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)

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. (shrink)

Changes in healthcare financing increasingly rely upon patient cost-sharing to control escalating healthcare expenditures. These changes raise new challenges for physicians that are different from those that arose either under managed care or traditional indemnity insurance. Historically, there have been two distinct bases for arguing that physicians should not consider costs in their clinical decisions—an “aspirational ethic” that exhorts physicians to treat all patients the same regardless of their ability to pay, and an “agency ethic” that calls on physicians to (...) be trustworthy advisors to their patients. In the setting of greater patient cost-sharing, physicians' aspiration and agency roles increasingly conflict. Satisfactorily navigating the new terrain of consumer-driven healthcare requires physicians to consider these two roles and how they can best be reconciled so as to maximize quality of care while respecting the heterogeneity of patients' financial resources and willingness to pay. (shrink)

On September 8, 2015, the Department of Health and Human Services issued a Notice of Proposed Rule Making to revise the Federal Policy for the Protection of Human Subjects, widely known as the “Common Rule.” The NPRM proposes several changes to the current system, including a dramatic shift in the approach to secondary research using biospecimens and data. Under the current rules, it is relatively easy to use biospecimens and data for secondary research. This approach systematically facilitates secondary research with (...) biospecimens and data, maximizing the capacity for substantial public benefit. However, it has been criticized as insufficiently protective of the privacy and autonomy interests of biospecimen and data sources. Thus, the NPRM proposes a more restrictive regime, although more so for biospecimens than data. Both the status quo and the NPRM's proposal are critically flawed. (shrink)

Both the USA and Europe limit access to care by undocumented immigrants. In the debate over what level of access to confer to IMs, there are various public policy rationales operating either explicitly, or below the surface, ranging from minimalist humanitarianism to full cosmopolitan equality, with several intermediate positions between these two poles. This article informs the international debate by providing a conceptual mapping of these underlying policy rationales. Each position is based on different lines of reasoning or bodies of (...) evidence, and each leads to somewhat different conclusions about the extent to which IMs should have access to different types of health care. It is unlikely that broad consensus will be achieved in this ongoing debate. However, by articulating the ethical, legal, pragmatic and conceptual reasons to support or oppose various positions, we hope to help determine where in the landscape of reasoned argument various positions lie, and how each position might be best supported or refuted. In particular, we see in this debate an illustration of Michael Walzer’s classic analysis of competing spheres of justice. Various positions depend to a considerable extent on whether their advocates approach this issue from the health policy sphere rather than the sphere of immigration policy, or whether they attempt to blend the two spheres. (shrink)

Centralized, democratic rules are often asserted as a superior basis for rationing than individualized physician discretion. This article counters this prevailing wisdom by exploring the deficiencies of rule-based rationing. Rules are too imprecise to accurately reflect all the nuances of physical and mental impairment and the complexity of medical science, particularly considering the widely varying personal values that different patients attach to medical risk and benefit. Rule-based rationing also suffers from the biasing effects of interest group pressure on political processes (...) and the tendency to absolve physicians from any moral responsibility for the rationing decisions they implement. Internalizing cost constraints is a more socially and professionally acceptable means of rationing and, in any event, it is inevitable since even a preponderance of rule-based rationing will leave considerable areas of discretion for physician judgment in the implementation and interpretation of the rules. As a consequence, despite the flaws of bedside rationing, it is foolhardy to dispense with it entirely in favor of an exclusively rule-based system. Keywords: Bedside rationing, cost-constraints, rule-based rationing CiteULike Connotea Del.icio.us What's this? (shrink)

Many proposals to reform health care finance and delivery require individuals or private employers to pay for private health insurance. Senators Ron Wyden and Robert Bennett’s Healthy Americans Act, for instance, would require every adult person who is not covered by a public program to purchase health insurance. Similarly, President Obama’s campaign proposal requires that parents arrange for coverage of their minor children and that all but small employers pay a tax if they do not provide their workers health insurance.This (...) paper addresses the constitutionality of such proposals. Compulsory health insurance might raise constitutional concerns because there is no existing social legislation that serves as a perfect legal analogy to an individual mandate for private health insurance. Insurance mandates are familiar in other contexts, such as automobile liability, but they present an easier case for constitutionality because they are a condition of exercising a privilege, such as driving a car. (shrink)

Health insurance mandates have been a component of many recent health care reform proposals. Because a federal requirement that individuals transfer money to a private party is unprecedented, a number of legal issues must be examined. This paper analyzes whether Congress can legislate a health insurance mandate and the potential legal challenges that might arise, given such a mandate. The analysis of legal challenges to health insurance mandates applies to federal individual mandates, but can also apply to a federal mandate (...) requiring employers to purchase health insurance for their employees. There are no constitutional barriers for Congress to legislate a health insurance mandate as long as the mandate is properly designed and executed, as discussed below. This paper also considers the likelihood of any change in the current judicial approach to these legal questions. (shrink)

It was a happy surprise when, overcoming partisan divisions and interest‐group lobbying, Congress enacted the No Surprises Act, which bans unfair out‐of‐network “balance billing.” Although this is only a modest legislative victory, key efforts by the health policy community made a real difference in a time of legislative gridlock.

“Unconscionable.” “Outrageous.” “Indefensible.” These are just some of the tamer descriptions for the billing practices of most hospitals, and also many physicians, that have recently come to the public's attention. Earlier this year, Time magazine published an extraordinary 24,000‐word exposé—the longest article it has ever published—detailing how even charitable hospitals routinely price‐gouge their patients.1 With characteristic flare for telling details, journalist Steven Brill documented ten‐fold markups of charges over costs at some prominent hospitals for common services like X rays and (...) lab tests, and one‐hundred‐fold mark‐ups on mundane supplies such as gauze pads and generic aspirin. Just as the buzz from Brill's article was abating, the Centers for Medicare & Medicaid Services released a comprehensive data set in May that galvanized local and national media across the country. This news tsunami caught hospital managers flat‐footed and tongue‐tied. Typical responses conceded that hospitals’ pricing practices are based neither on actual cost structures nor rational marketplace dynamics. Instead, hospitals attempted to deflect blame by noting that hardly anyone actually pays list prices, and they characterized their indefensible pricing as a symptom of a broken system that is beyond them to fix. There are two glaring faults in these standard defenses. (shrink)

Since 1991, over half the states have enacted laws that restrict or prohibit insurers’ use of genetic information in pricing, issuing, or structuring health insurance. Wisconsin was the first state to do so, in 1991, followed by Ohio in 1993, California and Colorado in 1994, and then several more states a year in each of the next five years. Similar legislation has been pending in Congress for several years. Also, a 1996 federal law known as the Health Insurance Portability and (...) Accountability Act prohibits group health insurers from applying “preexisting condition” exclusions to genetic conditions that are indicated solely by genetic tests and not by any actual symptoms. (shrink)

Health care reform is being assaulted from all sides. In January, the House of Representatives voted to repeal The Patient Protection and Affordable Care Act (the "Affordable Care Act"). For now, that effort will not succeed, owing to Democratic control of the Senate and the presidential veto. But conservative lawmakers in the House threaten to withhold key funding for implementation, and we can expect ongoing efforts to enact various partial amendments.Meanwhile, a core component of the reform law is running the (...) gauntlet of constitutional challenges in dozens of courts.1 So far, two federal district judges—in Richmond, Virginia, and Pensacola, Florida—have declared the individual mandate unconstitutional, as .. (shrink)

Not since the civil rights era has enacted national legislation been fought so fiercely as the Patient Protection and Affordable Care Act. Political, ideological, and social forces have mobilized to undermine the ACA at numerous fronts, including the Supreme Court, Congress, state governments, and the court of public opinion. The ACA has survived a constitutional challenge, a presidential re‐election, numerous repeal votes in the House, and avowedly obstreperous state regulators. But it has not yet run the full gauntlet of lethal (...) strategies. The latest line of attack is a collection of orchestrated lawsuits seeking to keep the federal exchange from paying any premium tax subsidies.What if the challengers eventually prevail? What would happen then? (shrink)

Since 1991, over half the states have enacted laws that restrict or prohibit insurers’ use of genetic information in pricing, issuing, or structuring health insurance. Wisconsin was the first state to do so, in 1991, followed by Ohio in 1993, California and Colorado in 1994, and then several more states a year in each of the next five years. Similar legislation has been pending in Congress for several years. Also, a 1996 federal law known as the Health Insurance Portability and (...) Accountability Act prohibits group health insurers from applying “preexisting condition” exclusions to genetic conditions that are indicated solely by genetic tests and not by any actual symptoms. (shrink)

Opponents of the Affordable Care Act have attempted to topple it in court by challenging the legality of two of its three legs. Three years ago, in NFIB v. Sibelius, Chief Justice Roberts narrowly upheld the constitutionality of the individual mandate, in a 5-to-4 decision that characterized the mandate as an optional tax rather than as a regulatory command. This year, on June 25, the health policy community exhaled a giant sigh of relief when the Supreme Court upheld the subsidy (...) leg of the ACA structure. In King v. Burwell, Justice Roberts again wrote the majority opinion, ruling as a matter of statutory interpretation that subsidies for insurance premiums are available not just through state-based exchanges but also through the federal exchange. (shrink)

The new millennium is still very young, so it is too early to declare National Federation of Independent Business v. Sebelius1 the health law “case of the century,” but that title would not be hyperbolic. Never before have we seen a case of such monumental importance for how health care is financed and delivered in the United States. At the Supreme Court, no decision has been more closely watched and more anxiously awaited since Bush v. Gore in 2000. In the (...) balance was the fate of President Obama's signature piece of domestic legislation, one that affects nearly every aspect of the largest segment of our economy, and so is perhaps the most important piece of social legislation since the New Deal. To no one's surprise, the decision was announced at the very end of the Court's term and was split five to four.What was very surprising, however, was the Court's embrace of the tax power defense of the individual mandate. And what was outright shocking was a seven‐to‐two majority in favor of finding the Medicaid expansion unconstitutional unless states are allowed to opt out of the expansion.The case holds great significance not only for the fate of the Patient Protection and Affordable Care Act—and, thus, for the nation's health care public policy—but also for constitutional doctrine that applies much more broadly than in the health care arena. (shrink)

As politicians revisit the merits of health insurance reform and courts deliberate its constitutionality, government regulators are busily working on the wonky details of implementation. The Affordable Care Act leaves vast swaths of regulation for various agencies to prescribe, most notably the Department of Health and Human Services. Infamously (or perhaps apocryphally, since I'm certainly not going to bother counting), the statute contains more than a thousand commands to the effect of, "the Secretary shall decide." This massive delegation of authority (...) is unavoidable in any attempt to comprehensively reform, yet preserve, our Byzantine health insurance system.Throughout this regulatory nativity, the government .. (shrink)

The overriding goal of health reform is to provide every American affordable access to adequate health care. Yet in every national effort to date, the focal means to this end has always been health insurance. Massachusetts is congratulated for having achieved nearly universal insurance coverage, and congressional Democrats are aiming for the same. But what if they don't succeed? Even in Massachusetts, 167,000 residents remain uninsured. Is it still possible to provide adequate access to medical care for those without insurance? (...) If so, shouldn't we reframe social goals to achieve universal access through any means possible, whether or not insurance is involved? (shrink)

This article reviews the primary avenues of judicial challenge to the ACA, focusing on those that have reached, or have the potential to reach, the Supreme Court. The review demonstrates how deep-seated public policy opposition can be expressed through litigation.

Strategies for disclosing investigators' financial interests to potential research participants have been adopted by many research institutions. However, little is known about how decisions are made regarding disclosures of financial interests to potential research participants, including what is disclosed and the rationale for making these determinations. We sought to understand the attitudes, beliefs, and practices of institutional review board chairs, conflict of interest committee chairs, and investigators regarding disclosure of financial interests to potential research participants. Several themes emerged, including general (...) attitudes toward conflicts of interest, circumstances in which financial interests should be disclosed, rationales and benefits of disclosure, what should be disclosed, negative effects of and barriers to disclosure, and timing and presentation of disclosure. Respondents cited several rationales for disclosure, including enabling informed decision making, promoting trust in researchers and research institutions, and reducing legal liability. There was general agreement that disclosure should happen early in the consent process. Respondents disagreed about whether to disclose the amounts of particular financial interests. Clarifying the goals of disclosure and understanding how potential research participants use the information will be critical in efforts to ensure the integrity of clinical research and to protect the rights and interests of participants. (shrink)

Investigator and institutional financial conflicts of interest have raised concerns about both the integrity of clinical research and protecting the rights and welfare of research participants. In response, professional groups and governmental bodies have issued guidance for managing conflicts of interest to minimize their potential untoward effects. Although a variety of approaches have been offered, a common protection is to disclose financial interests in research to potential research participants as part of the recruitment and informed consent process. This approach reinforces (...) a basic norm of candor, ideally allowing potential research participants to evaluate whether financial interests should affect their decision to participate in research. Disclosure to potential research participants is viewed as an alternative to having regulators or research institutions limit or prohibit all financial interests in research, assuming that not all such interests are unacceptable. (shrink)

Lack of guidance and regulation for authorizing medical cannabis for conditions involving the health and neurodevelopment of children is ethically problematic as it promulgates access inequities, risk-benefit inconsistencies, and inadequate consent mechanisms. In two virtual sessions using participatory action research and consensus-building methods, we obtained perspectives of stakeholders on ethics and medical cannabis for children and youth. The sessions focused on the scientific and regulatory landscape of medical cannabis, surrogate decision-making and assent, and the social and political culture of medical (...) cannabis. We found that evidence-gathering and data dissemination, pressures on clinical relationships, and the lack of integration of culturally diverse perspectives and Indigenous knowledges were key areas of concern. Participants emphasized the importance of utilizing adaptive study designs, highlighted the importance of trust-building between clinicians, patients and caregivers, and discussed barriers including historical and ongoing stigmatization of medical cannabis. We conclude that continued public consultation and strength-based research that integrate diverse perspectives are critical steps forward. (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)

Interest in NFIB v. Sebelius has been extraordinarily high, from as soon as the legislation was passed, through lower court rulings, the Supreme Court’s grant of certiorari, and the decision itself, both for its substantive holdings and the purported behind-the-scene dynamics. Legal blogs exploded with analysis, bioethicists opined on our collective responsibilities, and philosophers tackled concepts like ‘coercion’ and the activity/inactivity distinction. This volume aims to bring together scholars from disparate fields to analyze various features of the decision. It comprises (...) over twenty essays from a range of academic disciplines, namely law, philosophy, and political science. Essays are divided into five units: context and history, analyzing the opinions, individual liberty, Medicaid, and future implications. (shrink)

The interactivist approach to development generates a framework of types of constraints on what can be constructed. The four constraint types are based on: (1) what the constructed systems are about; (2) the representational relationship itself; (3) the nature of the systems being constructed; and (4) the process of construction itself. We give illustrations of each constraint type. Any developmental theory needs to acknowledge all four types of constraint; however, some current theories conflate different types of constraint, or rely on (...) a single constraint type to explicate development. Such theories will be inherently unable to explain important aspects of development. (shrink)

From the early days of European settlement in North America, Christianity has had a profound impact on American law and culture. This volume profiles nineteen of America's most influential Christian jurists from the early colonial era to the present day. Anyone interested in American legal history and jurisprudence, the role Christianity has played throughout the nation's history, and the relationship between faith and law will enjoy this worthy and unique study. The jurists covered in this collection were pious men and (...) women, but that does not mean they agreed on how faith should inform law. From Roger Williams and John Cotton to Antonin Scalia and Mary Ann Glendon, America's great Christian jurists have brought their faith to bear on the practice of law in different ways and to different effects. (shrink)

This article responds to Charlotta Friedner Parrat’s critique of our argument that the English School of international relations should embrace a more thoroughgoing interpretivism. We address four of Friedner Parrat’s objections to our argument: that our distinction between structuralism and interpretivism is too stark; that our understanding of the relationship between agency and structure is problematic; that our approach would confine the English School to the study of intellectual history; and that the English School should eschew explanation. We argue that (...) if the School is to use structuralism, it must be clearer about how it understands structures and their relationships to agents. We argue too that interpretivism not only offers a better account of situated agency, but also that it provides the English School with one way to move beyond the description and classification of institutions in international society towards better explanations of international relations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:William James, A Pluralistic Universe. A New Philosophical ReadingRichard A. S. Hall William James, A Pluralistic Universe. A New Philosophical Reading. Ed. H. G. Callaway. Newcastle, U.K.: Cambridge Scholars Publishing, 2008.In 1907 William James was invited to give the Hibbert Lectures at Manchester College, Oxford. Initially he was reluctant to do so since he feared undertaking them would divert him from developing rigorously and systematically some metaphysical (...) ideas of his own that had preoccupied him for some time. [End Page 130]In the end, however, he relented and in the spring of 1908 gave the lectures which were subsequently published as A Pluralistic Universe.As it happened, though, in the course of these lectures James presented some of those metaphysical ideas, though in a popular and informal style appropriate to lecturing. Later on he did get down to working out a systematic metaphysics in proper academic style, but the project was cut short by his untimely death in 1910. The incomplete Some Problems of Philosophy,posthumously published in 1911, recapitulates some major themes of A Pluralistic Universe.When James addressed his Oxford audience, the time was ripe for the advancement of his own brand of metaphysical pluralism and radical empiricism in opposition to the still-regnant forms of monistic idealism as represented by Bradley, Green, and Royce. The hegemony in the philosophical world long enjoyed by idealism was beginning to break up—something noted by James in his first lecture—due in no small part to the very ideas aired in his lectures and the then newly emerging schools of pragmatism and realism. The period between 1914 and 1918 not only rings the death knell of European imperialism but also, significantly, marks the watershed between nineteenth-and twentieth-century philosophy.The argument of A Pluralistic Universerevolves around the Parmenidean conundrum of the one-and-the-many. It is the solution to this problem that was the main bone of contention between James and absolute idealists like F. H. Bradley, T. H. Green, and Josiah Royce. For them, the world in reality is but one thing, though appearing illusorily as many, with a pervasive unity throughout—it is a "block-universe," to use James's expression for it; for James, by contrast, the world is irreducibly many things whose unities are partial and shifting. The gravamen of James's objections to absolute idealism was its monism, though he objected no less strenuously to other ideas associated with it: its doctrine of internal relations; its determinism; and, in particular, its deprecation of experience in favor of concepts (what James condemns as "vicious intellectualism"). James proposed, against this monolithic idealism, the alternative hypothesis of metaphysical pluralism. Here he affirmed the reality of external relations (particularly conjunctions) among things and the continuities within experience, thereby making his empiricism "radical." He approached experience phenomenologically, finding it, not concepts, to be constitutive of reality, the value of concepts being more practical than theoretical. He conceived of the universe as being open-ended, where human agency can make a difference for the better.A subtext of A Pluralistic Universeis James's advocacy of something like [End Page 131]traditional theism in contradistinction to the pantheism of absolute idealism. He rightly notes that the Absolute is not the God of Christianity. He believes that his pluralistic ontology allows for, and the religious experiences of people abundantly attest to, the existence of a personal God, albeit a finite one, with whom communion and commerce is possible. At a deeper, psychological level, though, A Pluralistic Universeis an expression of James's own desire to feel "at home" in the universe, a desire, I should add, that he shares with many protagonists of classic American fiction, and which is perhaps intensified by the experience of inhabiting and accommodating one's self to the relatively unfamiliar New World. He complains about the "foreignness" of the Absolute in objective idealism and of that sovereign God, in traditional theisms, subsisting beyond all human influence or effects.Howard Callaway's recent edition of James's Hibbert Lectures joins the Harvard edition of them, with a foreword by Richard J. Bernstein, as an indispensable volume of James's... (shrink)

Conspiracy theories (CTs) are widespread ways by which people make sense of unsettling or disturbing cultural events. Belief in CTs is often connected to problematic consequences, such as decreased engagement with conventional political action or even political extremism, so understanding the psychological and social qualities of CTs belief is important. CTs have often been understood to be “monological”, displaying the tendency for belief in one conspiracy theory to be correlated with belief in (many) others. Explanations of monologicality invoke a nomothetical (...) or “closed” mindset whereby mutually supporting beliefs based on mistrust of official explanations are used to interpret public events as conspiracies, independent of the facts about those events (which they may ignore or deny). But research on monologicality offers little discussion of the content of monological beliefs and reasoning from the standpoint of the CT believers. This is due in part to the “access problem” (Wood & Douglas, 2015): CT believers are averse to being researched because they often distrust researchers and what they appear to represent. We used several strategies to address the access problem, and investigated the symbolic resources underlying CTs by reconstructing a conspiracy worldview - a set of beliefs held by CT believers about important dimensions of ontology, epistemology, and human agency. To do this, we analysed media documents, conducted field observation, and engaged in semi-structured interviews,. We describe six main dimensions of a conspiracy worldview: Views of the nature of reality, the self, the outgroup, the ingroup, action, and the future. We also describe a typology of five types of CT believers, which vary according to their positions on each of these dimensions. Our findings converge with prior explorations of CT beliefs but also revealed novel aspects: A sense of community among CT believers, a highly differentiated representation of the outgroup, a personal journey of conversion, variegated kinds of political action, and optimistic belief in future change. These findings are at odds with the typical image of monological CT believers as paranoid, cynical, anomic and irrational. For many, the CT worldview may rather constitute the ideological underpinning of a nascent pre-figurative social movement. (shrink)

A new take on our bio-cultural evolution explores how the "inner theatre" of the brain and its "animal-human stages" are reflected in and shaped by the mirror of cinema. Vampire, werewolf, and ape-planet films are perennial favorites—perhaps because they speak to something primal in human nature. This intriguing volume examines such films in light of the latest developments in neuroscience, revealing ways in which animal-human monster movies reflect and affect what we naturally imagine in our minds. Examining specific films as (...) well as early cave images, the book discusses how certain creatures on rock walls and movie screens express animal-to-human evolution and the structures of our brains. The book presents a new model of the human brain with its theatrical, cinematic, and animal elements. It also develops a theory of "rasa-catharsis" as the clarifying of emotions within and between spectators of the stage or screen, drawing on Eastern and Western aesthetics as well as current neuroscience. It focuses on the "inner movie theater" of memories, dreams, and reality representations, involving developmental stages, as well as the "hall of mirrors," ape-egos, and body-swapping identifications between human beings. Finally, the book shows how ironic twists onscreen—especially of contradictory emotions—might evoke a reappraisal of feelings, helping spectators to be more attentive to their own impulses. Through this interdisciplinary study, scholars, artists, and general readers will find a fresh way to understand the potential for interactive mindfulness and yet cathartic backfire between human brains—in cinema, in theater, and in daily life. (shrink)

The expansion of the corpus of international human rights to include the right to water and sanitation has implications both for the process of recognizing human rights and for future developments in the relationships between technology, engineering and human rights. Concerns with threats to human rights resulting from developments in science and technology were expressed in the early days of the United Nations (UN), along with the recognition of the ambitious human right of everyone “to enjoy the benefits of scientific (...) progress and its applications.” This comment explores the hypothesis that the emerging concepts most likely to follow recognition of the human right to water primarily involve issues of science and technology, such as access to medicines or clean and healthy environment. Many threats to human rights from advances in science, which were identified in the past as potential, have become real today, such as invasion of privacy from electronic recording, deprivation of health and livelihood as a result of climate change, or control over individual autonomy through advances in genetics and neuroscience. This comment concludes by urging greater engagement of scientists and engineers, in partnership with human rights specialists, in translating normative pronouncements into defining policy and planning interventions. (shrink)

Physics, History, and the German Atomic Bomb. This paper examines the German concept of a nuclear weapon during National Socialism and the Second World War. Zusammenfassung: Physik, Geschichte und die deutsche Atombombe. Dieser Aufsatz untersucht die deutsche Vorstellung einer nuklearen Waffe während des Nationalsozialismus und des Zweiten Weltkrieges.

The claim that a functional kind is multiply realized is typically motivated by appeal to intuitive examples. We are seldom told explicitly what the relevant structures are, and people have often preferred to rely on general intuitions in these cases. This article deals with the problem by explaining how to understand the proper relation between structural kinds and the functions they realize. I will suggest that the structural kinds that realize a function can be properly identified by attending to the (...) context of functional explanation. *Received June 2006; revised June 2009. †To contact the author, please write to: Department of Philosophy, Seton Hall University, 400 South Orange Ave., South Orange, NJ 07079; e‐mail: mark[email protected]. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume 29, Number 1, April 2003, pp. 89-98 Another "Curious Legend" about Hume's An Abstract of a Treatise of Human Nature MARK G. SPENCER I In 1938, J. M. Keynes and P. Sraffa edited and introduced for Cambridge University Press a reprinting of An Abstract of A Treatise of Human Nature.1 The Abstract they claimed in their subtitle was "A Pamphlet hitherto unknown by DAVID HUME." (...) Arguing against a number of nineteenth and early-twentieth -century scholars who attributed authorship of an abstract of the Treatise to Adam Smith, Keynes and Sraffa convincingly documented in their introductory essay many solid reasons for thinking that the pamphlet being reprinted was Hume's.2 Sixty years on, their account dispelling this "curious legend" of Smith's authorship has now become the received opinion. T.E. Jessop accepted Keynes and Sraffa's argument (having seen it in proof before the edition was published) in his bibliography of 1938, and Norman Kemp Smith gave their version an early supportive review.3 E.C. Mossner, in his well-known biography of Hume, accepted wholeheartedly Keynes and Sraffa's findings.4 When in 1978 the Selby-Bigge's edition of Hume's Treatise saw its second edition the text of the Abstract was appended and a note gave P.H. Nidditch's opinion that "Hume's authorship is overwhelmingly likely."5 More recently Mark G. Spencer is Social Sciences and Humanities Research Council of Canada Postdoctoral Research Fellow, Department of History, University of Toronto. Sidney Smith Hall, 100 St. George St., Toronto, Ontario MSS 3GS, Canada. [email protected] 90 Mark G. Spencer in the pages of this journal, Jeff Broome, David Raynor, and David Fate Norton have all helped buttress the case for Hume's authorship, as did R. W. Connon and M. Pollard elsewhere.6 Despite an occasional dissenting voice,7 the Abstract is now widely, and rightly (or so it seems to this author), thought to have been Hume's. But with all of this scholarly attention focused on confirming Hume's authorship, another much more contentious aspect of Keynes and Sraffa's interpretation has gone largely unnoticed. Keynes and Sraffa's billing of the Abstract as "A Pamphlet hitherto unknown by DAVID HUME," suggested that before 1938 the Abstract had not been attributed publicly to Hume and that the contents of the pamphlet also had been completely unknown. "Students of Hume have known that an abstract of the Treatise was made and intended for publication," wrote a reviewer of Keynes and Sraffa, "[b]ut no copy of this abstract was known to exist: indeed it was usually supposed that the abstract had never been printed at all."8 Relying on Keynes and Sraffa it would be easy to suppose that the Abstract was never publicly ascribed to Hume and even that the contents of the pamphlet had been overlooked entirely until Keynes and Sraffa came along. One of the purposes of the present short essay is to dispel, once and for all, that misunderstanding about the Abstract. Norman Kemp Smith went part of the way toward that end in 1938 when he reviewed Keynes and Sraffa's edition. But in the process Kemp Smith introduced another "curious legend" that has slipped into scholarly acceptance with little comment and no debate. We will see that it is a mistake to argue, as Kemp Smith did, that Hume's authorship of a sixpenny pamphlet was known to readers of An universal biographical and historical dictionary, published in 1800. There is no discussion of Hume's Abstract in that book. However, the Abstract was discussed in print in at least three different publications between 1818 and 1827, long after its initial publication in 1740 and long before Keynes and Sraffa brought it to the attention of their audience in 1938. While pre-1938 Hume scholars had overlooked the Abstract, at least one of Hume's early nineteenth-century critics knew of the Abstract's existence, attributed the work to Hume, and even quoted extensively from Hume's "Preface." Most interesting of all, Hume's authorship of the Abstract was interpreted in ways that are telling of the historical reception of... (shrink)

Chief Judge Achilles and Judge Hera – uniqueness of proceedings – the nature of judicial decision-making – the judicial order of Mega-city One – source of judicial power – judicial styles – qualities required for judicial office – context of judicial action – requirement of reflection – interpretation and meaning in enforcement of law – adjudicative models – law as horrific – legal theories – Hans Kelsen – Justice Hercules – Jacques DerridaJudge Howard – critical assessment of judicial order of (...) Mega-city One – Hans Kelsen, positivism and democracy – merging of law fondatrice and law conservatrice – the “soul of the law” – fracture of the Rule of Law – fascism – comparisons with fascist regimes of twentieth Century Europe – signifiers in judicial uniform – consequences of dissent – reasons for, and consequences of, resignationChief Judge AchillesJudge HeraJudgement delivered 3 March 2138.Grand Hall of Justice, Mega-city One. (shrink)

Christian Wolff's 1721 Discourse on the Practical Philosophy of the Chinese is generally read as championing the autonomy of ethics from religion. This is too simple: Wolff's ethics was an antivoluntarist religious ethics. The example of the Chinese confirmed for Wolff that revelation is not necessary for knowledge or practice of genuine virtue, though he held that the Chinese achieve only the first of three “degrees of virtue.” (Most Christians, including the Pietists who drove Wolff from Halle shortly after he (...) delivered the Discourse, did not, in his judgment, achieve even that.) China's being perceived as outside of Western (and sacred) history made it a congenial example for the ethics and moral anthropology that, in Wolff's time, were struggling against the voluntarism of a Christian ethics premised on original sin. (shrink)

A comprehensive introduction to contemporary political ethics What is the relationship between politics and morality? May politicians bend moral constraints in the name of political necessity? Is it always wrong for leaders to lie? How much political compromise is too much? In Political Ethics, some of the world’s leading thinkers in politics, philosophy, and related fields offer a comprehensive and accessible introduction to key issues in this rapidly growing area of political theory. In a series of original essays, the contributors (...) examine a range of urgent political problems: lies and deception, compromise and refusal to compromise, the meaning and limits of political integrity, representation and failures of representation, good and bad democratic leadership, the virtues and excesses of partisanship, administrative ethics, political corruption, whistleblowing, legitimate and illegitimate claims of political emergency, and lobbying. What emerges are realistic but demanding ethical standards—and a clear-eyed understanding of the ethical challenges of political life in the twenty-first century. With contributions by Richard Bellamy, Alin Fumurescu, Edward Hall, Suzanne Dovi and Jesse McCain, Eric Beerbohm, Russell Muirhead and Nancy Rosenblum, Joseph Heath, Elizabeth David-Barrett and Mark Philp, Michele Bocchiola and Emanuela Ceva, Nomi Lazar, Phil Parvin, and Andrew Sabl. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Subjective Knowledge, Mental Disorders, and MedsHow to Parse the EquationMark D. Rego (bio)Keywordspsychopathology, antidepressants, suicidality, subjective experience, pre-reflectiveA few weeks, ago I was walking down the hall to my office when I spotted my brother-in-law coming the other way. This was odd on two accounts. First, he lives in Kentucky (I am in Connecticut) and second, he is at least a foot taller than the man in my (...) hallway. Nonetheless, I struggled to figure out why he was there. The resemblance was so striking it took me a minute or two to convince myself it was not him. Even after such convincing, the feeling that it was him remained.Later, I imagined that had I just returned from a crack cocaine den I would have been hypervigilant, if not paranoid, and consequently would be certain that my brother-in-law had arrived unannounced. Furthermore, I would probably assume that he was up to no good.How did I retain a strong feeling of recognition, the feeling that maybe it was really him, when I already concluded otherwise? And why, were I on crack cocaine, would the obvious facts be useless in rendering a decision about the identity of the man in the hall? Last, why would the post-cocaine man in the hall become a nefarious brother-in-law rather than a benign one?If I just computed some symbols to figure this out, wouldn't the feeling have gone away? If I activated a brother-in-law neural network, how did I come to acquire an evil brother-in-law neural network? And why wouldn't that go away either?In his article in this issue of Philosophy, Psychiatry, & Psychology, Hadreas looks at questions like these through the prism of before and after effects of people treated with selective serotonin reuptake inhibitors (SSRIs). Hadreas investigates the implications of a straightforward recomputation of self-awareness when treated with these medicines and finds such approaches unsatisfying and incomplete in their explanatory power. (My example looks at a type of awareness, but not specifically self-awareness, as does Hadreas. Furthermore, my paradigm asks about computational conclusions using language more common in psychiatric literature, whereas Hadreas uses standard philosophical terms. Although not isomorphic, I believe the interchange of the two remains true to the issues Hadreas is addressing). [End Page 57]In my example, there is clearly something else going on than the incorrect arrangement of symbols or the misfiring of nodes in a network that influences how I feel and what I think. Neither reason nor empiricism seem to serve me well here. Hadreas utilizes Husserl to begin to unpeel the layers of self-awareness and self-states that intermix to form the shifts and contradictions which are so common in psychiatric treatment (and in common experience as I describe).This is a welcome reckoning; the psychiatric literature is overflowing with unquestioned premises about the neuropsychiatric correlates of reason and empirical approaches (described more as computation and neural networks in the literature—again, not strictly analogous, but the same criticisms apply) Hadreas is critical of. Unfortunately, Hadreas has navigated through a sea of highly questionable assumptions about the psychopharmacology of depression to illustrate his points. This is due in large part to the common practice of consulting literary narratives and critics rather than one of immersion in the literature as a whole and the daily life of patients and active clinicians. He arrived at his destination despite this, because many of these details did not affect his particular analysis. However, to look forward to a continuation of this work and clarify some important issues I devote most of my commentary to these issues. The points I raise are more extensively discussed in a previous edition of this journal (Rego 2005).Affect to Reason ShiftLet's begin with the idea that SSRIs work by dampening emotions. An extension of this idea is that they dampen negative emotions and strengthen positive ones like assertiveness, confidence, and optimism. An even further development in this direction is that, by dampening strong emotions, cognitive enhancement takes place with SSRI treatment. A summary observation then is that SSRIs facilitate... (shrink)