Priority setting (also known as resource allocation or rationing) occurs at every level of every health system and is one of the most significant health care policy questions of the 21st century. Because it is so prevalent and context specific, improving priority setting in a health system entails improving it in the institutions that constitute the system. But, how should this be done? Normative approaches are necessary because they help identify key values that clarify policy choices, but insufficient because different (...) approaches lead to different conclusions and there is no consensus about which ones are correct, and they are too abstract to be directly used in actual decision making. Empirical approaches are necessary because they help to identify what is being done and what can be done, but are insufficient because they cannot identify what should be done. Moreover, to be really helpful, an improvement strategy must utilize rigorous research methods that are able to analyze and capture experience so that past problems are corrected and lessons can be shared with others. Therefore, a constructive, practical and accessible improvement strategy must be research-based and combine both normative and empirical methods. In this paper we propose a research-based improvement strategy that involves combining three linked methods: case study research to describe priority setting; interdisciplinary research to evaluate the description using an ethical framework; and action research to improve priority setting. This describe-evaluate-improve strategy is a generalizable method that can be used in different health care institutions to improve priority setting in that context. (shrink)

Abstract The goal of social explanation is to understand human action, both individual and collective. To do so successfully we must explain action on three distinct (but intertwined) levels: the actors? intentions, the meaning that actors and interpreters ascribe to action, and the structural ideals that govern action. Each level of explanation has certain types of rationality associated with it. Only on the level of intentionality does instrumental rationality assume a prime importance, yet even there it must compete with normative (...) and expressive accounts of action. (shrink)

As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed (...) the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. (shrink)

It is common to think of medical and ethical modes of thought as different in kind. In such terms, some clinical situations are made more complicated by an additional ethical component. Against this picture, we propose that medical and ethical modes of thought are not different in kind, but merely different aspects of what it means to be human. We further propose that clinicians are uniquely positioned to synthesise these two aspects without prior knowledge of philosophical ethics.

I argue that Aristotle believes that virtue comes in degrees. After dispatching with initial concerns for the view, I argue that we should accept it because Aristotle conceives of heroic virtue as the highest degree of virtue. I support this interpretation of heroic virtue by considering and rejecting alternative readings, then showing that heroic virtue characterized as the highest degree of virtue is consistent with the doctrine of the mean.

Plato seems to have been pessimistic about how most people stand with regard to virtue. However, unlike the Stoics, he did not conclude that most people are vicious. Rather, as we know from discussions across several dialogues, he countenanced decent ethical conditions that fall short of genuine virtue, which he limited to the philosopher. Despite Plato's obvious interest in this issue, commentators rarely follow his lead by investigating in detail such conditions in the dialogues. When scholars do investigate what kind (...) of virtue, if any, Plato thinks is open to non-philosophers, they typically look to the Republic. But in the Republic Plato sets out an ideal city; therefore, the virtue available to non-philosophers there is likely different from what he thinks is available to them in the real world. If we want to determine Plato's thoughts about the virtue of actual non-philosophers, we must look elsewhere. In this paper, I set my sights on the Phaedo. (shrink)

Résumé: Dans ce dialogue, deux personnages principaux, Philopolis et Éleuthérios, proposent la position communautarienne et la position contractualiste libérale comme fondements de la théorie politique. Le débat se déroule, comme tout bon débat devrait le faire, autour d’une bouteille de Chardonnay.

Harold Shapiro, the former president of Princeton, ventured to say that theology had been divorced from the liberal. Professor Doug Dix's book is about arranging a remarriage. His analysis suggests the divorce goes deeper than Shapiro may have realized. Love has been divorced from learning because money has replaced truth as the object of affection. Now students learn to earn. Natural Literacy strives to motivate students and faculty to instead learn to love.

Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients. I argue that it is morally permissible for HCWs to (...) abstain from work when their duty to treat is outweighed by the combined risks and burdens of that work. For HCWs who live with their families, the obligation to protect one’s family from infection contributes significantly to those burdens. There are, however, a range of complicating factors including the strength of duty to treat which varies according to the HCW’s role, the vulnerability of family members to the disease, the willingness of family members to risk infection and the resources available to the HCW to protect their family. In many cases, HCWs in ‘frontline’ roles with a weak duty to treat and families at home will be morally permitted to abstain from work given the risks posed by COVID-19; therefore, society should provide additional incentives to maintain sufficient staff in these roles. (shrink)

In the United States today, the use or possession of many drugs is a criminal offense. Can these criminal laws be justified? What are the best reasons to punish or not to punish drug users? These are the fundamental issues debated in this book by two prominent philosophers of law. Douglas Husak argues in favor of drug decriminalization, by clarifying the meaning of crucial terms, such as legalize, decriminalize, and drugs; and by identifying the standards by which alternative drug policies (...) should be assessed. He critically examines the reasons typically offered in favor of our current approach and explains why decriminalization is preferable. Peter de Marneffe argues against drug legalization, demonstrating why drug prohibition, especially the prohibition of heroin, is necessary to protect young people from self-destructive drug use. If the empirical assumptions of this argument are sound, he reasons, drug prohibition is perfectly compatible with our rights to liberty. (shrink)

Robert Card’s “Reasonability View” is a significant contribution to the debate over the place of conscientious objection in health care. In his view, conscientious objections can only be accommodated if the grounds for the objection meet a reasonability standard. I identify inconsistencies in Card’s description of the reasonability standard and argue that each version he specifies is unsatisfactory. The criteria for reasonability that Card sets out most frequently have no clear underpinning principle and are too permissive of immoral objections. Card (...) has also claimed that petitioners must justify their positions with Rawlsian public reason. I argue that, although the resulting reasonability standard is principled, it is overly restrictive. I also show that a reasonability standard built on Rawls’ more lenient conception of reasonableness would be overly permissive of objections at odds with professional healthcare standards. Finally, I argue for my favored solution, which bases the reasonability standard on minimal professional standards. (shrink)

Current mainstream approaches to conscientious objection either uphold the standards of public health care by preventing objections or protect the consciences of health‐care professionals by accommodating objections. Public justification approaches are a compromise position that accommodate conscientious objections only when objectors can publicly justify the grounds of their objections. Public justification approaches require objectors and assessors to speak a common normative language and to this end it has been suggested that objectors should be required to cast their objection in terms (...) of public reason. We provide critical support for such a public reason condition and argue that it would be neither too demanding nor too permissive. We also respond to objections that it unfairly favours secular over religious objectors and that public reasons cannot be held with the kind of sincerity thought to characterize conscientious objections. (shrink)

In this paper, we explicate the method of Investigative Ordinary Language Philosophy (IOLP). The term was coined by John Cook to describe the unique philosophical approach of Frank Ebersole. We argue that (i) IOLP is an overlooked yet valuable philosophical method grounded in our everyday experiences and concerns; and (ii) as such, Frank Ebersole is an important but neglected figure in the history of ordinary language philosophy.

Philosophical Investigations, Volume 45, Issue 4, Page 414-429, October 2022.

On one hand, it is commonly accepted that clinicians should not deceive their patients, yet on the other there are many instances in which deception could be in a patient’s best interest. In this paper, I propose that this conflict is in part driven by a narrow conception of deception as contingent on belief. I argue that we cannot equate non-deceptive care solely with introducing or sustaining a patient’s true belief about their condition or treatment, because there are many instances (...) of clinical care which are non-doxastic and non-deceptive. Inasmuch as this is true, better understanding of non-doxastic attitudes, such as hope and pretence, could improve our understanding of deception in clinical practice. (shrink)

Montaigne is generally portrayed either as a principal proponent of the mix of scepticism, neo-Stoicism and Tacitism that feeds the early-modern reason-of-state literature or as a thoroughgoing political moralist who rejects this literature's politics of necessity and princely deception in favour of a politics of classical or Christian virtue. I argue that Montaigne inhabits neither of these positions exclusively. Instead, he argues in utramque partem, both for and against reason of state, in order to educate > his readers about the (...) perils of following elites who would use either political necessity or religious moralism as pretexts for violence in pursuit of political gain. (shrink)

Why do some addicted people chronically fail in their goal to recover, while others succeed? On one established view, recovery depends, in part, on efforts of intentional planning agency. This seems right, however, firsthand accounts of addiction suggest that the agent’s self-narrative also has an influence. This paper presents arguments for the view that self-narratives have independent, self-fulfilling momentum that can support or undermine self-governance. The self-narrative structures of addicted persons can entrench addiction and alienate the agent from practically feasible (...) recovery plans. Strategic re-narration can redirect narrative momentum and therefore support recovery in ways that intentional planning alone cannot. (shrink)

The 2023 doctors’ strikes in the UK have elicited a familiar moral outcry that such strikes are morally wrong. We consider five arguments that might be thought to show doctors’ strikes are morally impermissible but show that they all fail. The most we can conclude from such arguments is that doctors’ strikes are morally permissible in a narrower range of circumstances than strikes in other sectors.We then outline two independent but compatible justifications for doctors’ strikes, one that appeals to doctors’ (...) interests in fair pay and working conditions and one that appeals to doctors’ duty to protect public health. We also suggest that doctors’ strikes can be supererogatory when they aim to correct a government failing in its own duty to protect public health. Finally, we assess the 2023 UK doctors’ strikes. We conclude that they are justified and there is a case for considering them supererogatory. (shrink)

In this essay, I investigate the longstanding philosophical problem of whether we have control over our actions in a deterministic world. In working through a range of everyday situations in which this problem could arise, I come to the realisation that determinism has no bearing on whether we have control over our actions, because having control over our actions and determinism only make sense under different aspects.

ABSTRACT‘Self-ambiguity’, we suggest, is best understood as an uncertainty about how strongly a given feature reflects who one truly is. When this understanding of self-ambiguity is applied to a view of the self as having both essential and shapable components, self-ambiguity can be seen to have two aspects: (1) uncertainty about one's essential or relatively unchangeable characteristics, e.g. one's sexuality, and (2) uncertainty about how to shape oneself, e.g. which values to commit to, actions to pursue, or essential features to (...) identify with. We explain how a narrative account of agency can accommodate these forms of self-ambiguity and argue that such an account also reveals another kind of self-ambiguity, namely, (3) uncertainty about whether one's established self-narrative represents who one really is. We illustrate this third form of self-ambiguity in the context of addiction where people's established addiction self-narratives make it difficult to identify with recovery. We argue that recovery will require embracing, especially, our third form of self-ambiguity as a chance for positive self-transformation. Treatment for addiction should, therefore, support people in going through and ultimately narratively resolving the inevitable self-ambiguities of the recovery process. (shrink)

My name is Doug Adam. I am a convicted felon. I turned myself in, in mid-1987, to a U.S. attorney in New York, pleading guilty to felony charges of tax fraud and fraud on a mutual fund. It leftme scared to death, millions of dollars in debt, with no job, and at the age of37 back living with my parents while I awaited sentencing. What began then was a painful process of self discovery. After thriving on competition and perfection (...) all my life, how could I admit I wasn't perfect? Perfection wasn't even close. I was a felon. (shrink)

In Discovering Alabama Forests, ecologist-educator Doug Phillips and photographer Robert Falls celebrate the current health and diversity of Alabama woodlands while sounding a call for their wise management and protection in the future.

For Howard Gardner, Multiple Intelligences Theory (MI) constitutes “a new understanding of human nature,” on a par with those proffered by Socrates and Freud. While the educational community in general has responded enthusiastically to MI, because it enables them to deal with students more holistically, MI embeds a significant dualism that is detrimental to truly holistic education. I will argue that: values are pervasive; intelligence requires the exercise of judgment, which no computational system can emulate; domains in which intelligence functions (...) are contested, as much as in the realm of “values,” judgments about “values” are “intelligent” in seeking to determine what conditions will promote flourishing, and the more appropriate distinction to draw is not between two structural domains of “empirical fact” and “subjective value,” but between structural conditions and directional responses to these conditions. (shrink)

RésuméDans ce dialogue, deux personnages principaux, Philopolis et Éleuthérios, proposent la position communautarienne et la position contractualiste libérale comme fondements de la théorie politique. Le débat se déroule, comme tout bon débat devrait lefaire, autour d'une bouteille de Chardonnay.

This ten chapter text is designed to be used as a stand-alone text or in conjunction with a set of primary readings in a twelve week course on modern social theory or the second half of a full-year course on sociological theory. It examines the most important theoretical approaches of the 20th and 21st centuries, balancing concise coverage with appropriate depth of analysis. It avoids rehashing classical theory while still placing recent theorists in a historical context. It takes into account (...) developments in social theory over the last twenty years and highlights Canadian theorists (such as Innis, McLuhan, and Grant) and context (for example, communications, technology, and nature). It includes sometimes overlooked subject areas such as situationism and postmodernism, as well as European theorists not covered by many texts. (shrink)

We conducted and analyzed qualitative interviews with 12 persons working on the Healthy Public Housing Initiative in Boston, Massachusetts in 2001. Our goal was to generate ideas and themes related to the ethics of the community-based participatory research in which they were engaged. Specifically, we wanted to see if we found themes that differed from conventional research that is based on an individualistic ethics. There were clearly distinct ethical issues raised with respect to projects and individuals who engage in community-based (...) collaborations. The differences that arose from the interviews were seeking equality between the partners, the need for the community partner to defend the community, dealing with unflattering data, meeting community expectations and producing tangible benefits to the community. (shrink)

All people are vulnerable to having their self-concepts shaped by others. This article investigates that vulnerability using a theory of narrative self-constitution. According to narrative self-constitution, people depend on others to develop and maintain skills of self-narration and they are vulnerable to having the content of their self-narratives co-authored by others. This theoretical framework highlights how vulnerability to co-authoring is essential to developing a self-narrative and, thus, the possibility of autonomy. However, this vulnerability equally entails that co-authors can undermine autonomy (...) by contributing disvalued content to the agent’s self-narrative and undermining her authorial skills. I illustrate these processes with the first-hand reports of several women who survived sexual abuse as children. Their narratives of survival and healing reveal the challenges involved in developing the skills required to manage vulnerability to co-authoring and how others can help in this process. Finally, I discuss some of the implications of co-authoring for the healthcare professional and the therapeutic relationship. (shrink)

In this paper I discuss the kinds of dependence relation that philosophers have argued may obtain between neural events and conscious events; between Ns and Cs. Three major candidate relations are constitution, realization, and identity. There are other candidates for the mind/body relation, but these will serve as the major options. Indeed, these are already more than three options, because philosophers do not agree on the best way to understand constitution; still less to understand realization. I argue that dispute is (...) not merely "metaphysical": each candidate has distinct empirical consequences. (shrink)

This essay explores the process and issues related to community collaborative research that involves Native Americans generally, and specifically examines the Navajo Nation’s efforts to regulate research within its jurisdiction. Researchers need to account for both the experience of Native Americans and their own preconceptions about Native Americans when conducting research about Native Americans. The Navajo Nation institutionalized an approach to protecting members of the nation when it took over Institutional Review Board (IRB) responsibilities from the US Indian Health Service (...) (IHS) in 1996. While written regulations for the Navajo Nation IRB are not dissimilar, and in some ways are less detailed than those of the IHS IRB, in practice the Navajo Nation allows less flexibility. Primary examples of this include not allowing expedited review and requiring prepublication review of all manuscripts. Because of its broad mandate, the Navajo Nation IRB may also require review of some projects that would not normally be subject to IRB approval, including investigative journalism and secondary research about Navajo People that does not involve direct data collection from human subjects. (shrink)

Sometimes healthcare professionals conscientiously refuse to treat patients despite the patient requesting legal, medically indicated treatments within the professionals’ remit. Recently, there has been a proliferation of views using the concept of public reason to specify which conscientious refusals of treatment should be accommodated. Four such views are critically assessed, namely, those of Robert Card, Massimo Reichlin, David Scott, and Doug McConnell. This paper argues that McConnell’s view has advantages over the other approaches because it combines the requirement that (...) healthcare professionals publicly justify the grounds of their conscientious refusals of treatment with the requirement that those grounds align with minimally decent healthcare. This relatively restrictive approach accommodates conscientious refusals from minimally decent healthcare professionals while still protecting good healthcare, the independence of the healthcare professions, and the fiduciary relationships. (shrink)

The COVID-19 pandemic has created unusually challenging and dangerous workplace conditions for key workers. This has prompted calls for key workers to receive a variety of special benefits over and above their normal pay. Here, we consider whether two such benefits are justified: a no-fault compensation scheme for harm caused by an epidemic and hazard pay for the risks and burdens of working during an epidemic. Both forms of benefit are often made available to members of the armed forces for (...) the harms, risks and burdens that come with military service. We argue from analogy that these benefits also ought to be provided to key workers during an epidemic because, like the military, key workers face unavoidable harms, risks and burdens in providing essential public good. The amount of compensation should be proportional to the harm suffered and the amount of hazard pay should be proportional to the risk and burden endured. Therefore, key workers should receive the same amount of compensation and hazard pay as the military where the harms, risks and burdens are equivalent. In the UK, a form of no-fault compensation has recently been made available to the surviving families of key workers who suffer fatal COVID-19 infections. According to our argument, however, it is insufficient because it offers less to key workers than is made available to the families of armed services personnel killed on duty. (shrink)

The theory of sexual selection suggests several possible explanations for the development of standards of physical attractiveness in humans. Asymmetry and departures from average proportions may be markers of the breakdown of developmental stability. Supernormal traits may present age- and sex-typical features in exaggerated form. Evidence from social psychology suggests that both average proportions and (in females) “neotenous” facial traits are indeed more attractive. Using facial photographs from three populations (United States, Brazil, Paraguayan Indians), rated by members of the same (...) three populations, plus Russians and Venezuelan Indians, we show that age, average features, and (in females) feminine/neotenous features all play a role in facial attractiveness. (shrink)

In The Time After, which references the process of photography as well as the future fate of our planet, fine arts photographer Doug Fogelson uses an iconoclastic multiple exposure technique in order to depict our collective surroundings, producing imagery that reflects our own alien experience of nature, as well as the distanced perspective of the viewer. This volume collects over 160 of Fogelson's spectacular images and pairs them with speculative and poetic essays by Derrick Jensen, Eiren Caffall, and Bridgette (...) R. McCullough. (shrink)