Trust relations in the health services have changed from asymmetrical paternalism to symmetrical autonomy-based participation, according to a common account. The promises of personalized medicine emphasizing empowerment of the individual through active participation in managing her health, disease and well-being, is characteristic of symmetrical trust. In the influential Kantian account of autonomy, active participation in management of own health is not only an opportunity, but an obligation. Personalized medicine is made possible by the digitalization of medicine with an ensuing increased (...) tailoring of diagnostics, treatment and prevention to the individual. The ideal is to increase wellness by minimizing the layer of interpretation and translation between relevant health information and the patient or user. Arguably, this opens for a new level of autonomy through increased participation in treatment and prevention, and by that, increased empowerment of the individual. However, the empirical realities reveal a more complicated landscape disturbed by information ‘noise’ and involving a number of complementary areas of expertise and technologies, hiding the source and logic of data interpretation. This has lead to calls for a return to a mild form of paternalism, allowing expertise coaching of patients and even withholding information, with patients escaping responsibility through blind or lazy trust. This is morally unacceptable, according to Kant’s ideal of enlightenment, as we have a duty to take responsibility by trusting others reflexively, even as patients. Realizing the promises of personalized medicine requires a system of institutional controls of information and diagnostics, accessible for non-specialists, supported by medical expertise that can function as the accountable gate-keeper taking moral responsibility required for an active, reflexive trust. (shrink)

Great hope has been placed on biobank research as a strategy to improve diagnostics, therapeutics and prevention. It seems to be a common opinion that these goals cannot be reached without the participation of commercial actors. However, commercial use of biobanks is considered morally problematic and the commercialisation of human biological materials is regulated internationally by policy documents, conventions and laws. For instance, the Council of Europe recommends that: “Biological materials should not, as such, give rise to financial gain”. Similarly, (...) Norwegian legislation reads: “Commercial exploitation of research participants, human biological material and personal health data in general is prohibited”. Both articles represent kinds of common moral intuitions. A problem, however, is that legislative documents are too vague and provide room for ample speculation. Through the use of focus group interviews with Norwegian biobank donors, we have tried to identify lay intuitions and morals regarding the commercial use of biobanks. Our findings indicate that the act of donation and the subsequent uses of the samples belong to two different spheres. While concerns around dignity and commodification were present in the first, injustice and unfairness were our informants’ major moral concerns in the latter. Although some opposition towards commercial actors was voiced, these intuitions show that it is possible to render commercial use of biobanks ethically acceptable based on frameworks and regulations which hinder commodification of the human body and promote communal benefit sharing. (shrink)

The argument in this essay is twofold. (1) Procedural justice requires,in particular cases, that we restrict property rights in natural resources, e.g., California agricultural land or Appalachian coal land. (2) Conditions imposed by Locke's political theory and by dense population require,in general, that we restrict property rights in finite or non-renewable natural resources such as land. If these arguments are correct, then we have a moral imperative to use land-use controls (such as taxation, planning, zoning, and acreage limitations) to restructure (...) land ownership and land use in a far more radical way than has ever been accomplished in the past. (shrink)

When Kangas suggested in 1986 that wildlife reserve designs could be much smaller than previously thought, community ecologists attacked his views on methodological grounds (island biogeographical theory is beset with uncertainties) and on conservation grounds (Kangas seemed to encourage deforestation and extinction). Kangas' defenders, like Simberloff, argued that in a situation of biological uncertainty (the degree/type of deforestation-induced extinction), scientists ought to follow the epistemologically conservative course and risk type-II error (the risk of not rejecting a null hypothesis that is (...) false), rather than type-I error. (This is the risk of rejecting a null hypothesis that is true). Kangas' opponents, like Noss, argued that, in a situation of scientific uncertainty, scientists ought to risk type-I, rather than type-II, error. This essay argues that there are different types of rationality appropriate to science and applied science and, therefore, in cases of applied science (like conservation biology), the more conservative course of action is for scientists to risk type-I error. The essay argues further that, on grounds of scientific rationality, Kangas, Simberloff, and others were correct in risking type-II error, but that, on grounds of decision-theoretic rationality, Noss, Waide, and others were correct in risking type-I error. (shrink)

Despite significant scientific uncertainties and strong public opposition, there appears to be an “iron triangle” of industry, government,and consultants/contractors promoting the siting of the world’s first permanent geological repository for high-level nuclear waste and spent fuel, proposed for Yucca Mountain, Nevada. Arguing that representatives of this iron triangle have ignored important epistemological and ethical difficulties with the proposed facility, I conclude that the business climate surrounding this triangle appears to leave little room for consideration of ethical issues related to public (...) safety, environmental welfare, and citizen consent to risk. If my analysis of the Yucca Mountain case is correct and typical, then some of themost pressing questions of business ethics may concern how to break the iron triangle or, at least, how to expand it into a quadrilateral that includes the public. (shrink)

The unknown nature of tomorrow’s research makes informed consent in biobank research a challenge. Whether the consent given by biobank participants is ‘broad’ or ‘narrow’, the ever present question remains the same: are new activities covered by the original consent? In this article, we focus on the meaning of, and the relation between, broad consent and re-consent in biobank research. We argue that broad consent should be understood as consenting to a framework—a framework which covers aims, core conditions for acceptable (...) use, governance and how these affect participants. Changes that alter the framework in a fundamental way call for re-consent. Three biobank cases of current international interest are used to debate when re-consent is an ethical necessity: whole-genome sequencing, data sharing and commercial utilization. These reflections give us a more nuanced view on what consent is for. We claim that the introduction of broad consents in biobank research has not represented a betrayal of individual participant interests, as some critics have asserted. Broad consents combined with the possible use of re-consent are in certain settings not inferior, but rather ethically superior to narrow consents. In population-based research biobanks, they allow for a reconciliation between individual interest and public matters in society at large. (shrink)

My two principal aims in this essay are interconnected. One aim is to provide a new interpretation of the ‘infinite modes’ in Spinoza’s Ethics. I argue that for Spinoza, God, conceived as the one infinite and eternal substance, is not to be understood as causing two kinds of modes, some infinite and eternal and the rest finite and non-eternal. That there cannot be such a bifurcation of divine effects is what I take the ‘infinite mode’ propositions, E1p21–23, to establish; E1p21–23 (...) show that each and every one of the immanent effects of an infinite and eternal God is an infinite and eternal mode. The other aim is to show that these propositions can be understood as part of an extended critical response to Descartes’s infamous doctrine that God creates eternal truths and true and immutable natures. If we have the correct (Spinozan) conceptions of what God is and how God works, we see that an eternal and infinite God can only be understood to cause ‘eternal truths,’ and that these eternal truths are infinite and eternal modes of God. (shrink)

In this essay, I suggest that Spinoza acknowledges a distinction between formal reality that is infinite and timelessly eternal and formal reality that is non-infinite (i. e., finite or indefinite) and non-eternal (i. e., enduring). I also argue that if, in Spinoza’s system, only intelligible causation is genuine causation, then infinite, timelessly eternal formal reality cannot cause non-infinite, non-eternal formal reality. A denial of eternal-durational causation generates a puzzle, however: if no enduring thing – not even the sempiternal, indefinite individual (...) composed of all finite, enduring things – is caused by the infinite, eternal substance, then how can Spinoza consistently hold that the one infinite, eternal substance is the cause of all things and that all things are modes of that substance? At the end of this essay, I sketch how Spinoza could deny eternal-durational causation while still holding that an infinite, eternal God is the cause of all things and that all things are modes. I develop the interpretation more in the companion essay. (shrink)

An old question in Spinoza scholarship is how finite, non-eternal things transitively caused by other finite, non-eternal things (i. e., the entities described in propositions like E1p28) are caused by the infinite, eternal substance, given that what follows either directly or indirectly from the divine nature is infinite and eternal (E1p21–23). In “Spinoza’s Monism I,” I pointed out that most commentators answer this question by invoking entities that are indefinite and sempiternal, but argued that perhaps we should not be so (...) quick to assume that in Spinoza’s system, an infinite and eternal substance could cause such indefinite, sempiternal entities. But if such eternal-durational causation is denied, then it seems harder to see how Spinoza’s system could be coherent: if Spinoza holds that the infinite, eternal substance cannot cause anything that is not infinite and not eternal, then how can he also hold that all things are modes immanently caused by substance (E1p15, E1p18, E1p25)? In this essay, I explain how Spinoza’s system could be understood in light of a denial of eternal-durational causation. On the interpretation I offer, God is the cause of all things and all things are modes because the essences of all things follow from the divine nature and all essences enjoy infinite, eternal reality as modes immanently caused by the infinite, eternal substance. The same non-substantial essences can also be conceived as enjoying non-infinite, non-eternal reality, but so conceived, they are enduring, finite (or sempiternal, indefinite) entities that cannot be conceived as modes caused by and inhering in the one infinite, eternal substance. I conclude by pointing out that if we take this interpretive route, we do have to understand Spinoza as committed to acosmism, or a denial of the reality of the world – at least the world of enduring, finite things. (shrink)

Health equity can be defined as the absence of disadvantage to individuals and communities in health outcomes, access to health care, and quality of health care regardless of one’s race, gender, nationality, age, ethnicity, religion, and socioeconomic status. Health equity concerns those disparities in public health that can be traced to unequal, systemic economic, and social conditions. Despite significant improvements in the health of the overall population, health inequities in America persist. Racial and ethnic minorities continue to experience higher rates (...) of morbidity and mortality than non-minorities across a range of health issues. For example, African-American children with asthma have a seven times greater mortality rate than Non-Hispanic white children with the illness. While cancer is the second leading cause of death among all populations in the U.S., ethnic minorities are especially burdened with the disease. (shrink)

Derk Pereboom's Four-Case Argument is among the most famous and resilient manipulation arguments against compatibilism. I contend that its resilience is not a function of the argument's soundness but, rather, the ill-gotten gain from an ambiguity in the description of the causal relations found in the argument's foundational case. I expose this crucial ambiguity and suggest that a dilemma faces anyone hoping to resolve it. After a thorough search for an interpretation which avoids both horns of this dilemma, I conclude (...) that none is available. Rather, every metaphysically coherent interpretation invites either a hard- or soft-line reply to Pereboom's argument. I then consider a recharacterization of the dilemma which seems to clear the way for the defence of a revised Four-Case Argument. I address this rejoinder by identifying a still more fundamental problem shared by all viable interpretations of the manipulation cases, showing that each involves a type of manipulation which undermines the victim's agency. Because this diagnosis supports a soft-line reply to every viable interpretation of the argument and can be endorsed by any compatibilist, I consider it the final piece of the Soft-line Solution to the Four-Case Argument. Finally, I suggest a new taxonomy of manipulation arguments, arguing that none that employs the suppressive variety of manipulation found in Pereboom's argument offers a threat to compatibilism. -/- (For direct download option, search Kristin M. Mickelson, Soft-line Solution). (shrink)

Health equity can be defined as the absence of disadvantage to individuals and communities in health outcomes, access to health care, and quality of health care regardless of one’s race, gender, nationality, age, ethnicity, religion, and socioeconomic status. Health equity concerns those disparities in public health that can be traced to unequal, systemic economic, and social conditions. Despite significant improvements in the health of the overall population, health inequities in America persist. Racial and ethnic minorities continue to experience higher rates (...) of morbidity and mortality than non-minorities across a range of health issues. For example, African-American children with asthma have a seven times greater mortality rate than Non-Hispanic white children with the illness. While cancer is the second leading cause of death among all populations in the U.S., ethnic minorities are especially burdened with the disease. (shrink)

The objective of Working Group 4 of the COST Action NET4Age-Friendly is to examine existing policies, advocacy, and funding opportunities and to build up relations with policy makers and funding organisations. Also, to synthesize and improve existing knowledge and models to develop from effective business and evaluation models, as well as to guarantee quality and education, proper dissemination and ensure the future of the Action. The Working Group further aims to enable capacity building to improve interdisciplinary participation, to promote knowledge (...) exchange and to foster a cross-European interdisciplinary research capacity, to improve cooperation and co-creation with cross-sectors stakeholders and to introduce and educate students SHAFE implementation and sustainability. To enable the achievement of the objectives of Working Group 4, the Leader of the Working Group, the Chair and Vice-Chair, in close cooperation with the Science Communication Coordinator, developed a template to map the current state of SHAFE policies, funding opportunities and networking in the COST member countries of the Action. On invitation, the Working Group lead received contributions from 37 countries, in a total of 85 Action members. The contributions provide an overview of the diversity of SHAFE policies and opportunities in Europe and beyond. These were not edited or revised and are a result of the main areas of expertise and knowledge of the contributors; thus, gaps in areas or content are possible and these shall be further explored in the following works and reports of this WG. But this preliminary mapping is of huge importance to proceed with the WG activities. In the following chapters, an introduction on the need of SHAFE policies is presented, followed by a summary of the main approaches to be pursued for the next period of work. The deliverable finishes with the opportunities of capacity building, networking and funding that will be relevant to undertake within the frame of Working Group 4 and the total COST Action. The total of country contributions is presented in the annex of this deliverable. (shrink)

I suggest a pluralistic account of folk psychology according to which not all predictions or explanations rely on the attribution of mental states, and not all intentional actions are explained by mental states. This view of folk psychology is supported by research in developmental and social psychology. It is well known that people use personality traits to predict behavior. I argue that trait attribution is not shorthand for mental state attributions, since traits are not identical to beliefs or desires, and (...) an understanding of belief or desire is not necessary for using trait attributions. In addition, we sometimes predict and explain behavior through appeal to personality traits that the target wouldn't endorse, and so could not serve as the target's reasons. I conclude by suggesting that our folk psychology includes the notion that some behavior is explained by personality traits—who the person is—rather than by beliefs and desires—what the person thinks. Consequences of this view for the debate between simulation theory and theory theory, as well as the debate on chimpanzee theory of mind are discussed. (shrink)

In this essay, I argue for the rejection of Vihvelin's ‘Three-fold Classification’ , a nonstandard taxonomy of free-will compatibilism, incompatibilism, and impossibilism. Vihvelin is right that the standard taxonomy of these views is inadequate, and that a new taxonomy is needed to clarify the free-will debate. Significantly, Vihvelin notes that the standard formal definition of ‘incompatibilism’ does not capture the historically popular view that deterministic laws pose a threat to free will. Vihvelin's proposed solution is to redefine ‘incompatibilism.’ However, Vihvelin's (...) formal definition of ‘incompatibilism’ is flawed according to her own arguments. In addition, Vihvelin's characterization of ‘compatibilism’ is incomplete, and at least two important free-will views are missing from her proposed taxonomy. Given the problems with Vihvelin's arguments for 3-FC, her novel view of the dialectic between the major free-will views lacks support. (shrink)

I argue in this paper that the work of Keith Lehrer, especially in his book Self-Trust has applications to feminist ethics; specifically care ethics, which has become the leading form of normative sentimentalist ethics. I extend Lehrer's ideas concerning reason and justification of belief beyond what he says by applying the notion of evaluation central to his account of acceptance to the need for evaluation of emotions. The inability to evaluate and attain justification of one's emotions is an epistemic failure (...) that leads one not to act on one's own aspirations and desires and treat those desires as if they did not exist. I argue that this is a common condition among women in patriarchal societies because patriarchy can cause women to believe that they are not worthy of their trust concerning what they accept, specifically acceptance of their anger over their own mistreatment. As a result, many women are unable to realize the self-protective role of their anger. All of this reflects a lack of what I shall call epistemic personhood, a concept based on Lehrer's theory concerning the keystone role of self-trust in the epistemic arch of rationality, justification and knowledge. Lastly, I use this concept of epistemic personhood to develop a care ethical account of self-respect that counters the Kantian account. (shrink)

Derk Pereboom's Four-Case Argument is among the most famous and resilient manipulation arguments against compatibilism. I contend that its resilience is not a function of the argument's soundness but, rather, the ill-gotten gain from an ambiguity in the description of the causal relations found in the argument's foundational case. I expose this crucial ambiguity and suggest that a dilemma faces anyone hoping to resolve it. After a thorough search for an interpretation which avoids both horns of this dilemma, I conclude (...) that none is available. Rather, every metaphysically coherent interpretation invites either a hard- or soft-line reply to Pereboom's argument. I then consider a recharacterization of the dilemma which seems to clear the way for the defence of a revised Four-Case Argument. I address this rejoinder by identifying a still more fundamental problem shared by all viable interpretations of the manipulation cases, showing that each involves a type of manipulation which undermines the victim's agency. Because this diagnosis supports a soft-line reply to every viable interpretation of the argument and can be endorsed by any compatibilist, I consider it the final piece of the Soft-line Solution to the Four-Case Argument. Finally, I suggest a new taxonomy of manipulation arguments, arguing that none that employs the suppressive variety of manipulation found in Pereboom's argument offers a threat to compatibilism. (shrink)

In spite of his status as a highly original thinker whose views were, in many ways, ahead of his time and anticipate those of more famous successors, the work of Johann Gottfried von Herder has not received the attention it deserves in mainstream philosophical discourse. In Herder's Hermeneutics, Kristin Gjesdal successfully addresses this deficit by exploring the enlightenment origins of the hermeneutic tradition through a careful and compelling reconstruction of Herder's theory of interpretation. Breaking with the widespread view of (...) Herder as a contra-Enlightenment thinker, Gjesdal conceives of Herder's hermeneutics as contributing to the enlightenment of the Enlightenment project through an immanent critique of... (shrink)

In spite of his status as a highly original thinker whose views were, in many ways, ahead of his time and anticipate those of more famous successors, the work of Johann Gottfried von Herder has not received the attention it deserves in mainstream philosophical discourse. In Herder's Hermeneutics, Kristin Gjesdal successfully addresses this deficit by exploring the enlightenment origins of the hermeneutic tradition through a careful and compelling reconstruction of Herder's theory of interpretation. Breaking with the widespread view of (...) Herder as a contra-Enlightenment thinker, Gjesdal conceives of Herder's hermeneutics as contributing to the enlightenment of the Enlightenment project through an immanent critique of... (shrink)

Clinical Ethics, Ahead of Print. BackgroundHow often does refractory suffering, which is suffering due to symptoms that cannot be adequately controlled, occur at the end of life in modern palliative care? What are the causes of such refractory suffering? Should euthanasia be offered for refractory suffering at the end of life? We sought to shed light on these questions through interviews with palliative care specialists.MethodsSemi-structured interviews with six nurses and six doctors working in palliative care in five Norwegian hospitals. Transcripts (...) were analysed with systematic text condensation, a qualitative analysis framework.ResultsInformants find that refractory suffering is rare, and that with palliative sedation satisfactory symptom control can nearly always be achieved at the end of life. However, the process of reaching adequate symptom control can be protracted, and there can be significant suffering in the meantime. Both somatic, psychological, social and existential factors can contribute to refractory suffering and potentiate each other. However, informants also place significant weight on factors pertaining to the organization of palliative care services as contributing to insufficient symptom control.ConclusionsIf refractory suffering is indeed rare, then this arguably weakens a common prima facie argument for the legalization of assisted dying. However, the process of reaching adequate symptom control can be protracted and involve significant suffering. The experiences of palliative care clinicians constitute important empirical premises for the assisted dying debate. The study points to several areas in which palliative care can be improved. (shrink)

Through a detailed study of Herder's Enlightenment thought, especially his philosophy of literature, Kristin Gjesdal offers a new and sometimes provocative reading of the historical origins and contemporary challenges of modern hermeneutics. She shows that hermeneutic philosophy grew out of a historical, anthropological, and poetic discourse in the mid-eighteenth century and argues that, as such, it represents a rich, stimulating, and relevant engagement with the potentials and limits of human meaning and understanding. Gjesdal's study broadens our conception of hermeneutic (...) philosophy - the issues it raises and the answers it offers - and underlines the importance of Herder's contribution to the development of this discipline. Her book will be highly valuable for students and scholars of eighteenth-century thought, especially those working in the fields of hermeneutics, aesthetics, and European philosophy. (shrink)

Summary Meteorology, a scientific discipline almost exclusively associated with weather forecasting in the first half of the twentieth century in the USA, was viewed with disdain by more mathematically based scientific communities. A descriptive science lacking in physical and mathematical rigor, meteorology was typically without an academic home in US colleges and universities. This stood in sharp contrast to the meteorological communities across the Atlantic which were supported by dedicated geophysical institutes. Four factors kept US meteorologists, unlike their European colleagues, (...) on the fringes of the scientific mainstream: a lack of ?rigor?, a lack of academic presence, a lack of patronage (governmental or private), and a pervasive public view that meteorological information was ?free? and yet should be tailored to a variety of users. The symbiotic relationship of these factors created an almost insurmountable hurdle to disciplinary advancement. That hurdle was effectively overcome in mid-century when the military demands of the Second World War presented meteorology with the opportunity to leave behind its legacy as a ?guessing science? and assume its place as a mathematically and physically based theoretical scientific discipline. (shrink)

Voluntary actions and their distal effects are intimately related in conscious awareness. When an expected effect follows a voluntary action, the experience of the interval between these events is compressed in time, a phenomenon known as ‘intentional binding’ . Current accounts of IB suggest that it serves to reinforce associations between our goals and our intention to attain these goals via action, and that IB only occurs for self-generated actions. We used a novel approach to study IB in the context (...) of shared intentions and actions. Pairs of participants judged the time of occurrence of actions and events attributed either to oneself or to another agent. We found that IB and subjective agency are not mutually predictive when an action can be attributed to only one of two ‘co-intending’ agents. Our results pose a complication for the prevailing view that IB and subjective agency reflect a common mechanism. (shrink)

European Journal of Philosophy, EarlyView.