BackgroundEthical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that (...) promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.MethodsIn this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.ResultsThe review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.ConclusionsThe review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations. (shrink)

Inference has long been a concern in epistemology, as an essential means by which we extend our knowledge and test our beliefs. Inference is also a key notion in influential psychological or philosophical accounts of mental capacities, from perception via utterance comprehension to problem-solving. Consciousness, on the other hand, has arguably been the defining interest of philosophy of mind over recent decades. Comparatively little attention, however, has been devoted to the significance of consciousness for the proper understanding of the nature (...) and role of inference. It is commonly suggested that inference may be either conscious or unconscious. Yet how unified are these various supposed instances of inference? Does either enjoy explanatory priority in relation to the other? In what ways or senses, can an inference be conscious, or fail to be conscious, and how does this matter? This book brings together original essays from established scholars and emerging theorists that illustrate how several current debates in epistemology, philosophy of psychology, and philosophy of mind can benefit from reflections on these and related questions about the significance of consciousness for inference. Contributors include: Kirk Ludwig and Wade Munroe; Michael Rescorla; Federico Bongiorno and Lisa Bortolotti; Berit Brogaard; Nicholas Allott; Jake Quilty-Dunn and Eric Mandelbaum; Corine Besson; Anders Nes; David Henderson, Terry Horgan, and Matjaž Potrč; Elijah Chudnoff; and Ram Neta. (shrink)

In this paper, I argue that sufficientarian principles are indispensable in the set of principles that have bearing on issues in distributive ethics. I provide two arguments in favor of this claim. First, I argue that sufficientarianism is the only framework that allows us to appropriately analyze what sort of obligations we have toward individuals who are badly off due to their own faults and choices. Second, I argue that sufficientarianism is the only theory that provides an adequate framework for (...) thinking about the desperately badly off. (shrink)

Background: Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts. Aim: To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies. Research design: An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses. Participants: The 69 participants attended a 1-year educational (...) programme for ambulance nurses at a Swedish university. Ethical consideration: The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study. Findings: The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care. Discussion: Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation. Conclusion: The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability. (shrink)

A wide range of gene knockout experiments shows that functional stability is an important feature of biological systems. On this backdrop, we present an argument for higher‐level causation based on counterfactual dependence. Furthermore, we sketch a metaphysical picture providing resources to explain the metaphysical nature of functional stability, higher‐level causation, and the relevant notion of levels. Our account aims to clarify the role empirical results and philosophical assumptions should play in debates about reductionism and higher‐level causation. It thereby contributes to (...) the development of a philosophical foundation for systems biology. †To contact the authors, please write to: CSMN/IFIKK, University of Oslo, Box 1020 Blindern, N‐0315, Oslo, Norway; e‐mail: anders[email protected] , [email protected]. (shrink)

Perceptual processes differ from cognitive, this paper argues, in functioning to be causally controlled by proximal stimuli, and being modular, at least in a modest sense that excludes their being isotropic in Jerry Fodor's sense. This claim agrees with such theorists as Jacob Beck and Ben Phillips that a function of stimulus-control is needed for perceptual status. In support of this necessity claim, I argue, inter alia, that E.J. Green's recent architectural account misclassifies processes deploying knowledge of grammar as perceptual. (...) _Pace_ Beck and Phillips, however, I argue a function of stimulus-control is insufficient for perceptual as opposed to cognitive status. One consideration in favour of such insufficiency, noted but (I argue) not convincingly rebutted by these theorists, concerns perpetually grounded demonstrative thought. Two other considerations trade on the fact that a function of stimulus-control can arise not from blind nature but intentional design or social institutions, where so-functioning processes may but need not be perceptual. I offer two cases where such processes are cognitive, viz. skilful play-by-play announcing of ongoing events, and voluntary visualizing of ongoing events under the guidance of apt play-by-play announcements, dubbed announcement-driven visualizing (ADV). The cognitive status of these three diverse phenomena cannot be explained by an absence of a perception-like representational format or content (for ADV has such) or by a presence of personal-level mental states causally mediating between stimuli and outputs (for perception has such). A bettter explanation invokes, I argue, the non-modular character of the generating process. (shrink)

According to perceptualism, fluent comprehension of speech is a perceptual achievement, in as much as it is akin to such high-level perceptual states as the perception of objects as cups or trees, or of people as happy or sad. According to liberalism, grasp of meaning is partially constitutive of the phenomenology of fluent comprehension. I here defend an influential line of argument for liberal perceptualism, resting on phenomenal contrasts in our comprehension of speech, due to Susanna Siegel and Tim Bayne, (...) against objections from Casey O'Callaghan and Indrek Reiland. I concentrate on the contrast between the putative immediacy of meaning-assignment in fluent comprehension, as compared with other, less ordinary, perhaps translation-based ways of getting at the meaning of speech. I argue this putative immediacy is difficult to capture on a non-perceptual view (whether liberal or non-liberal), and that the immediacy in question has much in common with that which applies in other, less controversial cases of high-level perception. (shrink)

The orthodox view of proper names, Millianism, provides a very simple and elegant explanation of the semantic contribution of referential uses of names–names that occur as bare singulars and as the argument of a predicate. However, one problem for Millianism is that it cannot explain the semantic contribution of predicative uses of names. In recent years, an alternative view, so-called the-predicativism, has become increasingly popular. According to the-predicativists, names are uniformly count nouns. This straightforwardly explains why names can be used (...) predicatively, but is prima facie less congenial to an analysis of referential uses. To address this issue, the-predicativists argue that referential names are in fact complex determiner phrases consisting of a covert definite determiner and a count noun—and so, a referential name is a definite description. In this paper, I will argue that despite the appearance of increased theoretical complexity, the view that names are ambiguous between predicative and referential types is in fact superior to the unitary the-predicativist view. However, I will also argue that to see why this ambiguity view is better, we need to give up the standard Millian analysis. Consequently, I will first propose an alternative analysis of referential names that retains the virtues of Millianism, but provides an important explanatory connection to the predicative uses. Once this analysis of names is adopted, the explanation for why names are systematically ambiguous between referential and predicative types is both simple and elegant. Second, I will argue that the-predicativism has the appearance of being simpler than an ambiguity view, but is in fact unable to account for certain key properties of referential names without making ad hoc stipulations. (shrink)

The paper addresses the phenomenology of inference. It proposes that the conscious character of conscious inferences is partly constituted by a sense of meaning; specifically, a sense of what Grice called ‘natural meaning’. In consciously drawing the (outright, categorical) conclusion that Q from a presumed fact that P, one senses the presumed fact that P as meaning that Q, where ‘meaning that’ expresses natural meaning. This sense of natural meaning is phenomenologically analogous, I suggest, to our sense of what is (...) said in fluently comprehending everyday utterances in our first language. The proposal that conscious inference involves a sense of natural meaning is compared with views according to which conscious inference involves taking the premises (i) to be good reasons for the conclusion (as defended by Thomson and Grice), (ii) to support it (as argued by Audi and, recently, Boghossian), or (iii) to imply it (as lately contended by Broome). I argue our proposal can explain certain phenomena handled by alternatives (i) and (ii), but that some further phenomena is handled by our account but not these alternatives. In relation to alternative (iii), I argue that, in so far as implicational and natural-meaning relations come apart, the latter are a better fit for what we sense or take to be so in conscious inference. (shrink)

The aim of the present study was to corroborate or undermine a previously presented conjecture that physicians’ estimations of others’ opinions are influenced by their own opinions. We used questionnaire based cross-sectional design and described a situation where an imminently dying patient was provided with alleviating drugs which also shortened life and, additionally, were intended to do so. We asked what would happen to physicians’ own trust if they took the action described, and also what the physician estimated would happen (...) to the general publics’ trust in health services. Decrease of trust was used as surrogate for an undesirable action. The results are presented as proportions with a 95 % Confidence Interval. Statistical analysis was based on inter-rater agreement -test as well as χ2 test and Odds Ratio with 95 % CI. We found a moderate inter-rater agreement between what would happen with the physicians’ own trust in healthcare and their estimations of what would happen with the general population’s trust. We identified a significant difference between being pro et contra the treatment with double intentions and the estimation of the general population’s trust. Focusing on either decreasing or increasing own trust and being pro or contra the action we identified a strong association [OR 79 ]. Although the inter-rater agreement in the present study was somewhat weaker compared to a study about the explicit use of the term ‘physicians assisted suicide’ we found that our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making. We suggest that Merton’s ideal of disinterestedness should be highlighted. (shrink)

New technologies and practices, such as drug testing, genetic testing, and electronic surveillance infringe upon the privacy of workers on workplaces. We argue that employees have a prima facie right to privacy, but this right can be overridden by competing moral principles that follow, explicitly or implicitly, from the contract of employment. We propose a set of criteria for when intrusions into an employee''s privacy are justified. Three types of justification are specified, namely those that refer to the employer''s interests, (...) to the interests of the employee her- or himself, and to the interests of third parties such as customers and fellow workers. For each of these three types, sub-criteria are proposed that can be used to determine whether a particular infringement into an employee''s privacy is morally justified or not. (shrink)

Understanding how individual agency and group agency relate is of great importance for a range of philosophical and practical concerns, including responsibility ascription and institutional design. This article discusses the relation between corporate and individual responsibility in agency—in particular, the relation between corporate and individual control of actions. First, I criticize Christian List and Philip Pettit’s causal account of combined corporate and individual control. Second, I develop an alternative account in terms of structural control, and I show how this gives (...) a better grasp of the issue. Third, I argue for an act-dualism that complements my account of control and sheds further light on the relation between corporate and individual agency and responsibility. (shrink)

Causal selection and priority are at the heart of discussions of the causal parity thesis, which says that all causes of a given effect are on a par, and that any justified priority assigned to a given cause results from causal explanatory interests. In theories of causation that provide necessary and sufficient conditions for the truth of causal claims, status as cause is an either/or issue: either a given cause satisfies the conditions or it does not. Consequently, assessments of causal (...) parity and priority require more resources, which can either be additional or part of the causal analysis itself. While adding resources in terms of a theory of causal explanation has been standard, here we develop a unified conceptual analysis that includes a range of different precise causal concepts that allows for assessments of causal priority in terms of different kinds of causal relevance. (shrink)

It has been reported as an ethical problem within prehospital emergency care that ambulance professionals administer physiologically futile cardiopulmonary resuscitation (CPR) to patients having suffered cardiac arrest to benefit significant others. At the same time it is argued that, under certain circumstances, this is an acceptable moral practice by signalling that everything possible has been done, and enabling the grief of significant others to be properly addressed. Even more general moral reasons have been used to morally legitimize the use of (...) futile CPR: That significant others are a type of patient with medical or care needs that should be addressed, that the interest of significant others should be weighed into what to do and given an equal standing together with patient interests, and that significant others could be benefited by care professionals unless it goes against the explicit wants of the patient. In this article we explore these arguments and argue that the support for providing physiologically futile CPR in the prehospital context fails. Instead, the strategy of ambulance professionals in the case of a sudden death should be to focus on the relevant care needs of the significant others and provide support, arrange for a peaceful environment and administer acute grief counselling at the scene, which might call for a developed competency within this field. (shrink)

Digital social analytics is a subset of Big Data methods that is used to understand the social environment in which people and organizations have to act. This paper presents an analysis of eight projects that are experimenting with the use of these methods for various purposes. It shows that two specific technological features influence the work with such methods in all the cases. The first concerns the need to distribute choices about the structure of data to third-party actors and the (...) second concerns the need to balance machine intelligence and human intuition when automating the analysis. These features set specific conditions for knowledge production, and the paper identifies two opposite approaches for engaging with each of these conditions. These features and approaches are finally combined into a two-dimensional affordance space that illustrates how there is flexibility in the way project leaders interact with the features of the data environment. It thereby also shows how digital social analytics come to have different affordances for different projects. (shrink)

This article analyzes approaches to nondeterminacy that suggest that one can make justified choices when primary criteria fail to fully determine a best alternative by introducing a secondary criterion. It is shown that these approaches risk violating Basic Contraction Consistency. Some ways of adjusting two-step models in order to protect against this are addressed, and it is suggested that proponents of two-step models should adopt formal conditions which qualify what counts as a permissible secondary criterion that resemble supervaluationist conditions that (...) qualify what counts as admissible precisifications of vague terms. (shrink)

Ethical dilemmas are common in the neonatal intensive care setting. The aim of the present study was to investigate the opinions of Swedish physicians and the general public on treatment decisions regarding a newborn with severe brain damage. We used a vignette-based questionnaire which was sent to a random sample of physicians (n = 628) and the general population (n = 585). Respondents were asked to provide answers as to whether it is acceptable to discontinue ventilator treatment, and when it (...) actually is discontinued whether or not it was acceptable to use drugs which hasten death unintentionally or intentionally. The response rate was 67 % of physicians and 46 % of the general population. A majority of both physicians [56 % (CI 50–62)] and the general population [53 % (CI 49–58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient’s symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. The study indicated that physicians and the general population have similar opinions regarding discontinuing life-sustaining treatment and providing effective drugs which might unintentionally hasten death but seem to have different views on intentions. The results might be helpful to physicians wanting to examine their own intentions when providing adequate treatment at the end of life. (shrink)

The Delegation for Medical Ethics within the Swedish Society of Medicine has taken the initiative to create national ethical guidelines on cardiopulmonary resuscitation. The reasons behind this initiative were indications of differences in the way decisions about cardiopulmonary resuscitation were made and documented and requests expressed by health-care professionals for new national ethical guidelines. During the process of creating the guidelines, a number of workshops were held with representatives from the delegation and clinical experts from various branches of medicine. Several (...) versions of the working document were sent to consultation bodies with requests for comments. We therefore believe that the final guidelines are well supported by the medical profession in Sweden. The purpose of this article is to present ethical issues on which it was difficult to reach consensus due to divergent opinions expressed by the people and organisations involved. The arguments for and against a particular point of... (shrink)

The discretionary powers of welfare state professionals are in tension with the requirements of the democratic Rechtsstaat. Extensive use of discretion can threaten the principles of the rule of law and relinquish democratic control over the implementation of laws and policies. These two tensions are in principle ineradicable. But does this also mean that they are impossible to come to grips with? Are there measures that may ease these tensions? We introduce an understanding of discretion that adds an epistemic dimension (...) (discretion as a mode of reasoning) to the common structural understanding of discretion (an area of judgment and decision). Accordingly we distinguish between structural and epistemic measures of accountability. The aim of the former is to constrain discretionary spaces or the behaviour within them while the aim of the latter is to improve the quality of discretionary reasoning. The focus in this article is on epistemic measures that are internally related to the main characteristic of accountability, namely justified use of discretionary power. (shrink)

Many philosophers hold that the phenomenology of thinking (also known as cognitive phenomenology) reduces to the phenomenology of the speech, sensory imagery, emotions or feelings associated with it. But even if this reductionist claim is correct, there is still a properly cognitive dimension to the phenomenology of at least some thinking. Specifically, conceptual content makes a constitutive contribution to the phenomenology of at least some thought episodes, in that it constitutes what I call their thematic unity. Often, when a thought (...) episode has a phenomenal character, the various associated speech, sensory imagery, emotions or feelings are often organized around a common theme, constituted by the conceptual content of one's thinking. (shrink)

We consider the expressive power of second - order generalized quantifiers on finite structures, especially with respect to the types of the quantifiers. We show that on finite structures with at most binary relations, there are very powerful second - order generalized quantifiers, even of the simplest possible type. More precisely, if a logic is countable and satisfies some weak closure conditions, then there is a generalized second - order quantifier which is monadic, unary and simple, and a uniformly obtained (...) sublogic of which is equivalent to. We show some other results of the above kind, relating other classes of quantifiers to other classes of structures. For example, if the quantifiers are of the simplest non-monadic type, then the result extends to finite structures of any arity. We further show that there are second - order generalized quantifiers which do not increase expressive power of first- order logic but do increase the power significantly when added to stronger logics. (shrink)

This collection of essays provides an exemplary overview of the diversity and relevance of current scholarship on German Idealism. The importance of German Idealism for contemporary philosophy has received growing attention and acknowledgment throughout competing fields of contemporary philosophy. Part of the growing interest rests on the claim that the works of Kant, Fichte, Schelling, Hegel remain of considerable interest for cultural studies, sociology, theology, aesthetics and other areas of interest. In the domain of philosophy, the renaissance of innovative readings (...) of German Idealism has taken scholarly debates beyond merely antiquarian perspectives. This renaissance has been a major factor of current efforts to bridge the gap between so-called “analytic” and so-called “continental” philosophy. The volume provides a selection of well-chosen examples of readings that contribute to systematic treatments of philosophical problems. It contains contributions by Markus Gabriel, Robert Pippin, Anders Moe Rasmussen, Sebastian Rödl. (shrink)

This article offers a discussion of the connection between technology and values and, specifically, I take a closer look at ethically sound design. In order to bring the discussion into a concrete context, the theory of Value Sensitive Design (VSD) will be the focus point. To illustrate my argument concerning design ethics, the discussion involves a case study of an augmented window, designed by the VSD Research Lab, which has turned out to be a potentially surveillance-enabling technology. I call attention (...) to a “positivist problem” that has to do with the connection between the design context and the use context, which VSD seems to presuppose, and I argue that it is necessary to clearly distinguish between the two, since the designers’ intentions do not always correspond with the users’ practice; in fact, the relation between design and use is very complex and principally unpredictable. Thus, a design theory must accept that foresight is limited to anticipation rather than prediction. To overcome the positivist problem, I suggest a phenomenological approach to technology inspired by Don Ihde’s concept of multistability. This argument, which is general in nature and thus applies to any theory of design ethics, is intended as a constructive criticism, which can hopefully contribute to the further development of design ethics. (shrink)

Parker’s article is a welcome attempt to address the importance of environmental sustainability in the realm of clinical ethics.1 We support the recent movement to seriously consider the environmental impact of healthcare institutions in bioethics.2 3 Still, we find two partly linked weaknesses of Parker’s analysis and guideline suggestion. These relate to a need in ‘green’ bioethics to see beyond the normal healthcare ethical focus on health-related values related to individual patients, and to primarily adopt institutional ways of framing central (...) decision problems. Traditional bioethics applies a restricted scope of values to assess clinical decisions: primarily health-related patient well-being (including life) and patient autonomy. If a decision improves (or, as in Parker’s inhaler case, maintains) a patient’s health-related well-being, this supports it. However, if a decision improves a patient’s non health-related well-being, say, winning a beauty contest or securing a job by having cosmetic surgery, it is not supported. And so on. This idea of healthcare as, in Michael Walzer’s classic terminology, a separate ‘sphere of justice’ has two interrelated limitations: it reflects a bias towards individual patients over other people, and it restricts the scope of values allowed to influence healthcare ethical judgements. These limitations appear once we see that the issue addressed by Parker can be framed either as prescription decisions taken by individual doctors against the background of …. (shrink)

Anders Pettersson presents a comprehensive account of the foundations of literature, grounded in an original analysis of the interactions between author and reader. Drawing on post-Gricean pragmatics and Nicholas Wolterstorff's notion of presentationality, Pettersson develops the idea of the verbal text and conveys an integrated and nuanced understanding of literary experience, its conditions, and the values it affords. In the second part of Verbal Art he systematically examines the cognitive, affective, and formal aspects of the literary work and explores (...) their interrelations.Pettersson demonstrates the implications and applications of the theory through a series of detailed studies of literary works, taking care to show that his theory is compatible with a broad variety of perspectives. Combining an intimate knowledge of modern literary theory and the aesthetics of literature with innovative applications of linguistics and cognitive psychology to the literary work, he provides a thorough treatment of fundamental problems in the area, including the concept of a text or work, the concept of form, and the distinctiveness of the literary use of language. (shrink)

A notorious problem that has recently received increased attention in axiology, normative theory and population ethics is the apparent ubiquity of what can be generally called nondeterminacy. This paper illustrates how nondeterminacy can spawn cyclical rankings. So, accepting that practical reasons can admit of nondeterminacy challenges the widely held idea that ‘better than’ is transitive. As a result, standard approaches to rational choice under nondeterminacy fail to be action-guiding, since in some situations all options are dominated, that is, impermissible according (...) to standard rational choice criteria. (shrink)

How should one understand comparisons in which neither of two alternatives is at least as good as the other? Much recent literature on comparability problems focuses on what the appropriate explanation of the phenomenon is. Is it due to vagueness or the possibility of non-conventional comparative relations such as parity? This paper argues that the discussions on how to best explain comparability problems has reached an impasse at which it is hard to make any progress. To advance the discussion we (...) suggest a new classification of comparability problems that focuses on the problems they cause for practical reasoning. (shrink)

Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is worse off lifetime QALY prioritarianism relies on assumptions of strict additivity, atomism and intertemporal separability of sublifetime attributes. These assumptions entail that (...) a health state at some period in time contributes with the same amount to how well off someone is regardless of intrapersonal and interpersonal distributions of health states. The paper argues that this is implausible and that prioritarians should take both intrapersonal and interpersonal distributions of goods into account when they establish who is worse off. They should therefore not accept that lifetime QALY is a reasonable ground for ascribing priority and reject lifetime QALY prioritarianism. (shrink)

Humanistic theory for more than the past 100 years is marked by extensive attention to practice and practices. Two prominent streams of thought sharing this focus are pragmatism and theories of practice. This volume brings together internationally prominent theorists to explore key dimensions of practice and practices on the background of parallels and points of contact between these two traditions. The contributors all are steeped in one or both of these streams and well-known for their work on practice. The collected (...) essays explore three important themes: what practice and practices are, normativity, and transformation. The volume deepens understanding of these three practice themes while strengthening appreciation of the parallels between and complementariness of pragmatism and practice theory. (shrink)

Much research aimed at developing measures for normative criteria to guide the assessment of healthcare resource allocation decisions has focused on health maximization, equity concerns and more recently approaches based on health capabilities. However, a widely embraced idea is that health resources should be allocated to meet health needs. Little attention has been given to the principle of need which is often mentioned as an alternative independent criteria that could be used to guide healthcare evaluations. This paper develops a model (...) and indicator of need satisfaction that aggregates the health needs of a population in a particular time period into a single measure that weights individual health needs by the severity of their ill health. The paper provides a first step towards formalizing the principle of need as a measurable objective for healthcare policy and we discuss some challenges for future research, including incorporating the duration of time into need-based health evaluations. (shrink)

A notorious debate in the ethics of healthcare rationing concerns whether to address rationing decisions with substantial principles or with a procedural approach. One major argument in favour of procedural approaches is that substantial principles are indeterminate so that we can reasonably disagree about how to apply them. To deal with indeterminacy, we need a just decision process. In this paper I argue that it is a mistake to abandon substantial principles just because they are indeterminate. It is true that (...) reasonable substantial principles designed to deal with healthcare rationing can be expected to be indeterminate. Yet, the indeterminacy is only partial. In some situations we can fully determine what to do in light of the principles, in some situations we cannot. The conclusion to draw from this fact is not that we need to develop procedural approaches to healthcare rationing, but rather that we need a more complex theory in which both substantial principles and procedural approaches are needed. (shrink)

MILLIANISM and DESCRIPTIVISM are without question the two most prominent views with respect to the semantics of proper names. However, debates between MILLIANS and DESCRIPTIVISTS have tended to focus on a fairly narrow set of linguistic data and an equally narrow set of problems, mainly how to solve with Frege's puzzle and how to guarantee rigidity. In this article, the author focuses on a set of data that has been given less attention in these debates—namely, so-called predicative uses, bound uses, (...) and shifted uses of names. The author first shows that these data points seem to favor a DESCRIPTIVIST view over a MILLIAN view, but the author then introduces an alternative view of names that not only provides a simple and elegant way of dealing with the data, but also retains rigidity without becoming subject to the problems raised by Frege's puzzle. This is the view that names are variables, also called VARIABILISM. (shrink)

This article presents an approach to how to make reasonable social choices when independent criteria (e.g., prioritarianism, religious freedom) fail to fully determine what to do. The article outlines different explanations of why independent criteria sometimes fail to fully determine what to do and illustrates how they can still be used to eliminate ineligible alternatives, but it is argued that the independent criteria cannot ground a reasonable social choice in these situations. To complement independent criteria when they fail to fully (...) determine what to do, it is suggested that society must engage in public deliberation by way of generating new reasons that can determine how to rank the alternatives. It is suggested that the approach to social choice presented here reveals a way of accepting the relevance of independent criteria for social choice without letting go of the idea that the attitudes of affected parties matter. (shrink)

This paper argues that decision problems and money-pump arguments should not be a deciding factor against accepting non-transitive better than relations. If the reasons to accept normative standpoints that entail a non-transitive better than relation are compelling enough, we ought to revise our decision method rather than the normative standpoints. The paper introduces the most common argument in favor of non-transitive better than relations. It then illustrates that there are different ways to reconceptualize rational choice so that rational choice is (...) possible also when the relevant better than relation is non-transitive. (shrink)

Kerry et al. criticize our discussion of causal knowledge in evidence-based medicine (EBM) and our assessment of the relevance of their dispositionalist ontology for EBM. Three issues need to be addressed in response: (1) problems concerning transfer of causal knowledge across heterogeneous contexts; (2) how predictions about the effects of individual treatments based on population-level evidence from RCTs are fallible; and (3) the relevance of ontological theories like dispositionalism for EBM.

The possibility of enhancing human abilities often raises public concern about equality and social impact. This chapter aims at one particular group of technologies, cognitive enhancement, and one particular fear, that enhancement will create social divisions and possibly expanding inequalities. The chapter argues that cognitive enhancements could offer significant social and economic benefits. The basic forms of internal cognitive enhancement technologies foreseen today are pharmacological modifications, genetic interventions, transcranial magnetic stimulation, and neural implants. Cognitive enhancements can influence the economy through (...) reduction of losses, individual economic benefits, and society‐wide benefits. The strongest objection to the introduction of any enhancement technology is that it will create inequality, injustice, and unfairness. While there are clear economic and social benefits to cognitive enhancement, there exist anumber of obstacles to its development and use. One obstacle is the present system for licensing drugs and medical treatments. (shrink)

How should scarce health-related resources be allocated? This paper argues that values that apply to these decisions fail to always fully determine what we should do. Health maximization and allocation-according-to-need are suggested as two values that should be part of a general theory of how to allocate health-related resources. The “small improvement argument” is used to argue that it is implausible that one alternative is always better, worse, or equal to another alternative with respect to these values. Approaches that rely (...) on these values are thus incomplete. To deal with this, it is suggested that we ought to use incomplete theories in a two-step process. Such a process first discards ineligible alternatives, and, second, uses reasons grounded in collective commitments to identify a unique, best alternative in the remaining set. (shrink)

The principle of need—the idea that resources should be allocated according to need—is often invoked in priority setting in the health care sector. In this article, I argue that a reasonable principle of need must be indeterminate, and examine three different ways that this can be dealt with: appendicizing the principle with further principles, imposing determinacy, or empowering decision makers. I argue that need must be conceptualized as a composite property composed of at least two factors: health shortfall and capacity (...) to benefit. When one examines how the different factors relate to each other, one discovers that this is sometimes indeterminate. I illustrate this indeterminacy in this article by applying the small improvement argument. If the relation between the factors are always determinate, the comparative relation changes by a small adjustment. Yet, if two needs are dissimilar but of seemingly equal magnitude, the comparative relation does not change by a small adjustment of one of the factors. I then outline arguments in favor of each of the three strategies for dealing with indeterminacy, but also point out that all strategies have significant shortcomings. More research is needed concerning how to deal with this indeterminacy, and the most promising path seems to be to scrutinize the position of the principle of need among a plurality of relevant principles for priority setting in the health care sector. (shrink)