Background: The high public demand for healthcare services during the COVID-19 pandemic and strict infection control measures, coupled with threat of severe illness and death, and limited resources, led to many healthcare workers (HCWs) experiencing ethically challenging situations (ECSs). Objective: To systematically explore first-hand accounts of ECS-evoking moral distress among HCWs during this public health emergency. Research design: This was an open cohort study. All participants were asked whether they had been in ECS-evoking moral distress during the pandemic. Those who (...) had were asked to describe these situations. Answers were systematically analyzed according to three levels of root causes for ECSs, using thematic analysis. Participants and research context: In January 2022, 977 HCWs from four Norwegian university hospitals participated. Ethical considerations: The study received ethical approval from the Norwegian Ethical Review Authority (No. 130944). Results: In total, 508 participants (52%) reported that they had experienced ECS-evoking moral distress during the pandemic, whereof 323 provided a qualitative description. We found that while a few reported ECSs caused at the patient level, and some described situations at the unit/team level, the vast majority reported situations caused at the system level, predominantly related to resource scarcity, particularly poor staffing. Conclusion: Our findings strongly indicate that efforts to mitigate moral distress among HCWs should be targeted at the system level. More specifically, the study findings highlight resource limitations, particularly poor staffing, as a major cause of moral distress during the pandemic. (shrink)

Surprises are important in our everyday lives as well as in our scientific and philosophical theorizing—in psychology, information theory, cognitive-neuroscience, philosophy of science, and confirmation theory. Nevertheless, there is no satisfactory theory of what makes something surprising. It has long been acknowledged that not everything unexpected is surprising. The reader had no reason to expect that there will be exactly 190 words in this abstract and yet there is nothing surprising about this fact. We offer a novel theory that explains (...) when and why an unexpected fact is surprising. We distinguish between descriptive and normative notions of what is surprising; clarify the sense in which surprising facts are unexpected; and, finally, develop and defend the significance account of surprise, according to which a fact is surprising to an agent if and to the extent that it is both unexpected and significant to the agent. Since a surprising fact can be significant to an agent in various ways—personal, moral, epistemic, and aesthetic—surprise is not merely or primarily epistemic. Fitting surprise reflects more than a person’s view of what is; it reflects a person’s view of what is significant. (shrink)

Motivated by examples, many philosophers believe that there is a significant distinction between states of affairs that are striking and therefore call for explanation and states of affairs that are not striking. This idea underlies several influential debates in metaphysics, philosophy of mathematics, normative theory, philosophy of modality, and philosophy of science but is not fully elaborated or explored. This paper aims to address this lack of clear explanation first by clarifying the epistemological issue at hand. Then it introduces an (...) initially attractive account for strikingness that is inspired by the work of Paul Horwich and adopted by a number of philosophers. The paper identifies two logically distinct accounts that have both been attributed to Horwich and then argues that, when properly interpreted, they can withstand former criticisms. The final two sections present a new set of considerations against both Horwichian accounts that avoid the shortcomings of former critiques. It remains to be seen whether an adequate account of strikingness exists. (shrink)

The dominant language of politics in the United States has been political individualism, with minimal restrictions on property and personal, voluntary conduct. But there are second languages of community that stress cooperation and group action. These second languages include the constitutional tradition for public health. Public health offers a community justification for paternalistic measures that, for example, discourage smoking or require seatbelts.

Some medical services have long generated deep moral controversy within the medical profession as well as in broader society and have led to conscientious refusals by some physicians to provide those services to their patients. More recently, pharmacists in a number of states have refused on grounds of conscience to fill legal prescriptions for their customers. This paper assesses these controversies. First, I offer a brief account of the basis and limits of the claim to be free to act on (...) one’s conscience. Second, I sketch an account of the basis of the medical and pharmacy professions’ responsibilities and the process by which they are specified and change over time. Third, I then set out and defend what I call the “conventional compromise” as a reasonable accommodation to conflicts between these professions’ responsibilities and the moral integrity of their individual members. Finally, I take up and reject the complicity objection to the conventional compromise. Put together, this provides my answer to the question posed in the title of my paper: “Conscientious refusal by physicians and pharmacists: who is obligated to do what, and why?”. (shrink)

Reviews the history of teaching in the United States over three hundred years, and describes aspects of recruitment, organization, and logic particular to the profession.

Faced with the choice between supporting industrial plant agriculture and hunting, Tom Regan’s rights view can be plausibly developed in a way that permits a form of hunting we call “dignitarian.” To motivate this claim, we begin by showing how the empirical literature on animal deaths in plant agriculture suggests that a non-trivial amount of hunting would not add to animal harm. We discuss how Tom Regan’s miniride principle appears to morally permit hunting in that case, and we address recent (...) objections by Jason Hanna to environmentally-based culling that may be seen to speak against this conclusion. We then turn to dignity, which is especially salient in scenarios where harm is necessary or justifiable. We situate “dignitarian” hunting within a larger framework of adversarial ethics, and argue that dignitarian hunting gives animals a more dignified death than the alternatives endemic to large-scale plant agriculture, and so is permissible based on the kinds of principles that Regan endorses. Indeed, dignitarian hunting may actually fit better with Regan’s widely endorsed animal rights framework than the practice of many vegans, and should only be rejected if we’re just as willing to condemn supporting conventional plant agriculture. (shrink)

[Updated 2/23/21: complete chapter scan] In this chapter I sketch a rightist approach to monumentary policy in a diverse polity beleaguered by old ethnic grievances. I begin by noting the importance of tribalism, memorialization, and social trust. I then suggest a policy which 1) gradually narrows the gap between peoples in the heritage landscape, 2) conserves all but the most offensive of the least beloved racist monuments, 3) avoids recrimination (i.e., “keeps it positive”) and eschews ideological commentary in new monuments (...) or revisions to old ones, 4) as much as politically feasible, recognizes only the offense of willing tribemates, and 5) responds to aesthetic and other “irrational” offenses more than to “objective” historical or philosophical critiques. (shrink)

Many of the arguments for and against robust moral realism parallel arguments for and against theism. In this article, I consider one of the shared challenges: the explanatory challenge. The article begins with a presentation of Harman's formulation of the explanatory challenge as applied to moral realism and theism. I then examine two responses offered by robust moral realists to the explanatory challenge, one by Russ Shafer-Landau and another by David Enoch. Shafer-Landau argues that the moral realist can plausibly respond (...) to the challenge in a way unavailable to theists. I argue that Shafer-Landau's response is implausible as it stands and that once revised, it will apply to theism just as well. I then argue that Enoch's response, to the extent that it is plausible, can be used to defend theism as well. (shrink)

Premodern Buddhists are sometimes characterized as veritable "mind scientists" whose insights anticipate modern research on the brain and mind. Aiming to complicate this story, Dan Arnold confronts a significant obstacle to popular attempts at harmonizing classical Buddhist and modern scientific thought: since most Indian Buddhists held that the mental continuum is uninterrupted by death, they would have no truck with the idea that everything about the mental can be explained in terms of brain events. Nevertheless, a predominant stream of Indian (...) Buddhist thought, associated with the seventh-century thinker Dharmakirti, turns out to be vulnerable to arguments modern philosophers have leveled against physicalism. By characterizing the philosophical problems commonly faced by Dharmakirti and contemporary philosophers such as Jerry Fodor and Daniel Dennett, Arnold seeks to advance an understanding of both first-millennium Indian arguments and contemporary debates on the philosophy of mind. The issues center on what modern philosophers have called _intentionality_--the fact that the mind can be about other things. Tracing an account of intentionality through Kant, Wilfrid Sellars, and John McDowell, Arnold argues that intentionality cannot, in principle, be explained in causal terms. Elaborating some of Dharmakirti's central commitments, Arnold shows that despite his concern to refute physicalism, Dharmakirti's causal explanations of the mental mean that modern arguments from intentionality cut as much against his project as they do against physicalist philosophies of mind. This is evident in the arguments of some of Dharmakirti's contemporaneous Indian critics, whose critiques exemplify the same logic as modern arguments from intentionality. Elaborating these various strands of thought, Arnold shows that seemingly arcane arguments among first-millennium Indian thinkers can illuminate matters still very much at the heart of contemporary philosophy. (shrink)

It is widely recognized that prioritizing health care resources by their relative cost-effectiveness can result in lower priority for the treatment of disabled persons than otherwise similar non-disabled persons. I distinguish six different ways in which this discrimination against the disabled can occur. I then spell out and evaluate the following moral objections to this discrimination, most of which capture an aspect of its unethical character: it implies that disabled persons' lives are of lesser value than those of non-disabled persons; (...) it constitutes “double jeopardy” or violates Frances Kamm's non-linkage principle; it conflicts with equality of opportunity; it conflicts with fairness, which requires ignoring (some/most) differential impacts of treatment; it wrongly gives lower priority to disabled persons for equally effective treatment; it conflicts with giving all persons an equal chance to reach their full potential; and, it is in conflict with giving priority to the worse off. (shrink)

From an evolutionary point of view, the function of moral behaviour may be to secure a good reputation as a co‐operator. The best way to do so may be to obey genuine moral motivations. Still, one's moral reputation maybe something too important to be entrusted just to one's moral sense. A robust concern for one's reputation is likely to have evolved too. Here we explore some of the complex relationships between morality and reputation both from an evolutionary and a cognitive (...) point of view. (shrink)

In _Buddhists, Brahmins, and Belief_, Dan Arnold examines how the Brahmanical tradition of Purva Mimamsa and the writings of the seventh-century Buddhist Madhyamika philosopher Candrakirti challenged dominant Indian Buddhist views of epistemology. Arnold retrieves these two very different but equally important voices of philosophical dissent, showing them to have developed highly sophisticated and cogent critiques of influential Buddhist epistemologists such as Dignaga and Dharmakirti. His analysis--developed in conversation with modern Western philosophers like William Alston and J. L. Austin--offers an innovative (...) reinterpretation of the Indian philosophical tradition, while suggesting that pre-modern Indian thinkers have much to contribute to contemporary philosophical debates. In logically distinct ways, Purva Mimamsa and Candrakirti's Madhyamaka opposed the influential Buddhist school of thought that emphasized the foundational character of perception. Arnold argues that Mimamsaka arguments concerning the "intrinsic validity" of the earliest Vedic scriptures are best understood as a critique of the tradition of Buddhist philosophy stemming from Dignaga. Though often dismissed as antithetical to "real philosophy," Mimamsaka thought has affinities with the reformed epistemology that has recently influenced contemporary philosophy of religion. Candrakirti's arguments, in contrast, amount to a principled refusal of epistemology. Arnold contends that Candrakirti marshals against Buddhist foundationalism an approach that resembles twentieth-century ordinary language philosophy--and does so by employing what are finally best understood as transcendental arguments. The conclusion that Candrakirti's arguments thus support a metaphysical claim represents a bold new understanding of Madhyamaka. (shrink)

Interest in the political relevance of the emotions is growing rapidly. In light of this, Hannah Arendt’s claim that the emotions are apolitical has come under renewed fire. But many critics have misunderstood her views on the relationship between individuals, emotions and the political. This paper addresses this issue by reconstructing the conceptual framework through which Arendt understands the emotions. Arendt often describes the heart – where the emotions reside – as a place of darkness. I begin by tracing this (...) metaphor through her work to demonstrate that it is meant to convey the inherently uncertain nature of emotions rather than a devaluation of them. I proceed to challenge the notion that Arendt adopts the Enlightenment dichotomy between reason and emotion. In fact, she rejects both as a basis for politics. However, she does identify some constructive roles for the emotions. I argue that fear is intrinsically connected to courage – the principal political virtue – in Arendt’s philosophy. In ligh... (shrink)

I argue for the merits of studying historical moral revolutions to inform moral and political philosophy. Such a research program is not merely of empirical, historical interest but has normative implications. To explain why, I situate the proposal in the tradition of naturalized epistemology. As Alison M. Jaggar and other scholars have argued, a naturalistic approach is characteristic of much feminist philosophy. Accordingly, I argue that the study of moral revolutions would be especially fruitful for feminist moral and political philosophers.

The intense and extensive debate over human embryonic stem cell research has focused primarily on the moral status of the human embryo. Some commentators assign full moral status of normal adult human beings to the embryo from the moment of its conception. At the other extreme are those who believe that a human embryo has no significant moral status at the time it is used and destroyed in stem cell research. And in between are many intermediate positions that assign an (...) embryo some degree of moral status between none and full. This controversy and the respective positions, like the abortion controversy, is by now well understood, despite the lack of progress in resolving it. I have argued briefly elsewhere that early embryos do not have significant moral status, but I do not want to reenter that debate here. Instead, I want to focus on an issue that has had relatively little explicit and separate attention, but is likely to loom larger in light of the Obama administration’s partial lifting of the Bush administration’s restriction on the embryos that can be used in stem cell research that receives federal funding. (shrink)

Most research on student plagiarism defines the concept very narrowly or with much ambiguity. Many studies focus on plagiarism involving large swaths of text copied and pasted from unattributed sources, a type of plagiarism that the overwhelming majority of students seem to have little trouble identifying. Other studies rely on ambiguous definitions, assuming students understand what the term means and requesting that they self-report how well they understand the concept. This study attempts to avoid these problems by examining student perceptions (...) of more complex citation issues. We presented 240 students with a series of examples, asked them to indicate whether or not each should be considered plagiarism, and followed up with a series of demographic and attitudinal questions. The examples fell within the spectrum of inadequate citation, patchwriting, and the reuse of other people’s ideas. Half were excerpted from publicized cases of academic plagiarism, and half were modified from other sources. Our findings indicated that students shared a very strong agreement that near verbatim copy and paste and patchwriting should be considered plagiarism, but that they were much more conflicted regarding the reuse of ideas. Additionally, this study found significant correlation between self-reported confidence in their understanding and the identification of more complex cases as plagiarism, but this study found little correlation between academic class status or exposure to plagiarism detection software and perceptions of plagiarism. The latter finding goes against a prevailing sentiment in the academic literature that the ability to recognize plagiarism is inherently linked to academic literacy. Overall, our findings indicate that more pedagogical emphasis may need to be placed on complex forms of plagiarism. (shrink)

In this article I shall analyse and evaluate analytic theists’ views of what it takes to be a person of faith. I suggest that the subject can be approached by posing requirements a person must allegedly fulfil in order to count as a person of faith. These requirements can be referred to as aspects of faith. According to my analysis, four different aspects of faith can be distinguished: the cognitive, the evaluative-affective, the practical, and the interpersonal. There have been divergent (...) assessments about which aspects are indispensable for faith and how they should be understood. (shrink)

It is sometimes said that a society should be judged ethically by how it treats its least-fortunate or worst-off members. In one interpretation this is not a point about justice, but instead about moral virtues such as compassion and charity. In our response to the least fortunate among us, we display, or show that we lack, fundamental moral virtues of fellow feeling and concern for others in need. In a different interpretation, however, this point is about justice and a just (...) society—the justice of a society is shown especially in how it treats its least-fortunate members. (shrink)

According to the orthodox interpretation of bounce cosmologies, the universe was born from an entropy-reducing phase in a previous universe. To defend the thesis that the whole of physical reality was caused to exist a finite time ago, Craig and Sinclair have argued the low-entropy interface between universes should instead be understood as the beginning of two universes. Here, I present Craig and Sinclair with a dilemma. On the one hand, if the direction of time is reducible, as friends of (...) the Mentaculus—for example, Albert, Loewer, and Papineau—maintain, then there is reason to think that the direction of time and the entropic arrow of time align. But on that account, efficient causation is likely reducible to non-causal phenomena. In consequence, contrary to Craig and Sinclair’s theological aims, things can begin to exist without causes. On the other hand, if the direction of time is not reducible, Craig and Sinclair’s interpretation of bounce cosmologies is unjustified. Lastly, a reply to a potential objection motivates a discussion of how to interpret bounce cosmologies on the tensed theory of absolute time favoured by Craig and Sinclair. I offer two interpretations of bounce cosmologies that, given a tensed theory of absolute time, are preferable to those Craig and Sinclair offer, yet inconsistent with their project in natural theology; on one interpretation, the universe does not require a supernatural cause and, on the other, bounce cosmologies represent the universe as never having begun to exist. (shrink)

The article examines some of the main theses about self-awareness developed in recent analytic philosophy of mind (especially the work of Bermúdez), and points to a number of striking overlaps between these accounts and the ones to be found in phenomenology. Given the real risk of unintended repetitions, it is argued that it would be counterproductive for philosophy of mind to ignore already existing resources, and that both analytical philosophy and phenomenology would profit from a more open exchange.

Rationing is the allocation of a good under conditions of scarcity, which necessarily implies that some who want and could be benefitted by that good will not receive it. One reflection of our ambivalence towards health care rationing is reflected in our resistance to having it distributed in a market like most other goods—most Americans reject ability to pay as the basis for distributing health care. They do not view health care as just another commodity to be distributed by markets. (...) Despite this widespread view, we are the only developed country without some form of universal health insurance, and so for the 46 million Americans without health insurance their access to health care often does depend on their ability to pay for it. Rationing largely remains a topic that the public, their elected leaders, and many health care professionals prefer to avoid. Ever-growing costs of health care will increasingly force the practice and issue of health care resource prioritization and rationing into the open for public, professional, and political attention. This paper explores some of the features of those practices and issues that make them especially ethically and politically difficult. Those issues will not be easily resolved, but avoiding them will not avoid the need or reality of rationing, it will only mean that it will go on covertly and unexamined. That will lead neither to better or more legitimate prioritization and rationing decisions. (shrink)

Organizational citizenship behaviors (OCBs) are essential for effective organizational functioning. Decisions by employees to engage in these important discretionary behaviors are based on how they make sense of the organizational context. Using fairness heuristic theory, we tested two important OCB predictors: manager trustworthiness and interactional justice. In the process, we control for the effects of dispositional factors (propensity to trust) and for system-based organizational fairness (procedural and distributive justice). Results, based on surveys collected from 120 employee–supervisor dyads, indicate that manager (...) trustworthiness explains variance in OCBs over and above the variance accounted for by interactional fairness. Implications for theory and practice are discussed. (shrink)

It is widely held that the Experience Machine is the basis of a serious objection to Hedonistic theories of welfare. It is also widely held that Desire Satisfactionist theories of welfare can readily avoid problems stemming from the Experience Machine. But in this paper, we argue that if the Experience Machine poses a serious problem for Hedonism, it also poses a serious problem for Desire Satisfactionism. We raise two objections to Desire Satisfactionism, each of which relies on the Experience Machine. (...) The first is very much like the well-known Experience Machine objection to Hedonism. The second asks whether someone who accepts Desire Satisfactionism should want to form a desire to plug into the Experience Machine. (shrink)

In this paper I address the relation between just claims to health care and severe cognitive impairment from dementia. Two general approaches to justice in allocation of health care are distinguished – prudential allocation and interpersonal distribution. First, I analyze why a patient who has died has no further claims to health care. Second, I show why prudential allocators would not provide for health care treatment should they be in a persistent vegetative state. Third, I argue that the destruction of (...) personal identity from severe dementia implies that only claims to palliative, but not life-sustaining, health care remain. Finally, I argue that the prudential allocator approach is indeterminate regarding life-sustaining care for the moderately demented and that social policy should not deny that care to patients. Keywords: elderly, health care, the severely-demented, justice CiteULike Connotea Del.icio.us What's this? (shrink)

Our understanding of language, its origins and subsequent evolution, is shaped not only by data and theories from the language sciences, but also fundamentally by the biological sciences. Recent developments in genetics and evolutionary theory offer both very strong constraints on what scenarios of language evolution are possible and probable, but also offer exciting opportunities for understanding otherwise puzzling phenomena. Due to the intrinsic breathtaking rate of advancement in these fields, and the complexity, subtlety, and sometimes apparent non-intuitiveness of the (...) phenomena discovered, some of these recent developments have either being completely missed by language scientists or misperceived and misrepresented. In this short paper, we offer an update on some of these findings and theoretical developments through a selection of illustrative examples and discussions that cast new light on current debates in the language sciences. The main message of our paper is that life is much more complex and nuanced than anybody could have predicted even a few decades ago, and that we need to be flexible in our theorizing instead of embracing a priori dogmas and trying to patch paradigms that are no longer satisfactory. (shrink)

Accountants preparing information are in a position to manipulate the view of economic reality presented in such information to interested parties. These manipulations can be regarded as morally reprehensible because they are not fair to users, they involve in an unjust exercise of power, and they tend to weaken the authority of accounting regulators. This paper develops a model for detecting earnings manipulators using financial statements’ ratios in a sample of Spanish listed companies. Our results provide evidence that accounting data (...) can be extremely useful in detecting manipulators. This approach can be used by a large category of users of accounting information among which we can cite stock exchange supervisors or investing professionals. (shrink)

With increasing momentum for health care reform, attention is shifting to finance reform that will provide for direct methods for controlling health care spending. This article outlines the two principal paths to direct cost control and outlines a national plan that retains our multiple sources of payment, yet also contains a powerful direct cost control technique: a single fund to finance all health care.

Contingent Valuation has been promoted as a catch-all approach to environmental valuation. While there have been numerous attempts in recent years to place monetary values on environmental amenities, studies have often reported a high frequency of protest, zero or inordinately large dollar-value responses. This paper reports on the results of a survey designed to obtain information on how people actually interpret questions of paying to avoid changes in their views of Rangitoto Island. Evidence suggests that the meaning respondents attach to (...) the actual dollar values they offer or bid are inconsistent with the conventional logic that underlies Contingent Valuation. Instead, respondents might be seen to be expressing views about how things ought to be in society, and that it is simply not right to develop Rangitoto Island. (shrink)

Competent adults should be permitted to determine the course of their own lives. We may try to influence them. We may ask them, perhaps even implore them, to change their minds. But in the end, they are in charge of their lives. They get to choose their careers, whether and whom to marry, whether to exercise, and whether to have surgery.This emphasis on respect for patients’ autonomy may seem to imply that allowing patients to make their own decisions should always (...) take precedence over other considerations. Given this presumption, there has been almost no discussion in the medical literature or elsewhere about how important this value is and whether it should sometimes be balanced against and give way to other values. This absence of guidance is especially problematic in cases where respect for patient autonomy conflicts with promoting patients’ clinical interests. (shrink)