This book is a comprehensive account of what it means to try to quantify health in distributing resources for health care. It examines the concept of QALYs which supposedly makes it more accurate to talk about life in terms of both quality and quantity of years lived when referring to health care policy. It offers an elegant new approach to comparing the costs and benefits of medical interventions. Cost-Utility Analysis is a method designed by economists to aid decision makers distribute (...) scarce resources to areas of health care where they will yield the greatest benefits. Erik Nord questions the feasibility of measuring patients' quality of life meaningfully in numerical terms, as CUA presupposes. He presents an alternative approach called cost-value analysis in which representative samples of the general public express preferences between different health-care programs. In this approach, subjects are allowed to include concerns for fairness that go beyond concerns for efficiency of conventional health economics. (shrink)

This book is a comprehensive account of what it means to try to quantify health in distributing resources for health care. It examines the concept of QALYs which supposedly makes it more accurate to talk about life in terms of both quality and quantity of years lived when referring to health care policy. It offers an elegant new approach to comparing the costs and benefits of medical interventions. Cost-Utility Analysis is a method designed by economists to aid decision makers distribute (...) scarce resources to areas of health care where they will yield the greatest benefits. Erik Nord questions the feasibility of measuring patients' quality of life meaningfully in numerical terms, as CUA presupposes. He presents an alternative approach called cost-value analysis in which representative samples of the general public express preferences between different health-care programs. In this approach, subjects are allowed to include concerns for fairness that go beyond concerns for efficiency of conventional health economics. (shrink)

To give priority to the young over the elderly has been labelled ‘ageism’. People who express ‘ageist’ preferences may feel that, all else equal, an individual has greater right to enjoy additional life years the fewer life years he or she has already had. We shall refer to this as egalitarian ageism. They may also emphasise the greater expected duration of health benefits in young people that derives from their greater life expectancy. We may call this utilitarian ageism. Both these (...) forms of ageism were observed in an empirical study of social preferences in Australia. The study lends some support to the assumptions in the QALY approach that duration of benefits, and hence old age, should count in prioritising at the budget level in health care. (shrink)

To give priority to the young over the elderly has been labelled ‘ageism’. People who express ‘ageist’ preferences may feel that, all else equal, an individual has greater right to enjoy additional life years the fewer life years he or she has already had. We shall refer to this asegalitarian ageism. They may also emphasise the greater expected duration of health benefits in young people that derives from their greater life expectancy. We may call thisutilitarian ageism. Both these forms of (...) ageism were observed in an empirical study of social preferences in Australia. The study lends some support to the assumptions in the QALY approach that duration of benefits, and hence old age, should count in prioritising at the budget level in health care. (shrink)

Daniel Hausman’s book ‘Valuing Health’ is a valuable contribution to our understanding of QALYs and DALYs and to moving health economics to adopting a broader perspective than that taken in conventional cost-effectiveness analysis. Hausman’s attempt at constructing a public value table for health states without having recourse to data from population preferences studies is also a fascinating read. But I have serious concerns about his resulting table. Hausman’s views on which dimensions of health a benevolent liberal state should care about (...) are essentially not different from what has long been emphasized in health economists’ work on valuations of health outcomes. His table would have been helpful as a sketch if it was the first attempt in health economics to quantify numerically the societal value of different types and degrees of health improvement. But research in the field has gone far beyond that. Multi-attribute utility instruments with much more accurate health classification systems than Hausman’s sketch are now at hand. Available also are models of societal valuations of QALYs that are broadly consistent with general population values, incorporate wider concerns than Hausman’s table does and do not have the questionable numerical properties that characterize Hausman’s sketch. (shrink)

By describing societal value judgements in health care in numerical terms one may in theory increase the precision of guidelines for priority setting and allow decision makers to judge more accurately the degree to which different health care programs provide societal value for money. However, valuing health programs in terms of QALYs disregards salient societal concerns for fairness in resource allocation. A different kind of numerical valuation of medical interventions, that incorporates concerns for fairness, is described. The usefulness to decision (...) makers of such numerical information remains to be tested. (shrink)

Advocates of EBM deserve much credit for theirefforts to increase the use of scientificevidence and economic evaluation in medicaldecision making. But EBM advocates' rigidrequirements of certainty in the estimation ofintervention effects may run counter tosociety's interest in maximising the expectedbenefits from resource use in health care.Also, their dedication to efficiency may leadsome to overlook societal concerns for fairnessin resource allocation.

By registering different health benefits on a common scale, CEA allows us to assess the relative social importance of different health care interventions and opens the way for the allocation decisions of health care policy. If it is really to be effective, however, CEA must be recalibrated so that it better reflects some of our widely held beliefs about the merits of different kinds of treatment.

By registering different health benefits on a common scale, CEA allows us to assess the relative social importance of different health care interventions and opens the way for the allocation decisions of health care policy. If it is really to be effective, however, CEA must be recalibrated so that it better reflects some of our widely held beliefs about the merits of different kinds of treatment.

C. S. Lewis is one of the most beloved Christian apologists of the twentieth century; David Hume and Bertrand Russell are among Christianity’s most important critics. This book puts these three intellectual giants in conversation with one another on various important questions: the existence of God, suffering, morality, reason, joy, miracles, and faith. Alongside irreconcilable differences, surprising areas of agreement emerge. Curious readers will find penetrating insights in the reasoned dialogue of these three great thinkers.

Forms, Matter and Mind. Three Strands in Plato’s Metaphysics -/- This book offers a new interpretation of Plato’s conception of man and of how it develops in the Corpus. Commonly, Plato’s anthropology is considered to be a version of naïve Orphism with the soul being a heavenly, but fallen, daemon. This is shown to be a misleading over-simplification. An examination of three basic and interrelated strands in Plato’s thought (Forms, Matter and Mind) demonstrates how Plato’s conception of man is an (...) integrated part of his metaphysics and develops with it. Thus, a change can be seen from a fairly unreflecting Socratic beginning via a transcendent soul to a rather sophisticated ‘Aristotelianism’. What is at issue is a non-materialistic, or more precisely, a dualistic view of man that has been discredited in modern times by two preconceptions: a widespread opinion that dualism must mean or involve Cartesianism, which seems untenable, and an equally widespread and, until recently, unshaken belief that man can be exhaustively described in materialistic terms. Both assumptions are questioned today. The present work shows that Plato’s view of man is fundamentally different from Cartesianism and furthermore that he rejects the materialist view as well. Hence, the book shows Plato’s increasing relevance for the current debate on the nature and possibilities of man. (shrink)

For the purpose of contributing to a clarification of the term “process”, different kinds of musical processes are investigated: A rule-determined phase shifting process in Steve Reich's Piano Phase (1966), a model for an indeterminate composition process in John Cage's Variations II (1961), a number of evolution processes in György Ligeti's In zart fliessender Bewegung (1976), and a generative process of fractal nature in Per Nørgård's Second Symphony (1970). In conclusion I propose that six process categories should be included in (...) a typology of processes: Rule-determined, goal-directed and indeterminate transformation processes, and rule-determined, goal-directed and indeterminate generative processes. (shrink)

There are several theses in political science that are usually explicitly called ‘laws’. Other theses are generally thought of as laws, but often without being explicitly labelled as such. Still other claims are well-supported and arguably interesting, while no one would be tempted to call them laws. This situation raises philosophical questions: which theses deserve to be called laws and which not? And how should we decide about this? In this paper we develop and motivate a strategy for thinking about (...) laws in political science which integrates two core concepts: spatio-temporal stability and social mechanisms. The proposed strategy is a set of guidelines that political scientists can use to reflect on and argue about specific cases within their discipline, not a clear-cut demarcation criterion. We defend and motivate this strategy and apply it to two cases (one with respect to state repression, one about parliamentary elections). After we have developed and motivated our strategy for political science, we show that our proposal is relevant for other disciplines in the social sciences. We explain how our views fit into critical realism and embed them in the debate on laws in general philosophy of science and in the philosophy of the social sciences. (shrink)

Develops a logical analysis of dialogue in which two or more parties attempt to advance their own interests. It includes a classification of the major types of dialogues and a discussion of several important informal fallacies.

In everyday life we often act adequately, yet without deliberation. For instance, we immediately obtain and maintain an appropriate distance from others in an elevator. The notion of normativity implied here is a very basic one, namely distinguishing adequate from inadequate, correct from incorrect, or better from worse in the context of a particular situation. In the first part of this paper I investigate such ‘situated normativity’ by focusing on unreflective expert action. More particularly, I use Wittgenstein’s examples of craftsmen (...) (tailors and architects) absorbed in action to introduce situated normativity. Situated normativity can be understood as the normative aspect of embodied cognition in unreflective skillful action. I develop Wittgenstein’s insight that a peculiar type of affective behaviour, ‘directed discontent’, is essential for getting things right without reflection. Directed discontent is a reaction of appreciation in action and is introduced as a paradigmatic expression of situated normativity. In the second part I discuss Wittgenstein’s ideas on the normativity of what he calls ‘blind’ rule-following and the ‘bedrock’ of immediate action. What matters for understanding the normativity of (even ‘blind’) rule-following, is not that one has the capacity for linguistic articulation or reflection but that one is reliably participating in a communal custom. In the third part I further investigate the complex relationships between unreflective skillful action, perception, emotion, and normativity. Part of this entails an account of the link between normativity at the level of the expert’s socio-cultural practice and the individual’s situated and lived normativity. (shrink)

The counterfactual comparative account of harm faces problems in cases that involve overdetermination and preemption. An influential strategy for dealing with these problems, drawing on a suggestion made by Derek Parfit, is to appeal to _plural harm_—several events _together_ harming someone. We argue that the most well-known version of this strategy, due to Neil Feit, as well as Magnus Jedenheim Edling’s more recent version, is fatally flawed. We also present some general reasons for doubting that the overdetermination and preemption problems (...) for the counterfactual comparative account can be satisfactorily solved by appealing to plural harm. (shrink)

Stimmung in music -- The philosophy of Stimmung -- Playing in between -- History -- Duration -- Aftersong.

The book revives the neutral monism of Mach, James, and Russell and applies the updated view to the problem of redefining physicalism, explaining the origins of sensation, and the problem of deriving extended physical objects and systems from an ontology of events.

A consideration of Mach's elements, his philosophy of neutral monism, and philosophy of physics, especially space and time, much of it based on unpublished writings from the Nachlass and other original sources. The historical connection between Mach and logical positivism is shown to be superficial at best, and Mach's elements are shown to be mind independent natural qualities (world-elements) with dynamic force, not limited to human sensations.

In Consequentialism Reconsidered, Carlson strives to find a plausible formulation of the structural part of consequentialism. Key notions are analyzed, such as outcomes, alternatives and performability. Carlson argues that consequentialism should be understood as a maximizing rather than a satisficing theory, and as temporally neutral rather than future oriented. He also shows that certain moral theories cannot be reformulated as consequentialist theories. The relevant alternatives for an agent in a situation are taken to comprise all actions that they can perform (...) in the situation. The defense of this idea necessitates certain modifications to the standard consequentialist criteria of obligatoriness, rightness and wrongness. The problem of whether agents should adapt their actions to their own future actions is also addressed. Further, a conditional analysis of performability is suggested, and it is argued that particular actions should in this connection be regarded as `abstract' rather than `concrete'. The final chapter sketches a consequentialist theory for collective agents. (shrink)

There are important structural similarities in the way that animals and humans engage in unreflective activities, including unreflective social interactions in the case of higher animals. Firstly, it is a form of unreflective embodied intelligence that is ‘motivated’ by the situation. Secondly, both humans and non-human animals are responsive to ‘affordances’ (Gibson 1979); to possibilities for action offered by an environment. Thirdly, both humans and animals are selectively responsive to one affordance rather than another. Social affordances are a subcategory of (...) affordances, namely possibilities for social interaction offered by an environment: a friend’s sad face invites comforting behavior, a person waiting for a coffee machine can afford a conversation, and an extended hand affords a handshake. I will review recent insights in the nature of the bodily intentionality characteristic of unreflective action. Such ‘motor intentionality’ can be characterized as “our direct bodily inclination to act in a situated, environmental context” (Kelly 2005, p. 106). Standard interpretations of bodily intentionality see grasping an object as the paradigmatic example of motor intentionality. I will discuss the implications of another, novel perspective that emphasizes the importance of unreflective switches from one activity to another (Rietveld 2004) and understands bodily intentionality in terms of adequate responsiveness to a field of relevant affordances. In the final section I will discuss some implications for cognitive neuroscientists who use empirical findings related to the ‘mirror neuron system’ as a starting point for a theory of motor intentionality and social cognition. (shrink)

In cognitive science, long-term anticipation, such as when planning to do something next year, is typically seen as a form of ‘higher’ cognition, requiring a different account than the more basic activities that can be understood in terms of responsiveness to ‘affordances,’ i.e. to possibilities for action. Starting from architects that anticipate the possibility to make an architectural installation over the course of many months, in this paper we develop a process-based account of affordances that includes long-term anticipation within its (...) scope. We present a framework in which situations and their affordances unfold, and can be thought of as continuing a history of practices into a current situational activity. In this activity affordances invite skilled participants to act further. Via these invitations one situation develops into the other; an unfolding process that sets up the conditions for its own continuation. Central to our process account of affordances is the idea that engaged individuals can be responsive to the direction of the process to which their actions contribute. Anticipation, at any temporal scale, is then part and parcel of keeping attuned to the movement of the unfolding situations to which an individual contributes. We concretize our account by returning to the example of anticipation observed in architectural practice. This account of anticipation opens the door to considering a wide array of human activities traditionally characterized as ‘higher’ cognition in terms of engaging with affordances. (shrink)

One of the lecture plates in the collection of the Museum of the University of Amsterdam, generally believed to be used by the Dutch botanist Hugo de Vries, has aroused much discussion in relation to the question of whether or not de Vries knew Mendel's laws before he published his rediscovery of them in 1900. The plate suggests that de Vries observed Mendelian segregation ratios in 1895 and 1896 in the progeny of a cross of two varieties of Papaver with (...) different flower colour. According to his own account, it was through this cross that he first deduced the laws of Mendel in 1896. Some researchers have accepted the lecture plate as proof for this claim. My conclusion is that the plate was not made before 1900 but in 1904 for a lecture course in the USA and, as a consequence, that it is not a contemporary piece of evidence. A closer look at the descriptions of the depicted experiment in de Vries' publications revealed that its original goal was not to investigate segregation but to transfer a monstrosity. The segregation of the flower colour was a accidental event. No research notes of the experiment have survived, but a note on an experiment with Veronica, performed in the same successive years as the Papaver experiment and definitely intended to investigate the segregation of flower colour, shows that this experiment was interpreted in a theoretically conceived, more or less Mendelian way. Because of a sloppy performance, no firm conclusions could be drawn from the experiment, but de Vries clearly had the idea of Mendelian segregation in 1896. That he never brought it up before 1900 suggests that he could not establish the general validity of segregation rules, as is shown in the case of Veronica. The reading of Mendel's paper in 1900 immediately put an end to de Vries' doubts. He scrapped the failures and kept the successes, proudly presenting these to the public as proof for the laws of segregation and, at the same time, of the independence of his discovery. (shrink)

One can (for the most part) formulate a model of a classical system in either the Lagrangian or the Hamiltonian framework. Though it is often thought that those two formulations are equivalent in all important ways, this is not true: the underlying geometrical structures one uses to formulate each theory are not isomorphic. This raises the question of whether one of the two is a more natural framework for the representation of classical systems. In the event, the answer is yes: (...) I state and sketch proofs of two technical results—inspired by simple physical arguments about the generic properties of classical systems—to the effect that, in a precise sense, classical systems evince exactly the geometric structure Lagrangian mechanics provides for the representation of systems, and none provided by Hamiltonian. The argument not only clarifies the conceptual structure of the two systems of mechanics, but also their relations to each other and their respective mechanisms for representing physical systems. It also shows why naïvely structural approaches to the representational content of physical theories cannot work. [Lagrange] grasped that he had gained a method of stating dynamical truths in a way, which is perfectly indifferent to the particular methods of measurement employed in fixing the positions of the various parts of the system. Accordingly, he went on to deduce equations of motion, which are equally applicable whatever quantitative measurements have been made, provided that they are adequate to fix positions. The beauty and almost divine simplicity of these equations is such that these formulae are worthy to rank with those mysterious symbols which in ancient times were held directly to indicate the Supreme Reason at the base of all things. (Whitehead [1948], p. 63)1. Introduction2.Classical Systems3. The Possible Interactions of a Classical System and the Structure of Its Space of States4. Classical Systems Are Lagrangian5. Classical Systems Are Not Hamiltonian6. How Lagrangian and Hamiltonian Mechanics Represent Classical Systems7. The Conceptual Structure of Classical Mechanics. (shrink)

An energy condition, in the context of a wide class of spacetime theories, is, crudely speaking, a relation one demands the stress-energy tensor of matter satisfy in order to try to capture the idea that "energy should be positive". The remarkable fact I will discuss in this paper is that such simple, general, almost trivial seeming propositions have profound and far-reaching import for our understanding of the structure of relativistic spacetimes. It is therefore especially surprising when one also learns that (...) we have no clear understanding of the nature of these conditions, what theoretical status they have with respect to fundamental physics, what epistemic status they may have, when we should and should not expect them to be satisfied, and even in many cases how they and their consequences should be interpreted physically. Or so I shall argue, by a detailed analysis of the technical and conceptual character of all the standard conditions used in physics today, including examination of their consequences and the circumstances in which they are believed to be violated. (shrink)

We propose to understand social affordances in the broader context of responsiveness to a field of relevant affordances in general. This perspective clarifies our everyday ability to unreflectively switch between social and other affordances. Moreover, based on our experience with Deep Brain Stimulation for treating obsessive-compulsive disorder (OCD) patients, we suggest that psychiatric disorders may affect skilled intentionality, including responsiveness to social affordances.

The increasing strategic importance of environmental, social and ethical issues as well as related performance measures has spurred interest in corporate sustainability performance measurement and management systems. This paper focuses on the balanced scorecard, a performance measurement and management system aiming at balancing financial and non-financial as well as short and long-term measures. Modifications to the original BSC which explicitly consider environmental, social or ethical issues are often referred to as sustainability balanced scorecards. There is much scholarly discussion about SBSC (...) architecture and how it can be designed to relate performance dimensions, strategic objectives and the logical links among these elements. To synthesise the widely scattered research findings and publications on the SBSC, we conducted a thematic analysis based on a systematic literature review containing 69 relevant articles spanning a period of two decades. We found that sustainability-oriented modifications of the BSC architecture are motivated by instrumental, social/political or normative theoretical perspectives. Moreover, these modifications can be mapped with a typology of generic SBSC architectures. The first dimension of the typology describes the hierarchy between performance perspectives and strategic objectives and how it is related to the organisational value system. The second dimension describes how sustainability-related strategic objectives are integrated into SBSC performance perspectives and how this is related to corporate sustainability strategy. This study contributes to the development of the emerging SBSC literature and practice and, more generally, to research on corporate sustainability performance measurement and management. We conclude with a research agenda and implications for management. (shrink)

The differences between critics and proponents of enhancement technologies are easily overblown. Both sides of this debate share the moral ideal of being “authentic” to oneself. They differ in how they prefer to understand authenticity, but even this difference is not as stark as it sometimes seems.

Ruth Chang has defended a concept of "parity", implying that two items may be evaluatively comparable even though neither item is better than or equally good as the other. This article takes no stand on whether there actually are cases of parity. Its aim is only to make the hitherto somewhat obscure notion of parity more precise, by defining it in terms of the standard value relations. Given certain plausible assumptions, the suggested definiens is shown to state a necessary and (...) sufficient condition for parity, as this relation is envisaged by Chang. (shrink)

We have argued that the counterfactual comparative account of harm and benefit (CCA) violates the plausible adequacy condition that an act that would harm an agent cannot leave her much better off than an alternative act that would benefit her. In a recent paper in this journal, however, Neil Feit objects that our argument presupposes questionable counterfactual backtracking. He also argues that CCA proponents can justifiably reject the condition by invoking so-called plural harm and benefit. In this reply, we argue (...) that Feit’s lines of criticism are both unsuccessful. (shrink)

: The differences between critics and proponents of enhancement technologies are easily overblown. Both sides of this debate share the moral ideal of being "authentic" to oneself. They differ in how they prefer to understand authenticity, but even this difference is not as stark as it sometimes seems.

The E-Z Reader model (Reichle et al. 1998; 1999) provides a theoretical framework for understanding how word identification, visual processing, attention, and oculomotor control jointly determine when and where the eyes move during reading. In this article, we first review what is known about eye movements during reading. Then we provide an updated version of the model (E-Z Reader 7) and describe how it accounts for basic findings about eye movement control in reading. We then review several alternative models of (...) eye movement control in reading, discussing both their core assumptions and their theoretical scope. On the basis of this discussion, we conclude that E-Z Reader provides the most comprehensive account of eye movement control during reading. Finally, we provide a brief overview of what is known about the neural systems that support the various components of reading, and suggest how the cognitive constructs of our model might map onto this neural architecture. Key Words: attention; eye-movement control; E-Z Reader; fixations; lexical access; models; reading; regressions; saccades. (shrink)

In QALY-thinking, an activity that takes N people from a bad state (including 'dying') to the state of healthy for X years should have priority over an activity that takes N other people from the same bad state to a state of moderate illness for the same number of years (given equal costs). An empirical study indicates that this view may not be shared by the general public in Norway. Subjects tended to emphasise equality in value of life and in (...) entitlement to treatment rather than level of health after treatment. The relevance of costs per QALY in prioritising between different health care programmes in Norway is thereby brought in to doubt. While the sample in the study is too small to support firm policy conclusions, the results should contribute to an increased interest among health economists in actually measuring people's ethical preferences in matters of prioritising, rather than taking it for granted that their own values are shared by the general public. (shrink)