A paradigmatic experience of agency is the felt effort associated with the act of making a difficult choice. The challenge of accounting for this experience within a compatibilist framework has been called ‘the agency problem of compatibilism’ (Vierkant, 2022, The Tinkering Mind: Agency, Cognition and the Extended Mind, Oxford University Press, 116). In this paper, I will propose an evolutionarily plausible, actional account of deciding which explains the phenomenology. In summary: The act of making a difficult choice is triggered by (...) a metacognitive decision to intentionally stop deliberating, despite ongoing uncertainty. This decision is the output of a metacognitive cost–benefit computation, which weighs the value of uncertainty reduction against the costs of ongoing deliberation. Strikingly, contemporary theories of effort suggest that this cost–benefit computation is also the source of the feeling of mental effort, which tracks the costs of that decision. If this account is correct, the agency problem of compatibilism has been solved. The act of making a difficult choice and the associated paradigmatic experience of agency, felt effort, both follow from the metacognitive evaluation. Implications are explored. (shrink)

Bakhtin and Voloshinov argued that dialogue is the intersubjective basis of consciousness, and of the creativity which makes historical changes in consciousness possible. The multiple dialogical relationships give every subject, who has developed through internalising them, the potential to distance him or herself from them. Consciousness is therefore an 'unfinalised' process, always open to a possible future which would not merely reiterate the past. But this book explores its corollary: The relative openness is a field of conflict where rival discourses (...) struggle for hegemony, by subordinating or eliminating their rivals. That is how the unconscious is created out of socio-historical conflicts. Hegemony is always incomplete, because there is always the possibility of a return of its repressed rivals in new combinations. (shrink)

The brutal wars in Iraq, Syria and now Ukraine have caused a massive influx of refugees to Europe. Turkey alone has received more than 4.8 million refugees. An important precondition for their economic and social incorporation is trust: refugees need to trust the citizens as well as the state and the justice system to find their place in the host country. Yet refugees’ propensity to trust may be affected by cultural differences between their home and host countries, their personal conflict (...) exposure and the experiences they had on the run. This study investigates how individual differences in exposure to armed conflict and institutional breakdown shape two types of trust among refugees: Generalized social trust and trust in the institutions of the settlement country. We survey a large and diverse sample of refugees from Syria and Iraq living in Turkish communities and deploy well-established measures of conflict exposure, posttraumatic stress, and posttraumatic growth. We find that higher degrees of conflict exposure are positively related to social trust, and to trust in courts and the police. These positive findings are largely driven by refugees who had very personal and emotionally powerful experiences. The psychological mechanism of posttraumatic growth cannot explain these findings, however, suggesting positive experiences of cooperation in the midst of war and displacement are potentially a better explanation for this finding than positive psychological changes resulting from trauma. At the same time, conflict exposure is negatively related to trust in political institutions. Posttraumatic stress may be the mechanism behind this result. We discuss the implications of these findings for the integration of war refugees—a topic that is tragically of great relevance today. (shrink)

The importance of preserving trust in physicians and in medical institutions has received widespread attention in recent years. Primarily, this is due to the threats to trust posed by managed care, but there is a general and growing recognition that trust deserves more attention than it traditionally has received in all aspects of medical ethics, law, and public policy. Trust has both intrinsic and instrumental value. Trust is intrinsically important because it is a core characteristic that affects the emotional and (...) interpersonal aspects of the physician/patient relationship. As an instrumental value, trust is widely believed to be essential for effective therapeutic encounters. It has been hypothesized or shown to affect a host of important behaviors and attitudes relating to care, including seeking care, disclosing private information, complying with treatment, and being satisfied with care. Moreover, trust may be a mediator of measurable clinical outcomes and a key factor in the mind–body interactions that underlie placebo/nocebo effects and the effectiveness of alternative medicine. It is no surprise, then, that preserving, justifying, and enhancing trust is the fundamental goal of much of medical ethics, and is a prominent objective in healthcare law and public policy. Discussions of trust and related concepts were commonplace in professionally based medical ethics prior to the 1970s. a 1 2. (shrink)

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

Serological data have been used to address anthropological problems since the turn of the century. These were predominantly problems of two kinds in anthropological systematics: the relations of human populations to one another (racial serology), and the relations of primate species to one another (systematic serology). Though they were the locus of considerable debate about the relative merits of 'genetic' versus 'traditional' data, the serological work had little lasting impact in the field. I attribute this to the fact that the (...) research was carried out largely externally to anthropology, and often interpreted in facile manners. To a large extent the history of this research has been ignored or rewritten following the development of 'molecular anthropology' in the 1960s. To some extent, however, contemporary genetic research in anthropology replays aspects of the serological era. (shrink)

There is overwhelming evidence that the opioid crisis—which has cost hundreds of thousands of lives and trillions of dollars (and counting)—has been created or exacerbated by webs of influence woven by several pharmaceutical companies. These webs involve health professionals, patient advocacy groups, medical professional societies, research universities, teaching hospitals, public health agencies, policymakers, and legislators. Opioid companies built these webs as part of corporate strategies of influence that were designed to expand the opioid market from cancer patients to larger groups (...) of patients with acute or chronic pain, to increase dosage as well as opioid use, to downplay the risks of addiction and abuse, and to characterize physicians’ concerns about the addiction and abuse risks as “opiophobia.” In the face of these pervasive strategies, conflict of interest policies have proven insufficient for addressing corporate influence in medical practice, medical research, and public health policy. Governments, the academy, and civil society need to develop counterstrategies to insulate themselves from corporate influence and to preserve their integrity and public trust. These strategies require a paradigm shift—from partnerships with the private sector, which are ordinarily vehicles for corporate influence, to a norm of separation. (shrink)

This paper responds to the commentaries from Stacy Carter and Alan Cribb. We pick up on two main themes in our response. First, we reflect on how the process of setting standards for empirical bioethics research entails drawing boundaries around what research counts as empirical bioethics research, and we discuss whether the standards agreed in the consensus process draw these boundaries correctly. Second, we expand on the discussion in the original paper of the role and significance of the concept of (...) ‘integrating’ empirical methods and ethical argument as a standard for research practice within empirical bioethics. (shrink)

This book offers a novel critique of public-private partnerships in public health. The author argues these relationships create webs of influence that undermine the integrity of public health agencies, and imperil public health. He makes a compelling case that the paradigm interaction between governments and corporations should be at arm's length: separation, not collaboration.

This article introduces the Special Issue on ‘Interpretivism and the English School of International Relations’. It distinguishes between what we term the interpretivist and structuralist wings of...

In Perfection and Disharmony in the Thought of Jean-Jacques Rousseau, Jonathan Marks offers an interpretation of the philosopher's thought and its place in the contemporary debate between liberals and communitarians. Against prevailing views, he argues that Rousseau's thought revolves around the natural perfection of a naturally disharmonious being. At the foundation of Rousseau's thought he finds a natural teleology that takes account of and seeks to harmonize conflicting ends. The Rousseau who emerges from this interpretation is a radical critic (...) of liberalism who is nonetheless more cautious about protecting individual freedom than his milder communitarian successors. Marks elaborates on the challenge that Rousseau poses to liberals and communitarians alike by setting up a dialogue between him and Charles Taylor, one of the most distinguished ethical and political theorists at work today. (shrink)

During times of crisis, institutions tend to focus on maintaining or restoring public trust, as well as on measures to insulate themselves (and their leadership) from potential legal liability. This is because institutions reflexively turn to lawyers, risk managers, crisis consultants, and public relations firms that focus on what they euphemistically call the “optics.” In this essay, I highlight the vital importance of addressing underlying reasons for an institution's loss of public trust—in particular, the loss (or erosion) of its integrity (...) and trustworthiness. Loss of public trust generates one kind of crisis—which I term “opsis.” But there is another kind of institutional crisis that so often remains unrecognized. Just as medical sepsis in the human body is a critical condition that endangers life, the loss of an institution's integrity and trustworthiness constitutes a type of sepsis—ethical sepsis—that poses an existential threat to the institution if unaddressed. (shrink)

This article analyses the evolution of the English school’s approach to international relations from the work of the early British Committee in the late 1950s and early 1960s to its revival in the...

Communism is not a reaction against the failure of the nineteenth century to organize optimal economic output. It is a reaction against its comparative success. It is a protest against the emptiness of economic welfare, an appeal to the ascetic in us all... The idealistic youth play with Communism because it is the only spiritual appeal which feels to them contemporary.

Let M be a structure for a language L on a set M of urelements. HYP(M) is the least admissible set above M. In § 1 we show that pp(HYP(M)) [ = the collection of pure sets in HYP(M] is determined in a simple way by the ordinal α = ⚬(HYP(M)) and the $\mathscr{L}_{\propto\omega}$ theory of M up to quantifier rank α. In § 2 we consider the question of which pure countable admissible sets are of the form pp(HYP(M)) for (...) some M and show that all sets L α (α admissible) are of this form. Other positive and negative results on this question are obtained. (shrink)

"Central Themes in Early Modern Philosophy is a selection of some of the best work being done in early modern philosophy by Anglo-American philosophers today.... The essays in this collection are historically informed and philosophically challenging. The book is a fitting tribute to Jonathan Bennett." -- Daniel Garber, University of Chicago.

“What’s the big deal?”The meaning of this interrogative depends on the inflection. From the mouths of proponents of public–private partnerships (PPPs) related to food and health, it asks—perhaps with some skepticism or bewilderment—what objections there could possibly be to public–private partnerships intended to address some of our most pressing public health challenges. This is due, in no small part, to the way such partnerships are often characterized by participants and proponents alike: they are a “win–win–win,” for the public sector actor, (...) for the private sector actor, and for the general public or relevant publics (often characterized as consumers).1 Posed by critics of PPPs, the question cynically .. (shrink)

The decision to initiate invasive, first-in-human trials involving Parkinson’s disease presents a vexing ethical challenge. Such studies present significant surgical risks, and high degrees of uncertainty about intervention risks and biological effects. We argue that maintaining a favorable riskbenefit balance in such circumstances requires a higher than usual degree of confidence that protocols will lead to significant direct and/or social benefits. One critical way of promoting such confidence is through the application of stringent evidentiary standards for preclinical studies. We close (...) with a series of recommendations for strengthening the internal and external validity of preclinical studies, reducing their tendency toward optimism and publication biases, and improving the knowledge base used to design and evaluate preclinical studies. (shrink)

Our knowledge of the evolution of human thought is limited not only by the nature of the evidence, but also by the values we bring to the authoritative scientific study of our ancestors. The tendency to see human thought as linear progress in rational capacities has been popular since the Enlightenment, and in the wake of Darwinism has been extended to other species as well. Human communication can be used to transmit useful information, but is rooted in symbolic processes that (...) are nonrational—that is, they involve choosing among functionally equivalent alternatives, any of which is as good an option as any other. The evolution of human thought cannot be realistically isolated from the evolution of human society or human communication, neither of which is rooted in obvious rationality. (shrink)

Clinical Ethics, Ahead of Print. This paper is a response to a recent BMJ Blog: ‘The duty to treat: where do the limits lie?’ Members of the Surrey Heartlands Integrated Care Service Clinical Ethics Group reflected on arguments in the Blog in relation to resuscitation during the COVID-19 pandemic.Clinicians have had to contend with ever-changing and conflicting guidance from the Resuscitation Council UK and Public Health England regarding personal protective equipment requirements in resuscitation situations. St John Ambulance had different guidance (...) for first responders.The situation regarding resuscitation led the CEG to consider ethical aspects of health care professionals’ responses to the need for resuscitation during COVID-19. Members agreed that professionals should, ideally, have the level of PPE required for an aerosol generating procedure. However, there was no consensus regarding professionals’ duty to care when this is not available. On the one hand, it was agreed that the casualty/patient’s interests regarding resuscitation should be prioritised due to professionals’ contract with the public and professional privilege. On the other hand, risk thresholds were considered relevant to individual decision-making and professionals’ duty to care. All agreed that decision-making should not be influenced by rewards or reprimands. It was agreed also that decisions to resuscitate should not be considered as moral heroism or supererogatory - regardless of PPE availability - but rather as ‘minimally decent’. We agreed that it may be acceptable for professionals, with good reasons, to opt out of resuscitation attempts and these should be reflected on and discussed before the event. (shrink)

Ideas about biology, race, and theology were bound up together in nineteenth‐century scholarship, although they are rarely, if ever, considered together today. Nevertheless, the new genealogical way of thinking about the history of life arose alongside a new way of thinking about the Bible, and a new way of thinking about people. They connected with one another in subtle ways, and modern scholarly boundaries do not map well on to nineteenth‐century scholarship.

Let $\mathscr{M}$ be a structure for a language $\mathscr{L}$ on a set $M$ of urelements. $\mathrm{HYP}(\mathscr{M})$ is the least admissible set above $\mathscr{M}$. In $\S 1$ we show that $pp(\mathrm{HYP}(\mathscr{M})) \lbrack = \text{the collection of pure sets in} \mathrm{HYP}(\mathscr{M}\rbrack$ is determined in a simple way by the ordinal $\alpha = \circ(\mathrm{HYP}(\mathscr{M}))$ and the $\mathscr{L}_{\propto\omega}$ theory of $\mathscr{M}$ up to quantifier rank $\alpha$. In $\S 2$ we consider the question of which pure countable admissible sets are of the form $pp(\mathrm{HYP}(\mathscr{M}))$ for (...) some $\mathscr{M}$ and show that all sets $L_\alpha (\alpha$ admissible) are of this form. Other positive and negative results on this question are obtained. (shrink)

We tend to think of conflict as bad and compromise as good. But how should we view conflict that exposes potential threats to the environment and health? And what about a compromise between litigants that may adversely affect the interests of third parties or undermine public health? There can be few places in the country where this issue has become more pressing than in my home state, Pennsylvania. The hydraulic fracturing of natural gas in the Marcellus Shale has transformed lives (...) and landscapes here, mainly in rural communities with low‐income populations. The Hallowich family is a case in point. (shrink)

Nell Toussaint is not well. In recent years, she has been diagnosed with uterine fibroids, uncontrolled hypertension, nephrotic syndrome, poorly controlled diabetes, hyperlipidemia, and a pulmonary embolism. She also suffers from decreased mobility, shortness of breath, and‐perhaps not surprisingly, given her other ailments‐anxiety. Toussaint is an indigent undocumented immigrant living in Canada who has been trying to secure medical coverage in the federal courts. In the process, she has sacrificed the medical confidentiality that most of us ordinarily enjoy. Toussaint first (...) came to Canada from Grenada as a visitor in 1999 and remained after the term of her visa expired. At first, she earned enough to sustain a living, but in 2006, her health began to deteriorate, and she was no longer able to work. Although she has received some medical care since then, it has been sporadic, on an emergency basis, and at great expense. When Toussaint applied for medical health coverage under Canada's Interim Medical Health Program, which covers the cost of emergency medical care for legally admitted indigents, her application was rejected. She challenged the decision in federal court on the grounds that her right to life and security of the person under the Canadian Charter had been violated and that the denial of coverage was discriminatory. (shrink)

These are not the words of a harsh critic of the Food and Drug Administration. They were penned by the agency’s deputy commissioner for food. That this is an insider’s view makes it all the more troubling. Recent studies suggest that roughly half the products on supermarket shelves proclaim their purported health benefits.2 But a trip to the supermarket suggests that this is a conservative estimate. The FDA is not powerless to regulate these claims, but it operates in a regulatory (...) framework that is the product of piecemeal reform and compromise, not intelligent design. And its limited staff resources and budget further constrain what it can do. The food industry is required to seek prior .. (shrink)

My invitation to respond to Lepora and Goodin may be the result of my work on complicity—in particular, the participation of health professionals in torture and aggressive interrogation in the so-called ‘war on terror’.1,2 However, instead of responding to the précis, I intend to address the section of the authors' book dealing with compromise and to explore the implications of their approach for some pressing public health issues.3,4 In their chapter entitled ‘Compromise as a Template’, Lepora and Goodin contend that (...) ‘[i]t is only when the intra-personal conflict forces an agent to choose among items of principled concern … to her that a compromise is genuinely involved’ (p. 19). The authors are right to emphasise the ethical significance of setting aside, forsaking or violating one's principles to reach an agreement. There may be serious implications for the integrity of an individual or an institution that makes such a compromise. But we should ensure that the intrapersonal focus does not lead to the neglect of other important ethical dimensions. A compromise may be problematic because of its impact on others who are affected by, but are not …. (shrink)

Selecting, applying and reporting on investment screens for socially responsible investing (SRI) presents challenges for companies, investors and fund managers. This article seeks to clarify the nature of these challenges in developing an understanding of the foundations of ethical investment screens. At a conceptual level this work argues that there is a common element to the ethical foundations of SRI, even with very different apparent motivations and investment restrictions. Establishing this commonality assists in explaining the information asymmetry problem inherent in (...) SRI. A market-facilitated solution illustrates how these insights might foster the development of socially responsible investment. (shrink)

We are currently seeing a revival of interest in Aquinas's moral thought among Christian ethicists, both Protestant and Catholic. Although recent studies of his moral thought have touched on a number of topics, the majority of these have focused on his account of the virtues and their place in the Christian life. Probing the questions of the relation of virtue and law, the role of reason and will, and the place of the passions in Aquinas's moral theology, I will examine (...) recent studies by Diana Cates, Pamela Hall, Simon Harak, James Keenan, Daniel Nelson, Daniel Westberg, and Paul Waddell. In different ways these studies return us repeatedly to the vexed and unresolved question of the scope of human freedom. (shrink)

This book explores the making of health care rationing decisions through the analysis of three alternative decision makers: patients paying out of pocket; officials setting limits on treatments and coverage; and physicians at the bedside. Hall develops this analysis along three dimensions: political economics, ethics, and law. The economic dimension addresses the practical feasibility of each method. The ethical dimension discusses the moral aspects of these methods, while the legal dimension traces the most recent developments in jurisprudence and health law.