Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes (...) be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence. (shrink)

In the literature on medical ethics, it is generally admitted that vulnerable persons or groups deserve special attention, care or protection. One can define vulnerable persons as those having a greater likelihood of being wronged – that is, of being denied adequate satisfaction of certain legitimate claims. The conjunction of these two points entails what we call the Special Protection Thesis. It asserts that persons with a greater likelihood of being denied adequate satisfaction of their legitimate claims deserve special attention, (...) care or protection. Such a thesis remains vague, however, as long as we do not know what legitimate claims are. This article aims at dispelling this vagueness by exploring what claims we have in relation to health care – thus fleshing out a claim-based conception of vulnerability. We argue that the Special Protection Thesis must be enriched as follows: If individual or group X has a greater likelihood of being denied adequate satisfaction of some of their legitimate claims to physical integrity, autonomy, freedom, social provision, impartial quality of government, social bases of self-respect or communal belonging, then X deserves special attention, care or protection. With this improved understanding of vulnerability, vulnerability talk in healthcare ethics can escape vagueness and serve as an adequate basis for practice. (shrink)

Il s’agit ici de présenter une version raffinée du libéralisme de la peur de Judith Shklar : le libéralisme de la prudence. Après en avoir brièvement présenté les grandes lignes et les principales faiblesses, j’esquisse les contours du libéralisme de la prudence et montre comment il réalise, mieux que libéralisme de la peur, le programme minimaliste poursuivi par Shklar. Je montre ensuite comment le libéralisme de la prudence nous permet de sortir du dilemme libéral posé par la tradition postrawlsienne : (...) justifier le libéralisme sur des bases morales, au risque de le priver de neutralité, ou le justifier sur des bases réalistes hobbesiennes, au risque d’en faire l’otage des rapports de force changeants. Enfin, j’examine comme le principal défaut apparent du libéralisme de la prudence – à savoir son ascétisme programmatique – est en fait son principal mérite. (shrink)

Je propose ici un argument « dilemmatique » en faveur de l’anti-paternalisme libéral. Soit il est vrai, comme le soutiennent les kantiens, que les règles impersonnelles, impartiales et universelles jouissent d’une priorité éthique ; soit il est vrai, comme le soutiennent des communautariens comme MacIntyre, que de telles règles ne jouissent pas d’une priorité éthique. Si les kantiens ont raison, alors – comme le veut la sagesse conventionnelle des manuels de philosophie politique – la neutralité de l’Etat à l’endroit des (...) conceptions du bien est justifiée. Et si les communautariens ont raison, alors – étonnamment – la neutralité de l’Etat est aussi justifiée. Donc la neutralité de l’Etat est justifiée. La première prémisse étant tautologique, elle s’impose d’elle-même. La seconde prémisse, établissant un lien entre priorité des règles universelles et neutralité de l’Etat, est trop connue pour retenir ici notre attention. La troisième prémisse, en revanche, établissant un lien entre la non-priorité des règles universelles et la neutralité de l’Etat, sonne comme un paradoxe. C’est donc sur elle que portera l’examen.I shall offer here a “dilemmatic” argument for liberal anti-paternalism. Either it is the case – as Kantians maintain – that impersonal, impartial and universal rules enjoy ethical priority ; or it is the case – as Communitarians like MacIntyre maintain – that universal rules do not enjoy any such priority. If Kantians are right, then – as suggested by the conventional wisdom of textbooks in political philosophy – State-neutrality towards conceptions of the good is justified. And if Communitarians are right, then – surprisingly – State-neutrality is justified too. Therefore State-neutrality is justified. The first premiss is tautological, and needs no special study. The second premiss, linking the priority of universal rules to State-neutrality, is too well known to deserve our attention. But the third premiss, linking the non-priority of universal rules to State-neutrality, sounds like a paradox. The paper thus focuses on that third controversial premiss. (shrink)

Vulnerability has been extensively discussed in medical research, but less so in health care. Thus, who the vulnerable in this domain are still remains an open question. One difficulty in their identification is due to the general criticism that vulnerability is not a property of only some, but rather of everyone. By presenting a philosophical analysis of the conditions of vulnerability ascription, we show that these seemingly irreconcilable understandings of vulnerability are not contradictory. Rather, they are interdependent: they refer to (...) the same concept with different likelihoods of manifestation. We argue that the general vulnerability of living beings relies on their having certain types of interests. In health care, those individuals are particularly vulnerable who are more likely to have these interests unjustly considered. They should be afforded special protection in order to receive what is due to everyone, but which they are likely to fail to receive. (shrink)

This paper demonstrates the central role of the Socratic elenchus in the Sophist. In the first part, I defend the position that the Stranger describes the Socratic elenchus in the sixth division of the Sophist. In the second part, I show that the Socratic elenchus is actually used when the Stranger scrutinizes the accounts of being put forward by his predecessors. In the final part, I explain the function of the Socratic elenchus in the argument of the dialogue. By contrast (...) with standard scholarly interpretations, this way of reading the text provides all the puzzles about being (241c4–251a4) with a definite function in the dialogue. It also reveals that Plato’s methodology includes a plurality of method and is more continuous than what is often believed. (shrink)

Nicolas Weill propose une lecture stimulante de ces textes qui constituent une des découvertes philosophiques les plus importantes de ces dernières années. La publication des "Cahiers" redonne une actualité brûlante à la question qui divise épigones et détracteurs du penseur allemand : comment continuer à philosopher avec Heidegger sans tenir compte d'une éventuelle contamination de cette philosophie par l'idéologie nazie? Par une analyse sans concession des "Cahiers", en se concentrant sur les Réflexions (tenues par Heidegger de 1931 à 1941) (...) mais tout en cherchant à en dégager les éléments proprement philosophiques, cet ouvrage invite à une approche équilibrée, quitte à "penser avec Heidegger, contre Heidegger", comme le suggérait Jürgen Habermas dès le début des années 1950. Il montre notamment comment l'auteur d'Etre et temps, en inventant une nouvelle forme de philosopher, a poursuivi et prolongé dans ces carnets la critique de la modernité telle qu'elle a été formulée par la "révolution conservatrice" allemande et par Oswald Spengler, le théoricien du déclin de l'Occident. (shrink)

With aims to both increase organ supply and better reflect individual donation preferences, many nations worldwide have shifted from ‘opt‐in’ to ‘opt‐out’ systems for post‐mortem organ donation (PMOD). In such countries, while a prospective donor's willingness to donate their organs/tissues for PMOD was previously ascertained—at least partially—by their having recorded positive donation preferences on an official register prior to death, this willingness is now presumed or inferred—at least partially—from their not having recorded an objection to PMOD—on an official organ donation (...) register. Using evidence regarding the presence and prevalence of selective donation preferences, and via exploration of how appeals to donation preferences are used to both motivate and legitimate shifts to opt‐out frameworks, this paper draws attention to a set of previously unexplored problems for opt‐out organ donation arising in contexts where: (a) individuals demonstrate selective post‐mortem organ/tissue donation preferences, (b) legislation provides prospective donors with the opportunity to selectively permit/refuse the donation of certain organs/tissues in line with these preferences. While selective preferences pose few problems for opt‐in systems where a selective occasion is built into the process of signing the donor register, this is not the case for opt‐out systems. The loss of this selective occasion can cause significant problems where appeals to preferences motivate/legitimate shifts to opt‐out but evidence regarding variable preferences does not feed into determinations regarding organ/tissue exclusions. The nature of these problems depends on how the authorization aspect of ‘opt‐out’ systems is framed (e.g. as presumed consent, deemed consent or, given the role of familial consent in many jurisdictions as consent in name only). (shrink)

This book is the first extensive treatment of Husserl's phenomenology of time-consciousness. Nicolas de Warren uses detailed analysis of texts by Husserl, some only recently published in German, to examine Husserl's treatment of time-consciousness and its significance for his conception of subjectivity. He traces the development of Husserl's thinking on the problem of time from Franz Brentano's descriptive psychology, and situates it in the framework of his transcendental project as a whole. Particular discussions include the significance of time-consciousness for (...) other phenomenological themes: perceptual experience, the imagination, remembrance, self-consciousness, embodiment, and the consciousness of others. The result is an illuminating exploration of how and why Husserl considered the question of time-consciousness to be the most difficult, yet also the most central, of all the challenges facing his unique philosophical enterprise"--Provided by publisher. (shrink)

In this article, we discuss how we used institutional ethnography (Institutional ethnography as practice, Rowman & Littlefield, Lanham, MD and 2006) to map out powerful ruling relations that organize nurses’ wound care work. In recent years, the growing number of people living with wounds that heal slowly or not at all has presented substantial challenges for those managing the demands on Canada's publicly insured health‐care system. In efforts to address this burden, Canadian health‐care administrators and policy‐makers rely on scientific evidence (...) about how wounds heal and what treatments are most effective. Advanced wound care exemplifies the growing authorization of particular forms of evidence that change the ways in which nurses come to know about and conduct their work. The focus of this paper's nursing inquiry is a critique of registered nurses’ wound work as it arises within the established uptake of scientific evidence. (shrink)

In recent years much research has been undertaken regarding the feasibility of the human uterine transplant as a treatment for absolute uterine factor infertility. Should it reach clinical application this procedure would allow such individuals what is often a much-desired opportunity to become not only social mothers, or genetic and social mothers but mothers in a social, genetic and gestational sense. Like many experimental transplantation procedures such as face, hand, corneal and larynx transplants, UTx as a therapeutic option falls firmly (...) into the camp of the quality of life transplant, undertaken with the aim, not to save a life, but to enrich one. However, unlike most of these novel procedures – where one would be unlikely to find a willing living donor or an ethics committee that would sanction such a donation – the organs to be transplanted in UTx are potentially available from both living and deceased donors. In this article, in the light of the recent nine-case research trial in Sweden which used uteri obtained from living donors, and the assertions on the part of a number of other research teams currently preparing trials that they will only be using deceased donors, I explore the question of whether, in the case of UTx, there exist compelling moral reasons to prefer the use of deceased donors despite the benefits that may be associated with the use of organs obtained from the living. (shrink)

Has the time come to put to bed the concept of a harm threshold when discussing the ethics of reproductive decision making and the legal limits that should be placed upon it? In this commentary, we defend the claim that there exist good moral reasons, despite the conclusions of the non-identity problem, based on the interests of those we might create, to refrain from bringing to birth individuals whose lives are often described in the philosophical literature as ‘less than worth (...) living’. (shrink)

Il n’est pas inhabituel de considérer l’imagination comme une conscience d’objets non réels, ayant la forme d’images internes ou de représentations privées de toute incarnation spatiale. Dans cet article j’interroge la phénoménologie de l’imagination de Husserl à partir de deux questions : l’imagination est-elle un type de conscience d’image ? L’imagination, est-elle privée de toute incarnation spatiale ? Après avoir reconstruit la distinction nette opérée par Husserl entre imagination et conscience d’image (l’imaginaire n’est pas une image mentale interne), j’explore la (...) thèse de Husserl, fort suggestive, selon laquelle toute imagination implique la projection du corps vécu. Loin d’être entièrement dépourvu de spatialité, l’imaginaire exhibe des caractéristiques quasi-spatiales, et il est fondé sur ce qui est « le plus propre » de mon corps vécu – cela même que, pour ainsi dire, j’amène toujours avec moi, même dans les envols les plus éloignés de mon imagination. (shrink)

Il n’est pas inhabituel de considérer l’imagination comme une conscience d’objets non réels, ayant la forme d’images internes ou de représentations privées de toute incarnation spatiale. Dans cet article j’interroge la phénoménologie de l’imagination de Husserl à partir de deux questions : l’imagination est-elle un type de conscience d’image? L’imagination, est-elle privée de toute incarnation spatiale? Après avoir reconstruit la distinction nette opérée par Husserl entre imagination et conscience d’image (l’imaginaire n’est pas une image mentale interne), j’explore la thèse de (...) Husserl, fort suggestive, selon laquelle toute imagination implique la projection du corps vécu. Loin d’être entièrement dépourvu de spatialité, l’imaginaire exhibe des caractéristiques quasi-spatiales, et il est fondé sur ce qui est « le plus propre » de mon corps vécu – cela même que, pour ainsi dire, j’amène toujours avec moi, même dans les envols les plus éloignés de mon imagination. (shrink)

When attempting to determine which of our acts affect future generations and which affect the identities of those who make up such generations, accounts of personal identity that privilege psychological features and person affecting accounts of morality, whilst highly useful when discussing the rights and wrongs of acts relating to extant persons, seem to come up short. On such approaches it is often held that the intuition that future persons can be harmed by decisions made prior to their existence is (...) mistaken as identity is a most fragile thing with even the smallest differences in the conditions under which we procreate affecting not the interests of distinct future persons, but the identities of those who will come to exist in the future. Within this paper I reject this view, holding that a subscription to these two accounts need not result in the conclusion that virtually all acts relating to possible persons are permitted. Further, I argue that such accounts may in fact allow a great deal more scope for the determination of prenatal harms than accounts of personal identity that privilege physical features. Finally, by interpreting claims regarding causal identity such as Parfit’s Time Dependence Claim in terms of Counterpart Theory I suggest that a solution to the non-identity problem can be found in the acceptance of, as relevant in prenatal cases, three kinds of objective similarity relations: Biological, Environmental and Decisional counterpart relations. (shrink)

It is commonly assumed that moral deliberation requires that the alternatives available in a choice situation are evaluatively comparable. This comparability assumption is threatened by claims of incomparability, which is often established by means of the small improvement argument (SIA). In this paper I argue that SIA does not establish incomparability in a stricter sense. The reason is that it fails to distinguish incomparability from a kind of evaluative indeterminacy which may arise due to the vagueness of the evaluative comparatives (...) ‘better than,’ ‘worse than,’ and ‘equally as good as.’. (shrink)

Most physics theories are deterministic, with the notable exception of quantum mechanics which, however, comes plagued by the so-called measurement problem. This state of affairs might well be due to the inability of standard mathematics to “speak” of indeterminism, its inability to present us a worldview in which new information is created as time passes. In such a case, scientific determinism would only be an illusion due to the timeless mathematical language scientists use. To investigate this possibility it is necessary (...) to develop an alternative mathematical language that is both powerful enough to allow scientists to compute predictions and compatible with indeterminism and the passage of time. We suggest that intuitionistic mathematics provides such a language and we illustrate it in simple terms. (shrink)

A new approach to sentencing Not Just Deserts inaugurates a radical shift in the research agenda of criminology. The authors attack currently fashionable retributivist theories of punishment, arguing that the criminal justice system is so integrated that sentencing policy has to be considered in the system-wide context. They offer a comprehensive theory of criminal justice which draws on a philosophical view of the good and the right, and which points the way to practical intervention in the real world of incremental (...) reform. They put the case for a criminal justice system which maximizes freedom in the old republican sense of the term, and which they call `dominion'. (shrink)

For the majority of scholars concerned with the ethics of living organ donation, inflicting moderate harms on competent volunteers in order to save the lives or increase the life chances of others is held to be justifiable provided certain conditions are met. These conditions tend to include one, or more commonly, some combination of the following: The living donor provides valid consent to donation. Living donation produces an overall positive balance of harm–benefit for donors and recipients which cannot be obtained (...) in a less harmful manner. Donation is not liable to cause significant and long-term morbidity to, or the death of, the donor. This paper critically examines the suggestion that these criteria are not sufficient to offer a general account of justified living organ donation in the context of competent volunteers and that key to justified living organ donation is that donors receive sufficient benefits from their donation that these outweigh the harms they suffer. However, although this view—termed here ‘The Donor Benefit Standard’—directs welcome attention to the many and complex motives which may underlie living organ donation, this paper ultimately concludes that given the threats this position poses to individual autonomy and the lives of those in need of organ transplants ‘The Donor Benefit Standard’ should ultimately be rejected. (shrink)

In the biomedical context, policy makers face a large amount of potentially discordant evidence from different sources. This prompts the question of how this evidence should be aggregated in the interests of best-informed policy recommendations. The starting point of our discussion is Hunter and Williams’ recent work on an automated aggregation method for medical evidence. Our negative claim is that it is far from clear what the relevant criteria for evaluating an evidence aggregator of this sort are. What is the (...) appropriate balance between explicitly coded algorithms and implicit reasoning involved, for instance, in the packaging of input evidence? In short: What is the optimal degree of ‘automation’? On the positive side: We propose the ability to perform an adequate robustness analysis as the focal criterion, primarily because it directs efforts to what is most important, namely, the structure of the algorithm and the appropriate extent of automation. Moreover, where there are resource constraints on the aggregation process, one must also consider what balance between volume of evidence and accuracy in the treatment of individual evidence best facilitates inference. There is no prerogative to aggregate the total evidence available if this would in fact reduce overall accuracy. (shrink)

Within contemporary penal philosophy, the view that punishment can only be justified if the offender is a moral agent who is responsible and hence blameworthy for their offence is one of the few areas on which a consensus prevails. In recent literature, this precept is associated with the retributive tradition, in the modern form of ‘just deserts’. Turning its back on the rehabilitative ideal, this tradition forges a strong association between the justification of punishment, the attribution of responsible agency in (...) relation to the offence, and the appropriateness of blame. By contrast, effective clinical treatment of disorders of agency employs a conceptual framework in which ideas of responsibility and blameworthiness are clearly separated from what we call ‘affective blame’: the range of hostile, negative attitudes and emotions that are typical human responses to criminal or immoral conduct. We argue that taking this clinical model of ‘responsibility without blame’ into the legal realm offers new possibilities. Theoretically, it allows for the reconciliation of the idea of ‘just deserts’ with a rehabilitative ideal in penal philosophy. Punishment can be reconceived as consequences—typically negative but occasionally not, so long as they are serious and appropriate to the crime and the context—imposed in response to, by reason of, and in proportion to responsibility and blameworthiness, but without the hard treatment and stigma typical of affective blame. Practically, it suggests how sentencing and punishment can better avoid affective blame and instead further rehabilitative and related ends, while yet serving the demands of justice. (shrink)

It is usual to identify initial conditions of classical dynamical systems with mathematical real numbers. However, almost all real numbers contain an infinite amount of information. I argue that a finite volume of space can’t contain more than a finite amount of information, hence that the mathematical real numbers are not physically relevant. Moreover, a better terminology for the so-called real numbers is “random numbers”, as their series of bits are truly random. I propose an alternative classical mechanics, which is (...) empirically equivalent to classical mechanics, but uses only finite-information numbers. This alternative classical mechanics is non-deterministic, despite the use of deterministic equations, in a way similar to quantum theory. Interestingly, both alternative classical mechanics and quantum theories can be supplemented by additional variables in such a way that the supplemented theory is deterministic. Most physicists straightforwardly supplement classical theory with real numbers to which they attribute physical existence, while most physicists reject Bohmian mechanics as supplemented quantum theory, arguing that Bohmian positions have no physical reality. (shrink)

In the 20th century, the boundaries of psychosis emerged as an area in which psychiatric judgement faced numerous and profound uncertainties. Between obvious neuroses and personality and reactive disorders on the one hand, and unquestionable psychoses on the other, psychiatrists faced a world of suspected cases of schizophrenia, doubtful personality disorder diagnoses or probable cases of psychosis constituting a garden of equivocal clinical presentations in which both individual psychiatrists and the discipline as a whole were confronted with the limits of (...) their knowledge. This article examines how psychiatrists from two German university clinics managed the multiple uncertainties involved in diagnosing cases of early psychosis between 1950 and 1980. Based on the analysis of a sample of records, we propose a pragmatic interpretation of the ways in which these uncertainties were recorded by psychiatrists. How were uncertainties and doubts expressed in the records and managed by clinicians? What means were used to dispel doubt? What were the consequences for patients of these diagnostic uncertainties? The article defines an uncertainty diagnosis as a diagnosis expressed with reservations by its author and recorded as such in a medical file. Depending on the nature of the uncertainty, the types of evidence used by the professionals and how this evidence was dealt with, we have identified three types of uncertainty diagnoses: suspicion, plausibility and probability diagnoses. The article then reflects on the role of the patients themselves in shaping these uncertain situations. (shrink)

In recent years, the question of whether prospective parents might have a moral obligation to select against disability in their offspring has piqued the attention of many prominent philosophers and bioethicists, and a large literature has emerged surrounding this question. Rather than looking to the most common arguments given in support of a positive response to the abovementioned question, such as those focusing on the harms disability may impose on the child created, duties and role-specific obligations, and impersonal ‘harms’, a (...) less commonly made set of arguments is focused upon which looks to the harms that a decision not to select against disability may impose on others. Three different possible arguments supporting a limited duty of disability avoidance are thus identified and subsequently explored: harms to parents themselves, harms to existing family members, and harms to other existing members of society. (shrink)

This paper offers a framework for consciousness of internal reality. Recent PET experiments are reviewed, showing partial overlap of cortical activation during self-produced actions and actions observed from other people. This overlap suggests that representations for actions may be shared by several individuals, a situation which creates a potential problem for correctly attributing an action to its agent. The neural conditions for correct agency judgments are thus assigned a key role in self/other distinction and self-consciousness. A series of behavioral experiments (...) that demonstrate, in normal subjects, the poor monitoring of action-related signals and the difficulty in recognizing self-produced actions are described. In patients presenting delusions, this difficulty dramatically increases and actions become systematically misattributed. These results point to schizophrenia and related disorders as a paradigmatic alteration of a ''Who?'' system for self-consciousness. (shrink)

In the present article, I introduce Husserl’s analyses of ‘natural causality’ and ‘volitional causality’, which are collected in the volume ‘Wille und Handlung’ of the Husserliana edition Studien zur Struktur des Bewußtseins. My aim is to show that Husserl’s insight into these phenomena enables us to understand more clearly both the specificity of, and the relation between, the motivational nexus belonging to the sphere of the will in contrast with the causal laws of nature. In light of this understanding, in (...) the last part of the article I reflect on whether and to what extent there is, in fact, an ontological and epistemological compatibility between volitional causality and natural causality. (shrink)

Nicola Lacey presents a new approach to the question of the moral justification of punishment by the State. She focuses on the theory of punishments in context of other political questions, such as the nature of political obligation and the function and scope of criminal law. Arguing that no convincing set of justifying reasons has so far been produced, she puts forward a theory of punishments which places the values of the community at its centre.

The capacity to attribute beliefs to others in order to understand action is one of the mainstays of human cognition. Yet it is debatable whether children attribute beliefs in the same way to all agents. In this paper, we present the results of a false-belief task concerning humans and God run with a sample of Maya children aged 4–7, and place them in the context of several psychological theories of cognitive development. Children were found to attribute beliefs in different ways (...) to humans and God. The evidence also speaks to the debate concerning the universality and uniformity of the development of folk-psychological reasoning. (shrink)

It is usual to identify initial conditions of classical dynamical systems with mathematical real numbers. However, almost all real numbers contain an infinite amount of information. I argue that a finite volume of space can’t contain more than a finite amount of information, hence that the mathematical real numbers are not physically relevant. Moreover, a better terminology for the so-called real numbers is “random numbers”, as their series of bits are truly random. I propose an alternative classical mechanics, which is (...) empirically equivalent to classical mechanics, but uses only finite-information numbers. This alternative classical mechanics is non-deterministic, despite the use of deterministic equations, in a way similar to quantum theory. Interestingly, both alternative classical mechanics and quantum theories can be supplemented by additional variables in such a way that the supplemented theory is deterministic. Most physicists straightforwardly supplement classical theory with real numbers to which they attribute physical existence, while most physicists reject Bohmian mechanics as supplemented quantum theory, arguing that Bohmian positions have no physical reality. (shrink)