This open access book discusses individual, collective, and institutional responsibilities with regard to vaccination from the perspective of philosophy and public health ethics. It addresses the issue of what it means for a collective to be morally responsible for the realisation of herd immunity and what the implications of collective responsibility are for individual and institutional responsibilities. The first chapter introduces some key concepts in the vaccination debate, such as ‘herd immunity’, ‘public goods’, and ‘vaccine refusal’; and explains why failure (...) to vaccinate raises certain ethical issues. The second chapter analyses, from a philosophical perspective, the relationship between individual, collective, and institutional responsibilities with regard to the realisation of herd immunity. The third chapter is about the principle of least restrictive alternative in public health ethics and its implications for vaccination policies. Finally, the fourth chapter presents an ethical argument for unqualified compulsory vaccination, i.e. for compulsory vaccination that does not allow for any conscientious objection. The book will appeal to philosophers interested in public health ethics and the general public interested in the philosophical underpinning of different arguments about our moral obligations with regard to vaccination. (shrink)

We describe a form of moral artificial intelligence that could be used to improve human moral decision-making. We call it the “artificial moral advisor”. The AMA would implement a quasi-relativistic version of the “ideal observer” famously described by Roderick Firth. We describe similarities and differences between the AMA and Firth’s ideal observer. Like Firth’s ideal observer, the AMA is disinterested, dispassionate, and consistent in its judgments. Unlike Firth’s observer, the AMA is non-absolutist, because it would take into account the human (...) agent’s own principles and values. We argue that the AMA would respect and indeed enhance individuals’ moral autonomy, help individuals achieve wide and a narrow reflective equilibrium, make up for the limitations of human moral psychology in a way that takes conservatives’ objections to human bioenhancement seriously, and implement the positive functions of intuitions and emotions in human morality without their downsides, such as biases and prejudices. (shrink)

We argue that individuals who have access to vaccines and for whom vaccination is not medically contraindicated have a moral obligation to contribute to the realisation of herd immunity by being vaccinated. Contrary to what some have claimed, we argue that this individual moral obligation exists in spite of the fact that each individual vaccination does not significantly affect vaccination coverage rates and therefore does not significantly contribute to herd immunity. Establishing the existence of a moral obligation to be vaccinated (...) despite the negligible contribution each vaccination can make to the realisation of herd immunity is important because such moral obligation would strengthen the justification for coercive vaccination policies. We show that two types of arguments—namely a utilitarian argument based on Parfit’s Principle of Group Beneficence and a contractualist argument—can ground an individual moral obligation to be vaccinated, in spite of the imperceptible contribution that any single vaccination makes to vaccine coverage rates. We add a further argument for a moral obligation to be vaccinated that does not require embracing problematic comprehensive moral theories such as utilitarianism or contractualism. The argument is based on a “duty of easy rescue” applied to collectives, which grounds a collective moral obligation to realise herd immunity, and on a principle of fairness in the distribution of the burdens that must be borne to realise herd immunity. (shrink)

This major publication is a history of the semantic tradition in philosophy from the early nineteenth century through its incarnation in the work of the Vienna Circle, the group of logical positivists that emerged in the years 1925–1935 in Vienna who were characterised by a strong commitment to empiricism, a high regard for science, and a conviction that modern logic is the primary tool of analytic philosophy. In the first part of the book, Alberto Coffa traces the roots of (...) logical positivism in a semantic tradition that arose in opposition to Kant's theory that a priori knowledge is based on pure intuition and the constitutive powers of the mind. In Part II, Coffa chronicles the development of this tradition by members and associates of the Vienna Circle. Much of Coffa's analysis draws on the unpublished notes and correspondence of many philosophers. The book, however, is not merely a history of the semantic tradition from Kant 'to the Vienna Station'. Coffa also critically reassesses the role of semantic notions in understanding the ground of a priori knowledge and its relation to empirical knowledge and questions the turn the tradition has taken since Vienna. (shrink)

We address the issue of whether, why and under what conditions, quarantine and isolation are morally justified, with a particular focus on measures implemented in the developing world. We argue that the benefits of quarantine and isolation justify some level of coercion or compulsion by the state, but that the state should be able to provide the strongest justification possible for implementing such measures. While a constrained form of consequentialism might provide a justification for such public health interventions, we argue (...) that a stronger justification is provided by a principle of State Enforced Easy Rescue: a state may permissibly compel individuals to engage in activities that entail a small cost to them but a large benefit to others, because individuals have a moral duty of easy rescue to engage in those activities. The principle of State Enforced Easy Rescue gives rise to an Obligation Enforcement Requirement: the state should create the conditions such that submitting to coercive or compulsive measures becomes a fundamental moral duty of individuals, i.e. a duty of easy rescue. When the state can create such conditions, it has the strongest justification possible for implementing coercive or compulsive measures, because individuals have a moral duty to temporarily relinquish the rights that such measures would infringe. Our argument has significant implications for how public health emergencies in the developing world should be tackled. Where isolation and quarantine measures are necessary, states or the international community have a moral obligation to provide certain benefits to those quarantined or isolated. (shrink)

The rapid development of vaccines against COVID‐19 represents a huge achievement, and offers hope of ending the global pandemic. At least three COVID‐19 vaccines have been approved or are about to be approved for distribution in many countries. However, with very limited initial availability, only a minority of the population will be able to receive vaccines this winter. Urgent decisions will have to be made about who should receive priority for access. Current policy in the UK appears to take the (...) view that those who are most vulnerable to COVID‐19 should get the vaccine first. While this is intuitively attractive, we argue that there are other possible values and criteria that need to be considered. These include both intrinsic and instrumental values. The former are numbers of lives saved, years of life saved, quality of the lives saved, quality‐adjusted life‐years (QALYs), and possibly others including age. Instrumental values include protecting healthcare systems and other broader societal interests, which might require prioritizing key worker status and having dependants. The challenge from an ethical point of view is to strike the right balance among these values. It also depends on effectiveness of different vaccines on different population groups and on modelling around cost‐effectiveness of different strategies. It is a mistake to simply assume that prioritizing the most vulnerable is the best strategy. Although that could end up being the best approach, whether it is or not requires careful ethical and empirical analysis. (shrink)

We argue that, from the point of view public health ethics, vaccination is significantly analogous to seat belt use in motor vehicles and that coercive vaccination policies are ethically justified for the same reasons why coercive seat belt laws are ethically justified. We start by taking seriously the small risk of vaccines’ side effects and the fact that such risks might need to be coercively imposed on individuals. If millions of individuals are vaccinated, even a very small risk of serious (...) side effects implies that, statistically, at some point side effects will occur. Imposing such risks raises issues about individual freedom to decide what risks to take on oneself or on one’s children and about attribution of responsibility in case of adverse side effects. Seat belt requirements raise many of the same ethical issues as vaccination requirements, and seat belt laws initially encountered some opposition from the public that is very similar to some of the current opposition to vaccine mandates. The analogy suggests that the risks of vaccines do not constitute strong enough reasons against coercive vaccination policies and that the same reasons that justify compulsory seat belt use—a measure now widely accepted and endorsed—also justify coercive vaccination policies. (shrink)

Wittgenstein defiende que los problemas filosóficos son ilegítimos. Sin embargo, no resulta del todo claro qué se entiende en general por problema filosófico, cuál es, pues, su naturaleza. El presente artículo intenta elucidar la observación de Wittgenstein que sostiene que la forma de un problema filosófico se puede presentar con la expresión “Yo no sé salir del atolladero” (IF § 123). En el artículo se elige, a manera de ejemplo, el escándalo kantiano, que demanda que demostremos con el uso de (...) la razón que la proposición “hay objetos físicos” es verdadera. Sin renunciar al ejemplo, se explora en qué sentido la expresión de Wittgenstein caracteriza en buena medida la naturaleza misma de la dificultad filosófica. En el ejercicio se atienden recomendaciones formales del Tractatus, terapias desplegadas en Sobre la Certeza y el recurso de distinguir entre sentido primario y sentido secundario de una expresión insinuado en las Investigaciones Filosóficas. (shrink)

I argue that appeals to conscience do not constitute reasons for granting healthcare professionals exemptions from providing services they consider immoral. My argument is based on a comparison between a type of objection that many people think should be granted, i.e. to abortion, and one that most people think should not be granted, i.e. to antibiotics. I argue that there is no principled reason in favour of conscientious objection qua conscientious that allows to treat these two cases differently. Therefore, I (...) conclude that there is no principled reason for granting conscientious objection qua conscientious in healthcare. What matters for the purpose of justifying exemptions is not whether an objection is ‘conscientious’, but whether it is based on the principles and values informing the profession. I provide examples of acceptable forms of objection in healthcare. (shrink)

Ethical debate surrounding human enhancement, especially by biotechnological means, has burgeoned since the turn of the century. Issues discussed include whether specific types of enhancement are permissible or even obligatory, whether they are likely to produce a net good for individuals and for society, and whether there is something intrinsically wrong in playing God with human nature. We characterize the main camps on the issue, identifying three main positions: permissive, restrictive and conservative positions. We present the major sub-debates and lines (...) of argument from each camp. The review also gives a flavor of the general approach of key writers in the literature such as Julian Savulescu, Nick Bostrom, Michael Sandel, and Leon Kass. (shrink)

In this paper, I want to hold, first, that a treatment of Frege cases in terms of a difference in cognitive phenomenology of the involved experiential mental states is not viable. Second, I will put forward another treatment of such cases that appeals to a difference in intentional objects metaphysically conceived not as exotica, but as schematic objects, that is, as objects that have no metaphysical nature qua objects of thought. This allows their nature to be settled independently of their (...) being thought of, in particular as concrete entities in the sense of entities that may be spatiotemporal occupiers. Yet third, as to Frege cases, cognitive phenomenology may return from the back door. For the realization that, if correct, solves any such case cannot but have a proprietary, though neither distinctive nor individuative, phenomenology. In my account, this is the realization that the different schematic intentional objects involved are none other than the same entity. (shrink)

I argue that much philosophical discussion of moral disgust suffers from two ambiguities: first, it is not clear whether arguments for the moral authority of disgust apply to disgust as a consequence of moral evaluations or instead to disgust as a moralizing emotion; second, it is not clear whether the word ‘moral’ is used in a normative or in a descriptive sense. This lack of clarity generates confusion between ‘fittingness’ and ‘appropriateness’ of disgust. I formulate three conditions that arguments for (...) the moral authority of disgust need—but typically fail—to satisfy, in order to avoid (1) circularity, (2) the naturalistic fallacy, and (3) redundancy. These conditions are, respectively, (1) the identification of the direction of the causal relation between disgust and moral evaluation, (2) a demonstration that disgust is ‘fitting’ to morally relevant properties, and (3) a demonstration that disgust is ‘appropriate’ when elicited by these morally relevant properties. I will also suggest that, regardless of whether an argument for the moral authority of disgust can be made, it would be better to avoid the rather obscure term ‘moral disgust’. (shrink)

We provide ethical criteria to establish when vaccine mandates for healthcare workers are ethically justifiable. The relevant criteria are the utility of the vaccine for healthcare workers, the utility for patients (both in terms of prevention of transmission of infection and reduction in staff shortage), and the existence of less restrictive alternatives that can achieve comparable benefits. Healthcare workers have professional obligations to promote the interests of patients that entail exposure to greater risks or infringement of autonomy than ordinary members (...) of the public. Thus, we argue that when vaccine mandates are justified on the basis of these criteria, they are not unfairly discriminatory and the level of coercion they involve is ethically acceptable—and indeed comparable to that already accepted in healthcare employment contracts. Such mandates might be justified even when general population mandates are not. Our conclusion is that, given current evidence, those ethical criteria justify mandates for influenza vaccination, but not COVID-19 vaccination, for healthcare workers. We extend our arguments to other vaccines. (shrink)

Although the COVID-19 pandemic is a serious public health and economic emergency, and although effective vaccines are the best weapon we have against it, there are groups and individuals who oppose certain kinds of vaccines because of personal moral or religious reasons. The most widely discussed case has been that of certain religious groups that oppose research on COVID-19 vaccines that use cell lines linked to abortions and that object to receiving those vaccine because of their moral opposition to abortion. (...) However, moral opposition to COVID-19 vaccine research can be based on other considerations, both secular and religious. We argue that religious or personal moral objections to vaccine research are unethical and irresponsible, and in an important sense often irrational. They are unethical because of the risk of causing serious harm to other people for no valid reason; irresponsible because they run counter to individual and collective responsibilities to contribute to important public health goals; and in the case of certain kinds of religious opposition, they might be irrational because they are internally inconsistent. All in all, our argument translates into the rather uncontroversial claim that we should prioritize people’s lives over religious freedom in vaccine research and vaccination roll out. (shrink)

The Handbook of Bioethical Decisions Volume II addresses and analyzes the most important ethical concerns and moral quandaries related to scientific integrity and institutional ethics. It counts on two parts, Part One: Research Ethics, which addresses issues related to Scientific Integrity, Research Misconduct and Conducting Ethical Research, and Part Two: Institutional Ethics and Bioethics Committees, which explores Institutional Ethics issues, Ethics and Bioethics Committees’ roles and scopes, and Bioethical Issues in Institutional Ethics. Consequently, the Handbook, Vol. II, offers a remarkable (...) collection of works by outstanding international experts on institutional and research ethics, in order for bioethics practitioners to obtain better elements to address key issues related to integrity in research as well as to decision-making processes. In this fashion, this volume is a valuable resource for professionals working on different bioethical and biomedical fields, such as, ethics and bioethics committees, health care institutions, biomedical and pharmacological companies, and academic settings, among others. Chapter 26 is available open access under a Creative Commons Attribution 4.0 International License via link.springer.com. (shrink)

We argue that we should provide extra payment not only for extra time worked but also for the extra risks healthcare workers (and those working in healthcare settings) incur while caring for COVID‐19 patients—and more generally when caring for patients poses them at significantly higher risks than normal. We argue that the extra payment is warranted regardless of whether healthcare workers have a professional obligation to provide such risky healthcare. Payment for risk would meet four essential ethical requirements. First, assuming (...) healthcare workers do not have a professional obligation to take on themselves the risks, payments in the form of incentives would preserve autonomy in deciding what risks to take on oneself. Second, even assuming that healthcare workers do have a professional obligation to take on themselves the risks, payments for risk would create fair working conditions by avoiding exploitation. Third, payments for risk would make it more likely that public healthcare systems can discharge their institutional responsibility to provide healthcare in circumstances where healthcare workers may otherwise (perhaps legitimately) opt out. Fourth, payments for risk would guarantee an efficient healthcare system in pandemic situations. Finally, we address two likely objections that some might raise against our proposal, particularly with regard to incentives, namely that such payments or incentives can themselves be coercive and that they represent a form of undue inducement. (shrink)

I argue that appeals to conscience do not constitute reasons for granting healthcare professionals exemptions from providing services they consider immoral (e.g. abortion). My argument is based on a comparison between a type of objection that many people think should be granted, i.e. to abortion, and one that most people think should not be granted, i.e. to antibiotics. I argue that there is no principled reason in favour of conscientious objection qua conscientious that allows to treat these two cases differently. (...) Therefore, I conclude that there is no principled reason for granting conscientious objection qua conscientious in healthcare. What matters for the purpose of justifying exemptions is not whether an objection is ‘conscientious’, but whether it is based on the principles and values informing the profession. I provide examples of acceptable forms of objection in healthcare. (shrink)

We discuss whether and under what conditions people should be allowed to choose which COVID-19 vaccine to receive on the basis of personal ethical views. The problem arises primarily with regard to some religious groups’ concerns about the connection between certain COVID-19 vaccines and abortion. Vaccines currently approved in Western countries make use of foetal cell lines obtained from aborted foetuses either at the testing stage or at the development stage. The Catholic Church’s position is that, if there are alternatives, (...) Catholic people have a moral obligation to request the vaccine whose link with abortion is more remote, which at present means that they should refuse the Oxford/AstraZeneca vaccine. We argue that any consideration regarding free choice of the vaccine should apply to religious and non-religious claims alike, in order to avoid religion-based discrimination. However, we also argue that, in a context of limited availability, considering the significant differences in costs and effectiveness profile of the vaccines available, people should only be allowed to choose the preferred vaccine if: 1) this does not risk compromising vaccination strategies; and 2) they internalize any additional cost that their choice might entail. The State should only subsidize the vaccine that is more cost-effective for any demographic group from the point of view of public health strategies. (shrink)

An important distinction lies between consciousness attributed to creatures, or subjects, (creature consciousness) and consciousness attributed to mental states (state consciousness). Most contemporary theories of consciousness aim at explaining what makes a mental state conscious, paying scant attention to the problem of creature consciousness. This attitude relies on a deeper, and generally overlooked, assumption that once an explanation of state consciousness is provided, one has also explained all the relevant features of creature consciousness. I call this the priority of state (...) consciousness thesis (PSC). In this paper, I want to explore how the renewed centrality bestowed to phenomenology in contemporary discussions on consciousness challenges PSC and, consequently, the standard way of framing the problem of consciousness. More precisely, I examine PSC in light of a view about the structure of phenomenal character that is paradigmatic of the approach above. This is subjectivism about phenomenal character (SUBJ), according to which a mental state is conscious when it acquires the property of for-me-ness. I argue that PSC and SUBJ are incompatible because the latter implies that creature consciousness is explanatorily prior to state consciousness. Consequently, if SUBJ is true, then PSC is false, and what constitutes the problem of consciousness is primarily a problem of explaining (a kind of) creature consciousness. I conclude by defending my claim from a pair of possible objections and drawing some implications for the discussion of for-me-ness and the debate on the explanation of consciousness. (shrink)

Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children would be vaccinated (...) at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public. (shrink)

In recent works, Chomsky has once more endorsed a computational view of rulefollowing, whereby to follow a rule is to operate certain computations on a subject’s mental representations. As is well known, this picture does not conform to what we may call the grammatical conception of rule-following outlined by Wittgenstein, whereby an elucidation of the concept of rule-following is aimed at by isolating grammatical statements regarding the phrase ‘to follow a rule’. As a result, Chomskyan and Wittgensteinian treatments of topics (...) immediately connected with rule-following, namely linguistic competence and understanding, are utterly different from one another. There are two possible stances that computationalists like Chomsky may adopt with regard to the discrepancy between the two aforementioned modes of dealing with rule-following, namely a conciliatory and a non-conciliatory attitude. According to the former attitude, grammatical remarks on and computationallyoriented theories of rule-following investigate one and the same topic although admittedly at different levels, namely a conceptual and an empirical one. According to the latter attitude, grammatical remarks are just a preliminary step in the investigation of rule-following which scientific advancement, presently represented by computationally-oriented theories on this matter, is well entitled to put aside. In what follows, however, I will try to show that both stances are problematic. The conciliatory attitude simply does not work, for it hardly copes with the fact that the concept of rule-following does not supervene, even weakly, on the property of rule-following, namely the property instantiated in the mental/cerebral phenomena that computationally-oriented theories of rule-following study. To take the contrary attitude, on the other hand, is to end up with another disappointing result, namely that the computational treatment of rule-following ultimately deals with something different from that which we wished to gain knowledge of when we began our inquiry into rule-following.. (shrink)

Se presentan dos variantes principales de la semántica actual (1990) que hace del concepto de condiciones veritativas de una oración la clave para desarrollar las ideas de significado y comprensión. Se examinan algunas críticas y se sostiene que no afectan esencialmente el programa. Se distingue entre las versiones al modo de Davidson de aquellas que siguen ideas de Montague y se sostiene que, cuando el fin teórico primario es explicar la comprensión lingüística, hay razones para dar preferencia a las variantes (...) del primer tipo, y que también las hay cuando se busque una semántica apropiada para caracterizar posiciones ontológicas dependientes de restricciones epistémicas; aunque las preferencias se invierten si la ontología que se quiere expresar va a formularse prescindiendo de consideraciones gnoseológicas. (shrink)

In this paper, we want to maintain that the puzzle of imaginative resistance is basically a pragmatic issue due to the failure of participative imagination, as involving a pre-semantic level relating to a wide context (the overall situation of discourse). Since the linguistic meanings of the relevant fiction-involving sentences violate some of our basic norms, what such sentences (fictionally) say cannot be participatively imagined. That failure leads one to refrain from ascribing such sentences the fictional truth-conditions they would have in (...) narrow fictional contexts (sets of fixed parameters) as determined by those meanings in those contexts. Yet one could still make that ascription, for one can cognitively imagine what such sentences would say in those contexts. As is proved by the fact that if one either adopts an alternative view on such norms or, for some reason, brackets them, one can again perform that ascription. (shrink)

Horwich’s paper is an intriguing and subtle attempt to extend deflationism from the theory of truth to the theory of meaning. Horwich endorses a use-theory of meaning which claims that one replacement instance of the schema “‘x’ means x”, e.g. “‘t1’ means t1”, is paraphrasable as U(‘t1’), while another replacement instance is..

In this paper, I explore the consequences of the thesis that externalism and internalism are (possibly, but as we will see not necessarily, opposite) metaphysical doctrines on the individuation conditions of a thought. If I am right, this thesis primarily entails that at least some naturalist positions on the ontology of the mind, namely the reductionistic ones, are hardly compatible with both externalism and a version of internalism so conceived, namely relational internalism. Indeed, according to both externalism and relational internalism, (...) intentionality constitutes (or at least grounds) the relational content property providing the individuation conditions of a thought, as a relation to an outer or to an inner object respectively. Yet since intentionality turns out to be a modal, hence a nonnatural, property, both externalism and relational internalism deny to thoughts at least token-identity with physical states. Finally, I will give some support to the idea that externalism and internalism must be interpreted as doctrines on the individuation conditions of a thought. (shrink)

There has been some concern m recent years that economic interests in the biotechnology area could, particularly through patenting, have a constricting influence on scientific research. Despite this concern, there have been no studies of this phenomenon beyond isolated cases. In this article we examine the evolution of the biomedical field of hybridoma/monoclonal antibody research with detailed examples of the three types of patent claims that have emerged there—basic claims, claims on application techniques, and claims on specific antibodies. We analyze (...) the impact of these claims and their legal histories on the free flow of scientific information and, the activity of scientific researchers. We conclude that such patent claims present severe restrictions for both, not only in the monoclonal area but in general, amounting to a subtle but significant shift in the political economy of science and technology. (shrink)

En un estilo claro, despojado de t rminos t cnicos, Alberto Clemente de la Torre traza un recorrido por los principales t picos de la f sica cu ntica destinados a todos aquellos que quieren descubrir uno de los temas m s sugerentes de la ciencia contempor nea, sin exigirles Para ello conocimientos previos.