The interpretation of the dead donor rule (DDR) has been central to recent debates regarding normothermic regional perfusion with controlled donation after circulatory death (NRP-cDCD). Proponents...

Despite increased calls for hospital ethics committees to serve as default decision-makers about life-sustaining treatment for unrepresented patients who lack decision-making capacity or a surrogate decision-maker and whose wishes regarding medical care are not known, little is known about how committees currently function in these cases. This was a retrospective cohort study of all ethics committee consultations involving decision-making about LST for unrepresented patients at a large academic hospital from 2007 to 2013. There were 310 ethics committee consultations, twenty-five of (...) which involved unrepresented patients. In thirteen cases, the ethics consultants evaluated a possible substitute decision-maker identified by social workers and/or case managers. In the remaining cases, the ethics consultants worked with the medical team to contact previous healthcare professionals to provide substituted judgement, found prior advance care planning documents, or identified the patient’s best interest as the decision-making standard. In the majority of cases, the final decision was to limit or withdraw LST or to change code status to Do Not Resuscitate/Do Not Intubate. Substitute decision-makers who had been evaluated through the ethics consultation process and who made the final decision alone were more likely to continue LST than cases in which physicians made the final decision. In our centre, the primary role of ethics consultants in decision-making for unrepresented patients is to identify appropriate decision-making standards. In the absence of other data suggesting that ethics committees, as currently constituted, are ready to serve as substitute decision-makers for unrepresented patients, caution is necessary before designating these committees as default decision-makers. (shrink)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

Recent research in epidemiology has identified a number of factors beyond access to medical care that contribute to health disparities. Among the so-called socioeconomic determinants of health are income, education, and the distribution of social capital. One factor that has been overlooked in this discussion is the effect that stigmatization can have on health. In this paper, I identify two ways that social stigma can create health disparities: directly by impacting health-care seeking behaviour and indirectly through the internalization of negative (...) interpersonal judgments. I then argue that social arrangements that foster self-respect can reduce the impact of stigmatization on health disparities. I conclude by showing how John Rawls' conception of justice can be used to address the intersection of stigma, health, and self-respect, in contrast to critics of his position, who have seen him as excessively focused on the allocation of material goods. (shrink)

Background: The bioethics literature contains speculation but little data about sociodemographic differences between patients for whom ethics committees (EC) are consulted for conflict about life-sustaining treatment (LST) and the broader hospital population that these committees serve. To provide an empirical context for this discussion, we examined differences in five sociodemographic factors between patients for whom an EC was consulted for conflict over LST and the general inpatient population, hypothesizing that nonwhite patients were most likely to be disproportionately represented. Methods: This (...) was a retrospective cohort study comparing self-reported race/ethnicity, household income, insurance status, primary language, and religious affiliation between patients involved in EC consultations for conflict over LST and the general adult inpatient population at a large academic hospital from January 1, 2007, through December 31, 2013. Results: There were 169 EC consultations involving conflict over LST and 243,197 adult inpatient admissions over the study period. On bivariate analysis, patients for whom the EC was consulted for conflict over LST were more likely to be nonwhite, low-income, and to speak a primary language other than English. They were not more likely to be underinsured or to report a religious affiliation. On multivariate analysis, patients for whom the EC was consulted for conflict over LST were more likely to be nonwhite (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.7–3.7; p <.001). They were also more likely to be low income (OR, 1.8; 95% CI, 1.1–3.0; p =.02). They were not more likely to speak a primary language other than English (OR, 1.4; 95% CI, 0.9–2.1; p =.17). None of the assessed variables were associated with conflict over LST requiring additional meetings beyond the first EC consultation. Conclusions: Nonwhite and low-income status patients are disproportionately represented in EC committee consultation for conflict over LST compared to the general inpatient population. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

The lung allocation score system in the United States and several European countries gives more weight to risk of death without transplantation than to survival following transplantation. As a result, centers transplant sicker patients, leading to increased length of initial hospitalization. The care of patients who have accumulated functional deficits or additional organ dysfunction during their prolonged stay can be ethically complex. Disagreement occurs between the transplant team, patients and families, and non-transplant health care professionals over the burdens of ongoing (...) intensive intervention. These cases highlight important ethical issues in organ transplantation, including the nature and requirements of transplant informed consent, the limits of physician prognostication, patient autonomy and decision-making capacity following transplant, obligations to organ donors and to other potential recipients, and the impact of program metrics on individualized recipient care. We outline general ethical principles for the care of lung transplant recipients with prolonged hospitalization and give regulatory, research, and patient-centered recommendations for these cases. (shrink)

Philosophical and political discussions of health inequalities have largely focused on questions of justice. The general strategy employed by philosophers like Norman Daniels is to identify a certain state of affairs—in his case, equality of opportunity—and then argue that health disparities limiting an individual's or group's access to that condition are unjust, demanding intervention. Recent work in epidemiology, however, has highlighted the importance of socioeconomic status in creating health inequalities. I explore the ways in which theories of justice have been (...) expanded in light of this data, suggesting that more work is required if such theories are to provide an adequate framework for addressing health disparities. I conclude by sketching an alternative possibility for thinking about health disparities outside of the context of justice. (shrink)

Philosophical and political discussions of health inequalities have largely focused on questions of justice. The general strategy employed by philosophers like Norman Daniels is to identify a certain state of affairs—in his case, equality of opportunity—and then argue that health disparities limiting an individual's or group's access to that condition are unjust, demanding intervention. Recent work in epidemiology, however, has highlighted the importance of socioeconomic status in creating health inequalities. I explore the ways in which theories of justice have been (...) expanded in light of this data, suggesting that more work is required if such theories are to provide an adequate framework for addressing health disparities. I conclude by sketching an alternative possibility for thinking about health disparities outside of the context of justice. (shrink)

Volume 20, Issue 7, July 2020, Page 158-160.

Childress et al. (2023) have provided a cogent overview of the ethical considerations involved in withdrawing extracorporeal membrane oxygenation (ECMO) over a capacitated patient’s objection. Alth...

We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation’s first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was (...) consulted, and salient features of the consults themselves. We include three case studies that illustrate important consult themes during this period. Our findings expand knowledge about the structure and workings of hospital ethics committees and illustrate how one ethics committee has developed and utilized policies on end-of-life care. More generally, we model a sociological approach to the study of clinical ethics consultation that could be utilized to contextualize institutional practices over time. (shrink)

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

Previous research has suggested that individuals who identify as being more religious request more aggressive medical treatment at end of life. These requests may generate disagreement over life-sustaining treatment (LST). Outside of anecdotal observation, however, the actual role of religion in conflict over LST has been underexplored. Because ethics committees are often consulted to help mediate these conflicts, the ethics consultation experience provides a unique context in which to investigate this question. The purpose of this paper was to examine the (...) ways religion was present in cases involving conflict around LST. Using medical records from ethics consultation cases for conflict over LST in one large academic medical centre, we found that religion can be central to conflict over LST but was also present in two additional ways through (1) religious coping, including a belief in miracles and support from a higher power, and (2) chaplaincy visits. In-hospital mortality was not different between patients with religiously versus non-religiously centred conflict. In our retrospective cohort study, religion played a variety of roles and did not lead to increased treatment intensity or prolong time to death. Ethics consultants and healthcare professionals involved in these cases should be cognisant of the complex ways that religion can manifest in conflict over LST. (shrink)

A growing body of research has demonstrated significant heterogeneity of hospital ethics committee (HEC) size, membership and training requirements, length of appointment, institutional support, clinical and policy roles, and predictors of self identified success. Because these studies have focused on HECs at a single point in time, however, little is known about how the composition of HECs changes over time and what impact these changes have on committee utilization. The current study presents 20 years of data on the evolution of (...) the Massachusetts General Hospital HEC. Between 1993 and 2012, the average number of committee members per year was 38 ± 3 and the average length of membership was 4.8 ± 0.4 years. During that time, the committee performed 934 consults, averaging 47 ± 3 per year. Attendance rates fell from 61.5 to 23.8 % over the study period and were inversely correlated with the total number of members. Between 1993 and 2012, the committee saw substantial growth in the diversity of the professional backgrounds of its members. Multivariate analysis, however, suggests that substantial changes in committee composition did not impact its utilization and that other factors are more likely to explain fluctuations in consultation volume. (shrink)

While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to (...) fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

The animalist says we are animals. This thesis is commonly understood as the universal generalization that all human persons are human animals. This article proposes an alternative: the thesis is a generic that admits of exceptions. We defend the resulting view, which we call ‘generic animalism’, and show its aptitude for diagnosing the limits of eight case-based objections to animalism.

There are predicates and subjects. It is thus tempting to think that there are properties on the one hand, and things that have them on the other. I have no quarrel with this thought; it is a fine place to begin a theory of properties and property-having. But in this paper, I argue that one such theory—bare particularism—is false. I pose a dilemma. Either bare particulars instantiate the properties of their host substances or they do not. If they do not, (...) then bare particularism is both unmotivated and false. If they do, then the view faces a problematic—and, I shall argue, false—crowding consequence. (shrink)

We develop a new puzzle concerning a material being's relationship to the smallest parts of the material world. In particular, we investigate how a being could be responsible for anything if its be...

Animalism is the view that we are animals: living, breathing, wholly material beings. Despite its considerable appeal, animalism has come under fire. Other philosophers have had much to say about objections to animalism that stem from reflection on personal identity over time. But one promising objection (the `Elimination Argument') has been overlooked. In this paper, I remedy this situation and examine the Elimination Argument in some detail. I contend that the Elimination Argument is both unsound and unmotivated.

There is a new objection to the Consequence Argument for incompatibilism. I argue that the objection is more wide-ranging than originally thought. In particular: if it tells against the Consequence Argument, it tells against other arguments for incompatibilism too. I survey a few ways of dealing with this objection and show the costs of each. I then present an argument for incompatibilism that is immune to the objection and that enjoys other advantages.

Some incompatibilists about free will or moral responsibility and determinism would abandon their incompatibilism were they to learn that determinism is true. But is it reasonable to flip-flop in this way? In this article, we contend that it is and show what follows. The result is both a defense of a particular incompatibilist strategy and a general framework for assessing other cases of flip-flopping.

Here's an interesting question: what are we? David Barnett has claimed that reflection on consciousness suggests an answer: we are simple. Barnett argues that the mereological simplicity of conscious beings best explains the Datum: that no pair of persons can itself be conscious. In this paper, I offer two alternative explanations of the Datum. If either is correct, Barnett's argument fails. First, there aren't any such things as pairs of persons. Second, consciousness is maximal; no conscious thing is a proper (...) part of another conscious thing. I conclude by showing how both moves comport with materialist theories of what we are and then apply them to another anti-materialist argument. (shrink)

According to the doctrine of animalism, we are animals in the primary and non-derivative sense. In this article, I introduce and defend a novel argument for the view.

Some strange cases have gripped philosophers of mind. They have been deployed against materialism about human persons, functionalism about mentality, the possibility of artificial intelligence, and more. In this paper, I cry “foul”. It’s not hard to think that there’s something wrong with the cases. But what? My proposal: their proponents ignore questions about composition. And ignoring composition is a mistake. Indeed, materialists about human persons, functionalists about mentality, and believers in the possibility of artificial intelligence can plausibly deploy moderate (...) theories of composition in defense of their views. And as it turns out, these strange cases are an interesting source of evidence for moderate theories of composition. (shrink)

According to theists, God is an immaterial thinking being. The main question of this article is whether theism supports the view that we are immaterial thinking beings too. I shall argue in the negative. Along the way, I will also explore some implications in the philosophy of mind following from the observation that, on theism, God’s mentality is in a certain respect magical.

Among your closest associates is a certain human animal – a living, breathing, organism. You see it when you look in the mirror. When it is sick, you don't feel too well. Where it goes, you go. And, one thinks, where you go, it must follow. Indeed, you can make it move through sheer force of will. You bear, in short, an important and intimate relation to this, your animal. So too rest of us with our animals. Animalism says that (...) this relation is nothing short of identity. According to animalists, we do not only coincide with or constitute or inhabit or otherwise hang out with these close associates, our animals: we are them. In this article, I offer an opinionated take on what animalism might be and situate it against contemporary rivals. Then, I outline a simple case for animalism. Finally, I sketch non-standard routes for animalists to take in light of standard challenges. My goal in all of this is to open up some new avenues of animalist thinking. (shrink)

Some have it that wholes are, somehow, identical to their parts. This doctrine is as alluring as it is puzzling. But in this paper, I show that the doctrine is inconsistent with two widely accepted theses. Something has to go.

Materialists about human persons think that we are material through and through—wholly material beings. Those who endorse materialism more widely think that everything is material through and through. But what is it to be wholly material? In this article, I answer that question. I identify and defend a definition or analysis of ‘wholly material’.

Digital artifacts — humanly-constructed items that inhabit our computers and networks — suffer an unfortunate reputation as being virtual and therefore unreal, and all too easy to reproduce on the cheap. These features together prompt the question of this article: if digital artifacts can be reproduced for free, and if they are unreal, why do they have economic value at all? Using a focal case study of bitcoin — the most unreal digital artifact of them all, and one that has (...) been copied and pasted a thousand times over — I answer the question. Some digital artifacts can't be copied on the cheap, as it turns out, and they are real enough to be useful. (shrink)

For good or for ill, we have animal bodies. Through them, we move around, eat and drink, and do many other things besides. We owe much – perhaps our very lives – to these ever-present animals. But how exactly do we relate to our animals? Are we parts of them, or they of us? Do we and these living animals co-inhere or constitute or coincide? Or what? Animalism answers that we are identical to them. There are many objections to animalism, (...) and a dizzying array of rival views. In this article, we do not propose to evaluate those objections and rivals. We will instead present a new argument for that view. The argument begins with the fact that we have emotions. (shrink)

Many say that ontological disputes are defective because they are unimportant or without substance. In this paper, we defend ontological disputes from the charge, with a special focus on disputes over the existence of composite objects. Disputes over the existence of composite objects, we argue, have a number of substantive implications across a variety of topics in metaphysics, science, philosophical theology, philosophy of mind, and ethics. Since the disputes over the existence of composite objects have these substantive implications, they are (...) themselves substantive. (shrink)

I introduce and argue for a Priority Principle, according to which we exemplify certain of our mental properties in the primary or non-derivative sense. I then apply this principle to several debates in the metaphysics and philosophy of mind.

Warrant is what fills the gap between mere true belief and knowledge. But a problem arises. Is there just one condition that satisfies this description? Suppose there isn’t: can anything interesting be said about warrant after all? Call this the uniqueness problem. In this paper, I solve the problem. I examine one plausible argument that there is no one condition filling the gap between mere true belief and knowledge. I then motivate and formulate revisions of the standard analysis of warrant. (...) Given these revisions, I argue that there is, after all, exactly one warrant condition. (shrink)

Animalism is at once a bold metaphysical theory and a pedestrian biological observation. For according to animalists, human persons are organisms; we are members of a certain biological species. In this article, I introduce some heretofore unnoticed data concerning the interlocking interests of human persons and human organisms. I then show that the data support animalism. The result is a novel and powerful argument for animalism. Bold or pedestrian, animalism is true.

Many have thought that there is a problem with causal commerce between immaterial souls and material bodies. In Physicalism or Something Near Enough, Jaegwon Kim attempts to spell out that problem. Rather than merely posing a question or raising a mystery for defenders of substance dualism to answer or address, he offers a compelling argument for the conclusion that immaterial souls cannot causally interact with material bodies. We offer a reconstruction of that argument that hinges on two premises: Kim’s Dictum (...) and the Nowhere Man principle. Kim’s Dictum says that causation requires a spatial relation. Nowhere Man says that souls can’t be in space. By our lights, both premises can be called into question. We’ll begin our evaluation of the argument by pointing out some consequences of Kim’s Dictum. For some, these will be costs. We will then present two defeaters for Kim’s Dictum and a critical analysis of Kim’s case for Nowhere Man. The upshot is that Kim’s argument against substance dualism fails. (shrink)

Here is a question as intriguing as it is brief: what are we? The animalist’s answer is equal in brevity: we are animals. This stark formulation of the animalist slogan distances it from nearby claims—that we are essentially animals, for example, or that we have purely biological criteria of identity over time. Is the animalist slogan—unburdened by modal or criterial commitments—still interesting, though? Or has it lost its bite? In this article we address such questions by presenting a positive case (...) for the importance of animalism and applying that case to recent critiques. (shrink)

Aristotle famously held that objects are comprised of matter and form. That is the central doctrine of hylomorphism (sometimes rendered “hylemorphism”—hyle, matter; morphe, form), and the view has become a live topic of inquiry today. Contemporary proponents of the doctrine include Jeffrey Brower, Kit Fine, David Hershenov, Mark Johnston, Kathrin Koslicki, Anna Marmodoro, Michael Rea, and Patrick Toner, among others. In the wake of these contemporary hylomorphic theories the doctrine has seen application to various topics within mainstream analytic metaphysics. Here, (...) appeals to form and matter are used to shed light on problems about ontology, personal identity, philosophy of mind, and philosophy of religion. The current entry documents this resurgence of interest in hylomorphism, the ways it has been applied, and its reception. (shrink)

Materialists about human persons say that we are, and must be, wholly material beings. Substance dualists say that we are, and must be, wholly immaterial. In this paper, I take issue with the “and must be” bits. Both materialists and substance dualists would do well to reject modal extensions of their views and instead opt for contingent doctrines, or doctrines that are silent about those modal extensions. Or so I argue.

Substance dualism is on the move. Though the view remains unfashionable, a growing and diverse group of philosophers endorse it on impressive empirical, religious, and purely metaphysical grounds. In this note, I develop and evaluate one conceptual argument for substance dualism. According to that argument, we may derive a conclusion about our nature from the mere fact that we have the concept of a spirit. The argument is intriguing and fruitful; but I shall contend that it is, nonetheless, unsound.

We uncover a surprising discovery about the basis of thoughts. We begin by giving some plausible axioms about thoughts and their grounds. We then deduce a theorem, which has dramatic ramifications for the basis of all thoughts. The theorem implies that thoughts cannot come deterministically from any purely “thoughtless” states. We expect this result to be too dramatic for many philosophers. Hence, we proceed to investigate the prospect of giving up the axioms. We show that each axiom’s negation itself has (...) dramatic consequences that should be of interest to philosophers of mind. Our proof of the theorem provides a new guiderail for thinking about the nature and origin of thoughts. (shrink)

Making room for agency in a physical world is no easy task. Can it be done at all? In this article, I consider and reject an argument in the negative.

In this article, we describe what cryptocurrency is, how it works, and how it relates to familiar conceptions of and questions about money. We then show how normative questions about monetary policy find new expression in Bitcoin and other cryptocurrencies. These questions can play a role in addressing not just what money is, but what it should be. A guiding theme in our discussion is that progress here requires a mixed approach that integrates philosophical tools with the purely technical results (...) of disciplines like computer science and economics. Note: this article is the first entry within a two-part sequence on the Philosophy, Politics, and Economics of Cryptocurrency. (shrink)

In this article, we identify three key design dimensions along which cryptocurrencies differ -- privacy, censorship-resistance, and consensus procedure. Each raises important normative issues. Our discussion uncovers new ways to approach the question of whether Bitcoin or other cryptocurrencies should be used as money, and new avenues for developing a positive answer to that question. A guiding theme is that progress here requires a mixed approach that integrates philosophical tools with the purely technical results of disciplines like computer science and (...) economics. Note: this article is the second entry within a two-part sequence on the Philosophy, Politics, and Economics of Cryptocurrency. (shrink)

In this article, we develop and defend a new argument for animalism -- the thesis that we human persons are human animals. The argument takes this rough form: since our pets are animals, we are too. We’ll begin with remarks on animalism and its rivals, develop our main argument, and then defend it against a few replies.

Paul Krugman and others deny that bitcoin has legitimate uses. Critics like Krugman also fail to distinguish bitcoin from other cryptocurrencies. But once we isolate bitcoin from the rest of the field, we see how special, and how useful, it is. In this chapter, we explain why bitcoin is unique among cryptocurrencies as a credibly neutral monetary asset and why this is important. Its uniqueness doesn’t owe entirely to its age (as the oldest) or market ranking (as the most valuable). (...) As a credibly neutral monetary asset, bitcoin solves problems for those in less than ideal circumstances. And beyond bitcoin’s functionality, its origin and surrounding culture also help to explain why people trust bitcoin more than any other cryptocurrency to solve these problems. Nothing else comes close. This gap between bitcoin and everything else has implications for policy-making, journalism, and academic research. (shrink)