In the wake of the COVID-19 pandemic, many have become increasingly dissatisfied with how science funding is distributed. Traditional grant funding processes are seen as stifling the creativity of researchers, in addition to being bureaucratic, slow, and inefficient. Consequently, there have been increasing popular calls to make “fast funding” – fast, unbureaucratic grant applications – a new standard for scientific funding. Though this approach to funding, implemented by Fast Grants, has been successful (...) as a pandemic response strategy, we believe there are serious costs to its wide-scale adoption, particularly for transparency and equity, and that the purported benefits – increased creativity and efficiency – are unlikely to materialize. While traditional funding mechanisms are certainly not perfect, scientific communities should think twice before adopting fast funding as a new standard for funding. (shrink)

As I write this, in November 1971, people are dying in East Bengal from lack of food, shelter, and medical caxc. The suffering and death that are occurring there now axe not inevitable, 1101; unavoidable in any fatalistic sense of the term. Constant poverty, a cyclone, and a civil war have turned at least nine million people into destitute refugees; nevertheless, it is not beyond Lhe capacity of the richer nations to give enough assistance to reduce any further suffering to (...) very small proportions. The decisions arid actions of human beings can prevent this kind of suffering. Unfortunately, human beings have not made the necessary decisions. At the individual level, people have, with very few exceptions, not responded to the situation in any signihczmt way. Generally speaking, people have not given large sums to relief funds; they have not written t0 their parliamentaxy representatives demanding increased government assistance; they have not demonstrated in the streets, held symbolic fasts, or done anything else directed toward providing thc refugees with the means to satisfy their essential needs. At thc government level, no govcrmmcnt has given the sort of massive aid that would enable the refugees to survive fm: more than a few days. Britain, for instance, has given rather more than most countries. It has, to date, given £14,750,000. For comparative purposes, B1~itain’s share of thc nonreccverabla development costs of the Anglo-French Concorde project is already in excess of £275,000,000, and on present estimates will reach £440,000,¤00. The implication is that the British government values a supersonic transport more than thirty times as.. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Semi-Personal Story from a Ukrainian NGO Professional (or a Semi-Professional Story from a Ukrainian Person) Living through the WarYuliya NogovitsynaI live in Kyiv with my husband and two daughters. On 24 February 2022, my husband woke me up at 5 am tapping me on the shoulder and saying, “Yulia, wake up. There are bombings outside. The war started”. [End Page 160]That day was our younger daughter’s birthday. She (...) turned six. We had planned a birthday party for her with friends, cake, candles and birthday gifts. Instead, we had to move both daughters to the bathroom where there are no windows so that broken glass did not hurt them if a missile hit.I am the Program Director at Tabletochki Charity Foundation, Ukraine’s largest childhood cancer NGO (https://tabletochki.org/en/). For 11 years before the war, we have been fostering childhood cancer care in Ukraine—through our direct assistance to families, support of pediatric oncology units, professional development of medical personnel, and advocacy.The Russian invasion of Ukraine in February 2022 dramatically changed the healthcare system landscape in Ukraine. The physical threat, treatment disruption, exposure of immunosuppressed patients to improper conditions in bomb shelters and cellars, interruption in supplies, infrastructure damage, logistics failure, and funding constraints have been among the most manifested immediate and deferred implications of the war for the health-care system in Ukraine.That said, the biggest professional challenge was uncertainty and inability to plan. You have nothing to rely on in developing at least a short-term strategy. This may sound speculative and unimportant—who bothers about uncertainty when there is a physical threat to your life? But this is a wrong perception—uncertainty paralyzes and disables long before a bullet or missile reaches you.War also brings the collapse of relationships, partnerships, and coalitions. It depletes and limits resources, whether human, financial, or emotional. Scarce resources make hospitals, healthcare professionals, and NGOs compete for patients, donors, and financing. The war and the external threat unite only for a short period of emergency response. Once the situation transitions to a protracted conflict, people and institutions start fighting for their own survival.My family stayed in Ukraine but moved to Lviv, a city in Western Ukraine, which turned into an evacuation hub for children with cancer. More than 1,000 children with cancer were evacuated and referred for treatment abroad through the SAFER Ukraine collaborative initiative by St. Jude Global, Tabletochki, West-Ukrainian Specialized Children’s Medical Center (WUSCMC), and other international and local partners.During the first months of the war, we worked hand-in-hand day and night to bring critically ill children to safety and treatment. We sent evacuation convoys from Lviv to Poland twice a week, the largest one with 71 families, included four buses and 11 ambulances. We slept 4-5 hours per day. Within two weeks, my hands and legs were trembling from constant tension, concentration, and tiredness.And even this extremely fast-responding and effective evacuation may be questioned. We have been facing an ethical dilemma—whether the safety needs of the existing patients prevail over the needs of future patients in diagnostics and treatment in Ukraine. We discussed more than once whether we should stop evacuation and referral of children to European hospitals to sustain the Ukrainian childhood cancer care system and prevent it from degradation. It is very uncomfortable to confront such questions. Could our heroic efforts to evacuate as many Ukrainian children with cancer as possible turn into an evil for future patients to come? By evacuating patients, we left pediatric oncology units empty, without work for Ukrainian pediatric oncologists, and the usual pathways for diagnostics and treatment were disrupted. A healthcare system without patients is like a cardiovascular system without blood.My family returned to Kyiv in August 2022 for our daughters to continue their schooling. There were (and still are) only five to seven kids in a class; other children left Ukraine or switched to online studies. My husband and I decided that our children will attend school offline—despite the regular missile attacks. This is a private school; we pay for it. In such a way... (shrink)

In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑BA decided in favor of NIPT, making the implementation of NIPT very likely, provided that other healthcare and political institutions also agree. This development could be interpreted as empowering from the perspective of reproductive (...) autonomy, since NIPT allows pregnant women to obtain valuable information on the health of the fetus in a fast and easy manner and without the risks of invasive methods. However, the routinization of NIPT also implies ethical challenges. Will the routinization lead to a normalization of prenatal quality control? Will it lead to an expansion to women outside the high-risk group? What would be the ethical implications of such a development? How should physicians, geneticists, and patients deal with the increased amount of obtainable information? What are the implications for choice and decision-making in the prenatal care context? In this paper, we analyze the ethical aspects of the routinization of NIPT, focusing on information and the counseling process, the burden of choice, and the threats to reproductive autonomy by societal interests linked to NIPT. (shrink)

In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑BA decided in favor of NIPT, making the implementation of NIPT very likely, provided that other healthcare and political institutions also agree. This development could be interpreted as empowering from the perspective of reproductive (...) autonomy, since NIPT allows pregnant women to obtain valuable information on the health of the fetus in a fast and easy manner and without the risks of invasive methods. However, the routinization of NIPT also implies ethical challenges. Will the routinization lead to a normalization of prenatal quality control? Will it lead to an expansion to women outside the high-risk group? What would be the ethical implications of such a development? How should physicians, geneticists, and patients deal with the increased amount of obtainable information? What are the implications for choice and decision-making in the prenatal care context? In this paper, we analyze the ethical aspects of the routinization of NIPT, focusing on information and the counseling process, the burden of choice, and the threats to reproductive autonomy by societal interests linked to NIPT. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS I. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[i] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[ii] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. II. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[iii] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[iv] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[v] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[vi] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[vii] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[viii] In democratic societies, one must take into consideration community morals and values.[ix] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[x] III. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[xi] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[xii] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[xiii] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[xiv] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. IV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[xv] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[xvi] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[xvii] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[xviii] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[xix] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[xx] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[xxi] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. VI. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[xxii] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[xxiii] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[xxiv] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. VII. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [i] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [ii] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [iii] Moss, p. 1295-1298. [iv] Moss, p. 1296. [v] Moss, p. 1295-1298. [vi] Moss, p. 1295-1298. [vii] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [viii] Cohen, p. 1299-1301. [ix] Moss, p. 1297. [x] Cohen, p. 1300. [xi] Cappelen, p. 478-480. [xii] Cappalen, p. 478-480. [xiii] Cappelen, p.479. [xiv] Cappelen, p. 479. [xv] Cappelen, p. 479 [xvi] Cohen, p. 1301. [xvii] Cappelen, p. 478. [xviii] Cohen, p. 1299-1301. [xix] Cohen, p. 1301. [xx] Cappelen, p. 476-480. [xxi] Cappelen, p. 476-480. [xxii] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [xxiii] Kawachi, p. 18-33. [xxiv] Kawachi, p. 18-33. (shrink)

Independent on Sunday October 2nd One of the country's lead­ing philosophical counsellers, and chairman of the Society for Philosophy in Practice (SPP), Tim LeBon, said it typically took around six 50 ­minute sessions for a client to move from confusion to resolution. Mr LeBon, who has 'published a book on the subject, Wise Therapy, said philoso­phy was perfectly suited to this type of therapy, dealing as it does with timeless human issues such as love, purpose, happiness and emo­tional challenges. `Wise (...) Therapy, is part of a series aimed at promoting an integrative attitude as its ethos. Among all the many perspectives of psychotherapists and counselors, philosophy needs to take its place and needs to find its voice. Tim LeBon has provided an effective means by which counselors can bring philosophy into their work with clients' - APPA journal `Tim Le Bon's Wise Therapy is a comprehensible and well argued book dealing with the practical therapeutic applications of philosophical research that may well be of interest to philosophers but -- as the author himself intends -- will be of most obvious benefit to therapists and counselors, both by informing their dialogue with clients in new ways and by helping them become more informed about ways to resolve the ethical dilemmas arising within the context of their own work' - Metapsychology `A fascinating workshop for therapists and clients, backed up a thorough degree if philosophical acuity' - Journal of the Society for Existential Analysis `I strongly recommend the book for philosophers as well as practitioners, teachers, students and supervisors in counselling and psychotherapy' - Self and Society `Provides some additional and valuable arrows for the therapist's quiver' - Irvin Yalom, author of Love's Executioner `Like Aristotle, Tim LeBon examines what is said and extracts what is best from it…. There are many fascinating exercises designed to bring out and enlighten the client's values, conception of the good life, well-being, happiness, pleasure, and the proper place of reason in life…. Wise Therapy is well written and engaging. The case histories are illuminating examples of therapeutic techniques at work, the thought experiments are well designed, and the philosophical position adapted from the internal debates of the philosophers is level headed…. I recommend it highly to philosophers with an interest in counselling, and psychological counsellors with an interest in philosophy' - Jeff Mason, The Philosophers' Magazine `Tim LeBon has… authored a text which should become a staple on the philosophical counsellor's bookshelf…. Wise Therapy is a concise, well-written book…. His ability to relate philosophical concepts to counselling concerns is admirable and attests to the skill and knowledge he possesses as a working counsellor. But, by far the most important part of Tim LeBon's book to PC is the last chapter, "The Counsellor's Philosophical Toolbox"' - Craig Munns in The Examined Life ` Tim LeBon has done a good job of offering practical approaches to some of the most important and vexing issues that arise in counselling…. Tim LeBon's book contains helpful suggestions, practical information, and useful examples, and would make a good addition to the library of any counsellors willing to allow philosophy to turn mere client sessions into wise therapy' - Peter Raabe, Practical Philosophy Wise Therapy is an original and practical guide to how philosophy can benefit counselling and psychotherapy. Tim LeBon argues that therapy, informed by philosophy, can help clients make better decision and achieve emotional wisdom. He uses philosophical approaches to explore issues of right and wrong, the emotions and reasons, well-being and the meaning of life, and develops a 'counsellor's toolbox' of techniques that can help practitioners apply the wisdom of philosophy to good therapeutic practice. For counsellors who may find philosophical approaches to therapy useful, this work addresses key philosophical topics - the emotions, free will, the meaning of life and ethics. It is jargon-free where possible and assumes no previous philosophical training. From The Independent, 16th November 2004 Plato is my agony aunt It was the end of a love affair that broke her heart. Could the wisdom of the great philosophers show her how to be happy again? Claire Smith tries a novel form of therapy "The unexamined life is not worth living," Socrates said. Nor is the life you're left with after your boyfriend has left you for another woman - at least, that's how it felt in October last year when mine broke rank and went off with an art student from Cleveland, Ohio. We were over there for the opening of his new art exhibition. He'd flown over four days before me and had met her at a party. Supposedly, they "connected". The five months that followed were a roller-coaster of confusion, vitriol and despair. I knew there'd been problems in our relationship. We saw the world very differently; he delighted in the charm of the ordinary, I wanted maximum divinity. He walked; I galloped. He drank tea; I loathed the stuff. But, along the banks of the Thames, we'd made a promise to always stick together. Our love was something unique: "transcendental", I called it. And besides, we recycled. Surely a commitment to save the world would save our relationship? Alas, no. So there I was, a woman scorned. Hell truly hath no greater fury. And what made it worse was that I still believed in our transcendental love. If I wanted to change the way I was feeling, I needed to alter the way I was thinking. But how? A few bottles of wine and a sharp blow to the head might have done the trick. Fortunately, there's an older, more trusted way of turning your head on its head that counsellors are starting to use: philosophy. The idea of employing Plato as an agony aunt was begun in 1981 by the German philosopher Gerd Achenbach. Although philosophy spends a lot of its time asking real-life questions that affect real-life people - What is happiness? And is it always wrong to lie? - most of the debate goes on in ivory towers. What Achenbach and subsequent philosophers including Tim LeBon, the chairman of the UK's Society for Philosophy in Practice, wanted to do was "give practical application" to this gigantic library of great thoughts. So how does it work? Like most types of therapy, you sign up for a set of sessions. "Two would give you a new perspective on one issue; six would help you to make a major life-decision, like a career change; with 12 you can start to rethink your entire life philosophy," explains LeBon. Each session lasts 50 minutes and costs £50 - and, no, you don't have to have any previous knowledge of philosophy. "If you think of Friends, it would suit Ross and Chandler more than Joey," LeBon says. "It's for anyone who wants to make their emotions more intelligent. Or for those who have tried other kinds of therapy, and want something more cerebral." The first session begins with the patient venting off about whatever's troubling them. The rant over, the counsellor then picks out some key concepts that are crucial to the problem - in the case of heartbreak, it is love and happiness that come hurtling to the fore - and then gets the patient to define what they mean. So, what is love? What is happiness? To kick-start the patient's thinking, LeBon describes what a great philosopher had to say about it. In my case, he tells me what Plato wrote about love in his Symposium: that to stop man fighting the gods, Zeus decided to cut each human in two, so they would lose their strength. "This, then, is the source of our desire to love each other," Plato said. "Each of us is a 'matching half' of a human whole, because each was sliced like a flatfish, two out of one, and each of us is always seeking the half that matches him." This method of probing what we might think are "obvious" ideas, such as love and happiness, was devised by Socrates in the squares of Athens. "The only I thing I know is that I know nothing at all," he boasted. What Socrates showed was that although many of the thinkers of his time thought they knew what justice, happiness and goodness meant, their understanding was tied in to their personal agenda and world view, and, what's more, when pushed, their ideas often contradicted themselves. A bit like me on love. Whereas part of my understanding of love was something that gave life meaning, made it worth living and bound us together, I also believed that true love was "transcendental": that it was out of this world, and it didn't matter if the two people who loved each other couldn't get along in the day-to-day. Love was bigger than the mundane. But when it came to the next stage of the therapy, critical thinking - "to check out whether your assumptions stand up to examination" - I walked head first into a contradiction. If I think love's purpose is to make life worth living, but then say it's irrelevant to daily life, surely my two ideas of love are not compatible? As the cogs in my brain start to creak into motion, I feel myself taking a step back from my predicament: thinking about how I've been thinking. This idea I had of transcendental love might have started off as a romantic dream. But when the relationship stopped working, and I found myself feeling trapped and frustrated, I used it to justify the mechanics of a relationship that just didn't work in the daily grind. I used it to lie to myself. In the final stage, LeBon gets me to start thinking about how to go forward. "You can't change what has happened," he says. "You can't change that he's left you, or how you behaved in the relationship. So, as the Stoics did, let's work on controlling the controllables: the things that you can change." To work out what can be changed, he gets me to try out a thought experiment, a method often used in philosophy to imagine other worlds where people can have different codes of behaviour. Thought experiments shatter your preconceived ideas of how the world should be and let your imagination run wild to how the world could be. "I find Viktor Frankl very useful here, the Austrian psychiatrist and concentration-camp survivor who actually believed that everything in life happens for a purpose," LeBon says. "Suppose this break-up did happen for a reason that will work to your benefit," he suggests. "What might that be? The answer might be that you can now focus on something important that was denied in the relationship. Or - the Hollywood version - so you'll meet someone who is really right for you." Temporarily freed of any sense of responsibility for the relationship that was, and its sorry demise, the list came fast. I could now travel more; he didn't like me travelling on my own, but too often he didn't want to go anywhere, preferring to stay in his studio and make art. I'd love to meet someone with a similar sense of adventure to mine. For the first time in two years, I was being honest with myself about what I really wanted - listening to those voices that we all have inside our heads, and too often try to muzzle. So did philosophy save me? Well, I'm now dating a travel writer I have to run to keep up with. I still haven't got over the fact that my replacement came from Cleveland, Ohio. But I guess I never will. Tim LeBon can be reached by e-mail at [email protected] A FEW WORDS FROM THE WISE Compiled by Ed Caesar · "At the touch of love, everyone becomes a poet" - Plato · "There is always some madness in love. But there is also always some reason in madness" - Friedrich Nietzsche · "That man shall live as his own master and in happiness who can say each day 'I have lived'" - Horace · "The good of man is the active exercise of his soul's faculties in conformity with excellence or virtue... Moreover this activity must occupy a complete lifetime; for one swallow does not make spring, nor does one fine day; and similarly one day or a brief period of happiness does not make a man supremely blessed and happy" - Aristotle · "There is nothing on this earth more to be prized than friendship" - Thomas Aquinas · "Whatever you do... love those who love you" - Voltaire · "Happiness is not an ideal of reason but of imagination" - Immanuel Kant · "Happiness is a state of which you are unconscious. The moment you are aware that you are happy, you cease to be happy" - Jiddu Krishnamurti · "Love is an ideal thing. Marriage is a real thing" - Johann Wolfgang von Goethe I shrink, therefore I am Therapy has many answers, but some questions require the help of a philosopher, says Clint Witchalls Sunday November 21, 2004 The Observer Danny had worked in the City of London for 10 years. As a research analyst, stockbroker and fund manager, he'd made a lot of valuable contacts, earnt a lot of cash, and learnt some important business skills. However, as he approached his mid-thirties, he no longer felt good about himself or what he did for a living, and he found his colleagues cold and unfriendly. A chronic illness made him realise his mortality, and he began to reassess his priorities. Danny had been struggling with his career conundrum for nearly five years when he met David Arnaud, a philosophical counsellor. After a few soul-searching sessions, Danny arrived at a decision. Today, he teaches economics to sixth-formers, and he loves it. 'It's a much better lifestyle,' he says. Many people are turning to philosophical counsellors to get answers to questions such as: 'How do I make sense of myself?' 'What is important to me?' 'Where am I going?' These are perhaps not the sort of questions that require psychiatric intervention, but Arnaud, who recently completed the first empirical study of philosophical counselling in the UK, has found that within just five sessions the majority of clients, with important decisions to make, tend to move from a state of concern and confusion to a resolution. Modern philosophical counselling can be traced back to 1981, when the philosopher Gerd Achenbach opened the first practice near Cologne. Achenbach referred to the new discipline as 'therapy for the sane.' Today, there are hundreds of philosophical counsellors around the world, with the movement particularly strong in the US, Britain and the Netherlands. 'The dilemmas people face aren't always primarily psychological,' says Alex Howard, a philosophical counsellor from Newcastle. 'If people face problems that are social or economic, it doesn't make sense to define their problems in purely psychological terms.' Tim LeBon, a founder member of the Society for Philosophy in Practice (SPP) and author of Wise Therapy, adds: 'We are faced with far more life choices than our grandparents, yet have far fewer resources to deal with them. Our grandparents may have gone to a priest or to other family members for advice; most people don't trust these solutions any more and so want to make their own well-informed, well thought-out choices. Philosophical counselling can help these people - people in mid-life crises who are wondering how to make the most of the rest of their life. People who want to take stock of their values.' Where stressed executives might once have been prescribed a course of tranquillisers or antidepressants, they can now get a dose of Bertrand Russell instead: 'Success is too dearly purchased if all the other ingredients have been sacrificed to obtain it.' While some philosophical counsellors do recommend books for their clients to read, most sessions are about helping the client identify faulty thoughts. For example, a briefing in Aristotelian logic might show a client why their beliefs are erroneous. The person might infer that they're a screw-up because they've screwed up. The counsellor could point out that they're making an error called 'fallacy of composition' - that is, what's true of the part isn't necessarily true of the whole. In philosophical counselling, problems aren't pathologised as they are by the psychiatric profession, and the dialogue between client and counsellor is more like a meeting of equals, compared to many therapies where the client is treated like a patient and seen as someone who is, in some way, inadequate. 'Anybody can benefit from philosophical counselling,' says Howard. 'But it does require someone who is willing to take stock.' Lou Marinoff, author of international bestseller Plato Not Prozac! has done much to promote philosophical counselling. 'Some people who have stabilised their neurochemistry and validated their emotions now wish to examine or re-examine the criteria of their beliefs, the principles of their conduct, or the meaning of their lives,' he says. 'With whom shall they do this? Psychologists and psychiatrists can shed light on such issues - as can rabbis, priests, imams and gurus. Philosophers are now rejoining the ranks of helpers.' LeBon believes certain therapies (such as cognitive behavioural therapy) don't go far enough in helping their clients. 'For instance, if you are anxious about your relationship, a cognitive therapist would try to dispute your catastrophising and jump to conclusions to make you feel less anxious,' says LeBon. 'A philosophical counsellor would do this, but would also look for existential meaning in your anxiety - perhaps you really don't want to be in the relationship and that is what your anxiety is telling you.' LeBon also gives short shrift to psychoanalysts. 'There's very little evidence for the Freudian unconscious, and it's time to move on to more intellectually satisfying and helpful therapies,' he says. However, Alain de Botton, the man who popularised philosophy as self-help, isn't ready to bury psychologists and their ilk just yet. 'The truth is that psychoanalysis grew out of philosophy - it's not some completely new idea, and in fact, done properly, psychoanalysis is philosophical anyway. It may even be dangerous to the mental health of some people to suggest a philosopher rather than a properly trained analyst. The knowledge of analysts when it comes to many emotional problems is now much greater than that of most philosophers.' Guardian Unlimited © Guardian Newspapers Limited 2004. (shrink)

Virtual enterprise is a dynamic alliance of businesses, in which multiple members undertake joint research, development, manufacturing, operation, etc. The complexity of the relationship between business members, coupled with many new technologies or methods applied in the alliance operation, leads to more uncertain factors and difficulties in the operation and risk management of the virtual enterprise. The distributed decision-making model is a fast and effective decision-making model, in which dispersed intellectual resources and information resources are dynamically integrated through virtual (...) organization forms and operating mechanisms, and the dynamic reorganization, result evaluation, and synthesis of the decision-making system are realized by certain control rules. On the basis of summarizing and analyzing previous research works, this paper expounded the research status and significance of the risk control of virtual enterprise; elaborated the development background, current status, and future challenges of distributed decision-making model; introduced the related works of decision-making variable calculation and constraint determination; constructed a risk control model for virtual enterprise based on distributed decision-making model; analyzed the multiobjective model and interval programming model of risk control; established a risk control approach for virtual enterprise based on distributed decision-making model; performed the optimal allocation of risk control funds and the selective optimization of backup allies; and finally conducted a case analysis. The study results show that, in view of the diversity of relationships between alliance businesses and the complexity of the distribution of cooperative areas, the distributed decision-making model can more reasonably describe the relationship between alliance members and accurately control the risks of virtual enterprise from multiple angles, which can effectively manage the risks of virtual enterprise. The study results of this paper provide a reference for further research on the risk control of virtual enterprise based on distributed decision-making model. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

In 2017, Ukraine’s Parliament passed legislation establishing a single health benefit package for the entire population called the Programme of Medical Guarantees,‎ financed through general taxes and administered by a single national purchasing agency. This legislation was in line with key principles for financing universal health coverage. However, health professionals and some policymakers have been critical of elements of the reform, including its reliance on general taxes as the source of funding. Using qualitative methods and drawing on deliberative democratic (...) theory and criteria for procedural fairness, this study argues that the acceptance and sustainability of these reforms could have been strengthened by making the decision-making process fairer. It suggests that three factors limited the extent of stakeholders’ participation in this process: first, a perception among reformers that fast-paced decision-making was required because there was only a short political window for much needed reforms; second, a lack of trust among reformers in the motives, representativeness, and knowledge of some stakeholders; and third, an under-appreciation of the importance of dialogic engagement with the public. These findings highlight a profound challenge for policymakers. In retrospect, some of those involved in the reform’s design and implementation believe that a more meaningful engagement with the public and stakeholders who opposed the reform might have strengthened its legitimacy and durability. At the same time, the study shows how difficult it is to have an inclusive process in settings where some actors may be driven by unconstrained self-interest or lack the capacity to be representative or knowledgeable interlocutors. It suggests that investments in deliberative capital (the attitudes and behaviours that facilitate good deliberation) and in civil society capacity may help overcome this difficulty. (shrink)

Photo by Alex Guillaume on Unsplash Introduction The problem of climate change raises some important philosophical, existential questions. I propose a radical solution designed to provoke reflection on the role of humans in climate change. To push the theoretical limits of what measures people are willing to accept to combat it, an extreme population control tool is proposed: allowing people to reproduce only if they make a financial commitment guaranteeing a carbon-neutral upbringing. Solving the problem of climate change in the (...) long run by halting the procreation of human beings is controversial. In the absence of human beings and consequent climate change, other animals and plant species would benefit from an atmosphere more conducive to prolonging their existence and even improving their ability to thrive. If someone were to invent something to reverse the effects of climate change and improve animals’ lives, then human beings’ presence would be justified by the invention. Whether the propagation of the human species is beneficial to anyone or anything but human beings themselves is difficult to answer. Perhaps human beings are unfit to tackle this issue, being unable to judge it objectively. Managing Procreation: An alternative to Piecemeal Approaches Measures aimed at reducing greenhouse gases by nudging individuals and corporations may have a positive effect, but if their behavior is not climate neutral, they continue to contribute to climate change. Consequently, as long as the number of people increases, reducing greenhouse gases is at best a mitigation tool. If humans could rely solely on renewable energy, decreasing the population arguably would not be necessary. Significantly reducing the number of people appears to provide a solution to both problems: people who do not exist do not contribute to climate change, and renewable energy could meet the demand of a smaller population. One option is to let only those who produce the problem pay for its solution. One could determine the expected annual emission of greenhouse gases per person, assuming an average life expectancy, and calculate the costs to compensate them by, e.g., installing extra solar panels. Those expected costs could then be paid by the parents of each new person annually over the first eighteen years of that person’s life by dividing the total expected costs by eighteen. There are also practical difficulties. It would be difficult to determine the payment necessary. What should be done if a child has been born whose parents cannot afford to pay? In addition, child benefits could be canceled, contrary to recent incentives for child births instated in Italy,[1] where additional benefits will be made available to pay for childcare, and Hungary,[2] where women with four children or more will be exempted for life from paying income tax. A transition period could exist once the policy has been adopted, since it would be unreasonable to confront those who are already pregnant with costs they could not reasonably have expected. While the analysis is both hypothetical and theoretical, the impracticality is a noteworthy obstacle. There are several practical issues that cannot be addressed here, like the difficulty of calculating the added negative effects of each new individual and the unlikelihood that many citizens will support politicians who propose adopting policies that discourage having children. The upshot of what I have proposed is that climate change can be solved in the long run without financial costs to society as a whole, notwithstanding the transitional measures that would bring costs with them. Managing Procreation to Reduce Suffering Should this be deemed too harsh a stance, it is important to consider the basic issue of whether it is justified to introduce measures to reduce the number of people in an already overpopulated world, especially if climate change leads to additional suffering. One need not agree with Benatar, but his perspective must at least be taken seriously: It is curious that while good people go to great lengths to spare their children from suffering, few of them seem to notice that the one guaranteed way to prevent all the suffering of their children is not to bring those children into existence in the first place.[3] Benatar argues that non-existence is preferable to existence,[4] which raises the question why new people should be created at all. Those who question whether this planet will be habitable for future generations presuppose that such generations will exist. If people are not brought into existence, they may be said to be deprived of what life has to offer, but life must not be presupposed to be something positive. Whether this is the case in fact merits an inquiry of its own. A solution to the problem of climate change despite an increased population does not equate to a positive outcome since it merely means that something negative is removed. After all, solving the problem is not a means to an end, but a means to a means, the latter means being a means to a happy life, which does not automatically ensue from a solution to the problem. Benatar, as an anti-natalist, argues that procreation is morally wrong. His basic idea is that there is an asymmetry between pleasure and pain and that the pleasure that is not experienced by someone because that person does not exist is not something bad whereas the absence of pain that is not experienced – for the same reason – is something good.[5] Accordingly, “The reason why we do not lament our failure to bring somebody into existence is because absent pleasures are not bad.”[6] One may question whether such a perspective suffices to prove that coming into existence is always a harm, but the assertion that coming into existence exposes a new being to potential harm is clear. Objections A drawback of the proposed radical solution, placing the financial impediment on procreation, is that it will not solve climate change in the short run. A significant drop in the number of people may have a positive effect in the long run, but for now the behavior of the people in existence is the problem. Other climate change mitigation policies would necessarily continue. Additionally, there are important practical reasons to continue to procreate. The benefits for the elderly are paid for by the labor force. It is a problem that new generations are created as mere means to benefit older people. Perhaps more troubling, a pyramid scheme is created: by the time those people have themselves become old, a new labor force must have been brought into existence, a process that must presumably continue. If a consideration for people in developing countries to have children is that they cannot provide for themselves at an advanced age, while benefits are either lacking or insufficient, developed countries could collectively fund a pension scheme.[7] This may be low-cost if it is tailored to the living standard in the countries in question and given the life expectancy. Such a pension scheme should be predicated on the countries’ efforts in reducing the birth rate. If the labor force decreases, the economy may suffer. The focus on economic growth is arguably one of the causes of climate change, but if the number of people is reduced, the living standard does not have to be compromised, since the economy can then still grow. If fewer people began to use natural resources and nonrenewable energy at higher per capita rates, then the procreation might not be beneficial to the climate. It would need to be accompanied by regulations on use. One may also object that only wealthy people will be able to afford children. This is correct, but there is no right to have a child one cannot afford. The right to procreate does not entail the right to have as many children as one wants.[8] Yet in many countries, like the United States, it is a fundamental right that is constitutionally protected. There are numerous social, emotional, and even biological reasons why people choose to procreate. These may include the joy of having a family, the hope that children may bring in society, and the intergenerational transference of knowledge. People may have a strong desire to raise children or even a religious duty. If someone procures a sports car that is highly polluting, it would be justifiable to impose a tax in such a case. Many taxes and fines are imposed on corporate polluters. Procreation is significantly different but if the issue is regarded with some distance, then a climate change prevention tax could be appropriate. Some may argue that raising children is expensive already, which nonetheless does not deter people from having children. The tax I propose would be additional and specifically dedicated to carbon neutrality, but it would be difficult to predict whether it would discourage procreation. One last objection may be that for those now dedicated to sustainability for preserving the earth for the sake of future generations, there would be little or no incentive to continue any climate change mitigation efforts at all. If they sense they cannot afford to procreate, they may simply use every natural resource rather than save the earth for animals or for next generations. In a democracy, this problem does not exist if the majority can afford to procreate and agree with legislation on the basis of which such behavior is discouraged or punished. CONCLUSION Prior to their existence, there is no obligation to bequeath the earth to next generations. Such generations will only exist if they are actually created, and there is no obligation to create them. The lack of existence should not be confused with harm. Climate change provides an important reason to stem overpopulation. Ironically, fast rates of procreation may lead to the earth becoming uninhabitable for humans altogether. The radical solution that has been proposed here is an unrealistic scenario. For now, the average global birth rate is just over 18 per thousand people, but there is a need to ensure that the number of people is not greater than the planet can endure. While it is better to prevent problems than to solve them, the interest in procreation and its associated joys, usefulness, and cultural value make mass reduction in the population unlikely. Some countries have smaller average family size than others and can act as models for reducing population in a less radical way. The need to continue efforts to reduce climate change persists. Whether it would curb population growth or not, an additional financial burden applied to neutralizing each person’s offspring’s carbon footprint provides a meaningful thought exercise that could help alleviate the pressure on current climate mitigation strategies. [1] The Local Italy, How Italy’s new ‘Family Act’ aims to increase the plunging birthrate, https://www.thelocal.it/20200612/what-you-need-to-know-about-italys-new-family-act/. [2] BBC, Hungary tries for baby boom with tax breaks and loan forgiveness, https://www.bbc.com/news/world-europe-47192612. [3] David Benatar, Better never to have been, 6. [4] David Benatar, Better never to have been, 44, 58. [5] David Benatar, Better never to have been, 14, 30, 38. [6] David Benatar, Better never to have been, 35. [7] Alastair Leithead, “Can Niger break out of its cycle of poverty?”, https://www.bbc.com/news/world-africa-41018081; Sebastien Malo, “Fewer children, fewer climate risks? Niger ponders a controversial option”, https://www.reuters.com/article/us-niger-climate-change-familyplanning-idUSKBN1WM11E. [8] Sarah Conly, “The Right to Procreation: Merits and Limits,” American Philosophical Quarterly 42, no. 2 : 105-115, 105, 106. (shrink)

In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑BA decided in favor of NIPT, making the implementation of NIPT very likely, provided that other healthcare and political institutions also agree. This development could be interpreted as empowering from the perspective of reproductive (...) autonomy, since NIPT allows pregnant women to obtain valuable information on the health of the fetus in a fast and easy manner and without the risks of invasive methods. However, the routinization of NIPT also implies ethical challenges. Will the routinization lead to a normalization of prenatal quality control? Will it lead to an expansion to women outside the high-risk group? What would be the ethical implications of such a development? How should physicians, geneticists, and patients deal with the increased amount of obtainable information? What are the implications for choice and decision-making in the prenatal care context? In this paper, we analyze the ethical aspects of the routinization of NIPT, focusing on information and the counseling process, the burden of choice, and the threats to reproductive autonomy by societal interests linked to NIPT. (shrink)

In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑BA decided in favor of NIPT, making the implementation of NIPT very likely, provided that other healthcare and political institutions also agree. This development could be interpreted as empowering from the perspective of reproductive (...) autonomy, since NIPT allows pregnant women to obtain valuable information on the health of the fetus in a fast and easy manner and without the risks of invasive methods. However, the routinization of NIPT also implies ethical challenges. Will the routinization lead to a normalization of prenatal quality control? Will it lead to an expansion to women outside the high-risk group? What would be the ethical implications of such a development? How should physicians, geneticists, and patients deal with the increased amount of obtainable information? What are the implications for choice and decision-making in the prenatal care context? In this paper, we analyze the ethical aspects of the routinization of NIPT, focusing on information and the counseling process, the burden of choice, and the threats to reproductive autonomy by societal interests linked to NIPT. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Expose of a BreakdownIngrid HindellIregard my pension as a social wage, and even though I wish it took my disability and the extra costs that brings into consideration, eighteen years ago, I felt privileged to be able to work in the community, not in a sheltered workshop.At this time, a number of us worked voluntarily for numerous little organizations when the government cut their funding and in effect, (...) took away our jobs.It was around this time that I started a “stress cough.” Foolishly, I didn’t take much notice. I was enjoying “life”—studying, working, taking part in a documentary called “Untold Desires” and being a member of the “Friendship Group”—in which a group of us tackled the subject and nature of friendship for people with and without disabilities....The processes and the cohesion of the group brought up a lot of “stuff” for me that I wasn’t able to articulate. It made me question the wisdom of my lifestyle up to then—of marrying a person without a physical disability, for example.My mother used to tell me to tell him to tidy the flat, not in the least realizing that: i) it was distressing that I couldn’t do this; ii) that given all our interests it was difficult to tidy up. (This situation was also not helped, I now realize, by us trying to live and run home businesses from my small three–roomed accommodation behind my parent’s home, without enough support worker hours....)The flat was always cluttered, not conducive to encouraging a feeling of ease in us bringing clients onto the premises. As Robert’s massage workload grew, so did our underlying tension, I see now. And when I was starting to counsel other people with disabilities the situation was made worse....Added to this, my mother had, just prior to this period in our lives, stopped giving us our main meal because we were becoming more and more interested in eating organic and vegetarian food.At the same time, listening to other group members’ stories made me realize how “undervalued” people with disabilities are in society as I had been brought up in a loving extended family and had not long been “out.”It made me realize how much people with disabilities were constrained by lack of governmental funding for recreational—especially relationship options—with each other and with able–bodied people. The government was trying to close down little advocacy organizations that could keep this issue in the forefront of policy makers’ minds. No wonder I was getting close to breaking point! [End Page E1]When I got really bad, my husband almost went mad himself trying to cope with me. I had been the outgoing partner in the relationship for the past 12 years. Now I was getting panic attacks and clinging like poison ivy....And the therapists I went to at that stage didn’t help. The Naturopath was so expensive she made me much worse. She had told a “friend” of Rob’s that she would treat me for $30.00 a time. She did not say that she would present me with an ever– increasing bill every time I had an appointment—to pay her back when I could! And that her admin assistant would keep commenting, in my hearing, that people wouldn’t pay their bills on time.... At last, when the amount got to $450.00, I paid her all my savings, and managed to quit.I now also believe she treated me with a totally inappropriate therapy—colonic irrigation—for far too long, any natural therapist would say nowadays—five weeks!I believe it made my mental state worse. People say that an unquiet mind can stress the body into illness but I believe losing too much weight too fast as I certainly did, stressed my mind, instead of other way around.By this time I wasn’t only having panic attacks. I had slipped into, what I recently discovered, was a clinical depression. This brought in its wake, a terror so real, so all encompassing that I wonder I lived through a day of it—much less four... (shrink)

continent. 1.1 (2011): 22-25. The Author gratefully acknowledges the financial support of CAPES (Coordenação de Aperfeiçoamento do Ensino Superior), Brazil. From the multifarious subdivisions of semiotics, be they naturalistic or culturalistic, the realm of semiotics of value is a ?eld that is getting more and more attention these days. Our entire political and economic systems are based upon structures of symbolic representation that many times seem not only to embody monetary value but also to determine it. The connection between monetary (...) and linguistic exchanges is self-evident: the former requires the latter and develops in direct relation to it. Creative experimentation and design of digital systems of value exchange are blossoming on the web. Dr. Gilson Schwartz, an economist turned media theorist and professor at the University of São Paulo, adopted the concept of Iconomics, originally created by Michael Kaplan, an author concerned with the linguistics of economic value. Empowering local communities and unlocking new levels of value creation and representation via digital technologies are the main goals of Dr. Schwartz’s projects, aiming at the re-designing of our relationship to the economic value of imagination and the social control of property. Schwartz is Assistant Professor at the School of Communication and Arts of the University of São Paulo, a former Chief Economist at BankBoston, Brazil and Advisor to the President of the National Social and Economic Development Bank (BNDES). FURTHER READING: Kaplan, Michael. “Iconomics: The Rhetoric of Speculation.” Public Culture . 15.3 (2003): 477-493. Renata Lemos-Morais: You have recently produced and directed a short documentary about Creative Currencies in Latin America. Could you tell us a bit about its process and its findings? Gilson Schwartz: The “Creative Currencies” project is a work-in-progress platform which unfolds as an action research agenda connected both to the production of audiovisual content and the development of social currency software. The initiative dates back to 2003 when I led an experimental project supported by the Presidency of Brazil. At that time, we issued paper currency in a small, touristic village in the Northeast Region which stimulated local cultural projects. But it was only in 2009 that the Central Bank of Brazil acknowledged “social currencies” as a legitimate economic agenda, calling for more debate at the I Financial Inclusion Forum. This year, the monetary authorities organized a second forum that also opened the room to discussions on mobile payment systems and new perspectives on poverty alleviation via State subsidies. The Ministry of Culture funded the “Creative Currencies” project in 2009-2010 and our next stage in this discovery process is to be supported by the National Social and Economic Development Bank (BNDES). In short, there is genuine interest among public officials in different areas and public funding for social currencies is on the rise in Brazil. However, after all these years we are still at a very early stage of research and practice. Some of the most successful initiatives (such as Banco Palmas) actually evolved out of local monetary creation to become correspondent banking operations for commercial banks and other financial groups. After eight years of price stability and social inclusion, Brazil stands out as a major opportunity for social experimentation, even the Grameen Bank is now entering the Brazilian market and many NGOs are geared towards different forms of entrepreneurialism in the base of the pyramid, riding solidarity economic models, microfinance and microcredit for local development. It is yet to be seen, however, whether these developments are just one more stage of “bankarization”, that is to say, an extension of regular banking services or actually a new form of social and symbolic self-determination at the local level. So far, the Central Bank of Brazil is open to new forms of credit and local finance as long as they are strictly territorial and very close to barter among the poor. In other words, whether the process of monetary creation could be made to fit an open source paradigm is yet to be seen. Community banking and social currencies might as well end up as just another channel for access to and use of banking services. The “Creative Currencies” project aims at promoting the discussion of more fundamental issues, such as the limits of central banking, the prospects for local financial development and the possibility of creating and managing financial icons as cultural assets. The purpose of this project is to produce short documentaries that will bear testimony to this evolving regulatory framework while inducing more discussion about the fundamental iconomic issues concealed in the process of money and wealth creation. RLM: What new potential is there in applying digital technologies to currency creation? GS: Globalization is a result of the virtualization of money, that is, the overcoming of illusions such as the “gold standard”. Money is an icon created by institutions, not on supposedly natural or material foundations but out of political and financial interests. The “dollar standard” is an outstanding evidence of this phenomenon and Kaplan´s paper, the first to use the expression “iconomics”, insists on the rhetoric and semiotic effects associated to a supposedly scientific model of money creation and management. This is a fundamental change that was perceived and discussed much before the digitalization of the world by unorthodox economists such as John Maynard Keynes since the early 20th century. The digitalization of global financial flows accelerated this immateriality and the creation of the Euro was yet another evidence of the political foundations of currencies. The banking establishment, however, is keen on the idea that scientific formulae hold the key to sound money creation. Keynesianism has been repeatedly associated to “inflationism” while the supposedly sound monetary policies of the Orthodoxy serve well the political and financial interests of a technocratic elite. Corporate media also serve this fictitious depiction of the monetary process despite the cyclical bust of monetary rules and financial regulations. The internet, however, has created numerous opportunities for the disintermediation in industries such as film, music and commodities. There is no reason to doubt that the financial industry can also be transformed by Peer-to-Peer (P2P) infrastructures. Money is media as well. Credit is but confidence. Once people realize that the distributed computing power of networks can also be the platform to weave new monetary and credit operations, there is room for grassroots emancipation out of the established owners of monetary institutions. So far, however, there has been a privatization of monetary management and there is not a clear path or model for the emergent (P2P) property democratization that is inherent to the internet. Digital assets, however, clearly have an inherent potential to escape central control and proprietary regulatory frameworks. RLM: How are social networks transforming the ways in which we exchange value? Do you believe that online influence and reputation might be translated into a new kind of currency? GS: The foundation for social currencies as envisaged by solidarity economics is the territory. Authorities are willing to concede local monetary creation as long as it is restricted to poor neighborhoods, as a proxy to barter. In this relevant but limited context, reputation, personal knowledge and informal ties form the matrix of local or “proximity” finance which are expected to keep credit and leverage to a sustainable level. Anything beyond that should and would lead to an integration of local finance into the established banking system. However, inasmuch as the internet promotes virtual territories and reputation is now subject to all sorts of digital manipulation and stardom becomes an everyday cultural process among teenagers and elders alike, the territorial “foundation” is substituted for more complex patterns of solidarity, cooperation and exchange that reach beyond the physical territory and even the “human.” Digital assets embody knowledge, technology, cultural and educational values that are exchanged at a global scale beyond the control of democratic States (Chinese-like intervention is the exception, not the rule). Hacktivism is unstoppable and so is monetary hacktivism. Especially in the Third World, mobile communications fast became conveyors of money transfers and other appropriation strategies. Banking and telecom sectors already battle for the control of these emerging markets and, as a matter of fact, have so far contributed to the containment of these processes. Governments serve these moguls and have usually adopted a wait-and-see attitude. If open source hardware and grassroots social movements combine to challenge these proprietary battles, then social networks may evolve into new forms of social capital and thus form the ground on which to design and implement social currencies. The global financial crisis, as well as the dollar demise, are an event of such a proportion that social networks may open the path for emancipator subjects to seize the opportunity. RLM: What are some of the social experiments that you think are revolutionizing the way in which value is exchanged? GS: There is a broad evolution of economic systems towards the valuation of intangible assets such as knowledge, reputation and sustainability. There are many examples of local as well as global events that call the traditional systems of exchange into question, from carbon credits to educational bonuses, digital barter frameworks and locally based solidarity and fair trade networks. These emerging examples, no matter how different in nature or scale, represent a challenge to the traditional value creation schemes and theories which are based on use and exchange value, supply and demand. This is not to say that utility and labour or scarcity are to be totally dismissed, but there is now an emerging perception that value is also a function of behavioral codes, symbolic patterns and the energy of institutional frameworks. The plasticity of digital platforms is relevant insofar as intellectual property becomes the central source of value creation. But when you discuss the property rights of public goods such as the environment or basic social rights (of minorities or localities), then a new paradigm seems to emerge. RLM: Are gaming and online storytelling digital practices that might have an impact on the way new currencies are created and developed? GS: “Play money” has been one of the early and most intriguing phenomena associated to the diffusion of virtual worlds. These virtual currencies have also been prone to “boom and bust” dynamics, speculation and pure theft (Second Life scams were common and led to “intervention” by the owners of the game). Storytelling is a major source of value, that is, the value of attention and the markets for audience. There are plenty of private monies created and managed by corporate entertainment groups, telecom operators (via mobile virtual network operators) and marketing frameworks. The casino economy, as already depicted by Keynes and other unorthodox economists, is always storytelling about future states of the world, confidence building and leverage of animal spirits. The novelty of current events is not the fictitious nature of any form of capital, but the potential for digital democratization of controls over the imaginary nature of value creation. But this is just a potential, a possibility, a figment that more often than not is appropriated by centralized and opaque private powers. The game industry is a testbed for new connections between storytelling and money creation. RLM: Monetary value was originally connected to the scarcity of precious metals, such as gold. Our entire monetary system seems therefore to function according to a logic of scarcity. Do you believe it is possible to reverse this logic into a logic of abundance? GS: The gold standard was a fiction itself, the “scarcity” is always produced by institutions that regulate confidence and access to credit. The key issue is not to fabricate abundance, but to question the institutions which produce scarcity out of any standard, gold or whatever. Central banks are at the service of private banks in the creation and management of scarcity. RLM: The promise that nanotechnology holds for our future is one of radical abundance (or so say transhumanists). The possibility of creating any kind of material substance through nanoengineering seems each day more feasible. What would this possibility entail in terms of systems of value exchange? GS: Nanotechnology, environmental concerns and grassroots appropriation of distributed knowledge are the frontiers of a new horizon of energy creation and management. Social groups in charge of managing scarcity for the sake of wealth and power concentration must be held accountable for the destruction of our future. Once this key political conundrum is accounted for, new systems of value exchange and even a non-mercantile society will come into existence. Revolutionary theorists such as Marx envisaged transformation via the extreme clash of contradictions between capital and labour. This approach has never led to a change in the systemic logic of scarcity for the sake of social control. We are once again facing the threshold of large scale societal change, but the outcome of the current crisis should come from our imagination, not from yet another paradox of abundance and scarcity. As long as we remain attached to the materiality of value, the illusion of freedom will but reinforce the massive manipulation of necessity. RLM: What do you think is the role of crowdfunding in this context? GS: Crowdsourcing as well as crowdfunding are examples of the peer to peer opportunities that come along with distributed computer power. However, the power structure behind wealth and scarcity creation may or may not be changed by crowd management. But it should not be taken at face value, so to speak. The stock market of course is an early form of crowdfunding without calling into question the proprietary framework of the companies offering their investment projects to the market. Any market is a form of crowdsourcing, that is to say, of distributed forms of supply and demand matchmaking. The wealth of networks, however, depends on the contractual ecosystem, the institutional framework, the channeling of social imagination, not on the purely quantitative distribution of bids and offers. I see economics as supply, demand and code. Once you have access to the code, once openness becomes part of the game, then there is a chance of crowd behavior becoming collective intelligence and sustainable imagination. RLM: Is the development of digital currencies headed towards a pluralistic ecology in which many micro currency systems co-exist, or is it penetrating the mainstream monetary system? If it is affecting the mainstream financial system, what would be its effect in the long-term? GS: The same issue is at stake both at local and global levels. The global system is, as a matter of fact, an unstable ecosystem of “micro currencies” whereas the dollar has so far exerted an overwhelming influence. Local currencies and private monies coexist with national currencies only to the extent that the Central Bank admits, for instance, that grassroots monetary emissions remain territorial and strictly connected to poverty. However, the question of how new developments in digital technologies and nanotechnologies might alter not only our current monetary systems but also our understanding of value in itself, is still an open question. (shrink)

During a pandemic, where there is widespread human infection, various and varying measures are taken that are targeted at public health objectives. During the early stages of a pandemic, these objectives may focus on containing the disease and minimizing its spread, but they may switch to mitigation as the emergent infectious disease takes hold in a population. There has been considerable debate and elucidation of the ethical principles and framework for the various responses including the need to fast track (...) research and vaccine development. However, the measures imposed during a pandemic would have unintended and untoward effect on ongoing clinical research. For example, precautionary measures, such as social distancing, may hamper ongoing clinical research, because recruitment and participation of patients and healthy volunteers is a potential source of virus spread. In this paper, we argue that a framework is needed to ensure the continuity of such research. Such a framework that considers the pertinent issues would need the ‘buy in’ of the key stakeholders (policy makers, funding agencies, institutional authorities, researchers and subjects) to ensure that the issues that are ethically relevant to pandemic planning would not be neglected or overlooked. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reflections on Academic ReflectionJohn D. Copenhaver Jr.Contemplative pedagogy deserves both the careful scrutiny and the sustained exploration that the Society for Buddhist-Christian Studies is uniquely well suited to provide. As higher education comes under increased pressure for accountability, we need to be able to explain clearly both the pedagogical value and academic integrity of these elements in our curriculum. Academics seeking to incorporate contemplative practices into their teaching need (...) to pay careful attention to their institutional setting. While people in all types of higher education may share certain values (e.g., free inquiry, critical thinking, intellectual rigor, clear reasoning), different institutional settings offer different kinds of opportunities and challenges. Shenandoah University, where I teach, is one of five private universities in Virginia related to the United Methodist Church (UMC). All these schools acknowledge the relationship, but some seem rather embarrassed by it. For us it is a warm embrace.In its mission statement, our university characterizes the relationship this way: “As an institution affiliated with the United Methodist Church, Shenandoah University practices the highest ethical standards in its interactions with the community and with students of other faiths.”1 While the university is clear about its church affiliation, the phrase “highest ethical standards in its interaction with students of other faiths” indicates the kind of mutual respect and understanding that characterize pluralism. Among its core values are “respect for diverse cultures, experiences, and perspectives” and “dedication to global outreach.”2 Dedication to “global outreach” sounds like window dressing, but it is genuine. With its Global Citizenship Project, the university funds all expenses for fifty-five students each year to travel to one of five countries over spring break for cultural immersion. This mission statement and our core values make it much easier to root our religious studies curriculum in an atmosphere of religious pluralism than one might expect at a church-related university.Our Department of Religion recognizes two purposes for religious studies. The first is to offer an array courses to meet general education needs for moral reasoning and cross-cultural understanding. One of the department’s goals for general education religion courses is to promote interreligious and multicultural understanding. Another is to serve the church by offering a program to train students for religious leadership roles, called the JustFaith Christian Leadership Program. It is designed to integrate theological education and spiritual formation that promotes social justice. [End Page 41] In the department’s view, this commitment to justice is consistent with our Wesleyan heritage, but is often neglected in churches and rare in higher education. Although our religion major requirements reflect the university’s Christian heritage, we do require a course in world religions and one course in a religious tradition other than Christianity.This institutional setting invites me to teach in very different ways. Of the eight courses I teach over a two-year rotation, two take a philosophical approach, two take a phenomenological approach without any contemplative practices, and two blend the phenomenological approach with contemplative practices.3 The other two I teach “from the inside,” as a Christian ordained in the United Methodist Church. I present my own experience and convictions as part of that tradition, and the course emphasizes religious practices such as fasting, prayer, meditation, contemplative prayer, and/or periods of solitude. This confessional approach would not be possible at a state university, but I think students should have this option at church-related schools. The delicate issue is that most students do not come to our university because of its religious heritage. Our students are much like their counterparts at state universities, and often register for courses on the basis of what fits their academic schedules rather than any particular interest in or affinity for the topic. For this reason, we try to be as clear as possible in course descriptions about the various contents and approaches of our courses. Still, that does not prevent a poorly advised agnostic or atheist from registering occasionally for my course on Christian spirituality. On the first day of class I discuss the confessional nature of the course and the spiritual exercises students will be expected to do. I do not screen anyone... (shrink)

This collection of current research on logic programming languages presents results from a three-year, ESPRIT-funded effort to explore the integration of the foundational issues of functional, logic, and object-oriented programming. It offers valuable insights into the fast-developing extensions of logic programming with functions, constraints, concurrency, and objects. Chapters are grouped according to the unifying themes of functional programming, constraint, logic programming, and object-oriented programming.

Most accounts of the influences on Gandhi's philosophy and tactics of nonviolent action do not give enough credit to the role that women in the British suffrage movement played in inspiring and guiding him. The article explains how, despite his specifically mentioning on occasion that he is NOT copying their tactics, he actually does repeat many of them in his 1913 satyagraha campaign in South Africa. And on many occasions he does credit them with inspiring him and his movement. In (...) the early years (1906-1912) Gandhi repeatedly suggested to men in his movement that they copy the brave determination of the British suffragettes, but he did not counsel Indian women to follow their example. Women in his own movement longed to court arrest since 1908, but were only allowed by Gandhi to participate in 1913. It's important to recognize the many ways in which women's leadership were crucial to the success of campaigns that Gandhi is given credit for, including the women's speech making, raising funds, suggesting tactics, as well as their bravery and willingness to endure suffering and even death in prison. (shrink)

Dieser Band der Husserliana Materialien enthält die Erstveröffentlichung der Dissertation von Winthrop Pickard Bell, dem ersten englischsprachigen Doktoranden Edmund Husserls. In seiner Arbeit untersucht Bell die Erkenntnistheorie seines einstigen Harvard-Professors, dem amerikanischen Pragmatisten und Idealisten Josiah Royce, und entwickelt hierzu eine Kritik vom Standpunkt der Husserl'schen Erkenntnisphänomenologie. Husserl selbst hatte ihn gebeten, über dieses Thema zu forschen. Die Beilagen dieses Bandes beinhalten Husserls Kommentare und Änderungsvorschläge zu der Arbeit sowie die 1922 im "Jahrbuch der philosophischen Fakultät in Göttingen" erschienene Zusammenfassung (...) derselben. Nachdem Winthrop Bell zwei Jahre in Harvard bei Josiah Royce studiert hatte, kam er 1910 nach Leipzig. Hier und später in Göttingen befasste er sich mit Husserls Phänomenologie und schloss sich dem Kreis der Studenten an, der sich um Husserl und Reinach als "Göttinger philosophische Gesellschaft" gebildet hatte. Im Sommer 1914 stellte Bell seine Dissertation schließlich zu einem denkbar ungünstigen Zeitpunkt fertig. Als kanadischer Staatsbürger - und somit Bürger eines Landes der feindlichen Alliierten - wurde er mit Ausbruch des Ersten Weltkriegs im August 1914 inhaftiert und verbrachte fast die gesamte Kriegszeit in einem Gefangenenlager bei Berlin. Das Dissertationsverfahren konnte erst im Jahr 1922 abgeschlossen werden. Im Zuge dieser Turbulenzen erschien 1922 lediglich eine Zusammenfassung von Bells Doktorarbeit im "Jahrbuch der philosophischen Fakultät in Göttingen", die Arbeit selbst blieb bis 2012 in Kanada unter Verschluss. Auf Husserls nachdrückliche Empfehlung trat Bell jedoch 1922 eine Professur in Harvard an und trug maßgeblich zur Verbreitung der Husserl’schen Phänomenologie in Nordamerika bei. Die Kapitel „Die ‚erste Ansicht des Idealismus‘ und die Voraussetzungen der Royce’schen Erkenntnistheorie“ und „Kritik von Royces Voraussetzungen. Der eigentliche Boden einer Erkenntnistheorie. Die reine Wesenslehre des Bewusstseins“ sind auf link.springer.com unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht. This book was produced with the generous funding of the Social Sciences and Humanities Research Council of Canada, KU Leuven, the Harrison McCain Foundation, the University of New Brunswick Busteed Publication Fund, the Department of Philosophy at the University of New Brunswick, and David Mawhinney. (shrink)

There is an old saw in health policy that everyone wants health care that is good, fast, and cheap — but it’s impossible to have more than two of these at one time.A similar bit of folk wisdom seems intuitively true for the development and testing of new pharmaceutical products. The public is in a bind. We want breakthrough drugs, and fast. But we also want these drugs to be affordable, thoroughly tested, safe, and effective. It seems we (...) can’t have it all.In this paper, we will not claim that one can have it all — but that we can do far better than we are at present. First, we review extensive data on contemporary problems in the design, conduct, and analysis of industry-sponsored clinical trials. Finding major issues that have been solidly documented over more than a decade, we provide many examples of the multifarious ways in which industry-funded trials have been manipulated to raise the likelihood of producing industry-friendly results. (shrink)

The growth of socially responsible investment (SRI) on public financial markets has drawn considerable academic attention over the last decade. Discarding from the previous literature, this article sets up to analyze the Private Equity channel, which is shown to have the potentiality to foster sustainable practices in unlisted companies. The fast integration of the environmental, social and governance issues by mainstream Private Equity investors is unveiled and appears to have benefited from the maturation of SRI on public financial markets (...) and the impetus of large conventional actors. Hypotheses on the characteristics and drivers of this movement are proposed and tested on a unique database covering the French Private Equity industry in 2011. Empirical findings support that Private Equity socially responsible investing is characterized by investor engagement and strategically driven by a need for new value creation sources, increased risk management and differentiation. In particular, results show that independent funds, which need to attract investors, are more likely than captive funds to develop socially responsible practices. Evolution of the movement and future research paths are proposed. (shrink)

This book invites a conversation among stakeholders of public education and conveys the need for a common vision for America’s public schools. Amy Fast argues that we have never had a clear purpose for our schools and that now, more than ever, educators in America ache for a more inspiring purpose than simply improving results on standardized assessments.

This trans-disciplinary, socio-spatial study analyzes the history of decolonial existentialist and phenomenological theory in the work of figures such as Simone de Beauvoir, Richard Wright, Franz Fanon, Lewis Gordon, Audre Lorde, Sylvia Wynter, and Jamaica Kincaid to decolonize dominant discourses on femininity, Blackness, and Black peoples.

In _Selving: A Relational Theory of Self Organization_, Irene Fast invokes the basic distinction between the self as "me" and the self as "I" in order to develop a contemporary theory of the self as subject. In a return to Freud's clinical finding that all psychological processes are personally motivated, she elaborates a notion of the "I-self" that is intrinsically dynamic and relational. Within this conception, our perceiving, thinking, feeling, and acting are not what our self does; rather, they (...) are what our self is. According to Fast, the basic unit of the dynamic I-self --of selving --is a scheme of personally motivated interaction between self and nonself. This notion, which comprehends development as a product of integration and differentiation among discrete I-schemes, provides a radically new framework for understanding those dynamic phenomena that Freud included within his structural model of the mind and that contemporary theorists have addressed within object relational perspectives. Via the notion of selving, Fast likewise brings fresh insight to a host of issues that have engaged psychoanalysts and developmental psychologists in recent years. These topics include the place of bodily experience in a relational model of mind, the organization of self as simultaneously individual and relational, the formulation of a constructivist model of psychic structure, among others. _Selving_ is not only a lucid demonstration of how a relational theory of self can reorder clinical observations in conceptually and therapeutically illuminating ways. It is also a convincing demonstration of how a constructivist model emphasizing the interactive nature of meaning-making provides bridges to Piagetian theory, developmental research, and observational infancy studies. (shrink)

In this paper, we examine the practicalities of nurse managers’ work. We expose how managers’ commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We (...) learned how nurse managers’ responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers’ responsibilities are shaped to conform to institutional purposes. (shrink)

Over the last few decades there has been a substantially higher percentage of successful organ transplants but also a significant imbalance between the demand for and the supply of organs, creating the basis for a highly profitable black market trade in human organs. Sometimes there are reports that children have been kidnapped, only to reappear later lacking one kidney, or that they simply disappear and are subsequently killed to have all their transplantable organs removed for profit. The European Union feels (...) that there is a need for action and that it has a duty to act in this field, especially for ethical reasons. There is now established close co-operation between the various European transplant organizations. The legal protection of children with regard to organ transplantation is not specifically mentioned in the existing conventions because this issue was not foreseen at the time of their preparation. However, the issue is covered in a broader sense by more general provisions. There are endless rumours surrounding this area. Members of various organizations who travel in the suspected countries say that the trafficking in children who are sold for transplantation is well known, but it is too difficult and very dangerous to catch the people involved. We have to conclude that it has been impossible to prove or disprove the rumours, but they are consistent and we all, especially in the health care professions, have an obligation to be keenly aware of how and where organs are obtained. (shrink)