Name der Zeitschrift: Semiotica Jahrgang: 2015 Heft: 207 Seiten: 327-368.

The coronavirus pandemic made the biopolitics of infection control the core object of states around the world. Globally, states governed spheres usually free of state control, implementing various restrictions, closing down society in the process. This is possible due to the state's capacities to act through and over society, grounded in the state's powers. I argue that while the pandemic has led to useful and interesting state-centric Foucauldian literature on the politics of COVID-19, this literature has not fully taken the (...) theoretical lessons of the pandemic into account. Explicating these lessons, I discuss how the pandemic invites us to reconsider the Foucauldian approach to the state. The purpose of this article is to combine the Foucauldian theory of power with a Weberian state theory based on Michael Mann's work on the state and the sources of power, so to lay the foundations for a Weberian-Foucauldian theory of the state. (shrink)

Digital Voice Assistants have become a ubiquitous technology in today’s home and childhood environments. Inspired by original study on how children’s ontological conceptualizations of life and technology were systematically associated with their real-world exposure to robotic entities, the current study explored this association for children in their middle childhood and with different levels of DVA-exposure. We analyzed correlational survey data from 143 parent–child dyads who were recruited on ‘Amazon Mechanical Turk’. Children’s ontological conceptualization patterns of life and technology were measured (...) by asking them to conceptualize nine prototypical organically living and technological entities with respect to their biology, intelligence, and psychology. Their ontological conceptualization patterns were then associated with their DVA-exposure and additional control variables. Compared to biology and psychology, intelligence was a less differentiating factor for children to differentiate between organically living and technological entities. This differentiation pattern became more pronounced with technological affinity. There was some evidence that children with higher DVA-exposure differentiated more rigorously between organically living and technological entities on the basis of psychology. To the best of our knowledge, this is the first study exploring children’s real-world exposure to DVAs and how it is associated with their conceptual understandings of life and technology. Findings suggest although psychological conceptualizations of technology may become more pronounced with DVA-exposure, it is far from clear such tendencies blur ontological boundaries between life and technology from children’s perspective. (shrink)

How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems unreasonable that (...) public values would straightforwardly decide the ethical question of how resources should be distributed. On the other hand, in a democratic society, it seems equally unreasonable that they would be considered irrelevant for this question. In this paper we draw on the notion of reflective equilibrium and discuss the relevance and roles that empirical studies may plausibly have for justification in priority setting ethics. We develop a framework for analysing how different kinds of empirical results may have different kinds of implications for justification. (shrink)

How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this article we analyze (...) Juth’s argument and observe that we already do compensate for indirectly operative factors, both outside and within cost-effectiveness evaluations, for formal equality reasons. Based on this we argue that we have reason to set cost-effectiveness thresholds to integrate equity concerns also including formal equality considerations. We find no reason not to compensate for group size to the extent we already compensate for other factors. Moreover, groups size implying a systematic disadvantage also on a global scale, i.e. taking different aspects of the health condition of patients suffering from rare diseases into account, will provide strong reason for why group size is indeed relevant to compensate for. (shrink)

Intensive research is carried out to develop a disease-modifying drug for Alzheimer’s disease. The development of drug candidates that reduce Aß or tau in the brain seems particularly promising. However, these drugs target people at risk for AD, who must be identified before they have any, or only moderate, symptoms associated with the disease. There are different strategies that may be used to identify these individuals. Each of these strategies raises different ethical challenges. In this paper, we analyse these challenges (...) in relation to the risk stratification for AD necessary for using these drugs. We conclude that the new drugs must generate large health benefits for people at risk of developing AD to justify the ethical costs associated with current risk stratification methods, benefits much larger than current drug candidates have. This conclusion raises a new set of ethical questions that should be further discussed. No data are available. (shrink)

In this paper we explore the relation between health-care needs and patients’ desires within shared decision-making in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to (...) arise due to the double focus on a patient’s need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine. (shrink)

Why do some people withdraw from biobank studies? To our knowledge, very few studies have been done on the reflections of biobank ex-participants. In this article, we report from such a study. 16 years ago, we did focus group interviews with biobank participants and ex-participants. We found that the two groups interestingly shared worries concerning the risks involved in possible novel uses of their biobank material, even though they drew opposite conclusions from their worries. Revisiting these interviews today reveals a (...) remarkable relevance to present concerns, since the possible developments that worried ex-participants and participants 16 years ago now are becoming realities. Drawing on conceptual distinctions by sociologist and philosopher Niklas Luhmann, we argue that while ex-participants express a loss of trust in the biobank institution to manage the use of their biobank material in a legitimate way, remaining participants expressed confidence in the management of the biobank institution to secure their interests. This analysis brings out important aspects of emerging trends in biobank research participation. (shrink)

In this study of an economic field and its relationships to a cultural field, we apply Pierre Bourdieu’s central concepts of economic capital, cultural capital, symbolic capital and field, and thus follow in a tradition that at the outset was considered to be post-structuralism, but which by Bourdieu later has been brought into the realm of realism. We have mapped relationships between the actors and thus the field structures that these relationships entail. The fields in which a segment of an (...) art world is operating is represented in multi-dimensional figures which illustrate relationships and bonds between the different categories of organizations. Some of the business actors we have studied are engaging in cultural activities with a great deal of autonomy, others are connected to the cultural field in less active ways. In participating in the cultural field they are in different ways and to different extents accumulating symbolic capital including prestige and honor. The method we have applied is multiple correspondence analysis which was frequently used by Bourdieu. (shrink)

When considering the introduction of a new intervention in a budget constrained healthcare system, priority setting based on fair principles is fundamental. In many jurisdictions, a multi-criteria approach with several different considerations is employed, including severity and cost-effectiveness. Such multi-criteria approaches raise questions about how to balance different considerations against each other, and how to understand the logical or normative relations between them. For example, some jurisdictions make explicit reference to a large patient benefit as such a consideration. However, since (...) patient benefit is part of a cost-effectiveness assessment it is not clear how to balance considerations of greater patient benefit against considerations of severity and cost-effectiveness. The aim of this paper is to explore the role of a large patient benefit as an independent criterion for priority setting in a healthcare system also considering severity and cost-effectiveness. By taking the opportunity cost of new interventions (i.e., the health forgone in patients already receiving treatment) into account, we argue that patient benefit has a complex relationship to priority setting. More specifically, it cannot be reasonably concluded that large patient benefits should be given priority if severity, cost-effectiveness, and opportunity costs are held constant. Since we cannot find general support for taking patient benefit into account as an independent criterion from any of the most discussed theories about distributive justice: utilitarianism, prioritarianism, telic egalitarianism and sufficientarianism, it is reasonable to avoid doing so. Hence, given the complexity of the role of patient benefit, we conclude that in priority practice, a large patient benefit should not be considered as an independent criterion, on top of considerations of severity and cost-effectiveness. (shrink)

It is uncontroversial to claim that the extent to which health care interventions benefit patients is a relevant consideration for health care priority setting. However, when effects accrue to the individual patient, effects of a more indirect kind may accrue to other individuals as well, such as the patient's children, friends, or partner. If, and if so how, such relational effects should be considered relevant in priority setting is contentious. In this paper, we illustrate this question by using disease‐modifying drugs (...) for Alzheimer's disease as a case in point. The ethical analysis begins by sketching the so‐called prima facie case for ascribing moral weight to relational effects and then moves on to consider a number of objections to it. We argue that, whereas one set of objections may be dismissed, there is another set of arguments that poses more serious challenges for including relational effects in priority setting. (shrink)

In Gustavsson et al,1 we discussed the ethical issues that arise when identifying the relevant population for disease-modifying drugs targeting Alzheimer disease. More specifically, we focused on novel immunotherapies aimed at amyloid β and tau, two relevant biomarkers. The commentaries to our paper2 3 acknowledge our conclusion: screening for AD involve ethical costs that cannot be justified unless a drug with clinically relevant effect becomes available. Since Aduhelm is the only immunotherapy targeting AD currently approved by the Food and Drug (...) Administration, we use that as a …. (shrink)

Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...) Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. (shrink)

In recent years, the issue of accepting a higher cost per health improvement for orphan drugs has been the subject of discussion in health care policy agencies and the academic literature. This article aims to provide an analysis of broadly egalitarian arguments for and against accepting higher costs per health improvement. More specifically, we aim to investigate which arguments one should agree upon putting aside and where further explorations are needed. We identify three kinds of arguments in the literature: considerations (...) of substantial equality, formal equality, and opportunity cost. We argue that considerations of substantial equality do not support higher costs per health improvement orphan drugs, even if such considerations are considered valid. On the contrary, arguments of formal equality may support accepting a higher cost per health improvement for orphan drugs. However, in order to do so, a number of both normative and empirical issues must be resolved; these issues are identified in the article. For instance, it must be settled to what extent the opportunity cost in terms of foregone health for other patients is acceptable in order to uphold formal equality. We conclude that certain arguments can be set aside, and future focus should be put on the unresolved normative and empirical issues related to formal equality and opportunity cost. (shrink)

In a recent extended essay, philosopher Daniel Hausman goes a long way towards dismissing severity as a morally relevant attribute in the context of priority setting in healthcare. In this response, we argue that although Hausman certainly points to real problems with how severity is often interpreted and operationalised within the priority setting context, the conclusion that severity does not contain plausible ethical content is too hasty. Rather than abandonment, our proposal is to take severity seriously by carefully mapping the (...) possibly multiple underlying accounts to well-established ethical theories, in a way that is both morally defensible and aligned with the term’s colloquial uses. (shrink)

In Parkinson’s disease, the fronto-striatal network is involved in motor and cognitive symptoms. Working memory updating training engages this network in healthy populations, as observed by improved cognitive performance and increased striatal BOLD signal. This two-part study aimed to assess the feasibility of WM updating training in PD and measure change in cognition, movement and functional brain response in one individual with PD after WM updating training. A feasibility and single-subject study were performed in which patients with PD completed computerized (...) WM updating training. The outcome measures were the pre-post changes in criterion and transfer cognitive tests; cognitive complaints; psychological health; movement kinematics; and task-related BOLD signal. Participants in the feasibility study showed improvements on the criterion tests at post-test. FL displayed the largest improvements on the criterion tests and smaller improvements on transfer tests. Furthermore, FL reported improved cognitive performance in everyday life. A shorter onset latency and smoother upper-limb goal-directed movements were measured at post-test, as well as increased activation within the striatum and decreased activation throughout the fronto-parietal WM network. This two-part study demonstrated that WM updating training is feasible to complete for PD patients and that change occurred in FL at post-test in the domains of cognition, movement and functional brain response. (shrink)

Combining information from two or possibly several blocks of data is gaining increased attention and importance in several areas of science and industry. Typical examples can be found in chemistry, spectroscopy, metabolomics, genomics, systems biology and sensory science. Many methods and procedures have been proposed and used in practice. The area goes under different names: data integration, data fusion, multiblock analyses, multiset analyses and a few more. This book is an attempt to give an up-to-date treatment of the most used (...) and important methods within an important branch of the area; namely methods based on so-called components or latent variables. These methods have already obtained an enormous attention in for instance chemometrics, bioinformatics, machine learning and sensometrics and have proved to be important both for prediction and interpretation. The book is primarily a description of methodologies, but most of the methods will be illustrated by examples from the above-mentioned areas. The book is written such that both users of the methods as well as method developers will hopefully find sections of interest. In the end of the book there is a description of a software package developed particularly for the book. This package is freely available in R and covers many of the methods discussed. To distinguish the different type of methods from each other, the book is divided into five parts. Part I is introduction and preliminary concepts. Part II is the core of the book containing the main unsupervised and supervised methods. Part III deals with more complex structures and, finally, Part IV discusses alternative unsupervised and supervised methods. The book ends with Part V discussing the available software. Our recommendation for reading the book are as follows. A minimum read of the book would involve chapters 1, 2, 3, 5 and 7. Chapters 4, 6 and 8 are more specialized and chapters 9 and 10 contain methods we think are more advanced or less obvious to use. We feel privileged to have so many friendly colleagues who were willing to spend their time on helping us to improve the book by reading separate chapters. We would like to express our thanks to: Rasmus Bro, Margriet Hendriks, Ulf Indahl, Henk Kiers, Ingrid MaÌ⁽ge, Federico Marini, AÌ⁽smund Rinnan, Rosaria Romano, Lars Erik Solberg, Marieke Timmerman, Oliver Tomic, Johan Westerhuis and Barry Wise. Of course, the correctness of the final text is fully our responsibility! (shrink)

Goal‐directed cognition is often discussed in terms of specialized memory structures like the “goal stack.” The goal‐activation model presented here analyzes goal‐directed cognition in terms of the general memory constructs of activation and associative priming. The model embodies three predictive constraints: (1) the interference level, which arises from residual memory for old goals; (1) the strengthening constraint, which makes predictions about time to encode a new goal; and (3) the priming constraint, which makes predictions about the role of cues in (...) retrieving pending goals. These constraints are formulated algebraically and tested through simulation of latency and error data from the Tower of Hanoi, a means‐ends puzzle that depends heavily on suspension and resumption of goals. Implications of the model for understanding intention superiority, postcompletion error, and effects of task interruption are discussed. (shrink)

Aggregating individuals’ consistent attitudes might produce inconsistent collective attitudes. Some groups therefore need the capacity to form attitudes that are irreducible to those of their members. Such groups, group-agent realists argue, are agents in control of their own attitude formation. In this paper, however, I show how group-agent realism overlooks the important fact that groups consist of strategically interacting agents. Only by eliminating group agency from our social explanations can we see how individuals vote strategically to gain control of their (...) groups and produce collective attitudes we cannot make sense of if we treat groups as agents. (shrink)

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis (...) is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment. (shrink)

Public reason liberals expect individuals to have justificatory reasons for their views of certain political issues. This paper considers how groups can, and whether they should, give collective public reasons for their political decisions. A problem is that aggregating individuals’ consistent judgments on reasons and a decision can produce inconsistent collective judgments. The group will then fail to give a reason for its decision. The paper considers various solutions to this problem and defends a deliberative procedure by showing how it (...) incentivizes information sharing and leads to outcomes most acceptable to the group members. (shrink)

Institutions promoting republican freedom as non-domination are commonly believed to differ significantly from institutions promoting negative freedom as non-interference. Philip Pettit, the most prominent contemporary defender of this view, also maintains that these republican institutions are neutral between the different conceptions of the good that characterise a modern society. This paper shows why these two views are incompatible. By analysing the institutional requirements Pettit takes as constitutive of republican freedom, I show how they also promote negative freedom by reducing overall (...) interference. To avoid this result, republican institutions must be more restrictive and require that citizens conform to a life of political engagement. But then republican freedom will not be a neutral ideal. Rejecting negative freedom therefore means sacrificing neutrality. (shrink)

The revival of republicanism was meant to challenge the hegemony of liberalism in contemporary political theory on the grounds that liberals show insufficient concern with institutional protection against political misrule. This article challenges this view by showing how neorepublicanism, particularly on Philip Pettit’s formulation, demands no greater institutional protection than does political liberalism. By identifying neutrality between conceptions of the good as the constraint on institutional requirements that forces neorepublicanism into the liberal framework, the article shows that neutrality is what (...) neorepublicans must jettison to offer a tenable critique of liberalism. Only then can neorepublicans ensure greater protection against misrule by demanding that citizens participate more actively in politics. They can then also criticize liberalism for failing to appreciate the importance of such protection. (shrink)

In the debate on how we ought to define political freedom, some definitions are criticized for implying that no one can ever be free to perform any action. In this paper, I show how the possibility of freedom depends on a definition that finds an appropriate balance between absence of interference and protection against interference. To assess the possibility of different conceptions of freedom, I consider the trade-offs they make between these two dimensions. I find that pure negative freedom is (...) clearly possible. Republican freedom might also be possible, though its protection requirement is too vague for a definitive verdict. Finally, the recently proposed ‘freedom as independence’ is impossible since it is an attempt to avoid the unavoidable trade-off. (shrink)

Can groups really be agents or is group agency just a fiction? Christian List and Philip Pettit argue influentially for group-agent realism by showing how certain groups form and act on attitudes in ways they take to be unexplainable at the level of the individual agents constituting them. Group agency is therefore considered not a fiction or a metaphor but a reality we must account for in explanations of certain social phenomena. In this paper, I challenge this defence of group-agent (...) realism by showing how it is undermined by individual-level analysis of how individuals interact within groups. While group agency can be a useful fiction, real agents are at the individual level, not the collective level. (shrink)

This wide-ranging collection of essays contains eighteen original articles by authors representing some of the most important recent work on Wittgenstein. It deals with questions pertaining to both the interpretation and application of Wittgenstein s thought and the editing of his works. Regarding the latter, it also addresses issues concerning scholarly electronic publishing. The collection is accompanied by a comprehensive introduction which lays out the content and arguments of each contribution. Contributors: Knut Erik Tranoy, Lars Hertzberg, Georg Henrik (...) von Wright, Marie McGinn, Cora Diamond, James Conant, David G. Stern, Eike von Savigny, P.M.S. Hacker, Hans-Johann Glock, Allan Janik, Kristof Nyiri, Antonia Soulez, Brian McGuinness, Anthony Kenny, Joachim Schulte, Herbert Hrachovec, Cameron McEwen.". (shrink)

In the interpretive literature from the 1950's through the 1970's the term 'criterion' was thought to be a central key to the understanding of Wittgenstein's later philosophy. Later on, it was relegated from this place of honour to being one of a variety of expressions used by Wittgenstein in dealing with philosophical questions. This Element tries to account for the shifting fate of this concept. It discusses the various occurrences of the word “criteria” in the Philosophical Investigations, argues that the (...) post-Wittgensteinian debate about criteria was put on the wrong track by a problematic passage in Wittgenstein's early Blue Book, and finally gives an overview of the main contributions to this debate, trying to achieve a reconciliation between the rival conceptions. (shrink)

John Rawls thinks republicanism is compatible with his political liberalism. Philip Pettit insists that the two conflict in important ways. In this paper, I make sense of this dispute by employing David Chalmers’s method of elimination to reveal the meaning underlying key terms in Rawls’s political liberalism and Pettit’s republicanism. This procedure of disambiguating terms will show how the two theories defend the same institutional arrangement on the same grounds. The procedure thus vindicates Rawls’s view of the two theories being (...) compatible. The reason for this compatibility is that both theories are politicized—that is, they are constructed to attract the compliance of all reasonable members of a modern, pluralistic society. (shrink)

Principles of justice, David Estlund argues, cannot be falsified by people’s unwillingness to satisfy them. In his Utopophobia, Estlund rejects the view that justice must bend to human motivation to deliver practical implications for how institutions ought to function. In this paper, I argue that a substantive argument against such bending of justice principles must challenge the reasons for making these principles sensitive to motivational limitations. Estlund, however, provides no such challenge. His dispute with benders of justice is therefore a (...) verbal one over the true meaning of justice, which need not worry those with the intuition that justice should perform a function that requires bending. By focusing on John Rawls’s reasons for bending his justice principles, I point towards a substantive critique of bent justice. (shrink)

Name der Zeitschrift: Semiotica Jahrgang: 2018 Heft: 224 Seiten: 269-293.

This article demonstrates the broad applicability of the concept of symbol in human communication, beyond but including verbal language. The starting point is Charles Sanders Peirce’s understanding of symbolicity as signification grounded on habits. The goal is to be able to conceptualize mediality in general and media interrelations, particularly in relation to symbolicity. Informed by a multimodal view on media, the author provides a systematic overview of symbolicity within the context of communication among human minds structured around two crossing parameters: (...) symbols being limited or widespread among people and symbols not being part of or being part of systems – languages. Based on this overview, I clarify the role of culture in language notions and conceptualize language in relation to mediality. I also suggest a way of more precisely describing similarities and differences between languages and media types, without either conflating or totally separating the two concepts. Finally, I investigate how the dependence of language and media type conceptions on culture affects the idea of intermediality. Together, these investigations and conceptualizations promote a more comprehensive understanding of symbolicity in general and a deeper knowledge of the role of symbolicity in human communication, including verbal language, and intermedial relations involving all kinds of different media types. (shrink)

In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and (...) analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity. (shrink)

Many people who claim to genuinely care about nature still seem reluctant to ascribe intrinsic value to it. Environmentalists, nature friendly people in general, and even environmental activists, often hesitate at the idea that nature possesses value in its own right—value that is not reducible to its importance to human or other sentient beings. One crucial explanation of this reluctance is probably the thought that such value—at least when attached to nature—would be mysterious in one way or another, or at (...) least very difficult to account for. In addition, Bryan Norton’s influential convergence hypothesis states that, from a practical point of view, it makes no or little difference whether we ascribe intrinsic value to nature, given the depth and variety of instrumental value it possesses. In this paper, I argue that people who genuinely care about nature cannot avoid ascribing intrinsic value (in a certain sense) to it, if they want to be able to consistently defend the kind of claims about protecting nature they arguably want to make, i.e., claims to the effect that we ought to protect for instance nature areas and species. The cost of denying intrinsic value in nature is the cost of giving up a crucial resource to philosophically defend such claims. (shrink)