When thinking about population level healthcare priority setting decisions, such as those made by the National Institute for Health and Care Excellence, good medical ethics requires attention to three main principles of health justice: (1) cost-effectiveness, an aspect of beneficence, (2) non-discrimination, and (3) priority to the worse off in terms of both current severity of illness and lifetime health. Applying these principles requires consideration of the identified patients who benefit from decisions and the unidentified patients who bear the opportunity (...) costs. (shrink)

This article examines Sagoff's criticisms of 'Four Dogmas of Environmental Economies' and argues that none of them are fatal. Many of the criticisms appear to rest on general misunderstandings about welfare economics. One misunderstanding is that transaction costs are theoretically indistinguishable from regular production costs. The theoretical distinction is that transaction costs vary under alternative policies and institutions whereas production costs are fixed by tastes, technology and endowments. Another misunderstanding is that market failure concerns only Pareto efficiency. Market failure also (...) concerns social efficiency with respect to the 'social welfare function', a device for making explicit ethical judgments about the interpersonal distribution of welfare. A third misunderstanding is that the 'rationality assumption' drives economic theory. In fact, the explanatory power of economic models comes mainly from explicit assumptions about the constraints facing economic agents. A fourth misunderstanding is that welfare economics is used as a mechanism for making legal and political decisions. Rather, welfare economics is used as a method for informing legal and political decisions by evaluating their outcomes on the basis of individual welfare. Used properly, it can improve the democratic process by bringing hidden costs and difficult issues to the attention of both policy-makers and the wider public. (shrink)

This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.

The main aim of this paper is to investigate the views of healthcare professionals in Portugal about healthcare rationing, and compare them with the views of college students. A self-administered questionnaire was used to collect data from a sample of 60 healthcare professionals and 180 college students. Respondents faced a hypothetical rationing dilemma where they had to order four patients and justify their choices. Multinomial logistic regressions were used to test for differences in orderings, and content analysis to categorize the (...) written justifications. The findings suggest that both groups appeared to support three main rationing principles: health maximization, priority to the severely ill and priority to the young. However, professionals seemed to give less weight to the latter principle. In conclusion, professionals have similar views to students about healthcare rationing, though may be slightly less inclined to give priority to the young. (shrink)

La cobertura universal de salud está en el centro de la acción actual para fortalecer los sistemas de salud y mejorar el nivel y la distribución de la salud y los servicios de salud. Este documento es el informe fi nal del Grupo Consultivo de la OMS sobre la Equidad y Cobertura Universal de Salud. Aquí se abordan los temas clave de la justicia (fairness) y la equidad que surgen en el camino hacia la cobertura universal de salud. Por lo (...) tanto, el informe es pertinente para cada agente que infl uye en ese camino y en particular para los gobiernos, ya que se encargan de supervisar y guiar el progreso hacia la cobertura universal de salud. (shrink)

This report from the WHO Consultative Group on Equity and Universal Health Coverage offers advice on how to make progress fairly towards universal health coverage.

The British Armed Nation, 1793?1815. By J. E. Cookson (Oxford: Oxford University Press, 1997) vi + 286 pp. £45.00/ $87.00 cloth. The Arming of Europe and the Making of the First World War. By David G. Herrmann (Princeton: Princeton University Press, 1997) 307 pp. $16.95 paper. State, Society and Mobilization in Europe during the First World War. John Horne, ed. (Cambridge U.K.: Cambridge University Press, 1997) xv + 292 pp. £35.00/ $59.95 cloth.

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

"The ancient and modern question of what is the nature of man and his activity and what ought to be the directions pursued in this activity is once again being ...

This book offers a new phenomenological interpretation of T.H. Green's (1836-1882) philosophy and political theory. By analyzing his theory of human practice, the moral idea, the common good, freedom and human rights, the book demonstrates that Green joins the same tradition as Kantian and Husserlian transcendentalism. The book offers a reconstruction of Green's idealism and demonstrates its potential to address contemporary debates on the nature of moral agency, positive and negative freedom and on justifying human rights.

From the Introduction: This inquiry is concerned with the themes of praxis and action in four philosophic movements: Marxism, existentialism, pragmatism, and analytic philosophy. It is rare that these four movements are considered in a single inquiry, for there are profound differences of emphasis, focus, terminology, and approach represented by these styles of thought. Many philosophers believe that similarities among these movements are superficial and that a close examination of them will reveal only hopelessly unbridgeable cleavages. While respecting the genuine (...) fundamental differences of these movements, this inquiry is undertaken in the spirit of showing that there are important common themes and motifs in what first appears to be a chaotic babble of voices. I intend to show that the concern with man as an agent has been a primary focal point of each of these movements and further that each contributes something permanent and important to our understanding of the nature and context of human activity. (shrink)

"A fascinating and timely treatment of the objectivism versus relativism debates occurring in philosophy of science, literary theory, the social sciences, ...

This book offers students a philosophical introduction to the ethical foundations of business management. It combines lessons from Kant with virtue ethics and also touches upon additional approaches such as utilitarianism. At the core of the book lies the concept of the nexus of imperfect managerial duty: building and reinforcing the virtuous managerial team, engaging in reasoned discourse among all stakeholders, and diligently pursuing business responsibilities, including the creative efforts necessary for modern organizations. Case illustrations of these applications are presented (...) throughout the book, including chapter appendices. Ancillary videos, test and answer banks and sample syllabi are available online via the author’s website. (shrink)

In healthcare, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the “Rule of Rescue”). This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue (...) in public resource allocation decisions by health technology funding advisory bodies such as the National Institute for Health and Clinical Excellence. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that that whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, exempt any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others. (shrink)

Drawing freely and expertly from Continental and analytic traditions, Richard Bernstein examines a number of debates and controversies exemplified in the works of Gadamer, Habermas, Rorty, and Arendt. He argues that a "new conversation" is emerging about human rationality—a new understanding that emphasizes its practical character and has important ramifications both for thought and action.

In this paper I argue that resource allocation in publicly funded medical systems cannot be done using a purely substantive theory of justice, but must also involve procedural justice. I argue further that procedural justice requires institutions and that these must be “local” in a specific sense which I define. The argument rests on the informational constraints on any non-market method for allocating scarce resources among competing claims of need. However, I resist the identification of this normative account of local (...) justice with the actual approach to local decision-making taken within the UK National Health Service. I illustrate my argument with reference to the case of provision of In Vitro Fertilisation within the UK NHS. (shrink)

To Serve With Honor should be required reading for all members of the officer corps of the United States military. Beyond that, it should be made required reading for all United States military academies, ROTC and officer candidate programs. This treatise on military ethics goes a long way in bridging the gap between the military and society's understanding of the military's ethical dilemma. It is a must for the student of military affairs. International Social Science Review To Serve With Honor (...) is the first book by an American to focus on the validity of current standards of military ethics in more than a century. This thoughtful study begins with the premise that the military profession is qualitatively different from any other profession. Author Richard Gabriel uses this assumption to address such vital questions as What are the limits of military obedience? and When does a soldier have an obligation to resist the orders of his superiors? (shrink)

A selection of speeches and essays from the author's second decade as president of Yale University.

Few philosophers have been as widely misunderstood as Nietzsche. His detractors and followers alike have often fundamentally misinterpreted him, distorting his views and intentions and criticizing or celebrating him for reasons removed from the views he actually held. Now available in paper, Nietzsche assesses his place in European thought, concentrating upon his writings in the last decade of his productive life. Nietzsche emerges in this comprehensive study as a philosopher of considerable sophistication who diverged sharply from traditional and ordinary ways (...) of thinking, but whose criticism, departures, and alternative views and strategies deserve to be given the most serious attention by philosophers. (shrink)

This article outlines how the international push for inclusive education cannot be aligned with current education systems centred on neoliberal ideals of individualism, measurement, and competition. The way that these systems are organised means that a proportion of (usually marginalised) students are necessarily excluded. In order to meaningfully address the global education crisis, that sees millions of children and young people either out of school or unengaged with learning, this ontological misalignment must be acknowledged, and discourse and engagement around it (...) must be promoted. Drawing from the work of Donella Meadows, I argue that ‘high leverage points’ (information flows, rules, system goals, mindsets) are crucial places to intervene in education systems. Intervention at such points, while challenging, has the potential to lead to transformational and sustainable change; change that current ‘low leverage point’ initiatives fail to produce. I conclude with a call for further discourse and research into an examination of ‘high leverage points’ within education systems, how they interact, and how the development of an associated framework would be beneficial for researchers and development partners. (shrink)

What we value, like, endorse, want, and prefer changes over the course of our lives. Richard Pettigrew presents a theory of rational decision making for agents who recognise that their values will change over time and whose decisions will affect those future times.

Orientalism and Religion offers us a timely discussion of the implications of contemporary post-colonial theory for the study of religion. Drawing on a variety of post-structuralist and post-colonial thinkers, including Foucault, Gadamer, Said, and Spivak, Richard King examines the way in which notions such as mysticism, religion, Hinduism and Buddhism are taken for granted, and shows us how religion needs to be redescribed along the lines of cultural studies.

The discussion of good and evil must not be confined to the sterile lecture halls of academics but related instead to ordinary human feelings, needs, and desires, says noted philosopher Richard Taylor. Efforts to understand morality by exploring human reason will always fail because we are creatures of desire as well. All morality arises from our intense and inescapable longing. The distinction between good and evil is always clouded by rationalists who convert the real problems of ethics into complex (...) philosophical puzzles. In the first part of Good and Evil, Taylor looks for a more meaningful conception by reexamining and rejecting the whole rationalistic tradition that dominates philosophical ethics. The second part provides an empirical explanation of good and evil, noting that one does not have to look too far to find prime examples of the failure of fixed moral rules. Including important commentary on Joseph Fletcher's groundbreaking situation ethics, and Aristotle's virtues (e.g., magnanimity and pride), Taylor rounds out the book by developing a philosophy of aspiration--personal worth as an ethical ideal--to replace the morality of duty. He offers a modified form of situation ethics to fit the contemporary problems we face. (shrink)

Throughout, this book questions our accepted definitions and biases, showing the self-reflective nature of scientific activity within society.

Ducklings were placed either singly or in pairs on a platform at two different heights. Both height and pairing influenced performance: More ducklings descended from the platform at low heights, and more single ducklings descended than paired ducklings. The social factor, pairing, made behavior more cautious and decreased the number of distress calls. A similar trend for pairing to influence performance was shown on the visual cliff. Without its peers, the duckling is a distressed animal. Previous careless behavior by ducklings (...) on the visual cliff may be ascribed to testing the ducklings outside their normal social environment. (shrink)

This is the third edition of a classic book first published in 1960, which has sold thousands of copies in two paperback edition and has been translated into several foreign languages. Popkin's work ha generated innumerable citations, and remains a valuable stimulus to current historical research. In this updated version, he has revised and expanded throughout, and has added three new chapters, one on Savonarola, one on Henry More and Ralph Cudworth, and one on Pascal. This authoritative treatment of the (...) theme of scepticism and its historical impact will appeal to scholars and students of early modern history now as much as ever. (shrink)

Thinking through the body: educating for the humanities -- The body as background -- Self-knowledge and its discontents: from Socrates to somaesthetics -- Muscle memory and the somaesthetic pathologies of everyday life -- Somaesthetics in the philosophy classroom: a practical approach -- Somaesthetics and the limits of aesthetics -- Somaesthetics and Burke's sublime -- Pragmatism and cultural politics: from textualism to somaesthetics -- Body consciousness and performance -- Somaesthetics and architecture: a critical option -- Photography as performative process -- Asian (...) ars erotica and the question of sexual aesthetics -- Philosophy as awakened life : everyday aesthetics of embodiment in American transcendentalism and Japanese Zen practice -- Somatic style. (shrink)

Conditionalization is one of the central norms of Bayesian epistemology. But there are a number of competing formulations, and a number of arguments that purport to establish it. In this paper, I explore which formulations of the norm are supported by which arguments. In their standard formulations, each of the arguments I consider here depends on the same assumption, which I call Deterministic Updating. I will investigate whether it is possible to amend these arguments so that they no longer depend (...) on it. As I show, whether this is possible depends on the formulation of the norm under consideration. (shrink)

According to certain normative theories in epistemology, rationality requires us to be logically omniscient. Yet this prescription clashes with our ordinary judgments of rationality. How should we resolve this tension? In this paper, I focus particularly on the logical omniscience requirement in Bayesian epistemology. Building on a key insight by Hacking :311–325, 1967), I develop a version of Bayesianism that permits logical ignorance. This includes: an account of the synchronic norms that govern a logically ignorant individual at any given time; (...) an account of how we reduce our logical ignorance by learning logical facts and how we should update our credences in response to such evidence; and an account of when logical ignorance is irrational and when it isn’t. At the end, I explain why the requirement of logical omniscience remains true of ideal agents with no computational, processing, or storage limitations. (shrink)

The book begins with an overview that introduces the Theorem and the issues surrounding it, and explores how the essays that follow contribute to our understanding of those issues.

Can we decide to trust? Sometimes, yes. And when we do, we need not believe that our trust will be vindicated. This paper is motivated by the need to incorporate these facts into an account of trust. Trust involves reliance; and in addition it requires the taking of a reactive attitude to that reliance. I explain how the states involved here differ from belief. And I explore the limits of our ability to trust. I then turn to the idea of (...) trusting what others say. I suggest that we sometimes decide to trust people to be sincere and knowledgeable; and that having taken this attitude towards them, we come to believe what they say. I spell out some consequences that this has for an account of testimony, and for van Fraassen's decision theoretic principle of Reflection. (shrink)

ABSTRACT The paper challenges the general perception that the positive–negative freedom discourse privileges negative liberty. It demonstrates that Constant and Berlin’s dual freedom conceptual scheme contains the blueprint of a modern concept of positive freedom and it reveals the nature of negative freedom in an entirely new light. Constant’s ancient and modern liberties have many similarities with Berlin’s two concepts of freedom – positive and negative. The paper shows that these similarities warrant a parallel study and allow us to examine (...) the relation between the two sides of the freedom dichotomy by using the compound terms modern/negative and ancient/positive freedom. It is argued that understanding the relation between the two freedoms depends on accepting ancient/positive liberty as practiced by the participants of modern revolutions. Then we can see why this freedom can both violate and complement modern/negative freedom. The paper argues that the combined tension and mutual dependency of the two freedoms can be explained by tapping into a metaphysical study of human agency, where metaphysics is understood as conceptualisation of moral experience. This helps demonstrate why Constant’s modern liberty and Berlin’s negative liberty rely on satisfaction as a key category reflecting individuals’ capacity for subjective judgement. (shrink)

2010 Reprint of 1905 edition.This work is the magnum opus of Bucke's career, a project that he researched and wrote over many years. In it, Bucke described his own experience, that of contemporaries, and the experiences and outlook of historical figures including Buddha, Jesus, Paul, Plotinus, Muhammad, Dante, Francis Bacon, and William Blake. Bucke developed a theory involving three stages in the development of consciousness: the simple consciousness of animals; the self-consciousness of the mass of humanity ; and cosmic consciousness (...) - an emerging faculty and the next stage of human development. Among the effects of this progression, he believed he detected a lengthy historical trend in which religious conceptions and theologies had become less and less fearful. A classic work. (shrink)

Richard Rorty's collected papers, written during the 1980s and now published in two volumes, take up some of the issues which divide Anglo-Saxon analytic philosophers and contemporary French and German philosophers and offer something of a compromise - agreeing with the latter in their criticisms of traditional notions of truth and objectivity, but disagreeing with them over the political implications they draw from dropping traditional philosophical doctrines. The second volume pursues the themes of the first volume in the context (...) of discussions of recent European philosophy focusing on the work of Heidegger and Derrida. (shrink)