main objectives of government expenditure on health care is to generate health. Since health is a function of both length of life and quality of life, the quality-adjusted life-year (QALY) has been developed in an attempt to combine the value of these attributes into a single index number. The QALY approach - and particularly the decision rule that healthcare resources should be allocated so as to maximise the number of QALYs generated - (...) has often been equated with the utilitarian philosophy of maximising `the greatest happiness of the greatest number'. This paper considers the extent to which the measurement and aggregation of QALYs really is utilitarian by developing a new taxonomy in order to classify utilitarianism and the different aspects of the QALY approach. It is shown that the measurement of QALYs is consistent with a number of different moral positions and that QALYs do not have to be aggregated according to the maximisation rule. Therefore it is inappropriate to necessarily equate QALYs with utilitarianism. It is shown that much turns on what in principle the QALY represents and how in practice it can be operationalised. The paper highlights the category confusion that is often present here and suggests possible avenues for future theoretical and empirical research. (shrink)

Behavioural spillovers refer to the influence that a given intervention targeting behaviour 1 exerts on a subsequent, non-targeted, behaviour 2, which may or may not be in the same domain (health, finance etc.) as one another. So, a nudge to exercise more, for example, could lead people to eat more or less, or possibly even to give more or less to charity depending on the nature of the spillover. But what if spillovers also operate backwards; that is, if the expectation (...) of behaviour 1 influences behaviour 0 that precedes it? For example, a person may form an intention to exercise prompted by a policy intervention but overeat at present as a result. We define such a possibility as a "spillunder". In the proposed article, we critically review the few papers that we have identified through a narrative literature review which have demonstrated spillunder effects to date, and we propose a conceptual framework. Based on evidence about the human mind and behaviour from psychology and economics, we argue that spillunder effects may be more common than the limited empirical findings suggest. We propose six representative mechanisms through which the prospect of behaviour 1 may impact behaviour 0: executive functions, moral licensing and moral cleansing, emotion regulation, energization, construal level, and savouring and dread. We further discuss the policy and practical implications of spillunder effects and examine methodological issues that need to be considered when empirically testing these effects. As with our earlier paper on spillovers, we aim to motivate other behavioural scientists to research behavioural spillunders more systematically and extensively, and to prompt decision makers to consider these effects when designing behavioural interventions. (shrink)

Background Researchers engaged in the study of the ethical, legal, and social implications (ELSI) of genetics and genomics are often publicly funded and intend their work to be in the public interest. These features of U.S. ELSI research create an imperative for these scholars to demonstrate the public utility of their work and the expectation that they engage in research that has potential to inform policy or practice outcomes. In support of the fulfillment of this “translational mandate,” the Center for (...) ELSI Resources and Analysis (CERA), funded by the National Human Genome Research Institute (NHGRI), aims to facilitate community-informed, ELSI research results synthesis and dissemination. However, little is known about how ELSI research scholars define the goals of translation and imagine the intended users of their research findings.Methodology We distributed a Qualtrics survey to ELSI scholars that aimed to determine: (1) researchers’ expectations for their research findings in relation to policy or practice outcomes, (2) the stakeholder groups researchers believe could benefit from their research findings, and (3) the methods researchers use to foster the uptake of their findings by those stakeholders.Results Most ELSI researchers surveyed thought there were stakeholders that could benefit from their research findings, including health care professionals, at-risk individuals, patients, and their family members, policy-makers, and researchers/scientists, and expected their research findings to inform the creation or revision of laws, policies, or practice guidelines. Most researchers planned to disseminate findings directly to relevant stakeholders, with fewer expecting dissemination support from research funders, universities, or other entities.Conclusion The broad range of research topics, disciplines, and set of potential end users represented in ELSI reseach complicate the work of a knowledge broker. Nonetheless, the CERA can play an important role in disseminating ELSI results to relevant stakeholders. Further research should explore outreach mechanisms. (shrink)

Public investments in genomic and precision medicine have begun to yield clinically useful interventions, most recently, for example, two new, FDA-approved gene therapies for sickle cell disease (F...

Descartes is widely portrayed as the arch proponent of “the epistemological transparency of thought” (or simply, “Transparency”). The most promising version of this view—Transparency-through-Introspection—says that introspecting (i.e., inwardly attending to) a thought guarantees certain knowledge of that thought. But Descartes rejects this view and provides numerous counterexamples to it. I argue that, instead, Descartes’s theory of self-knowledge is just an application of his general theory of knowledge. According to his general theory, certain knowledge is acquired only through clear and distinct (...) intellection. Thus, in his view, certain knowledge of one’s thoughts is acquired only through clear and distinct intellection of one’s thoughts. Introspection is a form of intellection and it can be clear and distinct. Ordinarily, however, introspection isn’t clear and distinct but is instead confused with dubitable perceptions of bodies. To make introspection clear and distinct, we need to “sharply separate” it from all perceptions of bodies by doubting all perceptions of bodies. Without such radical doubt, introspection remains confused and we lack certain knowledge not just of the specific features of our thoughts, but even of the minimal claim that a thought exists. Far from being the high priest of Transparency, Descartes is radically opposed to it. (shrink)

In _Matter and Consciousness_, Paul Churchland presents a concise and contemporary overview of the philosophical issues surrounding the mind and explains the main theories and philosophical positions that have been proposed to solve them. Making the case for the relevance of theoretical and experimental results in neuroscience, cognitive science, and artificial intelligence for the philosophy of mind, Churchland reviews current developments in the cognitive sciences and offers a clear and accessible account of the connections to philosophy of mind. For (...) this third edition, the text has been updated and revised throughout. The changes range from references to the iPhone's "Siri" to expanded discussions of the work of such contemporary philosophers as David Chalmers, John Searle, and Thomas Nagel. Churchland describes new research in evolution, genetics, and visual neuroscience, among other areas, arguing that the philosophical significance of these new findings lies in the support they tend to give to the reductive and eliminative versions of materialism. Matter and Consciousness, written by the most distinguished theorist and commentator in the field, offers an authoritative summary and sourcebook for issues in philosophy of mind. It is suitable for use as an introductory undergraduate text. (shrink)

The options in a decision problem generally have outcomes with common features. Putting aside the common features simplifies deliberations, but the simplification requires a philosophical justification that this book provides.

A cross-disciplinary dialogue among writers who are sympathetic to the humanist tradition, and interested in developing a new humanist project through debate. The book emerges from the Institute of Ideas' festival, the Battle of Ideas.

Ideas can define and transform society, but how healthy is intellectual life today? In a period when Big Brother refers not to George Orwell but to a reality TV show, and when bright young things are developing gameshow formats rather than scribbling essays; when thinkers join think tanks to design short-term government policy rather than reflecting on and challenging the status quo, and when the ever growing number of graduates seem more interested in job prospects than academic endeavour, is intellectual (...) life in terminal decline? This book looks at the idea of the public intellectual, considering whether such thinkers are becoming an endangered species. It also looks at the legacy of relativism and ethical doubts about the pursuit of knowledge, and the effect of such developments on intellectual life. The final section considers the expansion of higher education and the changing role of the academic. Taken together, the essays in this collection form a comprehensive overview of the intellectual climate today, and the possibilities for the future. This volume was previously published as a special issue of the journal _Critical Review of International Social and Political Philosophy _. (shrink)

This book demonstrates how children's imagination makes a continuing contribution to their cognitive and emotional development.

Although deductive reasoning is a closed system, one's beliefs about the world can influence validity judgements. To understand the associated functional neuroanatomy of this belief-bias we studied 14 volunteers using event-related fMRI, as they performed reasoning tasks under neutral, facilitatory and inhibitory belief conditions. We found evidence for the engagement of a left temporal lobe system during belief-based reasoning and a bilateral parietal lobe system during belief-neutral reasoning. Activation of right lateral prefrontal cortex was evident when subjects inhibited a prepotent (...) response associated with belief-bias and correctly completed a logical task, a finding consistent with its putative role in cognitive monitoring. By contrast, when logical reasoning was overcome by belief-bias, there was engagement of ventral medial prefrontal cortex, a region implicated in affective processing. This latter involvement suggests that belief-bias effects in reasoning may be mediated through an influence of emotional processes on reasoning. (shrink)

The twentieth century has witnessed an unprecedented 'crisis in the foundations of mathematics', featuring a world-famous paradox (Russell's Paradox), a challenge to 'classical' mathematics from a world-famous mathematician (the 'mathematical intuitionism' of Brouwer), a new foundational school (Hilbert's Formalism), and the profound incompleteness results of Kurt Gödel. In the same period, the cross-fertilization of mathematics and philosophy resulted in a new sort of 'mathematical philosophy', associated most notably (but in different ways) with Bertrand Russell, W. V. Quine, and Gödel himself, (...) and which remains at the focus of Anglo-Saxon philosophical discussion. The present collection brings together in a convenient form the seminal articles in the philosophy of mathematics by these and other major thinkers. It is a substantially revised version of the edition first published in 1964 and includes a revised bibliography. The volume will be welcomed as a major work of reference at this level in the field. (shrink)

This article examines how on-air conversations between journalists indicate how US television coverage of a race-related crisis can reflect racial ideology. Using critical discourse analysis, we examined interjournalistic discourse about African Americans in national network and cable news programs that aired after Hurricane Katrina reached New Orleans. While we expected conversational semantic items from conservative Fox News to reflect racial ideology, we also found such discursive elements from politically moderate and progressive news organizations such as CBS, CNN, and MSNBC. These (...) findings are consistent with Anxiety Uncertainty Management theory, which predicts that exposure to stressors in unfamiliar settings causes individuals to think in ethnocentric, dichotomous, stereotypical ways. Our research underscores the impact of white privilege on language, communication, and news production, and the need for cultural competence training to enhance journalists’ ability to discuss racial matters with ease. (shrink)

Zusammenfassungen der Referate in französischer Sprache.

An agent often does not have precise probabilities or utilities to guide resolution of a decision problem. I advance a principle of rationality for making decisions in such cases. To begin, I represent the doxastic and conative state of an agent with a set of pairs of a probability assignment and a utility assignment. Then I support a decision principle that allows any act that maximizes expected utility according to some pair of assignments in the set. Assuming that computation of (...) an option's expected utility uses comprehensive possible outcomes that include the option's risk, no consideration supports a stricter requirement. (shrink)

Schelling und Hegel benutzen in ihren philosophischen Texten mathematische und naturwissenschaftliche Modelle wie Unendlichkeit oder Gleichgewicht. Die Strukturen dieser Begriffe liefern einen Massstab fur den Vergleich der Positionen Schellings und Hegels, der fur Schellings Identitatsphilosophie und Hegels erste Jenaer Schriften durchgefuhrt wird. Als wichtigstes Resultat kann eine grundlegende Differenz zwischen beiden Positionen bereits um 1801 nachgewiesen und gezeigt werden, dass diese auf einer unterschiedlichen Auffassung der Rolle des Absoluten beruht.

Like Plato, Protagoras held that young children learn virtue from fine examples in poetry. Unlike Plato, Protagoras taught adults by correcting the diction of poets. In this paper I ask what his standard of correctness might be, and what benefit he intended his students to take from exercises in correction. If his standard of correctness is truth, then he may intend his students to learn by questioning the content of poems; that would be suggestive of Plato’s program in Republic III. (...) But his standard is more likely to be the accurate use of language; in that case he would intend his students to learn to express their thoughts clearly enough that their audience would understand what they were saying. That standard would be independent of the truth of what they are saying; and that would be a precursor to modern techniques by which we try to teach speaking and writing. Truth is not so easy to escape, however, and we shall see that Protagoras’ exercise must assume that the poet is trying to tell the truth. (shrink)

This study examines the complex and dynamic relationship between Kosovo and NATO. It argues that Kosovo’s prospects for NATO membership are shaped by an array of contradictory and often confusing international and domestic political forces. It draws on theoretical sources, media reports, and descriptive statistical data to the factors shaping expectations for NATO membership. The study relies on theories and concepts from the established and evolving literature on alliance formation and expansion to explain how states aspiring for membership in security (...) organizations must navigate a pattern of political and security hurdles in their quest for membership accession. It then explores Kosovo’s case for NATO membership by examining whether Kosovo has met key political and security benchmarks and devotes significant attention to the settlement dispute with Serbia, the roles played by the U.S. and E.U., and identifies alternative paths for Kosovo’s membership in NATO. (shrink)

Die MISCELLANEA MEDIAEVALIA präsentieren seit ihrer Gründung durch Paul Wilpert im Jahre 1962 Arbeiten des Thomas-Instituts der Universität zu Köln. Das Kernstück der Publikationsreihe bilden die Akten der im zweijährigen Rhythmus stattfindenden Kölner Mediaevistentagungen, die vor über 50 Jahren von Josef Koch, dem Gründungsdirektor des Instituts, ins Leben gerufen wurden. Der interdisziplinäre Charakter dieser Kongresse prägt auch die Tagungsakten: Die MISCELLANEA MEDIAEVALIA versammeln Beiträge aus allen mediävistischen Disziplinen - die mittelalterliche Geschichte, die Philosophie, die Theologie sowie die Kunst- und (...) Literaturwissenschaften sind Teile einer Gesamtbetrachtung des Mittelalters. (shrink)

Various promising claims have been made that business can help alleviate poverty, and can do so in ways that add value to the bottom line. This article begins by highlighting that the evidence for such claims is not especially strong, particularly if business is thought of as a development agent, i.e. an organization that consciously and accountably contributes towards pro-poor outcomes. It goes on to ask whether, if we did know more about either the business case or the poverty alleviation (...) case, would this give cause for greater optimism that business could make a significant contribution to development. By exploring the experiences of producers of Fairtrade tea in Kenya, we reveal the complex nature of what constitutes a beneficial outcome for the poor and marginalized, and the gap that can exist between ethical intentions and the experience of their intended beneficiaries. The lessons of these experiences are relevant for Fairtrade and any commercial initiative that seeks to achieve outcomes beneficial and recognizable to the poor, and raise questions about the integration of social and instrumental outcomes that a future generation of ethical entrepreneurship will need to address. (shrink)

I argue that supervenience is an inadequate device for representing relations between different levels of phenomena. I then provide six criteria that emergent phenomena seem to satisfy. Using examples drawn from macroscopic physics, I suggest that such emergent features may well be quite common in the physical realm.