Purpose: A study was made of attitudes of clinical geneticists regarding the age at which minors should be allowed to undergo a carrier test and the reasons they provide to explain their answer. Methods: European clinical institutions where genetic counselling is offered to patients were contacted. 177 (63%) of the 287 eligible respondents answered a questionnaire. Results: Clinical geneticists were significantly more in favour of providing a carrier test to a younger person if the request was made together with the (...) parents than if the adolescent requested the test personally. Although a large fraction of respondents (16%–30%) were “neither unwilling nor willing” to provide a carrier test to a 16-year-old adolescent who requested the test personally, for most disorders slightly more clinical geneticists were “very willing” or “willing”. Conclusion: Age is not the only decisive element when considering the participation of adolescents in decisions affecting their health. The clinical geneticists referred to cognitive, emotional and sexual maturity and the support of parents as crucial elements in their comments regarding when to tell children about their genetic risk or to allow adolescents to request a carrier test. (shrink)

Moral philosophers agree that welfare matters. But they disagree about what it is, or how much it matters. In this vital new work, Wayne Sumner presents an original theory of welfare, investigating its nature and discussing its importance. He considers and rejects all notable theories of welfare, both objective and subjective, including hedonism and theories founded on desire or preference. His own theory connects welfare closely with happiness or life satisfaction. Reacting against the value pluralism that currently dominates moral philosophy, (...) he advances welfare as the only basic ethical value. He concludes by discussing the implications of this thesis for ethical and political theory. Written in clear, non-technical language, and including a definitive survey of other work in this area, Sumner's book is essential reading for moral philosophers, political theorists, and welfare economists. (shrink)

Can philosophy offer reasonable grounds for the existence of a God possessing genuine religious significance and not proposed simply as the solution to a purely intellectual philosophical problem? Certainly many contemporary thinkers have insisted that no genuine religion could be based upon metaphysics. In this book, however, T. L. S. Sprigge examines sympathetically the most notable metaphysical systems of the last four centuries which purport to put religion on a rational footing and, after a thorough examination of their claims, considers (...) what kind of religious outlook they might support and how they actually affected the lives of their proponents. The thinkers studied include Spinoza, Hegel, T. H. Green, Bernard Bosanquet, Josiah Royce, A. N. Whitehead, and Charles Hartshorne, concluding with an exposition of the author's own viewpoint and a general discussion on the relation between metaphysics and religion. There is also a chapter on Kierkegaard as the most important critic of metaphysical religion. (shrink)

Critics of contemporary metaphysics argue that it attempts to do the hard work of science from the ease of the armchair. Physics, not metaphysics, tells us about the fundamental facts of the world, and empirical psychology is best placed to reveal the content of our concepts about the world. Exploring and understanding the world through metaphysical reflection is obsolete. In this paper, I will show why this critique of metaphysics fails, arguing that metaphysical methods used to make claims about the (...) world are similar to scientific methods used to make claims about the world, but that the subjects of metaphysics are not the subjects of science. Those who argue that metaphysics uses a problematic methodology to make claims about subjects better covered by natural science get the situation exactly the wrong way around: metaphysics has a distinctive subject matter, not a distinctive methodology. The questions metaphysicians address are different from those of scientists, but the methods employed to develop and select theories are similar. In the first section of the paper, I will describe the sort of subject matter that metaphysics tends to engage with. In the second section of the paper, I will show how metaphysical theories are classes of models and discuss the roles of experience, common sense and thought experiments in the construction and evaluation of such models. Finally, in the last section I will discuss the way these methodological points help us to understand the metaphysical project. Getting the right account of the metaphysical method allows us to better understand the relationship between science and metaphysics, to explain why doing metaphysics successfully involves having a range of different theories, to understand the role of thought experiments involving fictional worlds, and to situate metaphysical realism in a scientifically realist context. (shrink)

The paradox of knowability, derived from a proof by Frederic Fitch in 1963, is one of the deepest paradoxes concerning the nature of truth. Jonathan Kvanvig argues that the depth of the paradox has not been adequately appreciated. It has long been known that the paradox threatens antirealist conceptions of truth according to which truth is epistemic. If truth is epistemic, what better way to express that idea than to maintain that all truths are knowable? In the face of the (...) paradox, however, such a characterization threatens to undermine antirealism. If Fitch's proof is valid, then one can be an antirealist of this sort only by endorsing the conclusion of the proof that all truths are known.Realists about truth have tended to stand on the sidelines and cheer the difficulties faced by their opponents from Fitch's proof. Kvanvig argues that this perspective is wholly unwarranted. He argues that there are two problems raised by the paradox, one that threatens antirealism about truth and the other that threatens everybody's view about truth, realist or antirealist. The problem facing antirealism has had a number of proposed solutions over the past 40 years, and the results have not been especially promising with regard to the first problem. The second problem has not even been acknowledged, however, and the proposals regarding the first problem are irrelevant to the second problem. This book thus provides a thorough investigation of the literature on the paradox, and also proposes a solution to the deeper of the two problems raised by Fitch's proof. It provides a complete picture of the paradoxicality that results from Fitch's proof, and presents a solution to the paradox that claims to address both problems raised by the original proof. (shrink)

I defend a one category ontology: an ontology that denies that we need more than one fundamental category to support the ontological structure of the world. Categorical fundamentality is understood in terms of the metaphysically prior, as that in which everything else in the world consists. One category ontologies are deeply appealing, because their ontological simplicity gives them an unmatched elegance and spareness. I’m a fan of a one category ontology that collapses the distinction between particular and property, replacing it (...) with a single fundamental category of intrinsic characters or qualities. We may describe the qualities as qualitative charactersor as modes, perhaps on the model of Aristotelian qualitative (nonsubstantial) kinds, and I will use the term “properties” interchangeably with “qualities”. The qualities are repeatable and reasonably sparse, although, as I discuss in section 2.6, there are empirical reasons that may suggest, depending on one’s preferred fundamental physical theory, that they include irreducibly intensive qualities. There are no uninstantiated qualities. I also assume that the fundamental qualitative natures are intrinsic, although physics may ultimately suggest that some of them are extrinsic. On my view, matter, concrete objects, abstract objects, and perhaps even spacetime are constructed from mereological fusions of qualities, so the world is simply a vast mixture of qualities, including polyadic properties (i.e., relations). This means that everything there is, including concrete objects like persons or stars, is a quality, a qualitative fusion, or a portion of the extended qualitative fusion that is the worldwhole. I call my view mereological bundle theory. (shrink)

What does it mean for someone to have a moral right to something? What kinds of creatures can have rights, and which rights can they have? While rights are indispensable to our moral and political thinking, they are also mysterious and controversial; as long as these controversies remain unsolved, rights will remain vulnerable to skepticism. Here, Sumner constructs both a coherent concept of a moral right and a workable substantive theory of rights to provide the moral foundation necessary to dispel (...) such doubts. (shrink)

Preterm birth is defined as delivery occurring before 37 weeks gestation.1 Infants born prematurely have increased risks of morbidity and mortality throughout life, especially during the first year. These risks increase as the gestational age at birth decreases.2 Additionally, there are significant racial and ethnic differences in preterm birth rates. In 2022, the rate of preterm birth among non-Hispanic black women was approximately 50% higher than that observed in non-Hispanic white women.1 The outcomes for these infants are also disparate–preterm birth (...) and low birth weight are the second-leading causes of infant mortality (deaths before 1 year of age). Notably, among preterm neonates, infants born to non-Hispanic black women have a mortality rate more than double that of infants born to non-Hispanic white mothers.3 Importantly, there is a small but significant group of neonates that can be classified as severely premature (those born <28 weeks). Infants born before 28 weeks have varied and uncertain outcomes. While this group accounts for only 0.4% of preterm births, it also accounts for 40% of deaths among preterm neonates.4 As noted by Romanis and Adkins, the advent of artificial amnion and placenta technology (AAPT) holds promise for its potential to address the physiologic complications and mortality risks of extreme prematurity by introducing amniotic substitutes that mimic in vivo placental oxygenation and substrate delivery. In contrast …. (shrink)

To practise ‘fairly and justly’ a clinician must balance the needs of both the many and the few: the individual patient in front of them, and the many unseen patients in the waiting room, and in the county. They must consider the immediate clinical needs of those in the present, and how their actions will impact on future patients. The good medical practice guidance ‘Make the care of your patient your first concern’ provides no guidance on how doctors should act (...) when they care for multiple patients with conflicting needs. Moreover, conflicting needs extend far past simply those between different patients. At an organisational level, financial obligations must be balanced with clinical ones; the system must support those who work within it in a variety of roles; and, finally, in order for a healthcare service to be sustainable, the demands of current and future generations must be balanced.The central problem, we propose, is that there is no shared philosophical framework on which the provision of care or the development of health policy is based, nor is there a practical, fair and transparent process to ensure that the service is equipped to deal justly with new challenges as they emerge. Many philosophers have grappled with constructing a set of principles which would lead to a ‘good’ society which is just to different users; prominent among them is Rawls.Four important principles can be derived using a Rawlsian approach: equity of access, distributive justice, sustainability and openness. However, Rawls’ approach is sometimes considered too abstract to be applied readily to policymaking; it does not provide clear guidance for how individuals working within existing institutions can enact the principles of justice. We therefore combine the principles derived from Rawls with Scanlonian contractualism: by demanding that decisions are made in a way which cannot be ‘reasonably rejected’ by different stakeholders, we ensure that conflicting needs are considered robustly.We demonstrate how embedding this framework would ensure just policies and fair practice. We illustrate this by using examples of how it would help prevent injustice among different socioeconomic groups, prevent intergenerational injustice and prevent injustice in a crisis, for example, as we respond to new challenges such as COVID-19.Attempts to help individual doctors practise fairly and justly throughout their professional lives are best focused at an institutional or systemic level. We propose a practical framework: combining Scanlonian contractualism with a Rawlsian approach. Adopting this framework would equip the workforce and population to contribute to fair policymaking, and would ultimately result in a healthcare system whose practice and policies—at their core—were just. (shrink)

I summarize the main argument of Transformative Experience (OUP 2014). The book develops familiar examples from classical philosophical debates, as well as original examples, to argue that an agent’s decision to undergo a transformative experience—an experience constituted by radical personal and epistemic change for the agent—must either be authentic or irrational, but not both. The Precis of Transformative Experience walks the reader through the main ideas involved in epistemically and personally transformative experiences, the problems they pose for rational decision-making, and (...) discusses a number of key original examples of transformative experiences. (shrink)

I address two related questions: first, what is the best theory of how objects have de re modal properties? Second, what is the best defence of essentialism given the variability of our modal intuitions? I critically discuss several theories of how objects have their de re modal properties and address the most threatening antiessentialist objection to essentialism: the variability of our modal intuitions. Drawing on linguistic treatments of vagueness and ambiguity, I show how essentialists can accommodate the variability of modal (...) intuitions while holding that objects have their modal properties independently of contexts. (shrink)

In this book, T. L. Short places the notorious difficulties of Peirce's important writings in a more productive light, arguing that he wrote philosophy as a scientist, by framing conjectures intended to be refined or superseded in the inquiries they initiate. He argues also that Peirce held that the methods and metaphysics of modern science are amended as inquiry progresses, making metaphysics a branch of empirical knowledge. Additionally, Short shows that Peirce's scientific work expanded empiricism on empirical grounds, grounding his (...) phenomenology and subverting the fact/value dichotomy, and that he understood statistical explanations in nineteenth-century science as reintroducing the idea of final causation, now made empirical. Those innovations underlie Peirce's late ideas of a normative science and of philosophy as a branch of science. Short's rich and original study shows us how to read Peirce's writings and why they are worth reading. (shrink)

This chapter offers an overview of the phenomenological approach to delusions, emphasizing what Karl Jaspers called the "true delusions" of schizophrenia. Phenomenological psychopathology focuses on the experience of delusions and the delusional world. Several features of this approach are surveyed, including emphasis on formal qualities of subjective life and questioning of standard assumptions about delusions as erroneous belief. The altered modalities of world-oriented and self-oriented experience that precede and ground delusions in schizophrenia, especially the experiences of revelation that Klaus Conrad (...) termed the outer and inner apophany, are then discussed. The chapter first considers the famous "delusional mood", then the role of ipseity-disturbance. In both cases it is explained how delusions can develop out of these distinctive alterations of perception and feeling. The classic question of the understandability or comprehensibility of schizophrenic delusion, together with the related issues of wish-fulfillment and rationalizing motives are then considered. The chapter addresses the crucial but neglected issue of the felt reality-status of delusions or the delusional world, discussing derealization, "double bookkeeping", and "double exposure". The chapter concludes by discussing delusions typically found in paranoid and affective psychoses, and monothematic delusions found in certain organic conditions. (shrink)

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

A definitive feature of Kant's moral philosophy is its rationalism. Kant insists that moral theory, at least at its foundation, cannot take account of empirical facts about human beings and their circumstances in the world. This is the core of Kant's commitment to ‘metaphysics of morals’, and it is what he sees as his greatest contribution to moral philosophy. The paper clarifies what it means to be committed to metaphysics of morals, why Kant is committed to it, and where he (...) thinks empirical considerations may enter moral theory. The paper examines recent work of contemporary Kantians who argue that there is a central role for empirical considerations in Kant's moral theory. Either these theorists interpret Kant himself as permitting empirical considerations to enter, or they propose to extend Kant's theory so as to allow them to enter. With some qualifications, I argue that these interpretive trends are not supported by the texts, and that the proposed extensions are not plausibly Kantian. Kant's insistence on the exclusion of empirical considerations from the foundations of moral theory is not an incidental feature of his thought which might be modified while the rest remains unchanged. Rather, it is the very centre of his endeavours in moral philosophy. If we disagree with it, I argue, we have grounds for moving to a distinctly different theoretical framework. (shrink)

In this timely book L.W. Sumner addresses these issues within the wider context of palliative care for patients in the dying process.

Language, like other human traits, could only have evolved during one or more stages of development. We enlist the theoretical framework of human life history to account for certain aspects of linguistic evolution, with special reference to initial phases in the process. It is hypothesized that selection operated at several developmental stages, the earlier ones producing new behaviors that were reinforced by additional, and possibly more powerful, forms of selection during later stages, especially adolescence and early adulthood. Peer commentaries have (...) provided opportunities to explain human life history more comprehensively, and to add details to our account of spoken language. We made no attempt to explain syntax in the target article, but we propose here that selection for “vocal plumage” may have increased our species’ capacity for utterance complexity, a development that would have benefited all levels of language. (shrink)

Even though the measurement of fear of crime in criminological research commenced a few decades ago, specific populations, such as social activists, remain undocumented. This article is an attempt to address this gap. A study was conducted among 153 social activists involved in exposing corruption and irregularities that take place in the government system in India. This article explores the gap between the fear of crime and actual victimization among the specific social activists in India. The results indicate activists expressed (...) moderate fear of any one form of victimization including verbal and emotional, physical, and sexual victimization. It was also found that one-third of them have reported facing some form of abuse. The research implications are discussed. (shrink)

What is the nature of temporal passage—the movement of events or moments of time from the future through the present into the past? Is the future and the past as real as the present, or is the present—or perhaps the present and the past—all that exists? What role, if any, does language play in giving us an insight into temporal reality? Is it possible to travel through time into distant regions of the future or the past? What accounts for the (...) direction of time, the sense we have that we are moving toward the future and not back into the past? What is the relation between the physics of time and the philosophy of time? These are the kind of dizzying questions that have been addressed by metaphysicians since antiquity, and time has remained a critical concept for many thinkers and philosophers since then (for instance, in his Confessions, St Augustine, restating an observation by Plotinus, wrote: ‘So what is time? If no one asks me, I know; if I seek to explain it, I do not’). Interest in the subject has also been enduring—and has blossomed anew in the past century. The Philosophy of Time is a new title in the Routledge series, Critical Concepts in Philosophy. It meets the need for an authoritative reference work to make sense of the subject’s vast literature and the continuing explosion in research output. Edited by L. Nathan Oaklander, a leading scholar in the philosophy of time, this new Major Work from Routledge brings together in four volumes the canonical and the very best cutting-edge scholarship in the field to provide a synoptic view of all the key issues and current debates. With a comprehensive introduction to the collection, newly written by the editor, which places the collected material in its historical and intellectual context, The Philosophy of Time is an essential work of reference and is destined to be valued by philosophers of time—as well as those working in related areas of philosophy of science, philosophy of mind, and philosophy of religion—as a vital research resource. (shrink)

The genetic modification of pigs as a source of transplantable organs is one of several possible solutions to the chronic organ shortage. This paper describes existing ethical tensions in xenotransplantation (XTx) that argue against pursuing it. Recommendations for lifelong infectious disease surveillance and notification of close contacts of recipients are in tension with the rights of human research subjects. Parental/guardian consent for pediatric xenograft recipients is in tension with a child’s right to an open future. Individual consent to transplant is (...) in tension with public health threats that include zoonotic diseases. XTx amplifies concerns about justice in organ transplantation and could exacerbate existing inequities. The prevention of infectious disease in source animals is in tension with the best practices of animal care and animal welfare, requiring isolation, ethologically inappropriate housing, and invasive reproductive procedures that would severely impact the well-being of intelligent social creatures like pigs. (shrink)

A substantial portion of Adam Smith's discussion of Stoicism in TMS VII is dedicated to the Stoic “principle of suicide,” according to which suicide is sometimes morally required. While scholars agree that Stoicism exercised considerable influence over Smith, no recent work has explored his views on suicide, despite the central role it plays in his treatment of Stoicism. I argue that Smith opposes the principle of suicide on both epistemic and moral grounds, providing an important critique of Stoicism. I also (...) show how Smith departs from other early modern accounts of suicide by offering a notably humane analysis of this tragic act. I conclude by considering what Smith's discussion of Stoicism and suicide tells us about his moral theory, and I forward a reading of Smith as a skeptic. (shrink)

Rationality requires us to respond to apparent normative reasons. Given the independence of appearance and reality, why think that apparent normative reasons necessarily provide real normative reasons? And if they do not, why think that mistakes of rationality are necessarily real mistakes? This paper gives a novel answer to these questions. I argue first that in the moral domain, there are objective duties of respect that we violate whenever we do what appears to violate our first-order duties. The existence of (...) these duties of respect, I argue, ensures that apparent moral reasons are exceptions to the independence of appearance and reality. I then extend these arguments to the domain of overall reason. Just as there are objective duties of respect for moral reasons that explain moral blameworthiness, so there are objective duties of respect for reasons that explain blameworthiness in the court of overall reason. The existence of these duties ensures that apparent reasons are exceptions to the independence of appearance and reality. (shrink)