Following Jacques Hadamard, applied mathematicians typically investigate their models in the form of well-set problems, which actually consist of a family of applicational circumstances that vary in specific ways with respect to their initial and boundary values. The chief motive for investigating models in this wider manner is to avoid the improper behavioral conclusions one might reach from the consideration of a more restricted range of cases. Suitable specifications of the required initial and boundary variability typically appeal to previously established (...) experimental conclusions as to how the target system will behave under a range of eternally applied manipulations of the form “If the conditions pertaining to S were altered in manner M, internal features X would/would not alter”. In his investigations of causal reasoning within other parts of science, our first author has emphasized the conceptual importance of counterfactuals of this nature, for which he was been often criticized by authors of a self-styled “metaphysical” inclination. The purpose of this note is to argue, pace these objections, that closely analogous considerations have long been part of the practice of investigating differential equation models in a sensible way. (shrink)

Just health: meeting health needs fairly is an ambitious book, in which Norman Daniels attempts to bring together in a single framework all his work on health and justice from the past 25 years. One major aim is to reconcile his earlier work on the special moral importance of healthcare with his later work on the social determinants of health. In his earlier work, Daniels argued that healthcare is of special moral importance because it protects opportunity. In this later work, (...) Daniels argues that the social determinants of health (which in fact tend to have a larger effect on health outcomes than healthcare does) should also be considered special. This paper argues that it is a mistake to base a theory of justice for health on the claim that health (or the social determinants of health) are "special", for three reasons. First, once we realise that health is to a large part socially determined by features such as distribution of income, which are also of independent importance for justice, we cannot talk about a theory of justice for health in isolation from an overall theory of justice. Second, when we are trying to work out the place of health in a general theory of justice, being told that health (or the social determinants of health) is special is unhelpful. The relevant starting point should rather be whether health matters in a fundamental way for justice, or whether it matters merely for the effects it has on those goods which are of fundamental importance for justice. Third, treating the social determinants of health as special would in fact be counterproductive in terms of the broad approach to justice Daniels favours. (shrink)

This is the first textbook of surgical ethics. It is a practical, clinically comprehenive, well-organized guide to ethical issues in surgical practice, research, and education written by leading figures in surgery and bioethics. The authors cover the surgeon-patient relationship, the full range of surgical patients, surgical education and research, and surgery and managed care. Their chapters are not abstract discussions of ethical principles; rather, they connect directly with the everyday concerns of practicing surgeons.

The objective of the present text is to develop a reflection about the value of human life in today’s society bringing into focus the contrasting perspectives of the ordinary and the extraordinary of life. For that purpose, we emphasize the conception of the Catholic Church from the Second Vatican Council that suggests an attitude of a Pilgrim Church which longs for dialogue with human beings in their ordinary life (we intend to rescue the positive sense of the term "ordinary"), in (...) disadvantage of the triumphalist vision which gives priority to the great deeds of history. In that sense, we establish a dialogue with the literal work Crime and Punishment (1866) by Fyodor Dostoyevsky whose protagonist Raskolnikov reveals himself through the contemporary dilemma between being and not being extraordinary in the eyes of the society. His moral conscience is tested after a crime he committed. The apex of this revelation takes place after the reading of the Gospel relating to the resurrection of Lazarus shared with Sonia, a flagrant sinner, an ordinary in the eyes of the society represented in the work. In fact, how it happens in the painful passage of Raskolnikov, God makes himself known through the other in borderline situations and we take him into account through the experience which a man of faith realizes when discovering Him to be present. The presence of God in the world is surely not to be understood in the sphere of the extraordinary, what matters is the experience of refuge when we are seduced by the faith. (shrink)

Comprehensive Biomedical Research Centre and Centre for Philosophy, Justice and Health, UCL, First Floor, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ, UK. Tel.: +44 (0)20 7679 9417; Fax: +44 (0)20 7679 9426; Email: james-gs.wilson{at}ucl.ac.uk ' + u + '@' + d + ' '//--> . Abstract This paper aims to shed some light on the difficulties we face in constructing a generally acceptable normative framework for thinking about public health. It argues that there are three (...) factors that combine to make theorising about public health difficult, and which when taken together defeat simplistic top-down and bottom-up approaches to the design of public health policies. The first factor is the problem of complex systems, namely that the distribution of health both affects and is affected by the distribution of other goods. The second is the difficulty of defining the goals of public health: we still need to get clear about what we should mean by health in this context, and what the goals of public health should be. The third is that we stand in need of an account of how important health is relative to the importance of other goods that a just society should be trying to secure for its citizens. The paper argues that these problems should lead us to abandon the search for a ‘one-size fits all’ normative framework for thinking about public health. Rather, different approaches will be appropriate at different levels of abstraction. CiteULike Connotea Del.icio.us What's this? (shrink)

Research involving human subjects is much more stringently regulated than many other nonresearch activities that appear to be at least as risky. A number of prominent figures now argue that research is overregulated. We argue that the reasons typically offered to justify the present system of research regulation fail to show that research should be subject to more stringent regulation than other equally risky activities. However, there are three often overlooked reasons for thinking that research should be treated as a (...) special case. First, research typically involves the imposition of risk on people who do not benefit from this risk imposition. Second, research depends on public trust. Third, the complexity of the moral decision making required favors ethics committees as a regulative solution for research. (shrink)

Democracy establishes relationships of political equality, ones in which citizens equally share authority over what they do together and respect one another as equals. But in today's divided public square, democracy is challenged by political thinkers who disagree about how democratic institutions should be organized, and by antidemocratic politicians who exploit uncertainties about what democracy requires and why it matters. Democratic Equality mounts a bold and persuasive defense of democracy as a way of making collective decisions, showing how equality of (...) authority is essential to relating equally as citizens. James Lindley Wilson explains why the US Senate and Electoral College are urgently in need of reform, why proportional representation is not a universal requirement of democracy, how to identify racial vote dilution and gerrymandering in electoral districting, how to respond to threats to democracy posed by wealth inequality, and how judicial review could be more compatible with the democratic ideal. What emerges is an emphatic call to action to reinvigorate our ailing democracies, and a road map for widespread institutional reform. Democratic Equality highlights the importance of diverse forms of authority in democratic deliberation and electoral and representative processes—and demonstrates how that authority rests equally with each citizen in a democracy. (shrink)

This work argues that philosophy is not just useful, but vital, for thinking coherently about priorities in health policy and public policy.

The infant mortality rate in Liberia is 50 times higher than it is in Sweden, whilst a child born in Japan has a life expectancy at birth of more than double that of one born in Zambia. 1 And within countries, we see differences which are nearly as great. For example, if you were in the USA and travelled the short journey from the poorer parts of Washington to Montgomery County Maryland, you would find that ‘for each mile travelled life (...) expectancy rises about a year and a half. There is a twenty-year gap between poor blacks at one end of the journey and rich whites at the other’. (Marmot, 2004, p.2). There are two types of questions which it is important to ask about inequalities in health such as these. The first are social scientific questions about the extent of inequalities in health and the factors which are causally responsible for these inequalities. Examples of social scientific questions to ask might be: how do infant mortality rates in the UK differ according to social class? What is the difference in life expectancy between Japanese who emigrate to the US and those who remain in Japan? Why do civil servants in higher ranked jobs tend to live longer than civil servants in lower ranked jobs? The second type are normative questions about the reasons we have to care about inequalities in health. Important normative questions to answer are: which inequalities in health should we care about (all inequalities or merely some of them)? When is an inequality in health unjust? How should we weigh our concern for equality in health against other factors such as maximising the.. (shrink)

Book reviewed in this article: On Human Nature. By Edward O. Wilson.

Three main claims are made in this paper. First, it is argued that Onora O’Neill has uncovered a serious problem in the way medical ethicists have thought about both respect for autonomy and informed consent. Medical ethicists have tended to think that autonomous choices are intrinsically worthy of respect, and that informed consent procedures are the best way to respect the autonomous choices of individuals. However, O’Neill convincingly argues that we should abandon both these thoughts. Second, it is argued that (...) O’Neill’s proposed solution to this problem is inadequate. O’Neill’s approach requires that a more modest view of the purpose of informed consent procedures be adopted. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. It is argued that contrary to what O’Neill claims, the wrongness of coercion cannot be derived from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Third, it is argued that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. Respect for autonomy is in trouble. In recent work in this journal1 and elsewhere,2 O’Neill has forcefully argued that respect for autonomy, as it has come to be used in medical ethics, is philosophically indefensible. If her arguments are sound, then, contrary to the standard view, respect for autonomy cannot be the source of the ethical requirement to seek informed consent before treating a patient or enrolling a participant in a trial. So her critique goes to the heart of contemporary medical ethics: if O’Neill is right, medical ethicists have systematically misunderstood two of the most fundamental concepts they deal with—respect for autonomy and informed consent. This paper has four sections. Section 1 distinguishes between three different ways of talking about respect for autonomy, and looks in more detail at the one that has come to be central to bioethical writing on informed consent—namely, the idea that we should respect autonomous choices. Section 2 argues, following O’Neill, that it is implausible to think that the purpose of informed consent requirements is to respect autonomous choices. Section 3 argues that O’Neill’s proposed reworking of autonomy and informed consent is inadequate. O’Neill’s approach requires us to adopt a more modest view of the purpose of informed consent procedures. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. I argue that contrary to what O’Neill claims, we cannot derive the wrongness of coercion from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Section 4 argues that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. (shrink)

Philosophy & Public Affairs, Volume 50, Issue 2, Page 169-201, Spring 2022.

Although Leibniz characterised himself in the “New Essays” as a “Platonic” as opposed to a “Democritean” philosopher, his intellectual relationship with the most famous of the Renaissance Neoplatonists, Marsilio Ficino, has received little attention. Here we review what can be thus far established regarding Leibniz’s acquaintance with portions of Ficino’s Opera omnia of 1576. We compare Ficino’s disenchantment with the atomistic materialism of Lucretius, which he had favoured in his youth, and his turn to Platonism for inspiration, with Leibniz’s own (...) reported disenchantment with Gassendi’s Epicurean atomism and his invention of a vitalistic monadology that, despite Leibniz’s reservations regarding Ficinian magic, resembles Ficinian nature philosophy in number of striking respects. (shrink)

Intellectual property typically involves claims of ownership of types, rather than particulars. In this article I argue that this difference in ontology makes an important moral difference. In particular I argue that there cannot be an intrinsic moral right to own intellectual property. I begin by establishing a necessary condition for the justification of intrinsic moral rights claims, which I call the Rights Justification Principle. Briefly, this holds that if we want to claim that there is an intrinsic moral right (...) to φ, we must be able to show that (a) violating this right would typically result in either a wrongful harm or other significant wrong to the holder of the right, and (b) the wrongful harm or other wrong in question is independent of the existence of the intrinsic right we are trying to justify. I then argue that merely creating a new instance of a type is not the kind of action which can wrongfully harm the creator of that type. Insofar as there do seem to be wrongs involved in copying a published poem or computer program, these wrongs presuppose the existence of an intrinsic right to own intellectual property, and so cannot be used to justify it. I conclude that there cannot be an intrinsic right to own intellectual property. (shrink)

Examines the perennial issues that keep science and religion at arm's length, clarifies those issues, and fits them into an historical framework—from Plato, to Aquinas, to today's thinkers.

Resnik’s argument relies upon an undefended and unjustified overvaluation of liberty. First, he overlooks some important arguments in favour of restrictions to liberty, and his consideration of the two he does review is unfair; second his account grossly overestimates the autonomy of our food choices; and lastly his mechanism for balancing liberty against other concerns involves an illicit double counting of the weight of individual liberty.

When we talk about intellectual property, it is often implicitly assumed that we are talking about private intellectual property. However, private property and the idea of private ownership do not exhaust the possibilities for accounts of ownership and of property. There are other ways that ownership can operate, such as common property. A resource is common property if its use is ‘governed by rules whose point is to make them available for use by all or any members of the society.’.

In the book Valuing Health, Daniel Hausman sets out a normative framework for assessing social policy, which he calls restricted consequentialism. For the restricted consequentialist, government policy-making not only is, but ought to be, largely siloed in individual government departments. Each department has its own goal linked to a fundamental public value, which it should pursue in a maximizing way. I argue that, first, Hausman’s argument appears to be internally inconsistent: his case for thinking that health policy should default to (...) a form of maximization is plausible only if a much narrower vision of the goals of policy is adopted than Hausman thinks appropriate in the case of education. Secondly, it turns out that none of Hausman’s analysis helps us with the crucial question of how maximization should be constrained by other values—a question that even on Hausman’s account looks to be crucial, and that will be even more important if adopt a broader perspective on the purposes of health policy than Hausman allows. (shrink)

Drugs are much more expensive whilst they are subject to patent protection than once patents expire: patented drugs make up only 20% of NHS drugs prescriptions, but consume 80% of the total NHS drugs bill. This article argues that, given the relatively uncontroversial assumption that we should save the greater number in cases where all are equally deserving and we cannot save both groups, it is more difficult than is usually thought to justify why publicly funded healthcare systems should pay (...) for patented treatments. The claim to medical treatment of those who will be sick with a given condition once the patent runs out is just as strong as those who are sick with it now, but we will be able to treat more people with the same unit of resource in the future. Hence, when resource constraints entail that both cannot be funded, publicly funded healthcare systems ought to wait until patents expire before approving drugs for general use in the publicly funded system. (shrink)

The WHO Commission on the Social Determinants of Health revealed that there is a 28-year disparity between the life expectancy in the poorest postcode and the richest postcode of Glasgow (CSDH, 2008). There are two sets of questions that it is important to ask about health inequalities like these: first, epidemiological questions about the mechanisms that cause inequalities in health and the measures that are effective in reducing them. Second, normative questions about which inequalities in health are wrong and why (...) they are wrong. The papers in this symposium result from the inaugural conference of UCL's Centre for Philosophy, Justice and Health (CPJH) and focus on the relationship between these epidemiological and normative questions. (shrink)

Research data produced in both universities and the NHS are subject to the Freedom of Information Act 2000. This article examines the practical and ethical implications of freedom of information for research data, arguing that increased openness is both here to stay and is ethically justifiable. Researchers need to learn how best to cope with this.

Fair allocation of scarce healthcare resources has been much studied within philosophy and bioethics, but analysis has focused on a narrow range of cases. The Covid-19 pandemic provided significant new challenges, making powerfully visible the extent to which health systems can be fragile, and how scarcities within crucial elements of interlinked care pathways can lead to cascading failures. Health system resilience, while previously a key topic in global health, can now be seen to be a vital concern in high-income countries (...) too. Unfortunately, mainstream philosophical approaches to the ethics of rationing and prioritisation provide little guidance for these new problems of scarcity. Indeed, the cascading failures were arguably exacerbated by earlier attempts to make health systems leaner and more efficient. This paper argues that health systems should move from simple and atomistic approaches to measuring effectiveness to approaches that are holistic both in focusing on performance at the level of the health system as a whole, and also in incorporating a wider range of ethical concerns in thinking about what makes a health system good. (shrink)

In this article the basic principles of responsible authorship and peer review are surveyed, with special emphasis on (a) guidelines for refereeing archival journal articles and proposals; and (b) how these guidelines should be taken into account at all stages of writing.

The pandemic significantly raised the stakes for the translation of bioethics insights into policy. The novelty, range and sheer quantity of the ethical problems that needed to be addressed urgently within public policy were unprecedented and required high‐bandwidth two‐way transfer of insights between academic bioethics and policy. Countries such as the United Kingdom, which do not have a National Ethics Committee, faced particular challenges in how to facilitate this. This paper takes as a case study the brief career of the (...) Ethics Advisory Board (EAB) for the NHS Covid‐19 App, which shows both the difficulty and the political complexity of policy‐relevant bioethics in a pandemic and how this was exacerbated by the transience and informality of the structures through which ethics advice was delivered. It analyses how and why, after EAB's demise, the Westminster government increasingly sought to either take its ethics advice in private or to evade ethical scrutiny of its policies altogether. In reflecting on EAB, and these later ethics advice contexts, the article provides a novel framework for analysing ethics advice within democracies, defining four idealised stances: the pure ethicist, the advocate, the ethics arbiter and the critical friend. (shrink)

Conservative thinkers such as Francis Fukuyama have produced a battery of objections to the transhumanist project of fundamentally enhancing human capacities. This article examines one of these objections, namely that by allowing some to greatly extend their capacities, we will undermine the fundamental moral equality of human beings. I argue that this objection is groundless: once we understand the basis for human equality, it is clear that anyone who now has sufficient capacities to count as a person from the moral (...) point of view will continue to count as one even if others are fundamentally enhanced; and it is mistaken to think that a creature which had even far greater capacities than an unenhanced human being should count as more than an equal from the moral point of view. (shrink)

DeGrazia argues that post-persons have as much justification in believing that they have higher moral status than persons as persons have in believing that they have higher moral status than animals. DeGrazia's claim presupposes that what Buchanan calls the “moral equality assumption” is false. This article argues that DeGrazia has given us no reason to disbelieve the moral equality assumption. Further, even if DeGrazia's arguments about moral status were sound, it is unclear that his first-order normative claims about how we (...) should weigh human against animal interests would follow. (shrink)

This article concerns the nature and limits of individuals’ rights to privacy over information that they have made public. For some, even suggesting that an individual can have a right to privacy over such information may seem paradoxical. First, one has no right to privacy over information that was never private to begin with. Second, insofar as one makes once-private information public – whether intentionally or unintentionally – one waives one’s right to privacy to that information. In this article, however, (...) we suggest the moral situation is more complicated than this. Rather, we argue that there is a class of public information – namely, once-private information that individuals have made public unintentionally – which remains within the scope of an individuals’ right to privacy, even when it has passed into the public domain. Significantly, this class includes any information rights-holders were unaware could be inferred from information they have made public and which they would not otherwise have wanted to be in the public domain. As we show, as well as clarifying several everyday dilemmas with regards to individuals’ privacy rights, this finding has elucidates a number of problems in the ethics of Big Data. (shrink)

Since the 1960s we have moved rapidly from a “doctor-knows-best” society which in which medical paternalism -- such as withholding information from patients “for their benefit” -- was common, towards a society which celebrates patients’ rights to make informed decisions about their care. In Choosing Life, Choosing Death, Charles Foster mounts a polemic against the current enthusiasm for respect for autonomy in medical ethics and law.

Philosophical reflection on intellectual property (IP) is still very young. Whilst much has been written by lawyers on intellectual property, the vast majority of this writing is philosophically unsophisticated. This paper aims to at least partially remedy this philosophical deficit by examining what reflection on the ontology of intellectual property can add to our understanding of how to regulate IP. I argue that ontological reflection should bring us to an important basic fact, namely that ownership of intellectual property involves the (...) ownership of types rather than tokens. This difference in the ontological status of the objects owned makes a normative difference to how we should regulate ownership of intellectual property as compared to tangible property. The argument falls into three main parts. I begin by arguing that the type-token distinction is the best way to account for the ontology of intellectual property. I next argue that the realisation that we are dealing with ownership of types rather than tokens has important normative implications. In particular some of the standard arguments in favour of private ownership of physical property simply do not apply in the case of ownership of types, whilst some other arguments apply only in an attenuated way. The next section examines the limitations of ontology as a guide to the regulation of IP. I argue that whilst thinking through the normative implications of the type-token distinction is a necessary 1 condition for a sound regulatory approach to IP, it is certainly not sufficient. This is because many of the specific questions about the regulation of intellectual property that matter most in practice—such as how long the patent term should be, or how much someone should be able to quote from a book and it count as fair use—are not answerable by ontological reflection. Such questions concern the fair distribution of the burdens and benefits involved in the construction of public goods, rather than questions of ontology.. (shrink)

Equal Justice: Fair Legal Systems in an Unfair World, by Wilmot-SmithFrederick. Cambridge, MA: Harvard University Press, 2019. Pp. 256.