Against its prominent compatiblist and libertarian opponents, I defend Galen Strawson's Basic Argument for the impossibility of moral responsibility. Against John Martin Fischer, I argue that the Basic Argument does not rely on the premise that an agent can be responsible for an action only if he is responsible for every factor contributing to that action. Against Alfred Mele and Randolph Clarke, I argue that it is absurd to believe that an agent can be responsible for an action when no (...) factor contributing to that action is up to that agent. Against Derk Pereboom and Clarke, I argue that the versions of agent-causal libertarianism they claim can immunize the agent to the Basic Argument actually fail to do so. Against Robert Kane, I argue that the Basic Argument does not rely on the premise that simply the presence of indeterministic factors in the process of bringing an action about is itself what rules out the agent's chance for being responsible for that action. (shrink)

Some passages throughout Spinoza’s body of works suggest that an attribute in its absolute nature provides a sufficient condition for all of its modes, including the finite ones. Other passages suggest that an attribute in its absolute nature fails to provide a sufficient condition for its finite modes. My aim is to dispel this apparent tension. I argue that all finite modes are ultimately entailed by the absolute nature of their attribute. Furthermore, I explain how the Spinozistic positions that appear (...) incompatible with this view are in fact compatible. As I see it, we should read those passages where Spinoza says that no finite mode ultimately follows from the absolute nature of its attribute as saying merely that no finite mode ultimately follows in one-by-one fashion, independent of an infinite series of other modes, from the absolute nature of its attribute. (shrink)

Against its prominent compatiblist and libertarian opponents, I defend Galen Strawson’s Basic Argument for the impossibility of moral responsibility. Against John Martin Fischer, I argue that the Basic Argument does not rely on the premise that an agent can be responsible for an action only if he is responsible for every factor contributing to that action. Against Alfred Mele and Randolph Clarke, I argue that it is absurd to believe that an agent can be responsible for an action when no (...) factor contributing to that action is up to that agent. Against Derk Pereboom and Clarke, I argue that the versions of agent-causal libertarianism they claim can immunize the agent to the Basic Argument actually fail to do so. Against Robert Kane, I argue that the Basic Argument does not rely on the premise that simply the presence of indeterministic factors in the process of bringing an action about is itself what rules out the agent’s chance for being responsible for that action. (shrink)

Integrating cosmological and ontological lines of reasoning, I argue that there is a self-necessary being that (a) serves as the sufficient condition for everything, that (b) has the most perfect collection of whatever attributes of perfection there might be, and that (c) is an independent, eternal, unique, simple, indivisible, immutable, all-actual, all-free, all-present, all-powerful, all-knowing, all-good, personal creator of every expression of itself that everything is. My cosmo-ontological case for such a being, an everything-maker with the core features ascribed to (...) the God of classical theism, addresses the standard worries plaguing these lines of reasoning: (1) the richness required of such a being dissolves it into many beings; (2) the metaphysical possibility of such a being is assumed on insufficient grounds; (3) the features we ascribe to such a being are mere human-all-too-human projections. (shrink)

My general aim is to clarify the foundational difference between Stephen Jay Gould and Richard Dawkins concerning what biological entities are the units of selection in the process of evolution by natural selection. First, I recapitulate Gould’s central objection to Dawkins’s view that genes are the exclusive units of selection. According to Gould, it is absurd for Dawkins to think that genes are the exclusive units of selection when, after all, genes are not the exclusive interactors: those agents directly engaged (...) with, directly impacted by, environmental pressures. Second, I argue that Gould’s objection still goes through even when we take into consideration Sterelny and Kitcher’s defense of gene selectionism in their admirable paper “The Return of the Gene.” Third, I propose a strategy for defending Dawkins that I believe obviates Gould’s objection. Drawing upon Elisabeth Lloyd’s careful taxonomy of the various understandings of the unit of selection at play in the philosophy of biology literature, my proposal involves realizing that Dawkins endorses a different understanding of the unit of selection than Gould holds him to, an understanding that does not require genes to be the exclusive interactors. (shrink)

In this paper I attempt to show, against certain versions of trope theory, that properties with analyzable particularity cannot be merely exactly similar: such properties are either particularized properties (tropes) that are dissimilar to every any other trope, or else universalized properties (universals). I argue that each of the most viable standard and nonstandard particularizers that can be employed to secure the numerical difference between exactly similar properties can only succeed in grounding the particularity of properties, that is, in having (...) properties be tropes, at the expense of ruling out the possibility of their exact similarity. Here are the four nonstandard particularizers that I examine: the genealogy of a property, the history of a property, the causal effects of a property, and the duration of a property. And here are the two standard particularizers that I examine: the bearer of a property, by which I mean either a bare particular or a spatiotemporal location, and the property itself, by which I mean that the property is self-particularized. In my concluding remarks, I explain that the only remaining hope for preserving the possibility of exactly similar tropes is regarding properties as primitively particular, and that this must mean not that properties are self-particularized but that they are particularized due to nothing. I close by arguing that this may not help trope theory after all. (shrink)

This paper is intended primarily as a reference tool for participants in the debate between realism and nominalism concerning universals. It provides an exhaustive catalogue of the basic analyses of an entity being charactered that nominalists can employ in both a constituent and nonconstituent ontology.

EXCERPT.--With exception to early essays by George von Glahn and Mark Sanders, serious critical scholarship on the writings of Ted Kooser began after the 1980 release of the now-classic Sure Signs, Kooser’s fifth major collection of poems. Looking back over the thirty-plus years since then, only about a dozen or so significant studies—none of which book-length—currently boulder out against the relative flatscape of secondary materials constituted mostly by quick and dirty reviews. Aside from the essays by Wes Mantooth, Allan Benn, (...) and Mary K. Stillwell in this special issue of Midwestern Miscellany, the following works particularly stand out and, in my view, must be consulted by the Kooser scholar: David Baker’s “Ted’s Box”; William Barillas’s Chapter 7 of The Midwestern Pastoral; Victor Contoski’s “Words and Raincoats”; Dana Gioia’s “The Anonymity of the Regional Poet”; Jeff Gundy’s “Among the Erratics”; Jonathan Holden’s “The Chekov of American Poetry”; Denise Low’s “Sight in Motion”; David Mason’s “Introducing Ted Kooser”; and both Mary K. Stillwell’s “The ‘In Between’” and her “When a Walk is a Poem.”. (shrink)

My aim is to figure out whether Aristotle’s response to the argument for fatalism in De Interpretatione 9 is successful. By “response” here I mean not simply the reasons he offers to highlight why fatalism does not accord with how we conduct our lives, but also the solution he devises to block the argument he provides for it. Achieving my aim hence demands that I figure out what exactly is the argument for fatalism he voices, what exactly is his solution, (...) whether his solution is coherent, and whether it does indeed succeed. I find that the argument is essentially bivalence plus that the truth of a proposition stating that an event will happen in the future entails that this event will necessarily happen, that Aristotle’s solution is to restrict bivalence when it comes to propositions about contingent future events, that this solution is coherent, and that while it does not rule out the possibility of fatalism, it does succeed in blocking the argument for fatalism offered within chapter 9. (shrink)

This paper engages the controversy as to whether there is a link between Berkeley’s refutation of abstraction and his refutation of materialism. I argue that there is a strong link. In the opening paragraph I show that materialism being true requires and is required by the possibility of abstraction, and that the obviousness of this fact suggests that the real controversy is whether there is a link between Berkeley’s refutation of materialism and his refutation of the possibility of framing abstract (...) incomplete ideas and abstract general ideas. Although Berkeley can still defeat materialism without relying on his arguments that directly refute the possibility of framing abstract incomplete ideas and abstract general ideas, I contend that there is still a strong link between his refutation of materialism and his refutation of the possibility of framing these ideas. First, I show that the truth of the canonic version of materialism, according to which primary qualities are mindindependent and inhere in material substances, requires the possibility of the mind framing both of these ideas. Second, I show that there is a sense in which the truth of materialism is required by the possibility of either of these ideas. (shrink)

The study of identity crosses all disciplinary borders to address such issues as the multiple interactions of race, class, and gender in feminist, lesbian, and gay studies, postcolonialism and globalization, and the interrelation of nationalism and ethnicity in ethnic and area studies. Identities will help disrupt the cliche-ridden discourse of identity by exploring the formation of identities and problem of subjectivity. Leading scholars in literary criticism, anthropology, sociology, and philosophy explore such topics as "Gypsies" in the Western imagination, the mobilization (...) of the West in Chinese television, the lesbian identity and the woman's gaze in fashion photography, and the regulation of black women's bodies in early 20th-century urban areas. This collection of twenty articles brings together the special issue of Critical Inquiry entitled "Identities" (Summer 1992), two other previously published essays, and five previously published critical responses and rejoinders, all of which is interrogated in two new essays by Michael Gorra and Judith Butler. Contributors include Elizabeth Abel, Kwame Anthony Appiah, Akeel Bilgrami, Daniel Boyarin, Jonathan Boyarin, Judith Butler, Hazel V. Carby, Xiaomei Chen, Diana Fuss, Henry Louis Gates, Jr., Avery Gordon, Michael Gorra, Cheryl Herr, Saree S. Makdisi, Walter Benn Michaels, Christopher Newfield, Gananath Obeyesekere, Molly Anne Rothenberg, Gayatri Chakravorty Spivak, Sara Suleri, Katie Trumpener, and Joseph Valente. (shrink)

The goal of this paper is to figure out whether Aristotle's response to the argument for fatalism in De Interpretatione 9 is a success. By "response" it is meant not simply the reasons Aristotle offers to highlight why fatalism does not accord with how we conduct our lives, but also the solution he devises to block the argument for fatalism. This paper finds that a) Aristotle's argument for fatalism is essentially bivalence plus that the truth of a proposition implies necessity, (...) b) that Aristotle's solution is to restrict bivalence, c) that this solution is coherent, and d) that while this solution does not rule out the possibility of fatalism, it does succeed in blocking the argument for fatalism offered within chapter 9. El objetivo de este trabajo es esclarecer si la respuesta de Aristóteles al argumento a favor del fatalismo en De Interpretatione 9 resulta exitosa. Por "respuesta" se entienden no solo las razones que da Aristóteles para destacar porqué el fatalismo no concuerda con la manera en que llevamos nuestras vidas, sino también la solución que ofrece para bloquear el argumento a favor del fatalismo. El artículo plantea a) que el argumento de Aristóteles respecto del fatalismo consiste esencialmente en la bivalencia más el hecho de que la verdad de una proposición implica necesidad; b) que la solución de Aristóteles es restringir la bivalencia; c) que esta solución es coherente, y d) que si bien esta solución no elimina la posibilidad del fatalismo, sí logra bloquear el argumento a favor del fatalismo ofrecido en el capítulo 9. O objetivo deste trabalho é esclarecer se a resposta de Aristóteles ao argumento a favor do fatalismo em De Interpretatione 9 é bem-sucedida. Por "resposta" se entendem não somente as razões que Aristóteles dá para destacar por que o fatalismo não está de acordo com a maneira em que levamos nossas vidas, mas também a solução que oferece para bloquear o argumento a favor do fatalismo. Este artigo propõe que: a) o argumento de Aristóteles a respeito do fatalismo consiste essencialmente na bivalência mais o fato de que a verdade de uma proposição implica necessidade; b) a solução de Aristóteles é restringir a bivalência; c) essa solução é coerente, e d) embora essa solução não elimine a possiblidade do fatalismo, consegue bloquear o argumento a favor dele oferecido no capítulo 9. (shrink)

In this paper I attempt to show, against certain versions of trope theory, that properties with analyzable particularity cannot be merely exactly similar: such properties are either particularized properties (tropes) that are dissimilar to every any other trope, or else universalized properties (universals). I argue that each of the most viable standard and nonstandard particularizers that can be employed to secure the numerical difference between exactly similar properties can only succeed in grounding the particularity of properties, that is, in having (...) properties be tropes, at the expense of ruling out the possibility of their exact similarity. Here are the four nonstandard particularizers that I examine: the genealogy of a property, the history of a property, the causal effects of a property, and the duration of a property. And here are the two standard particularizers that I examine: the bearer of a property, by which I mean either a bare particular or a spatiotemporal location, and the property itself, by which I mean that the property is self-particularized. In my concluding remarks, I explain that the only remaining hope for preserving the possibility of exactly similar tropes is regarding properties as primitively particular, and that this must mean not that properties are selfparticularized but that they are particularized due to nothing. I close by arguing that this may not help trope theory after all. (shrink)

This paper describes the interventions by the International Committee of the Red Cross to support a hospital in Afghanistan during the mid–1990s. We present elements of the interventions introduced in Ghazni, Afghanistan, and consider a number of ethical issues stimulated by this analysis. Ethical challenges arise wherever humanitarian interventions to deal with complex political emergencies are undertaken: among those related to the case study presented are questions concerning: a) whether humanitarian support runs the risk of propping up repressive and irresponsible (...) governments; b) whether humanitarian relief activities can legitimately focus on a narrow range of interventions, or need to broaden to address the range of challenges facing the health system; and c) whether sustainability and quality of care should be routinely considered in such settings. The paper concludes by highlighting the value of case studies, suggesting mechanisms for extending transparency and accountability in humanitarian health interventions, and highlighting the need for contextualising humanitarian work if the interventions are to be successful. (shrink)

In the present paper I wish to argue that psychological egoism may well have a basis in the empirical facts of human psychology. Certain contemporary learning theorists, e.g., Hull and Skinner, have put forward behavioristic theories of the origin and functioning of human motives which posit a certain number of basically "selfish, " unlearned primary drives or motives (like hunger, thirst, sleep, elimination, and sex), explain all other, higher-order, drives or motives as derived genetically from the primary ones via certain (...) "laws of reinforcement," and, further, deny the "functional autonomy" of those higher-order drives or motive. Now it is a hotly debated issue in contemporary Learning Theory whether any theory such as we have described briefly above could adequately explain adult human behavior. I shall, however, argue only that a theory of the above kind may well be true, and that from such a theory, fortified only by one additional psychological premise, the truth of egoism (non-altruism) logically follows. I hope to show, thereby, that the question of psychological egoism is still an open empirical issue, however fallacious be the philosophical arguments for it. (shrink)

"The essays, both philosophical and historical, demonstrate the continuing significance of a neglected aspect of Kant’s thought."—Religious Studies Review Challenging the traditional view that Kant's account of religion was peripheral to his thinking, these essays demonstrate the centrality of religion to Kant's critical philosophy. Contributors are Sharon Anderson-Gold, Leslie A. Mulholland, Anthony N. Perovich, Jr., Philip J. Rossi, Joseph Runzo, Denis Savage, Walter Sparn, Burkhard Tuschling, Nicholas P. Wolterstorff, and Allen W. Wood.

In "Induction and Other Minds," Plantinga casts the Argument from Analogy in the form of an inductive argument in the following way.

Philosophers frequently treat certainty as some sort of absolute, while ordinary men typically do not. According to the Theory of Important Criteria, on which the present paper is based, this difference is not to be explained in terms of ambiguity or vagueness in the word?certain?, but rather in terms of disagreement between ordinary men and philosophers as to the importance of one of the criteria of the ordinary sense of?certain?. I argue that there is reason to think that certainty is (...) some sort of absolute, and thus that no empirical statement is certain. And in any case, the problem of empirical certainty is not a pseudo?problem, as metaphilosophers like Wittgenstein and Wisdom have thought. (shrink)

The co-edited volume under consideration presents the peer-reviewed proceedings of a homonymous conference held at the Free University of Brussels and the Royal Academy of Belgium in 2015. It opens with a general introduction by the editors to the topic of the conference and to its 17 constitutive papers. The contributions deal with ceremonial contexts and rituals of diverse kinds, which antedate, transcend, or develop beneath or independently of the polis and its institutions. The papers are...

The work under review, the twenty-second installment of the Eretria series, reflects a revised version of the A.’s prizewinning doctoral dissertation, defended at the University of Lausanne in the autumn of 2011. The principal objective of the volume is twofold: first, to offer a synthetic presentation of the Geometric structural and artifactual remains uncovered during the Greek and, subsequently, Swiss campaigns conducted intermittently over the span of roughly one century in and around the...

Recently, a number of philosophers of biology have endorsed views about random drift that, we will argue, rest on an implicit assumption that the meaning of concepts such as drift can be understood through an examination of the mathematical models in which drift appears. They also seem to implicitly assume that ontological questions about the causality of terms appearing in the models can be gleaned from the models alone. We will question these general assumptions by showing how the same equation (...) — the simple 2 = p2 + 2pq + q2 — can be given radically different interpretations, one of which is a physical, causal process and one of which is not. This shows that mathematical models on their own yield neither interpretations nor ontological conclusions. Instead, we argue that these issues can only be resolved by considering the phenomena that the models were originally designed to represent and the phenomena to which the models are currently applied. When one does take those factors into account, starting with the motivation for Sewall Wright’s and R.A. Fisher’s early drift models and ending with contemporary applications, a very different picture of the concept of drift emerges. On this view, drift is a term for a set of physical processes, namely, indiscriminate sampling processes. (shrink)

A literary historian might very well characterize the eighties as the period when race, class, and gender became the holy trinity of literary criticism. Critical Inquiry’s contribution to this shift in critical paradigms took the form of two special issues, ”Writing and Sexual Difference,” and “‘Race,’ Writing and Difference.” In the 1990s, however, “race,” “class,” and “gender” threaten to become the regnant clichés of our critical discourse. Our object in this special issue is to help disrupt the cliché-ridden discourse of (...) identity by exploring the formation of identities and the problem of subjectivity.Scholars in a variety of disciplines have begun to address what we might call the politics of identity. Their work expands on the evolving, anti-essentialist critiques of ethnic, sexual, national, and racial identities, particularly the work of those post-structuralist theorists who have articulated concepts of difference. The calls for a “post-essentialist” reconception of notions of identity have become increasingly common. The powerful resurgence of nationalisms in Eastern Europe provides just one example of the catalysts for such theorizing.Kwame Anthony Appiah, author of Assertion and Conditionals, Truth in Semantics, and Necessary Questions, has also published a novel, Avenging Angel, and a collection of essays, In My Father’s House. His most recent contribution to Critical Inquiry was “Is the Post- in Postmodernism the Post- in Postcolonial?”. Henry Louis Gates, Jr., is coeditor of Transition, a quarterly review, and the author of Figures in Black, The Signifying Monkey, and Loose Canons. His latest contribution to Critical Inquiry was “Critical Fanonism”. (shrink)

En la presente investigación se reflexionará sobre la guerra y su naturaleza en el contexto del sistema filosófico de Georg Wilhelm Friedrich Hegel, estableciendo como su fundamento ontológico la categoría del ser-para-sí o autoafirmación, aquella necesidad de toda autoconciencia que pretende ser libre, y que se alcanza a través del proceso dialéctico del reconocimiento. Se contrastará esta concepción con la clásica noción de guerra justa planteada por Tomás de Aquino, examinando el lugar que la negatividad del mal tiene en ambos (...) sistemas metafísicos, con el fin de determinar si es posible entender la eticidad de ambas guerras en un mismo sentido. (shrink)

Our commentary articulates some of the commonalities between Baumeister et al.'s theory of socially differentiated roles and Strategic Differentiation-Integration Effort. We expand upon the target article's position by arguing that differentiating social roles is contextual and driven by varying ecological pressures, producing character displacement not only among individuals within complex societies, but also across social systems and multiple levels of organization.

Several articles have recently appeared arguing that there really are no viable alternatives to mechanistic explanation in the biological sciences (Kaplan and Bechtel; Kaplan and Craver). We argue that mechanistic explanation is defined by localization and decomposition. We argue further that systems neuroscience contains explanations that violate both localization and decomposition. We conclude that the mechanistic model of explanation needs to either stretch to now include explanations wherein localization or decomposition fail or acknowledge that there are counterexamples to mechanistic explanation (...) in the biological sciences. (shrink)

Medical populism, as a political style of handling the challenges of a public health crisis, has primarily been analyzed in terms of its influence on the efficacy of governmental efforts to meet the challenges of the current pandemic (such as those related to testing, vaccination, and community restrictions). As these efforts have moral consequences (they, for instance, will affect people’s wellbeing and may lead to suffering, loss of opportunities, and unfair distributions), an analysis of the ethics of medical populism is (...) much needed. In this essay, we address the need to analyze the moral dimension of medical populism by relating it to issues in healthcare ethics. Specifically, we identify the moral significance of medical populism by demonstrating how it contributes to the failure of governments to discharge their moral duty to provide for the healthcare needs of their people, and, correlatively, to the violation of the people’s moral right to healthcare. We argue that with medical populism, governments tend to mishandle the constraints that would morally justify their shortcomings in fulfilling such duty. We identify such constraints as mainly referring to the governments’ given (economic and institutional) capacities and the relative degree of incumbency of their competing duties. (shrink)

The complex systems approach to cognitive science invites a new understanding of extended cognitive systems. According to this understanding, extended cognitive systems are heterogenous, composed of brain, body, and niche, non-linearly coupled to one another. This view of cognitive systems, as non-linearly coupled brain–body–niche systems, promises conceptual and methodological advances. In this article we focus on two of these. First, the fundamental interdependence among brain, body, and niche makes it possible to explain extended cognition without invoking representations or computation. Second, (...) cognition and conscious experience can be understood as a single phenomenon, eliminating fruitless philosophical discussion of qualia and the so-called hard problem of consciousness. What we call “extended phenomenological-cognitive systems” are relational and dynamical entities, with interactions among heterogeneous parts at multiple spatial and temporal scales. (shrink)

"These essays make a splendid book. Ignatieff's lectures are engaging and vigorous; they also combine some rather striking ideas with savvy perceptions about actual domestic and international politics.

Wealth and Virtue reassesses the remarkable contribution of the Scottish Enlightenment to the formation of modern economics and to theories of capitalism. Its unique range indicates the scope of the Scottish intellectual achievement of the eighteenth century and explores the process by which the boundaries between economic thought, jurisprudence, moral philosophy and theoretical history came to be established. Dealing not only with major figures like Hume and Smith, there are also studies of lesser known thinkers like Andrew Fletcher, Gershom Carmichael, (...) Lord Kames and John Millar as well as of Locke in the light of eighteenth century social theory, the intellectual culture of the University of Edinburgh in the middle of the eighteenth century and of the performance of the Scottish economy on the eve of the publication of the Wealth of Nations. While the scholarly emphasis is on the rigorous historical reconstruction of both theory and context, Wealth and Virtue directly addresses itself to modern political theorists and economists and throws light on a number of major focal points of controversy in legal and political philosophy. (shrink)

Largely due to the popular allegation that contemporary science has uncovered indeterminism in the deepest known levels of physical reality, the debate as to whether humans have moral freedom, the sort of freedom on which moral responsibility depends, has put aside to some extent the traditional worry over whether determinism is true. As I argue in this paper, however, there are powerful proofs for both chronological determinism and necessitarianism, forms of determinism that pose the most penetrative threat to human moral (...) freedom. My ultimate hope is to show that, despite the robust case against human moral freedom that can be made without even relying on them, chronological determinism and necessitarianism should be regarded with renewed urgency. (shrink)

Using hypersets as an analytic tool, we compare traditionally Gibsonian (Chemero 2003; Turvey 1992) and representationalist (Sahin et al. this issue) understandings of the notion ‘affordance’. We show that representationalist understandings are incompatible with direct perception and erect barriers between animal and environment. They are, therefore, scarcely recognizable as understandings of ‘affordance’. In contrast, Gibsonian understandings are shown to treat animal-environment systems as unified complex systems and to be compatible with direct perception. We discuss the fruitful connections between Gibsonian affordances (...) and dynamical systems explanation in the behavioral sciences and point to prior fruitful application of Gibsonian affordances in robotics. We conclude that it is unnecessary to re-imagine affordances as representations in order to make them useful for researchers in robotics. (shrink)

Bain's short but insightful monograph contrasts the idea of trusteeship with liberty, both of individuals and of communities. This sets his work apart, for most other analyses of trusteeship consider it in terms of civilization and barbarism.

In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this (...) process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. (shrink)

The rapid development in healthcare technologies in recent years has resulted in the need for health services, whether publicly funded or insurance based, to identify means to maximise the benefits and provide equitable distribution of limited resources. This has resulted in the need for rationing decisions, and there has been considerable debate regarding the substantive and procedural ethical principles that promote distributive justice when making such decisions. In this paper, I argue that while the scientifically rigorous approaches of evidence-based healthcare (...) are claimed as aspects of procedural justice that legitimise such guidance, there are biases and distortions in all aspects of the process that may lead to epistemic injustices. Regardless of adherence to principles of distributive justice in the decision-making process, evidential failings may undermine the fairness and legitimacy of such decisions. In particular, I identify epistemic exclusion that denies certain patient and professional groups the opportunity to contribute to the epistemic endeavour. This occurs at all stages of the process, from the generation, analysis and reporting of the underlying evidence, through the interpretation of such evidence, to the decision-making that determines access to healthcare resources. I further argue that this is compounded by processes which confer unwarranted epistemic privilege on experts in relation to explicit or implicit value judgements, which are not within their remit. I suggest a number of areas in which changes to the processes for developing, regulating, reporting and evaluating evidence may improve the legitimacy of such processes. (shrink)