In Setting Limits, Daniel Callahan advances the provocative thesis that age be a limiting factor in decisions to allocate certain kinds of health services to the elderly. However, when one looks at available data, one discovers that there are many more elderly women than there are elderly men, and these older women are poorer, more apt to live alone, and less likely to have informal social and personal supports than their male counterparts. Older women, therefore, will make the heaviest demand (...) on health care resources. If age were to become a limiting factor, as Dr. Callahan suggests it should, the limits that will be set are limits that will affect women more drastically than they affect men. This review essay examines the implications of Callahan's thesis for elderly women. (shrink)

Epistemologies have power. They have the power not only to transform worlds, but to create them. And the worlds that they create can be better or worse. For many people, the worlds they create are predictably and reliably deadly. Epistemologies can turn sacred land into ‘resources’ to be bought, sold, exploited, and exhausted. They can turn people into ‘labor’ in much the same way. They can not only disappear acts of violence but render them unnamable and unrecognizable within their conceptual (...) architectures. Settler systems of epistemic and conceptual resources and the relations among them are constructed to preclude certain forms of knowledge. This is not an accident; it is a central goal of colonial violence. Colonization and land dispossession would not be possible without the violent disruption of Indigenous knowledge systems and ongoing organized attempts to disrupt their survival. Violently disrupting the relationships of people to land is as much an epistemic project as it is a material one, and these two projects are inherently linked. The task of theorizing epistemic oppression is not only about epistemic oppression. Epistemic oppression is a story that gives language to a phenomenon in order to get past it, to carry on with the maintaining and reviving the forms of Indigenous and diasporic knowledge that colonialism has worked tirelessly to corrupt and silence. (shrink)

Many of the demands being voiced for a "humanizing" of health care center on the public's concern that they have some say In determining what happens to the individual in health care institutions. The essays in this volume address fundamental questions of conflicts of rights and autonomy as they affect four selected, controversial areas in health care ethics: the Limits of Professional Autonomy, Refusing! Withdrawing from Treatment, Electing "Heroic" Measures, and Advancing Reproductive Technology. Each of the topics is addressed in (...) such a way that it includes an examination of the locus of responsibility for ethical decision making. The topics are not intended to exhaustively review those areas of health care provision where conflicts of rights might be said to be an issue. Rather they constitute an examination of the difficulties so often encountered in these specific contexts that we hope will illuminate similar conflicts in other problem areas by raising the level of the reader's moral awareness. Many books in bioethics appeal only to a limited audience in spite of the fact that their subject matter is of deep personal concern to everyone. In part, this is true because they are frequently written from the perspective of a single discipline or a single profession. As a result, one is often left with the impression that such a book views the philosophical, historical, and! or theological problems as essentially indifferent to clinical, legal, and! or policy-making problems. (shrink)

In Setting Limits, Daniel Callahan advances the provocative thesis that age be a limiting factor in decisions to allocate certain kinds of health services to the elderly. However, when one looks at available data, one discovers that there are many more elderly women than there are elderly men, and these older women are poorer, more apt to live alone, and less likely to have informal social and personal supports than their male counterparts. Older women, therefore, will make the heaviest demand (...) on health care resources. If age were to become a limiting factor, as Dr. Callahan sug-gests it should, the limits that will be set are limits that will affect women more dras” tically than they affect men. This review essay examines the implications of Callahan's thesis for elderly women. (shrink)

A series of letters between a professor of philosophy and an eleven-year-old girl.

Review of Alastair V. Campbell: Medicine, Health and Justice: The Problem of Priorities.

In Setting Limits, Daniel Callahan advances the provocative thesis that age be a limiting factor in decisions to allocate certain kinds of health services to the elderly. However, when one looks at available data, one discovers that there are many more elderly women than there are elderly men, and these older women are poorer, more apt to live alone, and less likely to have informal social and personal supports than their male counterparts. Older women, therefore, will make the heaviest demand (...) on health care resources. If age were to become a limiting factor, as Dr. Callahan suggests it should, the limits that will be set are limits that will affect women more drastically than they affect men. This review essay examines the implications of Callahan's thesis for elderly women. (shrink)

The increasing use of cluster randomised trials in low-resource settings raises unique ethical issues. The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomised Trials is the first international ethical guidance document specific to cluster trials, but it is unknown if it adequately addresses issues in low-resource settings. In this paper, we seek to identify any gaps in the Ottawa Statement relevant to cluster trials conducted in low-resource settings. Our method is to analyse a prototypical cluster trial conducted (...) in a low-resource setting with the Ottawa Statement; to identify ethical issues in the design or conduct of the trial not captured adequately and to make recommendations for issues needing attention in forthcoming revisions to the Ottawa Statement. Our analysis identified six ethical aspects of cluster randomised trials in low-resource settings that require further guidance. The forthcoming revision of the Ottawa Statement should provide additional guidance on these issues: streamlining research ethics committee review for collaborating investigators who are affiliated with other institutions; the classification of lay health workers who deliver study interventions as health providers or research participants; the dilemma experienced by investigators when national standards seem to prohibit waivers of consent; the timing of gatekeeper engagement, particularly when researchers face funding constraints; providing ancillary care in health services or implementation trials when a routine care control arm is known to fall below national standards and defining vulnerable participants needing protection in low-resource settings. (shrink)

I Norge har vi hatt kontroverser omkring regulering avhumanmedisinsk bioteknologi siden 1980-tallet. Denneartikkelen analyserer et lite utsnitt av disse reguleringsdebattene,nærmere bestemt kontroversen omkring forskningpå befruktede egg. Med utgangspunkt i skriftlig materialeknyttet til tre reguleringsrunder undersøker vi her hvordan ulike aktører arbeidet forå ramme inn denne kontroversen, bl.a. ved hjelp av ulikevitenskapelige og politiske representasjoner av det befruktedeegget.Vi finner at det i perioden 1987–2007 ble arbeidet medulike innramminger som utgangspunkt for retoriske ogpolitiske strategier: På den ene siden ser vi forsøk på (...) å innrammekontroversen i et risikorammeverk som først ogfremst fokuserte på de potensielle negative sidene vedhumanmedisinsk bioteknologi, og som spesielt vektlarespekten for det ufødte liv. På den andre siden ser vi atman arbeidet med en forventningsinnramming som lahovedvekten på håpet om nye behandlingsregimer foralvorlig syke mennesker.Forbudet mot forskning på befruktede egg som ble vedtatti 1987, ble opprettholdt i 1994 og 2003. Med lovendringeni 2008 fikk vi imidlertid et markant brudd i dennorske lovgivningspraksisen, da forskning på befruktedeegg ble tillatt på visse premisser. Vi argumenterer for at den viktigste årsaken til denne lovendringen var Mehmet-saken, en sak som medførtesåkalte «oversvømmelser» i begge innrammingsforsøkenesom er omtalt ovenfor. Mehmet-saken eksponerte samtidig et generelt demokratiskdilemma. Saken illustrerte hvor sårbare lovregler og etiske prinsippkan være for det som for allmennheten fremstår som helt urimelig, og dennesaken etterspør slik sett mer hybride måter å tenke forholdet mellom det universelleog det partikulære, mellom prinsipiell etikk og lekmannsskjønn, mellomfakta og verdier som utgangspunkt for politikkutforming.Nøkkelord: humanmedisinsk bioteknologi, forskning på befruktede egg,kontrovers, representasjoner, Mehmet-sakenEnglish abstract: Effective representations? Concerns and expectationsregarding research on fertilized eggsSince the 1980s, there have been several debates and controversies concerningthe regulation of medical biotechnology. In this article, we analyze three suchinstances in Norway, mainly the debates concerning research on fertilizedeggs. Analyzing the debates surrounding the regulations of 1994, 2003/2004and 2008, we investigate how different stakeholders strived to mobilize whatwe call different framings of the controversy, utilizing the different scientificand political representations of the fertilized egg.Framing involves creating baselines for rhetorical and political stratagems.Two framings appear more pronounced than others in the Norwegian debate.On one hand, we find attempts of framing the controversy in a risk centricframework, which mostly emphasizes the potential negative effects of medicalbiotechnology as it focuses on the universal reverence for the unborn life. Onthe other hand, we see attempts to mobilize a positive frame of expectationthat emphasizes on the hope of finding new and effective treatment options forthe severely ill.The ban against research on fertilized eggs that was passed in Norway in1987 was repeated in 1994 and 2003. However, with the changes introducedto the law in 2008, there was a noticeable shift in Norwegian legislation, asresearch on fertilized eggs became permissible if specific conditions were met.We argue that the turning point in this regulative change was the Mehmentcase, a particular case that entailed the so-called «overflowing» in both the negative and the positive frame. The Mehmet case exposed a moregeneral democratic and political dilemma. In our opinion, it illustrates howvulnerable can regulation that is based on general ethical principles be in theface of what appears to the laity as unreasonable. Thus, we argue that thisactualizes the need for more hybridized ways to view the relationship betweenthe universal and the particular, between principle-based ethics and theunderstandings of lay people, between facts, and values and actual cases inpolicy shaping and practice. (shrink)

[1] Elul. Yamim Noraʼim. Sukot -- [2] Pesaḥ. Shevuʻot. Galut u-geʼulot. Ḥanukah. Purim.

ha-R. ha-ḳ. R. Mosheh mi-Drogiṭshin -- ha-R. ha-ḳ. R. Avraham me-Ulinov -- ha-R. ha-ḳ. R. Shelomoh Leyb mi-Lenṭshna -- ha-R. ha-ḳ. R. Meʼir mi-Primishla -- ha-R. ha-ḳ. R. Avraham mi-Miḳalyov -- ha-R. ha-ḳ. R. Daṿid mi-Zovliṭov -- ha-R. ha-ḳ. R. Shmelḳe mi-Sasov -- ha-R. ha-ḳ. R. Yeshaʻy. Shor -- ha-R. ha-ḳ. R. Yeḥiʼel Mikhal.

There is good reason to believe that scientific realism requires a commitment to the objective modal structure of the physical world. Causality, equilibrium, laws of nature, and probability all feature prominently in scientific theory and explanation, and each one is a modal notion. If we are committed to the content of our best scientific theories, we must accept the modal nature of the physical world. But what does the scientific realist’s commitment to physical modality require? We consider whether scientific realism (...) is compatible with Humeanism about the laws of nature, and we conclude that it is not. We specifically identify three major problems for the best-systems account of lawhood: its central concept of strength cannot be formulated non-circularly, it cannot offer a satisfactory account of the laws of the special sciences, and it can offer no explanation of the success of inductive inference. In addition, Humeanism fails to be naturalistically motivated. For these reasons, we conclude that the scientific realist must embrace natural necessity. (shrink)

Calls for civility have been on the rise recently, as have presumptions that civility is both an academic virtue and a prerequisite for rational engagement and discussion among those who disagree. One imperative of epistemic decolonization is to unmask the ways that familiar conceptual resources are produced within and function to uphold a settler colonial epistemological framework. I argue that rhetorical deployments of ‘civility’ uphold settler colonialism by obscuring the systematic production of state violence against marginalized populations and Indigenous peoples, (...) relying on the colonial conceptual framework of ‘civilized’ vs ‘savage’, and excusing death-promoting rhetoric under the guise of liberal disagreement. (shrink)

Structural gaslighting arises when conceptual work functions to obscure the non-accidental connections between structures of oppression and the patterns of harm they produce and license. This paper examines the role that structural gaslighting plays in white feminist methodology and epistemology using Fricker’s (2007) discussion of hermeneutical injustice as an illustration. Fricker’s work produces structural gaslighting through several methods: i) the outright denial of the role that structural oppression plays in producing interpretive harm, ii) the use of single-axis conceptual resources to (...) understand intersectional oppression, and iii) the failure to recognize the legacy of women of color’s epistemic resistance work surrounding the issue of sexual harassment in the workplace. I argue that Fricker’s whitewashed discussion of epistemic resistance to sexual harassment in the United States is a form of structural gaslighting that fails to treat women of color as knowers and exemplifies the strategic forgetting that is a central methodological tactic of white feminism. (shrink)

Causal structuralism is the view that, for each natural, non-mathematical, non-Cambridge property, there is a causal profile that exhausts its individual essence. On this view, having a property’s causal profile is both necessary and sufficient for being that property. It is generally contrasted with the Humean or quidditistic view of properties, which states that having a property’s causal profile is neither necessary nor sufficient for being that property, and with the double-aspect view, which states that causal profile is necessary but (...) not sufficient. Shoemaker’s (1998) and Hawthorne’s (2001) arguments in favor of causal structuralism primarily focus on problematic consequences of the other two views. I argue, however, that causation does not provide an appropriate framework within which to characterize all physical properties for two main reasons. First, there are physical properties that do not have causal profiles and properties whose causal profiles do not exhaust their essences. Second, there is no unified notion of causation across the sciences. After distinguishing between the causal and the nomological, I suggest that what is needed is a structuralist view of properties that is not merely causal but that incorporates a physical property’s higher-order mathematical and nomological properties into its identity conditions. Such a view retains the naturalistic motivations for causal structuralism while avoiding the problems it faces. (shrink)

While the pursuitworthiness of philosophical ideas has changed over time, philosophical practice and methodology have not kept pace. The worthiness of a philosophical pursuit includes not only the ideas and objectives one pursues but also the methods with which one pursues them. In this paper, we articulate how empirical approaches benefit philosophy of science, particularly advocating for the use of qualitative methods for understanding the social and normative aspects of scientific inquiry. After situating qualitative methods within empirical philosophy of science, (...) we discuss how to adapt these traditionally sociological methods to empirically inform philosophical questions. Our aim is to normalize and legitimize qualitative methods for philosophical purposes and discuss how they can elucidate descriptive and normative components of scientific practice in a more generalizable non-idealized manner. We contend that qualitative methods are particularly well suited to philosophical interest in the social norms of science, their achievability, and their mutability. Furthermore, unlike more historical case studies in philosophy, qualitative methods enable more confidence in generalizability, albeit limited, from a concrete sample to a larger class. We conclude by addressing anxieties about the distinctness of empirical philosophy of science from social epistemology and from sociology of science. (shrink)

The aim of this paper is to present a perspective on Iris Murdoch conception of metaphysics, starting from her puzzling contention that she could describe herself as a ?Wittgensteinian Neo-Platonist?. I argue that this statement is a central clue to the nature both of her philosophical method which is strongly reminiscent of Wittgenstein's, and of her Platonism, which in its emphasis on the everyday and metaphorical aspects of his work differs starkly from received modern interpretations. Placing Murdoch between Plato and (...) Wittgenstein can help us to understand the nature of her metaphysics as a complex, continuous, pictorial activity, which shows a deep awareness of and is compatible with the late twentieth century and contemporary distrust of large metaphysical systems or explanations. (shrink)

v. 1. Chugŭl ttae kkaji i kŏrŭm ŭro -- v. 2. kyŏul i manil ondamyŏn -- v. 3. pabosae ŭi norae.

Recent developments in AI programming allow for new applications: individualized chatbots which mimic the speaking and writing behaviour of one specific living or dead person. ‘Deathbots’, chatbots of the dead, have already been implemented and are currently under development by the first start-up companies. Thus, it is an urgent issue to consider the ethical implications of deathbots. While previous ethical theories of deathbots have always been based on considerations of the dignity of the deceased, I propose to shift the focus (...) on the dignity and autonomy of the bereaved users of deathbots. Drawing on theories of internet-scaffolded affectivity and on theories of grief, I argue that deathbots may have a negative impact on the grief process of bereaved users and therefore have the potential to limit the emotional and psychological wellbeing of their users. Deathbot users are likely to become dependent on their bots which may make them susceptible to surreptitious advertising by deathbot providing companies and may limit their autonomy. At the same time, deathbots may prove to be helpful for people who suffer from prolonged, severe grief processes. I caution against the unrestricted usage of deathbots and suggest that they should be classified as medical devices. This classification would not the least mean that their non-harm, as well as their helpfulness for people suffering from prolonged grief needs to be proven and that their potential for autonomy infringements is reduced. (shrink)

In a recent editorial published in Nature, the journal's editors comment on a new automated software that has been used to check findings in psychology publications. The editors express concern with the way in which the anonymous fact-checkers have proceeded, but at the same time, they underscore the crucial role of peer criticism for scientific progress and insist: "self-correction is at the heart of science." Brief as it is, the editorial showcases that peer criticism and the application of norms of (...) good research practice are very thorny issues indeed.It is essential for the functioning of science that empirical findings, arguments, as well as methodological approaches are scrutinized... (shrink)

Traditionally, empiricism has relied on the specialness of human observation, yet science is rife with sophisticated instrumentation and techniques. The present article advances a conception of empirical evidence applicable to actual scientific practice. I argue that this conception elucidates how the results of scientific research can be repurposed across diverse epistemic contexts: it helps to make sense of how evidence accumulates across theory change, how different evidence can be amalgamated and used jointly, and how the same evidence can be used (...) to constrain competing theories in the service of breaking local underdetermination. (shrink)

Global Health involves, among many things the intensified travelling of people, resources, technologies, knowledge, standards, and ideas. This book describes what happens when innovations are transferred to new settings: What work is needed to make them work, but also how they change the setting into which they are introduced.

Based on brain imaging findings, we present a model according to which addiction emerges as an imbalance in the information processing and integration among various brain circuits and functions. The dysfunctions reflect (a) decreased sensitivity of reward circuits, (b) enhanced sensitivity of memory circuits to conditioned expectations to drugs and drug cues, stress reactivity, and (c) negative mood, and a weakened control circuit. Although initial experimentation with a drug of abuse is largely a voluntary behavior, continued drug use can eventually (...) impair neuronal circuits in the brain that are involved in free will, turning drug use into an automatic compulsive behavior. The ability of addictive drugs to co‐opt neurotransmitter signals between neurons (including dopamine, glutamate, and GABA) modifies the function of different neuronal circuits, which begin to falter at different stages of an addiction trajectory. Upon exposure to the drug, drug cues or stress this results in unrestrained hyperactivation of the motivation/drive circuit that results in the compulsive drug intake that characterizes addiction. (shrink)

Social studies of science and technology are dominated by action and macro approaches. This has led to a neglect of institutions and institutional arrangements at the meso level, which are important, in particular to the student of technology. The transfer of concepts and methods from social studies of science to technology studies has conserved this lack of concern with the meso level. This article suggests a more critical evaluation of this transfer, along with a review of the now popular assumption (...) of a high degree of similarity between science and technology. Two case studies show how meso-level considerations are important to an understanding of the nature of technological innovation and illustrate the lack of similarity between scientific and technological development. (shrink)

Das Buch ist eine systematische Bearbeitung der neukantischen Philosophie und enthält einen Überblick über die wichtigsten Vertreter aller sieben neukantianischen Richtungen und Schulen: physiologische, metaphysische, relativistische, psychologische, realistische, so wie auch Badische Schule und Marburger Schule.

This book critically reflects upon how images are mobilised within certain knowledge traditions, beyond the established categories of art, scientific visualisations and religious images. Thinking through and with images across ages, the authors seek to expand our understanding of the relationship between the visual and the epistemic.

Epistemic exploitation occurs when privileged persons compel marginalized persons to educate them about the nature of their oppression. I argue that epistemic exploitation is marked by unrecognized, uncompensated, emotionally taxing, coerced epistemic labor. The coercive and exploitative aspects of the phenomenon are exemplified by the unpaid nature of the educational labor and its associated opportunity costs, the double bind that marginalized persons must navigate when faced with the demand to educate, and the need for additional labor created by the default (...) skepticism of the privileged. I explore the connections between epistemic exploitation and the two varieties of epistemic injustice that Fricker (2007) identifies, testimonial and hermeneutical injustice. I situate epistemic exploitation within Dotson’s (2012; 2014) framework of epistemic oppression, and I address the role that epistemic exploitation plays in maintaining active ignorance and upholding dominant epistemic frameworks. (shrink)

Four detailed cases of delusions of misidentification (DM) are presented: two cases of misidentification of the reflected self, one of reverse intermetamorphosis, and one of reduplicative paramnesia. The cases are discussed in the context of three levels of interpretation: neurological, cognitive and phenomenological. The findings are compared to previous work with DM patients, particularly the work of Ellis and Young (1990; Young, 1998) who found that loss of the normal affective response to familiar faces was a contributing factor in the (...) Capgras delusion. The four cases presented suggest that this particular deficit is not a critical factor in the development of other forms of DM. (shrink)

Artikkelen undersøker hvordan NIPT ble vedtatt implementert i det norske fosterdiagnostiske systemet gjennom en fagligpolitisk prosess mellom 2012 og 2017. Prosessen innebar at Nasjonalt kunnskapssenter for helsetjenesten, Helsedirektoratet, Bioteknologirådet og Helse- og Omsorgsdepartementet ga sine vurderinger av testen og sine råd omkring en eventuell innføring. Artikkelen viser at det i denne prosessen foregikk en forsiktig tilnærming eller sammensmelting mellom de tradisjonelt helt ulike måtene å forstå og å ramme inn fosterdiagnostikk på i Norge, dvs. i en ‘autonomi/ behandlingsramme’ og en (...) ‘sorteringsramme’. Artikkelen argumenterer videre for at denne tilnærmingen eller konvergensen var mulig fordi prosessen ble holdt innenfor de fagligpolitiske byråkratiene, og de ulike etatene var innstilt på å ‘samarbeide’ om å inkludere både kunnskap og verdier fra begge rammene i sine tilrådninger. Politikk for fosterdiagnostikk er imidlertid et svært politisk betent område i Norge, og denne konvergensen var et skjørt byggverk. Den sprakk da også opp i løpet av tre uker i mai 2020, da Fremskrittspartiet plutselig inngikk et ‘bioteknologiforlik’ med Arbeiderpartiet og SV etter at de hadde gått ut av Solbergregjeringen. Dermed endte spørsmålet om implementeringen av NIPT i Stortinget, hvor konvergensen i den fagpolitiske prosessen ble erstattet av de tradisjonelle frontene, og de gamle innrammingene igjen ble ‘satt i arbeid’. Artikkelen diskuterer avslutningsvis kort de bortimot uløselige dilemmaene disse innrammingene både representerer og produserer. Nøkkelord: NIPT, fosterdiagnostikk, humanmedisinsk bioteknologi, regulering English Title: Fetal diagnostics between medicine and ethics: Implementation of Prenatal Invasive Testing in a turbulent policy area: The article examines how the decision to implement Prenatal Invasive Testing in the Norwegian Fetal Diagnostic System was reached through a professional policy process between 2012 and 2017. The process involved the Norwegian Research Centre for Health Services, the Norwegian Directorate of Health, the Norwegian Biotechnology Advisory Board and the Ministry of Health and Care Services, which provided their individual assessments and advice regarding the potential implementation of the test. The article finds that a careful convergence took place between traditionally opposing ways to understand and frame fetal diagnostics in Norway – either as a ‘treatment frame’ or a ‘sorting frame’. The article further argues that this convergence was possible because the process was kept within these bureaucracies, and that the different agencies were willing to collaborate to include knowledge and values from both frames in their recommendations. However, policy for fetal diagnostics is a very turbulent political area in Norway, and this convergence was a fragile construction. During three weeks in May 2020, the convergence collapsed when the Norwegian Progress Party suddenly entered a “biotechnology settlement” with the Labour Party and the Socialist Left Party after exiting the conservative Government coalition. Hence, the question of implementing NIPT ended up in the Norwegian Parliament, where the convergence from the professional policy process was replaced by the traditional fronts, and the old framings were again set in motion. Lastly, the article briefly discusses the almost unsolvable dilemmas these framings both produce and represent. Keywords: NIPT, non-invasive prenatal testing, fetal diagnostics, medical biotechnology, regulation. (shrink)