Over the past two decades we have seen dramatic improvements in the efficacy, safety and availibity of antiretroviral therapy (ART). In the USA and Europe, life expectancy in people living with HIV disease approaches that of the HIV-uninfected.1 Even in regions hardest hit by the HIV epidemic, effective HIV therapy has reversed more than a decade of HIV-related decreased survival. Despite these advances in ART, motivations to pursue HIV cure remain strong due to the toxicity, adherence challenges, cost and access (...) to care issues associated with HIV therapy, as well as the persistant stigma associated with having HIV infection. Further and renewed motivation comes from a single case of HIV cure after stem cell transplantation for acute leukaemia. Given the tremendous improvements in ART, it is important to assess how effective and safe an HIV cure would need to be in order to be a viable option compared to ART. We argue that this should be done prior to the availability of a cure to provide realistic goals for researchers and policy makers. One methodology that has been increasingly popular over the past decade is the use of mathematical simulation modelling to assess the clinical impact, cost-effectiveness and clinical role of different treatment strategies in HIV disease, as well as in medicine broadly.2 Such models provide a framework and approach for using the best available data at any point in time, and assessing the potential impact of emerging innovations. Further, unlike individual trials focused on a single endpoint, these models can integrate multiple data sources to project beyond the timeline or outcomes of individual studies and project long-term outcomes in many domains, including virologic, immunologic, clinical and cost.3 Mathematical models have particular value in their ability to assess uncertainty in clinical care. Examples include parameters determined in …. (shrink)

Whether to treat autism as exculpatory in any given circumstance appears to be influenced both by models of autism and by theories of moral responsibility. This article looks at one particular combination of theories: autism as theory of mind challenges and moral responsibility as requiring appropriate experience of the reactive attitudes. In pursuing this particular combination of ideas, we do not intend to endorse them. Our goal is, instead, to explore the implications of this combination of especially prominent ideas about (...) autism and about moral responsibility. These implications can be quite serious and practical for autists and those who interact directly with autists, as well as for broader communities as they attend to the fair, compassionate, and respectful treatment of increasing numbers of autistic adults. We find that these theories point to a limited range of situations in which autists should not be blamed for transgressive actions for which neurotypical individuals should be blamed. We build on what others have written on these issues by bringing in a recent cognitive model of the role theory of mind plays in empathy, by discussing the social implications of the theoretical findings, and by raising questions about the compatibility of reactive attitude theories of moral responsibility with the neurodiversity approach to autism. (shrink)

Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms on (...) which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery."Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education. (shrink)

“Imagination may be thought of as a ‘work-around.’ It is a resourceful tactic to ‘undo’ a rule by creating a path around it without necessarily defying it.... Transgression, on the other hand, is rule breaking. There is no pretense of reinterpretation; it is defiance pure and simple. Whether imagination or disobedience is the source, constraints need not constrain, ties need not bind.” So writes Kenneth A. Shepsle in his introduction to Rule Breaking and Political Imagination. Institutions are thought to (...) channel the choices of individual actors. But what about when they do not? Throughout history, leaders and politicians have used imagination and transgression to break with constraints upon their agency. Shepsle ranges from ancient Rome to the United States Senate, and from Lyndon B. Johnson to the British House of Commons. He also explores rule breaking in less formal contexts, such as vigilantism in the Old West and the CIA’s actions in the wake of 9/11. Entertaining and thought-provoking, Rule Breaking and Political Imagination will prompt a reassessment of the nature of institutions and remind us of the critical role of political mavericks. (shrink)

This chapter contains sections titled: Abstract What is Conceptual Relativism? The Kantian Roots of Conceptual Relativism Epistemology or Metaphysics? Conceptual Relativism and Truth The Scheme and Content Relativized? Davidson Against the Very Idea of a Conceptual Scheme Empirical Sources: Conceptual Relativism in Linguistics and Psychology References.

This essay examines the syntax of names. It argues that names are a syntactically and not just semantically distinctive class of expressions. Its central claim is that names are a distinguished type of anaphoric device—devices of explicit co-reference. Finally it argues that appreciating the true syntactic distinctiveness of names is the key to resolving certain long-standing philosophical puzzles that have long been thought to be of a semantic nature.

Philosophers and bioethicists have mostly given up on human dignity. As a concept, dignity has seemed obscure and unintelligible, or forbidden because of its connection with theology. Here I take a fresh look, and identify two families of dignity concepts: dignity as arche and dignity as telos. Arche draws on the idea of an origin or source, as in ‘archetype’ or ‘archeology.’ Dignity as arche refers to the qualities inherent in a being that is the source (the arche) of our (...) duties to that being. Dignity as telos is the endpoint (telos) that we try to promote in our patients and in ourselves. I illustrate these ideas using examples from Frances Hodgson Burnett’s book for young readers, A Little Princess. Identifying these two families of dignity concepts helps to identify the dignity-related tasks for psychotherapists. These are to help patients recognise, connect with, and respect their own dignity as arche, and to help them realise their own dignity as telos. Revisiting Maslow’s hierarchy of needs helps us to see how these tasks also apply to the broader goals of healthcare. (shrink)

This paper examines and rejects some purported refutations of eliminative materialism in the philosophy of mind: a quasi-transcendental argument due to Jackson and Pettit (1990) to the effect that folk psychology is “peculiarly unlikely” to be radically revised or eliminated in light of the developments of cognitive science and neuroscience; and (b) certain straight-out transcendental arguments to the effect that eliminativism is somehow incoherent (Baker, 1987; Boghossian, 1990). It begins by clarifying the exact topology of the dialectical space in which (...) debates between eliminativist and anti-eliminativist ought to be framed. I claim that both proponents and opponents of eliminativism have been insufficiently attentive to the range of dialectical possibilities. Consequently, the debate has not, in fact, been framed within the correct dialectical setting. I then go onto to show how inattentiveness to the range of dialectical possibilities undermines both transcendental and quasi-transcendental arguments against eliminativism. In particular, I argue that the quasi-transcendentalist overestimates the degree to which folk psychology can be insulated from the advance of neuroscience and cognitive science just in virtue of being a functional theory. I argue further that transcendental arguments are fallacious and do not succeed against even the strongest possible form of eliminativism. Finally, I argue that that transcendental arguments are irrelevant. Even if such arguments do succeed against a certain'very strong form of eliminativism, they remain complete non-starters against certain weaker forms of eliminativism. And I argue that if any of these weaker forms is true, folk psychology is in trouble enough to vindicate Paul Ckurchland's claim that our common sense psychological framework is “a radically false and misleading conception of the causes of human behavior and the nature of cognitive activity”. (shrink)

This chapter addresses ethical issues for informed consent when recruiting autistic participants for research. The process of informed consent for participation in research involves some abilities, such as dialogue and understanding the intentions of the researchers, that can be especially challenging when autistic individuals are being asked to participate. This chapter reviews these abilities, and suggests ways to provide meaningful support to promote autonomy and help researchers meet their responsibilities. Beyond these more general challenges, it explores Hans Jonas’s suggestion that (...) true informed consent for research requires that participants identify with the goals of the researchers. Given the plurality of perspectives on how to respond to autism, Jonas’s ideas point to additional ethical concerns that can arise when autistic people are recruited for research on autism. (shrink)

In the article Privacy and Health Practices in the Digital Age, the authors describe current privacy challenges for digital health data and review the theoretical framework on privacy in the contex...

I argue that a certain initially appealing Fregean conception of our shared semantic competence in our shared language cannot be made good. In particular, I show that we must reject two fundamental Fregean principles‐what I call Frege's Adequacy Condition and what I call Frege's Cognitive Constraint on Reference Determination. Frege's adequacy condition says that in an adequate semantic theory, sentence meanings must have the same fineness of grain as attitude contents. The Cognitive Constraint on Reference Determination says that in an (...) adequate semantic theory mechanisms of reference determination will fix routes of epistemic access to referents and will mediate one‐sided recognition judgments about referents. I argue against Frege's adequacy condition that if meanings are sliced as finely as it requires there will be too many meanings to go around. I argue against the cognitive constraint on reference determination that even in an adequate theory of reference, mechanisms of reference determination must be sharply distinguished from routes of epistemic access. If so, we have little reason to expect an adequate theory of reference determination to directly illuminate Frege's cognitive puzzles or be sufficient to explain the basis of our one‐sided recognition judgments. (shrink)

The premise of this article is that technologies are not neutral in terms of their design objectives, their scale, and the fact that they reflect the physical and social environments in which they have developed. Specific agricultural technologies, the midwestern plow, the California tomato harvester, and various biotechnologies, are evaluated in these terms and shown to have generally predictable impacts upon rural regions and farmers. Finally, the article examines a series of major threats such as climate change that require the (...) rethinking and restructuring of agriculture along more sustainable lines, something the can be accomplished only with a conscious recognition of the non-neutrality of technologies. (shrink)

A translation of Aristotle’s Nicomachean Ethics.

Schools in liberal societies are responsible for producing liberal citizens. However, if they have too robust a view of citizenship, they may find themselves undermining the view of good lives held by many pacific and law abiding groups. Here I argue against treating citizenship as an educational good that simply trumps private values when they conflict and in favor of a view that seeks a context sensitive balance between such conflicting goods. The paper explores Rawls's distinction between two moral powers (...) as a way of understanding the character of some of the private interests in schooling. (shrink)

This paper examines two questions. The first is what it would mean for schools to be communities. This question is pursued by examining four metaphors for community: families, congregations, guilds, and democratic polities. Three models of school communities are then sketched. The second question is whether schools that are communities are inherently illiberal. The paper distinguishes between a liberal interpretation of schools as communities, where schools are viewed as limited-purpose free associations, and a communitarian interpretation where community and polity are (...) not adequately distinguished. I argue that, within a framework of liberal pluralism, schools can be communities without being illiberal. (shrink)

As a neurodevelopmental condition that affects cognitive functioning, autism has been used as a test case for theories of moral responsibility. Most of the relevant literature focuses on autism’s impact on theory of mind and empathy. Here I examine aspects of autism related to executive function. I apply an account of how we might fail to be reasons responsive to argue that autism can increase the frequency of excuses for transgressive behavior, but will rarely make anyone completely exempt from moral (...) responsibility in general. On this account, although excuses may apply more often to autists than to others, the excuses that apply to autists are just the same excuses that can apply to anyone. (shrink)

This paper responds to Goodwin Liu's argument in Volume II of this Journal that a pedagogy must be supported by an appropriate theory of knowledge, and that the epistemology which best supports the service-learning pedagogy is anti-foundational pragmatism. The author shows that Liu's characterization of the pragmatist model of knowledge does not avoid the dualism which he sees as a fault of the traditional epistemology. After suggesting a remedy to this, the author then extends Liu's argument by indicating the limits (...) to what the appropriately modified epistemological support will sanction. These limits are shown to be more restrictive than Liu suggests. The result is an improved philosophical justification of the service-learning pedagogy and some suggestions for evaluating proposed curriculum. (shrink)

This essay poses the question of whether grassroots organizations can provide an alternative center of authority to the state in inducing multinational corporations to incorporate human rights criteria in their investment and trade decisions. In examining the anti-apartheid movement and attempts to replicate it in the 1990s in the campaigns against corporate involvement in Burma and Nigeria, it presents a mixed picture. In each case, citizen pressures increased the costs and risks of "business as usual" with target states and induced (...) corporations either to undertake social obligations or to disengage beyond what was required by national regulations or market forces. At the same time, nonstate actors are limited by the fact that they can induce but, unlike the state, cannot command corporate behavior; their success is dependent upon state policies; and their most powerful weapon—municipal procurement power—has been predominantly a U.S. phenomenon. (shrink)

Strike explores the differences between Marxists and liberals over the nature of the good life, about how human beings are formed, and about episemology, and uses these discussions to explore views of schooling.

We glide easily from thought and talk about worldly objects to thought and talk about the contents of our beliefs about such worldly objects all the time. Smith ask Jones about the whereabouts of their pet cat and on the basis of Jones’s assertion that the cat is on the mat, Smith comes to believe that the cat is on the mat. Black in turn may ascribe to Smith the belief that the cat is on the mat. Such transitions from (...) thought and talk about worldly objects to thought and talk about states of mind are so familiar to us as to seem second nature. But there is a long-standing philosophical tradition, originating with Frege, but endorsed by philosophers with otherwise varying philosophical outlooks, which makes the very possibility of such transitions puzzling. That tradition assumes that in making at least certain attitude ascriptions – so-called de dicto or “notionally sensitive” ascriptions -- speakers refer to, describe, quantify over, or somehow pragmatically implicate the notions, representations, or modes of presentations that plausibly figure as constituents of our mental contents -- either to the exclusion of the worldly objects themselves or in addition to those objects. Such attitude ascriptions are widely taken to be the primary or unmarked case of an attitude ascription. But it is seldom acknowledged that twin facts that on this approach worldly objects will relate to the representational items that supposedly serve as ingredients of thought content in a one-many fashion and there is no automatic way “back-up” from worldly objects to modes of presentation thereof together generate a mystery about how possibly we are able execute transitions from thought and talk about worldly objects to thought and talk about representational states of mind. It is argued in this essay that the way around this mystery is to see that de re, rather than de dicto ascriptions are the unmarked form of attitude ascription and that our representations of mental contents are parasitic on our representations of worldly objects. That is, we talk about the contents of our states of mind not by adverting, in the first instance, to talk about peculiarly mental or representational entities like notions or modes of presentations, but primarily by talking about worldly entities themselves. That is, to attribute to another the belief that the cat is on the mat, one need not refer to modes of presentations, or their ilk, of said cat or said mat, but only to the relevant cat and the relevant mat. (shrink)

The Ethics Consultation Quality Assessment Tool (ECQAT) establishes standards by which the quality of ethics consultation records (ECRs) can be assessed. These standards relate to the ethics question, consultation-specific information, ethical analysis, and recommendations and/or conclusions, and result in a score associated with one of four levels of ethics consultation quality. For the ECQAT to be useful in assessing and improving the quality of healthcare ethics consultations, individuals who rate the quality of ECRs need to be able to reliably use (...) the tool.We developed a short course to train ethics consultants in using the ECQAT, and evaluated whether the participants (1) achieved an acceptable level of calibration in matching expert-established quality scores for a set of ethics consultations, and (2) were satisfied with the course. We recruited 28 ethics consultants to participate in a virtual, six-session course. At each session participants and faculty reviewed, rated, and discussed one to two ECRs. The participants’ calibration in matching expert-established quality scores improved with repeated exposure at all levels of ethics consultation quality. Participants were generally more accurate when assessing consultation quality at the dichotomous level of “acceptable” (scores of three or four) versus “unacceptable” (scores of one or two) than they were with a more specific score. Participants had higher rates of accuracy with the extreme ratings of “strong” (level four) or “poor” (level one). Although participants were highly satisfied with the course, only a minority of participants achieved the prespecified acceptable level of calibration (that is, 80 percent or greater accuracy between their score and expert-established scores). These results suggest that ECQAT training may require more sessions or need modification in the protocol to achieve higher reliability in scoring. Such trainings are an important next step in ensuring that the ECQAT is a tool that can be used to promote improvement in ethics consultation quality. (shrink)

The argument in this paper is that the exclusion of empirical research has led to a deficiency in the Positivist model; the neglect of conflict in the form of the trouble-case. In the attempt to define law in a relatively narrow way Positivists have avoided important knowledge about social behavior. In addition the analytical method of Positivism has been connected with a value-position which tends to exaggerate the extent to which law functions within social structures as an orderly system. One (...) consequence of this perspective is that the role of conflict in the law process is hardly appreciated. Studies of law in some primitive societies suggest that although social behavior generally is not regulated in rule-terms, conflict often is institutionalized in a manner capable of providing norms appropriate to new situations. It is suggested that the focus upon the trouble-case is more likely to develop our understanding of conflict as a dynamic element in the law process. (shrink)

In the ‘Justice Cascade’, Kathryn Sikkink argues that “foreign prosecutions and international tribunals can be cost-effective alternatives to military intervention.” Yet, the successes of the Special Court for Sierra Leone—in prosecuting former Liberian President Charles Taylor and in imposing accountability on the leaders of all armed groups regardless of political alignment—were dependent on a commitment by Western powers and international and regional organizations to a military victory against the rebels in Sierra Leone and coercive regime change in Liberia. The lesson (...) that should be drawn from this case—which parallels that of other international tribunals set up during ongoing violence—is that the prospects for international criminal justice during civil wars are dependent on the political strategies adopted by outsiders to address the conflict and that taking criminal accountability seriously requires an interventionist rather than a consent-based approach to conflict resolution. (shrink)