Embodied cognition theory posits that concept representations inherently rely on sensorimotor experiences that accompany their acquisitions. This is well established through concrete concepts. However, it is debatable whether representations of abstract concepts are based on sensorimotor representations. This study investigated the causal role of associated motor experiences that accompany concept acquisition in the involvement of the motor system in the abstract verb processing. Through two experiments, we examined the action–sentence compatibility effect, in the test phase after an increase in motor (...) features during the learning phase for abstract verbs with low motor features or novel words with no conceptual features at all. After associated motor experiences were added in the word learning phase, action–sentence compatibility effect was found in the semantic processing tasks during the test phase for abstract verbs and novel words. This was lacking in the word font color judgment task requiring no semantic processing. Coupled with our previous study, these findings suggest that motor features formed during word learning could causally affect embodiment in the motor system for abstract verbs, and reactivation of motor experiences in abstract verb processing depends on a given task’s demands. Our study supports the view that conceptual representations, even abstract concepts, can be grounded in sensorimotor experiences. (shrink)

Chronic stress impairs working memory, but few studies have explored the protective factors of the impairment. We aimed to investigate the effect of self-awareness on WM processing in people under chronic stress. Participants under chronic stress completed an n-back task after a self-awareness priming paradigm during which electroencephalograms were recorded. The behavioral results showed that participants whose self-awareness was primed reacted faster and more accurately than the controls. Event-related potentials revealed the following P2 was more positive in the self-awareness group (...) than in the controls, indicating that self-awareness enhanced allocation of attention resources at the encoding stage. N2 was attenuated in the self-awareness group compared with the controls, indicating that smaller attention control efforts were required to complete WM tasks adequately after self-awareness priming; and enhanced late positive potential was evoked in the self-awareness group compared with the controls, suggesting self-awareness enabled participants to focus attention resources on the information at the maintenance stage. Critically, mediational analyses showed that LPP mediated the relationship between self-awareness and WM response times. This result suggests that the fact that participants whose self-awareness was primed were able to achieve better behavioral performances may be attributed to their mobilization of sustained attention resources at the maintenance stage. In summary, self-awareness exerted a protective effect on WM in those under chronic stress, which may be due to the enhancements in the allocation and mobilization of attention. These results could be used to develop more specific coping strategies for people under chronic stress. (shrink)

Résumé: Après la promulgation de la loi sur le mariage de la République populaire de Chine en 1950, les œuvres littéraires dérivées du besoin de publicité ont des implications politiques et une signification disciplinaire distinctes. Parce que le problème du divorce a la rationalité des “droits libres” et la sensibilité de l’agitation sociale, le récit du “divorce” à cette époque se situe dans une certaine mesure entre la politique et la réalité. D’une part, les œuvres littéraires doivent promouvoir positivement le (...) concept juridique de “liberté de divorce” et, d’autre part, elles doivent être soumises à un traitement narratif insensible. Les récits de divorce sont donc vagues et capricieux. Toutefois, la littérature a comblé dans une certaine mesure le fossé entre la loi et la réalité en réimaginant les problèmes réels causés par le divorce. (shrink)

Zheng zhi zi you shi wei zi you si xiang di yi yi. Ran er, Zhongguo xian dai zheng zhi zi you guan nian shi ru he dan sheng de zhe ge hua ti tai da, wo men guan zhu de shi ta yu xian Qin zhu zi si xiang zhi jian de guan xi he ru. Ben shu yi shi jian, pai bie wei xian suo, yi lun ti, fan chou he nei zai jie gou wei mai luo, jie (...) he Zhongguo xian dai si xiang jia lun ji zheng zhi zi you he xian Qin zhu zi guan xi de ju ti yan lun, lai tao lun Zhongguo xian dai zheng zhi zi you guan ji qi yu xian Qin zhu zi guan xi, miao mo chu duo ceng ci, duo yuan hua de Zhongguo xian dai zheng zhi zi you lun de bo lan zhuang kuo de si xiang hua mian. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ideal of Shared Decision Making Between Physicians and PatientsDan W. Brock (bio)IntroductionShared treatment decision making, with its division of labor between physician and patient, is a common ideal in medical ethics for the physician-patient relationship.1 Most simply put, the physician's role is to use his or her training, knowledge, and experience to provide the patient with facts about the diagnosis and about the prognoses without treatment and with (...) alternative treatments. The patient's role in this division of labor is to provide the values—his or her own conception of the good—with which to evaluate these alternatives, and to select the one that is best for himself or herself. As a rough guide to practice, this is a reasonable conception; most of the time it is likely to produce sound treatment decisions. However, as an ideal it is too simplistic, and is subject to several challenges that I will explore in this paper.Some challenges relate to the physician's role. This facts/values division of labor seems to assume that the physician can and should provide the facts about treatment alternatives in a value-neutral form. But some have questioned whether the sciences on which medicine is based are, or can be, value free. Moreover, the concepts of health and disease, and of the normal and pathological, are held by many to be value laden. And even if it is possible for physicians to provide only value-neutral facts to the patient, should the physicians' role be restricted in this way?Other challenges that I will present in the paper are to the patient's role [End Page 28] as provider of the values for the evaluation of the different treatment alternatives. One defense of this role is based on the claim that physicians are not in a position to know reliably what is in a patient's best interests (Buchanan, forthcoming). I believe at least as influential—even if often not explicitly stated—is an extreme subjectivism about values that assumes that the patient's own ultimate values, which define his or her own conception of the good, are incorrigible. By incorrigible, I mean they cannot be mistaken. In the standard case in which treatment is pursued for the patient's benefit, this extreme subjectivism is thought to support the patient's values guiding treatment decision making and treatment. I will explore this incorrigibility claim and will argue that on each of the main philosophical conceptions of the good for persons it is indefensible and should not be the basis for shared treatment decision making.Underlying this view of the physician-patient division of labor are assumptions and beliefs about the nature and relation of facts and values, and science and ethics, that are largely the legacy of a logical positivism that has long since been rejected by most philosophers. It is time that these unstable foundations for our normative ideal of the physician-patient relation were finally removed and replaced with more defensible underpinnings.Two Models of the Physician-Patient RelationshipPositivists insisted on a relatively sharp distinction between descriptive or empirical claims and science, on the one hand, and evaluative claims and ethics, on the other.2 Descriptive statements and the claims of science were to be true or false according to whether they in fact correctly described and explained the world. By remaining properly descriptive or empirical, science could, at least in principle, be entirely value neutral or value free.In its more extreme versions, positivism held that ethical judgments lacked cognitive content, but were instead expressions of emotions or attitudes, and as such could be neither true nor false, correct or mistaken. Because no evaluative statements were held to be logically entailed by any descriptive or empirical statements, moral reasoning was thought to be properly understood not as reasoning but as attempts at nonrational persuasion.3 Many drew from this an extreme subjectivism in ethics along the lines of what I have called above the incorrigibility thesis—there is no meaningful sense in which an individual's ultimate values defining his or her own conception of the good life could be mistaken, false, or unfounded.These... (shrink)

This the tenth volume in the Vancouver Studies in Cogntive Science series. It concerns metarepresentation: the construction and use of representations that represent other representations. Metarepresentations are ubiquitous among human beings, whenever we think or talk about mental states or linguistic acts, or theorize about the mind or language. It is crucial to the unconscious process we use to divine the mental states of others, and ultimately to any workable theory of the mind. This volume collects previously unpublished studies on (...) the subject by an interdisciplinary group of contributors, including: Daniel Dennett, Alvin Goldman, Keith Lehrer, Leda Cosmides and John Tooby. (shrink)

In recent years more and more people have started talking about the necessity ofreconciliating phenomenology with the project of naturalization. Is it possible to bridge the gap between phenomenological analyses and naturalipossible to naturalize phenomenology? In their long introduction to the book NaturalizingPhenomenology published by Stanford University Press in 1999, the four coPetitot, Francisco Varela, Bernard Pachoud might be seen as a kind of manifesto for this new approach. An examination of this introduction is consequently a good starting point for (...) a discussion of the issue. (shrink)

In her editorial introduction to the special issue 10 years of Viewing from Within: the Legacy of Francisco Varela as well as in her co-authored contribution 'The validity of first-person descriptions as authenticity and coherence' , Claire Petitmengin expresses some reservations about the way I have been characterizing reflection in some of my earlier writings. In replying to the criticism, I will use the occasion to amplify some of my previous remarks, pinpoint what I take to be some ambiguities in (...) Petitmengin and Bitbol's own positive proposal, make some additional points that relate directly to the important questions that they raise in their joint paper, and finish off with a few remarks regarding one of the central claims made by Vermersch in his contribution to the special issue. (shrink)

Manfred Frank has in recent publications criticized a number of prevailing views concerning the nature of self-awareness,1 and it is the so-called reflection theory of self-awareness which has been particularly under fire. That is, the theory which claims that self-awareness only comes about when consciousness directs its 'gaze' at itself, thereby taking itself as its own object. But in his elaboration of a position originally developed by Dieter Henrich (and, to a lesser extent, by Cramer and Pothast) Frank has also (...) more generally criticized every attempt to conceive original self-awareness as a relation, be it a relation between two acts or a relation between the act and itself.2 Every relation entails a distinction between two (or more) relata and, according to Frank, it would be impossible to account for the immediacy and infallibility of selfawareness (particularly its so-called immunity to the error of misidentification), if it were in any way a mediated process. Thus, self-awareness cannot come about as the result of a self-identification, a reflection, an inner vision or introspection, nor should it be conceived as a type of intentionality or as a conceptually mediated propositional attitude, all of which entails the distinction between two or more relata. The pre-reflective self-awareness of an experience is not mediated by foreign elements such as concepts and classificatory criteria, nor by any internal difference or distance. It is an immediate and direct self- acquaintance which is characterized by being completely and absolutely irrelational (and consequently best described as a purely immanent self-presence).3 Frank's approach is unusually broad, since he draws on the resources of several different philosophical traditions, including German Idealism, analytical philosophy of mind, and phenomenology. When it comes to the latter, it is particularly in Sartre that Frank has found important insights, whereas he has criticized Husserl's position persistently in most of his writings on self-awareness.. (shrink)

Background Randomized controlled trials are central to generating knowledge about effectiveness of interventions as well as risk, protective and prognostic factors related to diseases in emergency newborn care. Whether prospective participants understand the purpose of research, and what they perceive as the influence of the context on their understanding of the informed consent process for RCTs in emergency obstetric and newborn care are not well documented. Methods Conceptual review. Discussion Research is necessary to identify how the illnesses may be prevented, (...) to explore the causes, and to investigate what medications could be used to manage such illness. Voluntary informed consent requires that prospective participants understand the disclose information about the research, and use this to make autonomous informed decision about participation, in line with their preferences and values. Yet the emergency context affects how information may be disclosed to prospective research participants, how much participants may comprehend, and how participants may express their voluntary decision to participate, all of which pose a threat to the validity of the informed consent. I challenge the claim that the ‘understanding’ of research is always necessary for ethical informed consent for research during emergency care. I argue for reconceptualization of the value of understanding, through recognition of other values that may be equally important. I then present a reflective perspective that frames moral reflection about autonomy, beneficence and justice in research in emergency research. Conclusion While participant ‘understanding’ of research is important, it is neither necessary nor sufficient for a valid informed consent, and may compete with other values with which it needs to be considered. (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)

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)

This book argues that political libertarianism can be grounded in widely shared, everyday moral beliefs--particularly in strictures against shifting our burdens onto others. It also seeks to connect these philosophical arguments with related work in economics, history, and politics for a wide-ranging discussion of political economy.

We first want to express our thanks to the commentators for their close and critical readings of The Phenomenological Mind. We would like to treat their comments and challenging questions as a productive opportunity to clarify and to make our positions more precise. Before we address the specific points raised by our colleagues, we do want to say that the intersection between phenomenology and the cognitive sciences is a rich one, and growing richer as collaboration and research continues. Our book (...) was meant to be an introduction to this area rather than a complete map of ongoing research. For that reason we were not able to cover every interesting issue, many of which are raised in the set of commentaries. (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.

As the Mohist doctrine of inclusive care (jian ai 兼愛) is usually understood, it is an affront to both human nature and commonsense morality.1 We are told that the Mohists rejected all particularist ties, especially to family, in the interests of a radically universalist ethic.2 But love for those close to us is deeply rooted in our natures, and few would deny that this love has moral significance. If the Mohists did deny this, it would be easy to dismiss them, (...) regardless of the abstract weight of their arguments. But the Mohists did not deny this. They consistently took it for granted that we have special attitudes and obligations toward those close to us. Filial piety was one of their core values, and .. (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)

Since the publication of Chalmer’s influential work, The Conscious Mind, it has been customary to divide the philosophical problems of consciousness into two groups. Whereas the so-called ‘hard problem’ of consciousness concerns the nature of phenomenal awareness and the first-person perspective, the ‘easy problems of consciousness’ mainly concern the notion of intentionality. But is it really possible to investigate intentionality thoroughly without taking the experiential dimension into account? And vice versa, is it possible to understand the nature of subjectivity and (...) experience if we ignore intentionality, or do we not run the risk of thereby reinstating a Cartesian subject-world dualism that ignores everything captured by the phrase “being-in-the-world”? In my article, I will inquire whether phenomenal consciousness and intentionality are two sides of the same coin that cannot be separated without committing a fallacy of division. (shrink)

In the past two decades, African American filmmakers like Spike Lee have made significant contributions to the dialogue about race in the United States by adapting techniques from classic _film noir _to black American cinema. This book is the first to examine these artistic innovations in detail from a philosophical perspective informed by both cognitive film theory and critical race theory. Dan Flory explores the techniques and themes that are used in black _film noir _to orchestrate the audience’s emotions of (...) sympathy and empathy felt toward morally complex characters whom people might not typically find appealing in real life, such as thugs, drug dealers, or murderers. Using an approach that combines the cognitive insights of theorists like David Bordwell, Noël Carroll, and Murray Smith with the reflective Wittgensteinian methods for considering film employed by Stanley Cavell, Stephen Mulhall, and William Rothman, Flory shows how these films scrutinize the state of race in America, induce their viewers to do so as well, and illuminate the ways in which categories of race have defined and continue to direct much of our vision of the moral self and what counts as appropriate moral sensibility. (shrink)

An understanding of cause--effect relationships is fundamental to the study of cognition. In this book, outstanding specialists from comparative psychology, social psychology, developmental psychology, anthropology, and philosophy present the newest developments in the study of causal cognition and discuss their different perspectives. They reflect on the role and forms of causal knowledge, both in animal and human cognition, on the development of human causal cognition from infancy, and on the relationship between individual and cultural aspects of causal understanding. The result (...) is a state-of-the-art, informative, insightful, and interdisciplinary debate aimed at the non-specialist. (shrink)

In this short paper I survey recent contextualist answers to the challenge from disagreement raised by contemporary relativists. After making the challenge vivid by means of a working example, I specify the notion of disagreement lying at the heart of the challenge. The answers are grouped in three categories, the first characterized by rejecting the intuition of disagreement in certain cases, the second by conceiving disagreement as a clash of non-cognitive attitudes and the third by relegating disagreement at the pragmatic (...) level. For each category I present several important variants and raise some (general) criticisms. The paper is meant to offer a quick introduction to the current contextualist literature on disagreement and thus a useful tool for further research. (shrink)

Max Ferdinand Scheler was born in Munich on August 22, 1874 and brought up in an orthodox Jewish household.1 Aft er completing high school in 1894, he started to study medicine, philosophy, and psychology. He studied with Th eodor Lipps in Munich, with Georg Simmel and Wilhelm Dilthey in Berlin, and with Rudolf Eucken in Jena,2 where he received his doctorate in 1897 with a thesis entitled Beiträge zur Feststellung der Beziehungen zwischen den logischen und ethischen Prinzipien. Two years later (...) this was followed by his habilitation thesis on Die transzendentale und die psychologische Methode. In 1902, Scheler met Edmund Husserl for the fi rst time at a reception in Halle given by Hans Vaihinger, the editor of Kant-Studien. Th. (shrink)

This chapter examines whether an individual’s being worse off than others should be a relevant consideration in the allocation of limited medical resources. It reviews arguments pressed by proponents of different theories of justice about whether being worse off than others makes special demands on health care resource prioritization. Even if there is good reason to restrict the concern for the worse off to those with worse health in the prioritization and allocation of health care resources, additional issues remain. One (...) is how to determine who has worse health, and whether the worse off are those with the worse overall health or those with the most serious medical condition now in need of treatment. Another issue is whether only individuals’ present health, or instead their lifetime health, including past and expected future health, is relevant. (shrink)

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)

The claim that the human cognitive system tends to allocate resources to the processing of available inputs according to their expected relevance is at the basis of relevance theory. The main thesis of this chapter is that this allocation can be achieved without computing expected relevance. When an input meets the input condition of a given modular procedure, it gives this procedure some initial level of activation. Input-activated procedures are in competition for the energy resources that would allow them to (...) follow their full course. What determines which of the procedures in competition get sufficient resources to trigger their full operation is the dynamics of their activation. This dynamics depend both on the prior degree of mobilisation of a modular procedure and on the activation that propagates from other active modules. It is quite conceivable also that the mobilisation of some procedures has inhibitory effects on some others. The relevance-theoretic claim is that, at every instant, this dynamics of activation provides rough physiological indicators of expected relevance. The flow of energy in the system is locally regulated by these indicators. As a result, those input-procedure combinations that have the greatest expected relevance are the more likely ones to receive sufficient energy to follow their course. (shrink)

In this chapter, we focus on the debate over publicly maintained racist monuments as it manifests in the mid-2010s Anglosphere, primarily in the United States and South Africa. After pointing to some representative examples of racist monuments, we discuss ways a monument can be thought racist and neutrally categorize removalist and preservationist arguments heard in the monument debate. We suggest that both extremist and moderate removalist goals are likely to be self-defeating and that when concerns of civic sustainability are put (...) on moral par with those of fairness and justice, something like a Mandela-era preservationist policy is best: one which removes the most offensive of the minor racist monuments, but which focuses on closing the monumentary gap between peoples and reframing existing racist monuments. (shrink)

行動経済学によって、さまざまに系統的な不合理さが見えてきた。手をかけることが高評価をもたらすIKEA効果、やる気をそいでいる高額ボーナス、自分で思いついた(と思わせられた)意見は好ましい、雑用は一気に 片づけるほうが楽...。行動経済学研究の第一人者が、わたしたちがなぜ、どのように不合理な行動をしてしまうのかをユニークな実験で紹介。わかりやすい数々の実例で経済の真の姿を解明し、よりよい決断へとつなげ る話題作。.

After a unilateral focus on medical professional obligations to patients in most of the 20th century, there is a growing, if modest, interest in patient responsibility. This article critiques some public assertions, explores the ethics literature, and attempts to find some consensus and moral grounds for positions taken on the question, "Does a patient have moral obligations in the process of interactions with medical and other professional caregivers?" There is widespread agreement on a few responsibilities, such as "truth telling" and (...) "avoiding harm to others," but no apparent consensus either on the list of duties or on the appropriate justification for such duties. The context and clinical realities of patient interactions are noted to suggest that feasibility is important in making judgments of patient obligations. (shrink)

Charles S. Peirce attempted to develop his semiotic theory of cognitive signs interpretation, which are originated in our basic perceptual operations that quasi-prove the truth of perceptual judgment representing reality. The essential problem was to explain how, by a cognitive interpretation of the sequence of perceptual signs, we can represent external physical reality and reflectively represent our cognitive mind’s operations of signs. With his phaneroscopy introspection, Peirce shows how, without going outside our cognitions, we can represent external reality. Hence Peirce (...) can avoid the Berkeleyian, Humean, and Kantian phenomenologies, as well as the modern analytic philosophy and hermeneutic phenomenology. Peirce showed that with the trio of semiotic interpretation – abductive logic of discovery of hypotheses, deductive logic of necessary inference, and inductive logic of evaluation – we can reach a complete proof of the true representation of reality. This semiotic logic of reasoning is the epistemic logic representing human confrontation in reality, with which we can achieve knowledge and conduct our behavior. However, Peirce did not complete his realistic revolution to eliminate previously accepted nominalistic and idealistic epistemologies of formal logic and pure mathematics. Here, I inquire why Peirce did not complete his historical realist epistemological revolution and following that inquiry I attempt to reconstruct it. (shrink)

Background Factors that could potentially act as facilitators and barriers to successful recruitment strategies in perinatal clinical trials are not well documented. The objective was to assess lay persons’ understanding of the informed consent for randomized clinical trial in emergency obstetric and newborn care. Methods This was a qualitative study conducted among survivors of severe obstetric complications who were attending the post-natal clinic of Kawempe National Referral Hospital, Uganda, 6–8 weeks after surviving severe obstetric complications during pregnancy or childbirth. The (...) study that involved 18 in-depth interviews was conducted from June 1, 2019 to July 6, 2019. The issues explored included perceptions of the purpose and necessity to conduct such research how research-related information would be disclosed, and what could be the potential benefits and risks of participation. The data was analyzed by thematic analysis. Results Respondents felt that research was necessary to investigate the cause, prevention or complications of an illness, especially as much was known about some pregnancy and newborn complications. Most believed that the emergency contexts affects whether and what prospective participants may understand if information about research was disclosed. Whereas they did not see the value of procedures like randomization, they felt that if these and any other procedures necessary should be done transparently and fairly. The decisions to participate would significantly be influenced by possibility of risk to the unborn baby or the newborn. Solidarity was an important influence on decision-making. Conclusions Respondents valued participation in RCTs in emergency obstetric and newborn care. However, they expressed concerns and valued openness, transparency and accountability with regard to how clinical trials information is disclosed and the decision-making process for clinical trial participation. While autonomy and solidarity are contradictory values, they complement each other during decision-making for informed consent. (shrink)

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)