There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID-19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...) describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...) describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

With each novel infectious disease outbreak, there is scholarly attention to healthcare providers’ obligation to assume personal risk while they care for infected patients. While most agree that healthcare providers have a duty to assume some degree of risk, the extent of this obligation remains uncertain. Furthermore, these analyses rarely examine healthcare institutions’ obligations during these outbreaks. As a result, there is little practical guidance for healthcare institutions that are forced to weigh whether or when to exclude healthcare providers from (...) providing care or allow them to opt out from providing care to protect themselves. This article uses the COVID-19 pandemic to examine the concept of risk and the professional duties of both healthcare providers and healthcare institutions, and proposes a framework that can be used to make concrete institutional policy choices. This framework should be a useful tool for any hospital, clinic, or health agency that must make these choices during the current pandemic and beyond. (shrink)

Healthcare-associated infections due to multidrug-resistant organisms continue to increase in incidence. To control the transmission of these pathogens, such as methicillin-resistant Staphylococcus aureus , some have advocated active surveillance cultures of all hospitalized patients, followed by institution of contact precautions. While there has been extensive debate about the effectiveness of this approach in reducing infections, little attention has been given to the ethical issues raised by the intervention. Active surveillance for multidrug-resistant organisms is a quality improvement measure and ethical implications (...) arise through the potential to inadvertently cause harm. Unintended adverse effects may include decreased contact with healthcare workers, increased depression and anxiety, and increased rates of noninfectious adverse events among patients placed in contact precautions. The potential risks and benefits are not distributed fairly; patients placed in contact precautions are exposed to the risks, while those not isolated experience the benefit. Ethical challenges involve a conflict between the interests of the individual patient and the patient population not already colonized with the organism. For healthcare systems, active surveillance increases the complexity of bed management, exacerbating problems with patient placement, patient throughput, emergency department overcrowding and ambulance diversion for some hospitals. It also poses ethical dilemmas regarding societal resource allocation. Investing in an unproven or marginally beneficial quality improvement activity such as this must be balanced against other public health priorities competing for scarce resources. CiteULike Connotea Del.icio.us What's this? (shrink)

Minors are generally considered incompetent to provide legally binding decisions regarding their health care, and parents or guardians are empowered to make those decisions on their behalf. Parental authority is not absolute, however, and when a parent acts contrary to the best interests of a child, the state may intervene. The best interests standard is the threshold most frequently employed in challenging a parent''s refusal to provide consent for a child''s medical care. In this paper, I will argue that the (...) best interest standard provides insufficient guidance for decision-making regarding children and does not reflect the actual standard used by medical providers and courts. Rather, I will suggest that the Harm Principle provides a more appropriate threshold for state intervention than the Best Interest standard. Finally, I will suggest a series of criteria that can be used in deciding whether the state should intervene in a parent''s decision to refuse medical care on behalf of a child. (shrink)

A pioneering work in the philosophy of mind, Content and Consciousness brings together the approaches of philosophers and scientists to the mind--a connection that must occur if genuine analysis of the mind is to be made. This unified approach permits the most forbiddingly mysterious mental phenomenon--consciousness--to be broken down into several distinct phenomena, and these are each given a foundation in the physical activity of the brain. This paperback edition contains a preface placing the book in the context of recent (...) work in the area. (shrink)

In this book by the award-winning author of Just Healthcare, Norman Daniels develops a comprehensive theory of justice for health that answers three key questions: what is the special moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? Daniels' theory has implications for national and global health policy: can we meet health needs fairly in ageing societies? Or protect health in the workplace while respecting individual liberty? Or (...) meet professional obligations and obligations of justice without conflict? When is an effort to reduce health disparities, or to set priorities in realising a human right to health, fair? What do richer, healthier societies owe poorer, sicker societies? Just Health: Meeting Health Needs Fairly explores the many ways that social justice is good for the health of populations in developed and developing countries. (shrink)

In this book Daniel Wegner offers a novel understanding of the relation of consciousness, the will, and our intentional and voluntary actions. Wegner claims that our experience and common sense view according to which we can influence our behavior roughly the way we experience that we do it is an illusion.

The _Physics_ is a foundational work of western philosophy, and the crucial one for understanding Aristotle's views on matter, form, essence, causation, movement, space, and time. This richly annotated, scrupulously accurate, and consistent translation makes it available to a contemporary English reader as no other does—in part because it fits together seamlessly with other closely associated works in the New Hackett Aristotle series, such as the _Metaphysics_, _De Anima_, and forthcoming _De Caelo_ and _On Coming to Be and Passing Away_. (...) Eventually the series will include all of Aristotle's works. Sequentially numbered endnotes provide the information most needed at each juncture, while a detailed Index of Terms indicates places where focused discussion of key notions occurs. An illuminating general Introduction describes the book that lies ahead, explaining what sort of work it is and what sorts of evidence it relies on. (shrink)

The best interest standard is the threshold most frequently employed by physicians and ethics consultants in challenging a parent’s refusal to provide consent for a child’s medical care. In this article, I will argue that the best interest standard has evolved to serve two different functions, and that these functions differ sufficiently that they require separate standards. While the best interest standard is appropriate for choosing among alternative treatment options for children, making recommendations to parents, and making decisions on behalf (...) of a child when the legal decision makers are either unable to make a decision or are in dispute, a different standard is required for deciding when to seek state interference with parental decision-making authority. I will suggest that the harm principle provides a more appropriate threshold for determining when to seek state intervention than the best interest standard. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health (...) care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

The case of Ashley X involved a young girl with profound and permanent developmental disability who underwent growth attenuation using high-dose estrogen, a hysterectomy, and surgical removal of her breast buds. Many individuals and groups have been critical of the decisions made by Ashley's parents, physicians, and the hospital ethics committee that supported the decision. While some of the opposition has been grounded in distorted facts and misunderstandings, others have raised important concerns. The purpose of this paper is to provide (...) a brief review of the case and the issues it raised, then address 25 distinct substantive arguments that have been proposed as reasons that Ashley's treatment might be unethical. We conclude that while some important concerns have been raised, the weight of these concerns is not sufficient to consider the interventions used in Ashley's case to be contrary to her best interests, nor are they sufficient to preclude similar use of these interventions in the future for carefully selected patients who might also benefit from them. (shrink)

Reasoning about situations we take to be impossible is useful for a variety of theoretical purposes. Furthermore, using a device of impossible worlds when reasoning about the impossible is useful in the same sorts of ways that the device of possible worlds is useful when reasoning about the possible. This paper discusses some of the uses of impossible worlds and argues that commitment to them can and should be had without great metaphysical or logical cost. The paper then provides an (...) account of reasoning with impossible worlds, by treating such reasoning as reasoning employing counterpossible conditionals, and provides a semantics for the proposed treatment. (shrink)

Précis for a book symposium, with contributions from Meg Wallace, Louis deRosset, and Chris Tillman and Joshua Spencer.

Our ability to locate moral responsibility is often thought to be a necessary condition for conducting morally permissible medical practice, engaging in a just war, and other high-stakes endeavors. Yet, with increasing reliance upon artificially intelligent systems, we may be facing a wideningresponsibility gap, which, some argue, cannot be bridged by traditional concepts of responsibility. How then, if at all, can we make use of crucial emerging technologies? According to Colin Allen and Wendell Wallach, the advent of so-called ‘artificial moral (...) agents’ (AMAs) is inevitable. Still, this notion may seem to push back the problem, leaving those who have an interest in developing autonomous technology with a dilemma. We may need to scale-back our efforts at deploying AMAs (or at least maintain human oversight); otherwise, we must rapidly and drastically update our moral and legal norms in a way that ensures responsibility for potentially avoidable harms. This paper invokes contemporary accounts of responsibility in order to show how artificially intelligent systems might be held responsible. Although many theorists are concerned enough to develop artificial conceptions ofagencyor to exploit our present inability to regulate valuable innovations, the proposal here highlights the importance of—and outlines a plausible foundation for—a workable notion ofartificial moral responsibility. (shrink)

Clinical ethics training programs are responsible for preparing their trainees to be competent ethics consultants worthy of the trust of patients, families, surrogates, and healthcare professionals. While the American Society for Bioethics and Humanities (ASBH) offers a certification examination for healthcare ethics consultants, no tools exist for the formal evaluation of ethics trainees to assess their progress toward competency. Medical specialties accredited by the Accreditation Council for Graduate Medical Education (ACGME) use milestones to report trainees’ progress along a continuum of (...) professional development as a means of “operationalizing and implementing” medical competencies. Utilizing the Core Competencies for Healthcare Ethics Consultation and the ACGME and American Board of Pediatrics’ (ABP) Pediatric Milestones Project, we developed milestones for 17 subcompetencies in clinical ethics consultation and academic bioethics. As the field of clinical ethics becomes more standardized, such tools will be needed to promote the development of robust training programs and to certify that their graduates are competent practitioners. (shrink)

One of the world’s leading philosophers offers aspiring thinkers his personal trove of mind-stretching thought experiments. Over a storied career, Daniel C. Dennett has engaged questions about science and the workings of the mind. His answers have combined rigorous argument with strong empirical grounding. And a lot of fun. Intuition Pumps and Other Tools for Thinking offers seventy-seven of Dennett’s most successful "imagination-extenders and focus-holders" meant to guide you through some of life’s most treacherous subject matter: evolution, meaning, mind, (...) and free will. With patience and wit, Dennett deftly deploys his thinking tools to gain traction on these thorny issues while offering readers insight into how and why each tool was built. Alongside well-known favorites like Occam’s Razor and reductio ad absurdum lie thrilling descriptions of Dennett’s own creations: Trapped in the Robot Control Room, Beware of the Prime Mammal, and The Wandering Two-Bitser. Ranging across disciplines as diverse as psychology, biology, computer science, and physics, Dennett’s tools embrace in equal measure light-heartedness and accessibility as they welcome uninitiated and seasoned readers alike. As always, his goal remains to teach you how to "think reliably and even gracefully about really hard questions." A sweeping work of intellectual seriousness that’s also studded with impish delights, Intuition Pumps offers intrepid thinkers—in all walks of life—delicious opportunities to explore their pet ideas with new powers. (shrink)

In this paper I will present a puzzle about epistemic akrasia, and I will use that puzzle to motivate accepting some non-standard views about the nature of epistemological judgment. The puzzle is that while it seems obvious that epistemic akrasia must be irrational, the claim that epistemic akrasia is always irrational amounts to the claim that a certain sort of justified false belief—a justified false belief about what one ought to believe—is impossible. But justified false beliefs seem to be possible (...) in any domain, and it’s hard to see why beliefs about what one ought to believe should be an exception. I will argue that when we get clearer about what sort of psychological state epistemic akrasia is, we can resolve the puzzle in favor of the intuitive view that epistemic akrasia is always irrational. (shrink)

Thousands of U.S. parents choose to refuse or delay the administration of selected vaccines to their children each year, and some choose not to vaccinate their children at all. While most physicians continue to provide care to these families over time, using each visit as an opportunity to educate and encourage vaccination, an increasing number of physicians are choosing to dismiss these families from their practice unless they agree to vaccinate their children. This paper will examine this emerging trend along (...) with the reasons given by those who advocate such an approach. I will argue that the strategy of refusing to allow families into a clinic unless they agree to vaccinate their children is misguided, and the arguments for doing so fail to stand up to close scrutiny. Such a strategy does not benefit the child or the health of the community, and may have a negative impact on both. Furthermore, some of the arguments in support of dismissal policies ignore the importance of professional obligation and appear to favor self-interest over the interest of the patient. (shrink)

This collection of essays explores the metaphysical thesis that the living world is not made up of substantial particles or things, as has often been assumed, but is rather constituted by processes. The biological domain is organised as an interdependent hierarchy of processes, which are stabilised and actively maintained at different timescales. Even entities that intuitively appear to be paradigms of things, such as organisms, are actually better understood as processes. Unlike previous attempts to articulate processual views of biology, which (...) have tended to use Alfred North Whitehead’s panpsychist metaphysics as a foundation, this book takes a naturalistic approach to metaphysics. It submits that the main motivations for replacing an ontology of substances with one of processes are to be found in the empirical findings of science. Biology provides compelling reasons for thinking that the living realm is fundamentally dynamic, and that the existence of things is always conditional on the existence of processes. The phenomenon of life cries out for theories that prioritise processes over things, and it suggests that the central explanandum of biology is not change but rather stability, or more precisely, stability attained through constant change. This edited volume brings together philosophers of science and metaphysicians interested in exploring the consequences of a processual philosophy of biology. The contributors draw on an extremely wide range of biological case studies, and employ a process perspective to cast new light on a number of traditional philosophical problems, such as identity, persistence, and individuality. (shrink)

The potential to collect brain data more directly, with higher resolution, and in greater amounts has heightened worries about mental and brain privacy. In order to manage the risks to individuals posed by these privacy challenges, some have suggested codifying new privacy rights, including a right to “mental privacy.” In this paper, we consider these arguments and conclude that while neurotechnologies do raise significant privacy concerns, such concerns are—at least for now—no different from those raised by other well-understood data collection (...) technologies, such as gene sequencing tools and online surveillance. To better understand the privacy stakes of brain data, we suggest the use of a conceptual framework from information ethics, Helen Nissenbaum’s “contextual integrity” theory. To illustrate the importance of context, we examine neurotechnologies and the information flows they produce in three familiar contexts—healthcare and medical research, criminal justice, and consumer marketing. We argue that by emphasizing what is distinct about brain privacy issues, rather than what they share with other data privacy concerns, risks weakening broader efforts to enact more robust privacy law and policy. (shrink)

This paper proposes a new account of bounded or minimal doxastic rationality (in the sense of Cherniak 1986), based on the notion that beliefs are answers to questions (à la Yalcin 2018). The core idea is that minimally rational beliefs are linked through thematic connections, rather than entailment relations. Consequently, such beliefs are not deductively closed, but they are closed under parthood (where a part is an entailment that answers a smaller question). And instead of avoiding all inconsistency, minimally rational (...) believers only avoid blatant inconsistencies (where some beliefs are blatantly inconsistent when they contradict one another on a particular question). Rather than cohering into a single overall world view, beliefs are more loosely connected in what is best described as a web of questions. This view of minimally rational belief naturally gives rise to an account of deductive inquiry on which deductive reasoning is a matter of posing new questions. (shrink)

Supporters of open borders sometimes argue that the state has no pro tanto right to restrict immigration, because such a right would also entail a right to exclude existing citizens for whatever reasons justify excluding immigrants. These arguments can be defeated by suggesting that people have a right to stay put. I present a new form of the exclusion argument against closed borders which escapes this “right to stay put” reply. I do this by describing a kind of exclusion that (...) has not been discussed in depth, which I call “territorial exclusion.” Territorial exclusion is the process according to which the group that wishes to exclude current citizens secedes from the territory in which those citizens reside. I argue that the wrongness of territorial exclusion explains why there is no pro tanto right for a state to exclude immigrants, because otherwise there would be a pro tanto right for the state to kick people out by seceding from the territory they inhabit. Because kicking people out like this is typically wrong, borders cannot be closed. (shrink)

I defend the cosmopolitan instrumentalist theory of secession, according to which a group has a right to secede only if this would promote cosmopolitan justice. I argue that the theory is preferable to other theories of secession because it is an entailment of cosmopolitanism, which is independently attractive, and because, unlike other theories of secession, it allows us to give the answers we want to give in cases like secession of the rich or secession that would make things worse for (...) minorities. I defend the view against the objections that it allows for colonialism and annexation, that it is not a distinct theory, and that it is impractical. (shrink)

While the contemporary philosophical literature is replete with discussion of the control or freedom required for moral responsibility, only more recently has substantial attention been devoted to the knowledge or awareness required, otherwise called the epistemic condition. This area of inquiry is rapidly expanding, as are the various positions within it. This chapter introduces two major positions: the reasonable expectation view and the quality of will view. The chapter then explores two dimensions of the epistemic condition that serve as fault (...) lines along which these two views diverge. The first dimension concerns different kinds of ignorance. The second concerns what agents can be directly blameworthy for. The chapter closes by sketching a novel approach that incorporates advantages of opposing positions on this topic. (shrink)

This chapter introduces readers to the view that praise is a form of address, or is communicative in the sense of seeking uptake from its target. The proposal that praise is communicative will seem counterintuitive if we take blame to be our paradigm of what it is for a responsibility-response to be communicative. This is because blame is communicative in a manner that intuitively presupposes some normative failure; it involves calling its target to account (or answer) for some wrongdoing. But, (...) the ‘rightdoer’ already properly regarded the relevant reasons in acting praiseworthily. So, there is nothing for which the praiseworthy agent must similarly account or answer for. How then could praise be communicative in sense of seeking uptake from its target? This chapter develops the view that praise is communicative in that it invites the praiseworthy agent to accept credit by co-valuing their action in the evaluative terms supplied by the praiser. This proposal is defended against three objections, namely that it is descriptively inadequate regarding our actual practices, that it is morally mistaken about when we owe others a response, and that it implies redundant communication. (shrink)

The case of Ashley X involved a young girl with profound and permanent developmental disability who underwent growth attenuation using high-dose estrogen, a hysterectomy, and surgical removal of her breast buds. Many individuals and groups have been critical of the decisions made by Ashley's parents, physicians, and the hospital ethics committee that supported the decision. While some of the opposition has been grounded in distorted facts and misunderstandings, others have raised important concerns. The purpose of this paper is to provide (...) a brief review of the case and the issues it raised, then address 25 distinct substantive arguments that have been proposed as reasons that Ashley's treatment might be unethical. We conclude that while some important concerns have been raised, the weight of these concerns is not sufficient to consider the interventions used in Ashley's case to be contrary to her best interests, nor are they sufficient to preclude similar use of these interventions in the future for carefully selected patients who might also benefit from them. (shrink)

This volume provides a detailed account of the syntax of expressive language, that is, utterances that express, rather than describe, the emotions and attitudes of the speaker... Daniel Gutzmann demonstrates that expressivity has strong syntactic reflexes that interact with the semantic and pragmatic interpretation of these utterances, and argues that expressivity is in fact a syntactic feature on a par with other established features such as tense and gender. Evidence for this claim is drawn from three detailed case studies (...) of expressive adjectives, intensifiers, and vocatives; their puzzling properties are accounted for through a minimalist approach to syntactic features and agreement, which shows that expressivity can partake in agreement operations, trigger movement, and be selected for syntactically. The analysis not only supports the hypothesis of expressive syntax, but also highlights the hidden role that grammar may play in phenomena that are traditionally considered to be solely semantic in nature" -- Publisher. (shrink)

Choices confront us with questions. How we act depends on our answers to those questions. So the way our beliefs guide our choices is not just a function of their informational content, but also depends systematically on the questions those beliefs address. This paper gives a precise account of the interplay between choices, questions and beliefs, and harnesses this account to obtain a principled approach to the problem of deduction. The result is a novel theory of belief-guided action that explains (...) and predicts the decisions of agents who, like ourselves, fail to be logically omniscient: that is, of agents whose beliefs may not be deductively closed, or even consistent. (Winner of the 2021 Isaac Levi Prize.). (shrink)

After 50 years of debate, the ethics of aggregation has reached a curious stalemate, with both sides arguing that only their theory treats people as equals. I argue that, on the issue of equality, both sides are wrong. From the premise that “each counts for one,” we cannot derive the conclusion that “more count for more”—or its negation. The familiar arguments from equality to aggregation presuppose more than equality: the Kamm/Scanlon “Balancing Argument” rests on what social choice theorists call “(Positive) (...) Responsiveness,” Kamm’s “Aggregation Argument” assumes that “equal” lives are fungible, and Hsieh et al. have it that spreading goods broadly best approximates equality. In each case, the crucial premise is not equality itself but a further idea that Taurek, I argue, can safely reject. I conclude with a conjecture: there is no theory-neutral argument that settles the question of whether the numbers count. (shrink)

This paper presents a new interpretation of Michel Foucault’s critical project. It is well known that Foucault’s genealogical critique does not focus on issues of justification, but instead tackles “aspectival captivity,” that is, apparently inevitable limits of thought that constrain the agent’s freedom but that, in fact, can be transformed. However, it has not been recognized that, according to Foucault, critique can proceed along two distinct paths. In a key passage of “What Is Critique?,” Foucault states that critique is tasked (...) with questioning truth about its effects of power and with questioning power about its discourses of truth. We show that this “double movement” organizes Foucault’s critical project as a whole, giving it a significantly wider scope and a more complex structure than has been previously acknowledged. At the heart of the above-mentioned bifurcation lies an apparent tension between two contrastive roles Foucault assigns to truth-telling in the context of critique: on the one hand, truth-telling (as avowal) is a target of critique; on the other, truth-telling (as parrhesia) is one of critique’s methods. We argue that combining these two dimensions in a unified account is crucial for understanding and re-evaluating Foucault’s critical project as a whole. By showing that truth-telling remains an essential element of Foucauldian critique, this paper also rectifies some influential misinterpretations according to which Foucault’s critical project seeks to eliminate truth from the picture. (shrink)

In this volume of newly commissioned essays, leading moral philosophers offer a comprehensive overview of virtue ethics.

This chapter draws on insights from non-equilibrium thermodynamics to demonstrate the ontological inadequacy of the machine conception of the organism. The thermodynamic character of living systems underlies the importance of metabolism and calls for the adoption of a processual view, exemplified by the Heraclitean metaphor of the stream of life. This alternative conception is explored in its various historical formulations and the extent to which it captures the nature of living systems is examined. Following this, the chapter considers the metaphysical (...) implications of reconceptualizing the organism from complex machine to flowing stream. What do we learn when we reject the mechanical and embrace the processual? Three key lessons for biological ontology are identified. The first is that activity is a necessary condition for existence. The second is that persistence is grounded in the continuous self-maintenance of form. And the third is that order does not entail design. (shrink)

I argue that the phenomenon underlying Bernard Williams’ (1976) “agent-regret” is considerably broader than appreciated by Williams and others. Agent-regret— an anguished response that agents have for harms they have caused, even if faultlessly— I maintain, is a species of a more general response to harms that need not be one’s fault, but which nonetheless impact one’s practical identity in a special way. This broader genus includes as a species what I call “relation-regret”, a pained response to harm caused by (...) a person to whom one is intimately related, as a co-member of a group partly constitutive of one’s practical identity (e.g. one’s family). After providing an account of the moral psychology of relation-regret, I attend to its normative significance, proposing in particular that acceptance of relation-regret provides us with reasons for accepting a novel form of moral luck, namely associative luck: the luck of being vulnerable to responsibility-responses in virtue of one’s attachments to others, despite one’s personal faultlessness. (shrink)

We propose to analyze well-known cases of "imaginative resistance" from the philosophical literature (Gendler, Walton, Weatherson) as involving the inference that particular content should be attributed to either: (i) a character rather than the narrator or, (ii) an unreliable, irrational, opinionated, and/or morally deviant "first person" narrator who was originally perceived to be a typical impersonal, omniscient, "effaced" narrator. We model the latter type of attribution in terms of two independently motivated linguistic mechanisms: accommodation of a discourse referent (Lewis, Stalnaker, (...) Kamp) and 'cautious' updating as a model of non-cooperative information exchange (Eckardt). (shrink)

As a strategy for exploring the relationship between understanding and knowledge, we consider whether epistemic luck – which is typically thought to undermine knowledge – undermines understanding. Questions about the etiology of understanding have also been at the heart of recent theoretical debates within epistemology. Kvanvig (2003) put forward the argument that there could be lucky understanding and produced an example that he deemed persuasive. Grimm (2006) responded with a case that, he argued, demonstrated that there could not be lucky (...) understanding. In this paper, we empirically examine how participants' patterns of understanding attributions line up with the predictions of Kvanvig and Grimm. We argue that the data challenge Kvanvig's position. People do not differentiate between knowing-why and understanding-why on the basis of proper etiology: attributions of knowledge and understanding involve comparable (and minimal) roles for epistemic luck. We thus posit that folk knowledge and understanding are etiologically symmetrical. (shrink)

The case presented here is tragic, not just in the sense of being a sad story, but in the dramatic meaning of tragedy. It presents us with a situation where there is no clear path, where moral ambiguity exists, and where no possible solution could unequivocally be declared the right or good one. Ethical deliberation can help here, but only as a way of clarifying the issues and offering reasonable solutions. It cannot show us the one right way.Baby G has (...) profound medical conditions, including respiratory failure, a chest wall deformity that will require surgery, and profound neurodevelopmental disability. Even a best case scenario portends a shortened lifespan and.. (shrink)

Thirty years ago, Buchanan and Brock distinguished between guidance principles and interference principles in the setting of surrogate decision making on behalf of children and incompetent adult patients. They suggested that the best interest standard could serve as a guidance principle, but was insufficient as an interference principle. In this issue of The Journal of Clinical Ethics, Ross argues that the best interest standard can serve as neither a guidance nor interference principle for decision making on behalf of children, but (...) that her model of constrained parental autonomy can serve as both. I will argue that Buchanan and Brock were correct that a single model or standard cannot serve as both a guidance and interference principle in pediatrics and that the best interest standard is a sufficient guidance principle. The harm principle fulfills the conditions necessary for an interference principle, at least insofar as deciding when state intervention to interfere with parental decision making is justified. (shrink)

In the 1960s, human experimentation and public funding of research increased significantly, and with the rise of the modern teaching hospital, the distinction between clinical care and experimentation became more and more blurred. Yet little in the way of meaningful government regulation existed in the United States prior to 1970. In 1966, Paul Freund, the president of the American Academy of Arts and Sciences, appointed an interdisciplinary working group to consult on the issues being raised by human experimentation. Contributions from (...) the group were published in a 1969 issue of Daedalus titled Ethical Aspects of Experimentation with Human Subjects. In the lead essay, Hans Jonas challenged then‐conventional understandings of the moral problems posed by research involving humans and argued for an alternative moral framework. To Jonas, it mattered whether the physician was trying to make the patient well rather than trying to find out how to improve the health of future patients. (shrink)

In his recent book Where the Conflict Really Lies, Alvin Plantinga articulates a number of arguments about the conceptual relationship between science and faith, especially Christian faith. He uses Herbert Simon’s evolutionary account of altruism and David Sloan Wilson’s evolutionary account of religion as exemplars of theories that are in genuine but superficial conflict with Christian faith. This paper argues that any conflict between Christian faith and evolutionary psychology or Simonian science is even more superficial than Plantinga himself admits. We (...) argue that apparent conflicts between Christian control beliefs and social scientific theorizing are due predominantly to misunderstanding the scope of a theory or metatheoretical overreaching on the part of one side or the other. Specifically, the apparent conflict between Simon’s account and Christian faith is rooted in a misunderstanding of Simon’s limited definitions of rationality and altruism. The apparent conflict between Wilson’s account and Christian faith is a result of failing to distinguish Wilson’s broader metatheoretical commitments from the more limited scope of his scientific theory of religion. (shrink)