This article has two main divisions, the first consisting in parts 1-3, the second in parts 4-8. The purpose of the first division is to assess Hauerwas's contentions regarding what he takes to be serious debilities in modern theological culture. The objects of Hauerwas's criticism are: (1) natural theology; (2) reason as it is represented in the structure of the modern university and in the "Enlightenment Project"; and (3) liberal Protestantism--the latter particularly as it turns up, by his account, in (...) Reinhold Niebuhr's theology. The article will offer a defense of natural theology and an alternative approach to Niebuhr's theology while showing how Hauerwas's contentions concerning these two matters are mistaken. Parts 4-8 are theological studies. These studies concentrate on selected though main aspects of Hauerwas's outlook. Part 4 concerns a problematic implication of the notion, mainly from Barth, of divinity's humanity; Part 5 a note of difficulty from William James about the idea of the theistic God and its pertinence to the Barthian or Hauerwasian God; Part 6 the relation between belief and witness; Part 7 theology's discourse and analogy; Part 8 the Barthian-Hauerwasian theology as a metaphysics. Part 1, concerning natural theology, stands over both divisions. These observations are not in the main intended as textual studies, though in certain passages the analysis is closely attentive to Hauerwas's text. Also, the paper does not offer the sort of account that would come from a historian, intellectual biographer, or social or cultural analyst or critic. Its focus is philosophical-theological criticism. (shrink)

This article has two main divisions, the first consisting in parts 1-3, the second in parts 4-8. The purpose of the first division is to assess Hauerwas's contentions regarding what he takes to be serious debilities in modern theological culture. The objects of Hauerwas's criticism are: natural theology; reason as it is represented in the structure of the modern university and in the "Enlightenment Project"; and liberal Protestantism--the latter particularly as it turns up, by his account, in Reinhold Niebuhr's theology. (...) The article will offer a defense of natural theology and an alternative approach to Niebuhr's theology while showing how Hauerwas's contentions concerning these two matters are mistaken. Parts 4-8 are theological studies. These studies concentrate on selected though main aspects of Hauerwas's outlook. Part 4 concerns a problematic implication of the notion, mainly from Barth, of divinity's humanity; Part 5 a note of difficulty from William James about the idea of the theistic God and its pertinence to the Barthian or Hauerwasian God; Part 6 the relation between belief and witness; Part 7 theology's discourse and analogy; Part 8 the Barthian-Hauerwasian theology as a metaphysics. Part 1, concerning natural theology, stands over both divisions. These observations are not in the main intended as textual studies, though in certain passages the analysis is closely attentive to Hauerwas's text. Also, the paper does not offer the sort of account that would come from a historian, intellectual biographer, or social or cultural analyst or critic. Its focus is philosophical-theological criticism. (shrink)

This book introduces student to the three major figures of modern philosophy known as the rationalists. It is not for complete beginners, but it is an accessible account of their thought. By concerning itself with metaphysics, and in particular substance, the book relates an important historical debate largely neglected by the contemporary debates in the once again popular area of traditional metaphysics. in philosophy. (Do Not USE).

This volume provides a philosophical introduction to and analysis of the study of metaphor. By proceeding from the concrete analysis of complex metaphors, White is able to identify a range of features which are incompatible with standard accounts of the way words function in metaphor.

Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...) Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. (shrink)

Introduction -- The mathematical roots of the concept of analogy -- Aristotle : the uses of analogy -- Aristotle : analogy and language -- Thomas Aquinas -- Immanuel Kant -- Karl Barth -- Final reflections.

The most pressing issues of the twenty-first century—climate change and persistent hunger in a world of food surpluses, to name only two—are not problems that can be solved from within individual disciplines, nation-states, or cultural perspectives. They are predicaments that can only be resolved by generating sustained and globally robust coordination across value systems. The scale of the problems and necessity for coordinated global solutions signal a world historical transit as momentous as the Industrial Revolution: a transition from the predominance (...) of technical knowledge to that of ethical deliberation. This volume brings together leading thinkers from around the world to deliberate on how best to correlate worth (value) with what is worthwhile (values), pairing human prosperity with personal, environmental, and spiritual flourishing in a world of differing visions of what constitutes a moral life. Especially in the aftermath of what is now being called the Great Recession, awareness has mounted of the imperative to question the modern divorce of economics from ethics. While the domains of economics and ethics were from antiquity through at least the eighteenth century understood in many cultures to be coterminous and mutually entailing, the modern assumption has been that the goal of maximizing human prosperity and the aim of justly enhancing our lives as persons and as communities were functionally and practically distinct. Working from a wide array of perspectives, the contributors to this volume offer a set of challenges to the assumed independence of the quantitative and qualitative dimensions of human and planetary well-being. Reflecting on the complex interrelationship among economics, justice, and equity, the book resists "one size fits all" approaches and struggles to revitalize the marriage of economics and ethics by activating cultural differences as the basis of mutual contribution to shared human flourishing. The publication of this important collection will stimulate or extend critical debates among scholars and students working in a number of disciplines in the social sciences and humanities, including philosophy, history, environmental studies, economics, and law. Contributors: Roger T. Ames, James Behuniak Jr., Steve Bein, Nalini Bhushan, Purushottama Bilimoria, Steven Burik, Amita Chatterjee, Baoyan Cheng, Gordon Davis, Jay L. Garfield, Steven F. Geisz, Peter D. Hershock, Larry A. Hickman, Kathleen M. Higgins, Heidi M. Hurd, Thomas P. Kasulis, Workineh Kelbessa, Lori Keleher, Oliver Leaman, James McRae, Jin Y. Park, James Peterman, Naoko Saito, May Sim, Robert Smid, Paul Standish, Kenneth W. Stikkers, Karsten J. Struhl, Meera Sushila Viswanathan, Wu Shiu- Ching, Xu Di, T. Yamauchi, Yang Liuxin. (shrink)

In a recent extended essay, philosopher Daniel Hausman goes a long way towards dismissing severity as a morally relevant attribute in the context of priority setting in healthcare. In this response, we argue that although Hausman certainly points to real problems with how severity is often interpreted and operationalised within the priority setting context, the conclusion that severity does not contain plausible ethical content is too hasty. Rather than abandonment, our proposal is to take severity seriously by carefully mapping the (...) possibly multiple underlying accounts to well-established ethical theories, in a way that is both morally defensible and aligned with the term’s colloquial uses. (shrink)

Principles of need are constantly referred to in health care priority setting. The common denominator for any principle of need is that it will ascribe some kind of special normative weight to people being worse off. However, this common ground does not answer the question how a plausible principle of need should relate to the aggregation of benefits across individuals. Principles of need are sometimes stated as being incompatible with aggregation and sometimes characterized as accepting aggregation in much the same (...) way as utilitarians do. In this paper we argue that if one wants to take principles of need seriously both of these positions have unreasonable implications. We then characterize and defend a principle of need consisting of sufficientarian elements as well as prioritarian which avoids these unreasonable implications. (shrink)

Synaesthesia is considered a rare perceptual capacity, and one that is not capable of cultivation. However, meditators report the experience quite commonly, and in questionnaire surveys, respondents claimed to experience synaesthesia in 35% of meditation retreatants, in 63% of a group of regular meditators, and in 86% of advanced teachers. These rates were significantly higher than in nonmeditator controls, and displayed significant correlations with measures of amount of meditation experience. A review of ancient texts found reports suggestive of synaesthesia in (...) advanced meditators from India and China. These findings suggest that synaesthesia may be cultivated by meditation, and that laboratory studies of meditators could be rewarding. (shrink)

How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems unreasonable that (...) public values would straightforwardly decide the ethical question of how resources should be distributed. On the other hand, in a democratic society, it seems equally unreasonable that they would be considered irrelevant for this question. In this paper we draw on the notion of reflective equilibrium and discuss the relevance and roles that empirical studies may plausibly have for justification in priority setting ethics. We develop a framework for analysing how different kinds of empirical results may have different kinds of implications for justification. (shrink)

Intensive research is carried out to develop a disease-modifying drug for Alzheimer’s disease. The development of drug candidates that reduce Aß or tau in the brain seems particularly promising. However, these drugs target people at risk for AD, who must be identified before they have any, or only moderate, symptoms associated with the disease. There are different strategies that may be used to identify these individuals. Each of these strategies raises different ethical challenges. In this paper, we analyse these challenges (...) in relation to the risk stratification for AD necessary for using these drugs. We conclude that the new drugs must generate large health benefits for people at risk of developing AD to justify the ethical costs associated with current risk stratification methods, benefits much larger than current drug candidates have. This conclusion raises a new set of ethical questions that should be further discussed. No data are available. (shrink)

One generally considered plausible way to allocate resources in health care is according to people’s needs. In this paper I focus on a somewhat overlooked issue, that is the conceptual structure of health care needs. It is argued that what conceptual understanding of needs one has is decisive in the assessment of what qualifies as a health care need and what does not. The aim for this paper is a clarification of the concept of health care need with a starting (...) point in the general philosophical discussion about needs. I outline three approaches to the concept of need and argue that they all share the same conceptual underpinnings. The concept of need is then analyzed in terms of a subject x needing some object y in order to achieve some goal z. I then discuss the relevant features of the object y and the goal z which make a given need qualify as a health care need and not just a need for anything. (shrink)

In recent years, the issue of accepting a higher cost per health improvement for orphan drugs has been the subject of discussion in health care policy agencies and the academic literature. This article aims to provide an analysis of broadly egalitarian arguments for and against accepting higher costs per health improvement. More specifically, we aim to investigate which arguments one should agree upon putting aside and where further explorations are needed. We identify three kinds of arguments in the literature: considerations (...) of substantial equality, formal equality, and opportunity cost. We argue that considerations of substantial equality do not support higher costs per health improvement orphan drugs, even if such considerations are considered valid. On the contrary, arguments of formal equality may support accepting a higher cost per health improvement for orphan drugs. However, in order to do so, a number of both normative and empirical issues must be resolved; these issues are identified in the article. For instance, it must be settled to what extent the opportunity cost in terms of foregone health for other patients is acceptable in order to uphold formal equality. We conclude that certain arguments can be set aside, and future focus should be put on the unresolved normative and empirical issues related to formal equality and opportunity cost. (shrink)

In this paper we explore the relation between health-care needs and patients’ desires within shared decision-making in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to (...) arise due to the double focus on a patient’s need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine. (shrink)

How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this article we analyze (...) Juth’s argument and observe that we already do compensate for indirectly operative factors, both outside and within cost-effectiveness evaluations, for formal equality reasons. Based on this we argue that we have reason to set cost-effectiveness thresholds to integrate equity concerns also including formal equality considerations. We find no reason not to compensate for group size to the extent we already compensate for other factors. Moreover, groups size implying a systematic disadvantage also on a global scale, i.e. taking different aspects of the health condition of patients suffering from rare diseases into account, will provide strong reason for why group size is indeed relevant to compensate for. (shrink)

There is a growing body of literature which suggests that decisions about healthcare priority setting should take into account the extent to which patients are worse off. However, such decisions are often based on how badly off patients are with respect to the condition targeted by the treatment whose priority is under consideration (condition‐specific severity). In this paper I argue that giving priority to the worse off in terms of condition‐specific severity does not reflect the morally relevant sense of being (...) worse off. I conclude that an account of giving priority to the worse off relevant for healthcare priority setting should take into account how badly off patients are when all of their conditions are considered (holistic severity). (shrink)

Can we justify our most basic beliefs about morality, religion and the nature of the world? Can there be a rational and objective way of choosing between alternative societies, modes of life or world-views? Dr Trigg shows how philosophical analysis is relevant to these questions and criticizes the tendency to emphasize notions of commitment and convention at the expense of truth and reason. He draws parallels between issues that are often too isolated from each other and identifies a cluster of (...) related ideas, all of which stress the notion of self-contained conceptual systems that define their own standards of rationality. First published in 1973, this book will interest professional philosophers as a vigorous and distinctive exposition of several fundamental philosophical problems and more especially it can be used as an introduction for students to a wide range of philosophical problems. (shrink)

This paper argues for two theses: that degrees of belief are context sensitive; that outright belief is belief to degree 1. The latter thesis is rejected quickly in most discussions of the relationship between credence and belief, but the former thesis undermines the usual reasons for doing so. Furthermore, identifying belief with credence 1 allows nice solutions to a number of problems for the most widely-held view of the relationship between credence and belief, the threshold view. I provide a sketch (...) of a formal framework on which both theses are true. This is a modified Bayesian framework; I argue that despite making credences context-sensitive, the framework lets Bayesians hold on to their signature explanatory successes. The sort of context-sensitivity claimed for credences here mirrors the sort of context-sensitivity I have elsewhere claimed for outright belief: one's credences depend, in part, on the space of alternative possibilities one takes seriously in a context. (shrink)

This is a three-part exchange on the relationship between belief and credence. It begins with an opening essay by Roger Clarke that argues for the claim that the notion of credence generalizes the notion of belief. Julia Staffel argues in her reply that we need to distinguish between mental states and models representing them, and that this helps us explain what it could mean that belief is a special case of credence. Roger Clarke's final essay reflects on the (...) compatibility of the previously discussed views with dualist and monist interpretations of our mental states and our ways of modeling them. (shrink)

Background Health care workers (HCWs) are susceptible to moral stress and distress when they are faced with morally challenging situations where it is difficult to act in line with their moral standards. In times of crisis, such as disasters and pandemics, morally challenging situations are more frequent, due to the increased imbalance between patient needs and resources. However, the concepts of moral stress and distress vary and there is unclarity regarding the definitions used in the literature. This study aims to (...) map and analyze the descriptions used by HCWs regarding morally challenging situations (moral stress) and refine a definition through conceptual analysis. Methods Qualitative data were collected in a survey of 16,044 Swedish HCWs who attended a COVID-19 online course in autumn 2020. In total, 643 free-text answers with descriptions of moral stress were analyzed through content analysis. Results Three themes emerged from the content analysis (1) “Seeing, but being prevented to act; feeling insufficient/inadequate and constrained in the profession,” (2) “Someone or something hindered me; organizational structures as an obstacle,” and (3) “The pandemic hindered us; pandemic-related obstacles.” The three themes correspond to the main theme, “Being prevented from providing good care.” Discussion The main theme describes moral stress as various obstacles to providing good care to patients in need and acting upon empathic ability within the professional role. The themes are discussed in relation to established definitions of moral stress and are assessed through conceptual analysis. A definition of moral stress was refined, based on one of the established definitions. Conclusions On the basis of the study results and conceptual analysis, it is argued that the presented definition fulfils certain conditions of adequacy. It is essential to frame the concept of moral stress, which has been defined in different ways in different disciplines, in order to know what we are talking about and move forward in developing prevention measures for the negative outcomes of this phenomenon. (shrink)

When considering the introduction of a new intervention in a budget constrained healthcare system, priority setting based on fair principles is fundamental. In many jurisdictions, a multi-criteria approach with several different considerations is employed, including severity and cost-effectiveness. Such multi-criteria approaches raise questions about how to balance different considerations against each other, and how to understand the logical or normative relations between them. For example, some jurisdictions make explicit reference to a large patient benefit as such a consideration. However, since (...) patient benefit is part of a cost-effectiveness assessment it is not clear how to balance considerations of greater patient benefit against considerations of severity and cost-effectiveness. The aim of this paper is to explore the role of a large patient benefit as an independent criterion for priority setting in a healthcare system also considering severity and cost-effectiveness. By taking the opportunity cost of new interventions (i.e., the health forgone in patients already receiving treatment) into account, we argue that patient benefit has a complex relationship to priority setting. More specifically, it cannot be reasonably concluded that large patient benefits should be given priority if severity, cost-effectiveness, and opportunity costs are held constant. Since we cannot find general support for taking patient benefit into account as an independent criterion from any of the most discussed theories about distributive justice: utilitarianism, prioritarianism, telic egalitarianism and sufficientarianism, it is reasonable to avoid doing so. Hence, given the complexity of the role of patient benefit, we conclude that in priority practice, a large patient benefit should not be considered as an independent criterion, on top of considerations of severity and cost-effectiveness. (shrink)

In Gustavsson et al,1 we discussed the ethical issues that arise when identifying the relevant population for disease-modifying drugs targeting Alzheimer disease. More specifically, we focused on novel immunotherapies aimed at amyloid β and tau, two relevant biomarkers. The commentaries to our paper2 3 acknowledge our conclusion: screening for AD involve ethical costs that cannot be justified unless a drug with clinically relevant effect becomes available. Since Aduhelm is the only immunotherapy targeting AD currently approved by the Food and (...) Drug Administration, we use that as a …. (shrink)

Fair priority setting is based on morally sound criteria. Still, there will be cases when these criteria, our primary considerations, are tied and therefore do not help us in choosing one allocation over another. It is sometimes suggested that such cases can be handled by tiebreakers. In this paper, we discuss two versions of tiebreakers suggested in the literature. One version is to preserve fairness or impartiality by holding a lottery. The other version is to allow secondary considerations, considerations that (...) are not part of our primary priority setting criteria, to be decisive. We argue that the argument for preserving impartiality by holding a lottery is sound, while the argument for using tiebreakers as secondary considerations is not. Finally, we argue that the instances where a tiebreaker seems necessary are precisely the situations where we have strong reasons for preferring a lottery. We conclude that factors that we consider valuable should all be included among the primary considerations, while ties should be settled by lotteries. (shrink)

It is uncontroversial to claim that the extent to which health care interventions benefit patients is a relevant consideration for health care priority setting. However, when effects accrue to the individual patient, effects of a more indirect kind may accrue to other individuals as well, such as the patient's children, friends, or partner. If, and if so how, such relational effects should be considered relevant in priority setting is contentious. In this paper, we illustrate this question by using disease‐modifying drugs (...) for Alzheimer's disease as a case in point. The ethical analysis begins by sketching the so‐called prima facie case for ascribing moral weight to relational effects and then moves on to consider a number of objections to it. We argue that, whereas one set of objections may be dismissed, there is another set of arguments that poses more serious challenges for including relational effects in priority setting. (shrink)