The central theme of the volume is cultural diversity, a vast subject that is highly relevant today. The particular focus here is on the many ways in which this diversity is managed within the framework of State law. The twelve contributors to this book have a special interest in how cultural traditions and their various forms of expression are handled by the law. They were all participants in the 2009 Research Programme of the Centre for Studies and Research of the (...) Hague Academy of International Law. The breadth of the subject is reflected in the wide spectrum of perspectives from which the topic has been explored. Starting in each case from the existing State and international legal frameworks, the contributors explore how the interactions between positive law and other normative orders can be placed at the service of a legal system that is as fair as possible within a plural context. Contributors were asked to choose from two alternative approaches: either they could look at cultural diversity issues in the field of private (international) law, a fairly traditional field that is especially relevant to the legal treatment of cultural diversity; or they could situate cultural diversity within the wider and more theoretical area of "legal pluralism", whether on a local or regional level or at the international (United Nations) level. Edited by Marie-Claire Foblets and Nadjma Yassari With the contribution of: M. Ben Lamine; N. Bialostozky; R. Colavitti; L.-M. Crăciunean; I. Gallala-Arndt; P. Kruiniger; V. Mainetti; S. Ouechtati; J. Ringelheim; B. Truffin; J. Verhellen; A. Vigorito. Le th me au coeur de ce volume est la diversit culturelle, vaste sujet de grande actualit. L'int r t porte ici plus particuli rement sur les mani res disparates dont cette diversit est agenc e dans le droit (formel) des Etats. Les douze auteurs portent tous un int r t particulier pour la question du sort qui est r serv, en droit, aux traditions culturelles et leurs diverses formes d'expression. L'ouvrage est le fruit des travaux du Centre d' tude et de recherche de l'Acad mie de droit international de La Haye en 2009. Le choix des sujets abord s dans ce volume est vaste. Le point de d part de chaque contribution toutefois est le cadre normatif existant, tant le cadre tatique que les instruments internationaux, pour ensuite explorer les diverses mani res dont ceuxci se positionnent par rapport d'autres logiques normatives perceptibles dans la soci t et qui tendent, chacune sa mani re, obtenir une forme de reconnaissance de la part du droit tatique. Plusieurs pistes s'offraient aux auteurs: une premi re piste consistait s'int resser surtout aux questions de droit international priv, un domaine traditionnel du droit qui regorge d'int r t pour la question du traitement juridique de la diversit culturelle. Une autre piste tait de faire le jour sur les m canismes de protection juridique de la diversit culturelle travers le prisme du pluralisme juridique et de voir jouer celui-ci divers niveaux: local, r gional, national et international. Les contributions illustrent les liens signifiants existant entre l'ordre juridique d'un Etat et les multiples ordres juridiques parall les (religieux, philosophiques, ethniques, ou autres) pr sents sur son territoire. Originally published as Colloques / Workshops - Law Books of the Academy, Volume 33. (shrink)

In this article, I attempt to resuscitate the perennially unfashionable distinctive feeling theory of pleasure (and pain), according to which for an experience to be pleasant (or unpleasant) is just for it to involve or contain a distinctive kind of feeling. I do this in two ways. First, by offering powerful new arguments against its two chief rivals: attitude theories, on the one hand, and the phenomenological theories of Roger Crisp, Shelly Kagan, and Aaron Smuts, on the other. Second, by (...) showing how it can answer two important objections that have been made to it. First, the famous worry that there is no felt similarity to all pleasant (or unpleasant) experiences (sometimes called ‘the heterogeneity objection’). Second, what I call ‘Findlay’s objection’, the claim that it cannot explain the nature of our attraction to pleasure and aversion to pain. (shrink)

What is it for a life to be meaningful? In this article, I defend what I call Consequentialism about Meaning in Life, the view that one's life is meaningful at time t just in case one's surviving at t would be good in some way, and one's life was meaningful considered as a whole just in case the world was made better in some way for one's having existed.

Purposeful infection of healthy volunteers with a microbial pathogen seems at odds with acceptable ethical standards, but is an important contemporary research avenue used to study infectious diseases and their treatments. Generally termed ‘controlled human infection studies’, this research is particularly useful for fast tracking the development of candidate vaccines and may provide unique insight into disease pathogenesis otherwise unavailable. However, scarce bioethical literature is currently available to assist researchers and research ethics committees in negotiating the distinct issues raised by (...) research involving purposefully infecting healthy volunteers. In this article, we present two separate challenge studies and highlight the ethical issues of human challenge studies as seen through a well-constructed framework. Beyond the same stringent ethical standards seen in other areas of medical research, we conclude that human challenge studies should also include: independent expert reviews, including systematic reviews; a publicly available rationale for the research; implementation of measures to protect the public from spread of infection beyond the research setting; and a new system for compensation for harm. We hope these additions may encourage safer and more ethical research practice and help to safeguard public confidence in this vital research alternative in years to come. (shrink)

In this paper, I reconstruct Robert Nozick's experience machine objection to hedonism about well-being. I then explain and briefly discuss the most important recent criticisms that have been made of it. Finally, I question the conventional wisdom that the experience machine, while it neatly disposes of hedonism, poses no problem for desire-based theories of well-being.

Three plausible views—Presentism, Truthmaking, and Independence—form an inconsistent triad. By Presentism, all being is present being. By Truthmaking, all truth supervenes on, and is explained in terms of, being. By Independence, some past truths do not supervene on, or are not explained in terms of, present being. We survey and assess some responses to this.

Strategies to increase influenza vaccination rates have typically targeted healthcare professionals and individuals in various high-risk groups such as the elderly. We argue that they should focus on increasing vaccination rates in children. Because children suffer higher influenza incidence rates than any other demographic group, and are major drivers of seasonal influenza epidemics, we argue that influenza vaccination strategies that serve to increase uptake rates in children are likely to be more effective in reducing influenza-related morbidity and mortality than those (...) targeting HCPs or the elderly. This is true even though influenza-related morbidity and mortality amongst children are low, except in the very young. Further, we argue that there are no decisive reasons to suppose that children-focused strategies are less ethically acceptable than elderly or HCP-focused strategies. (shrink)

The philosophical study of well-being concerns what makes lives good for their subjects. It is now standard among philosophers to distinguish between two kinds of well-being: - lifetime well-being, i.e., how good a person's life was for him or her considered as a whole, and - temporal well-being, i.e., how well off someone was, or how they fared, at a particular moment in time or over a period of time longer than a moment but shorter than a whole life, say, (...) a day, month, year, or chapter of a life. Many theories have been offered of each of these kinds of well-being. A common view is that lifetime well-being is in some way constructed out of temporal well-being. This book argues that much of this literature is premised on a mistake. Lifetime well-being cannot be constructed out of temporal well-being, because there is no such thing as temporal well-being. The only genuine kind of well-being is lifetime well-being. The Passing of Temporal Well-Being will prove essential reading for professional philosophers, especially in moral and political philosophy. It will also be of interest to welfare economists and policy-makers who appeal to well-being. (shrink)

This book stems from an examination of how Western philosophy has accounted for the foundations of law. In this tradition, the character of the “sovereign” or “lawgiver” has provided the solution to this problem. But how does the sovereign acquire the right to found law? As soon as we ask this question we are immediately confronted with a convoluted combination of jurisprudence and theology. The author begins by tracing a lengthy and deeply nuanced exchange between Derrida and Nancy on the (...) question of community and fraternity and then moves on to engage with a diverse set of texts from the Marquis de Sade, Saint Augustine, Kant, Hegel, and Kafka. These texts—which range from the canonical to the apocryphal—all struggle in their own manner with the question of the foundations of law. Each offers a path to the law. If a reader accepts any path as it is and follows without question, the law is set and determined and the possibility of dialogue is closed. The aim of this book is to approach the foundations of law from a series of different angles so that we can begin to see that those foundations are always in question and open to the possibility of dialogue. (shrink)

Animals suffer harms not only in human captivity but in the wild as well. Some of these latter harms are due to humans, but many of them are not. Consider, for example, the harms of predation, i.e. of being hunted, killed, and eaten by other animals. Should we intervene in nature to prevent these harms? In this article, I consider two possible ways in which we might do so: (1) by herbivorising predators (i.e. genetically modify them so that their offspring (...) gradually evolve into herbivores) and (2) by painlessly killing predators. I argue that, among these options, painlessly killing predators would be preferable to herbivorising them. I then argue that painlessly killing predators, despite its costs to predators, might under certain circumstances be justifiable. (shrink)

An overview (about 8,000 words) of act utilitarianism, covering the basic idea of the theory, historical examples, how it differs from rule utilitarianism and motive utilitarianism, supporting arguments, and standard objections. A closing section provides a brief introduction to indirect utilitarianism (i.e., a Hare- or Railton-style view distinguishing between a decision procedure and a criterion of rightness).

Recent literature on intrinsic value contains a number of disputes about the nature of the concept. On the one hand, there are those who think states of affairs, such as states of pleasure or desire satisfaction, are the bearers of intrinsic value (“Mooreans”); on the other hand, there are those who think concrete objects, like people, are intrinsically valuable (“Kantians”). The contention of this paper is that there is not a single concept of intrinsic value about which Mooreans and Kantians (...) have disagreed, but rather two distinct concepts. I state a number of principles about intrinsic value that have typically (though not universally) been held by Mooreans, all of which are typically denied by Kantians. I show that there are distinct theoretical roles for a concept of intrinsic value to play in a moral framework. When we notice these distinct theoretical roles, we should realize that there is room for two distinct concepts of intrinsic value within a single moral framework: one that accords with some or all of the Moorean principles, and one that does not. (shrink)

In this article I defend a new argument against moralist theories of legitimacy and in favour of realist theories. Moralist theories, I argue, are vulnerable to ideological and wishful thinking because they do not connect the demands of legitimacy with the interests of rulers. Realist theories, however, generally do manage to make this connection. This is because satisfying the usual realist criteria for legitimacy – the creation of a stable political order that transcends brute coercion – is usually necessary for (...) rulers to preserve their rule. (shrink)

Efforts to promote equitable public policy with algorithms appear to be fundamentally constrained by the “impossibility of fairness” (an incompatibility between mathematical definitions of fairness). This technical limitation raises a central question about algorithmic fairness: How can computer scientists and policymakers support equitable policy reforms with algorithms? In this article, I argue that promoting justice with algorithms requires reforming the methodology of algorithmic fairness. First, I diagnose the problems of the current methodology for algorithmic fairness, which I call “formal algorithmic (...) fairness.” Because formal algorithmic fairness restricts analysis to isolated decision-making procedures, it leads to the impossibility of fairness and to models that exacerbate oppression despite appearing “fair.” Second, I draw on theories of substantive equality from law and philosophy to propose an alternative methodology, which I call “substantive algorithmic fairness.” Because substantive algorithmic fairness takes a more expansive scope of analysis, it enables an escape from the impossibility of fairness and provides a rigorous guide for alleviating injustice with algorithms. In sum, substantive algorithmic fairness presents a new direction for algorithmic fairness: away from formal mathematical models of “fair” decision-making and toward substantive evaluations of whether and how algorithms can promote justice in practice. (shrink)

There is significant controversy over whether patients have a ‘right not to know’ information relevant to their health. Some arguments for limiting such a right appeal to potential burdens on others that a patient’s avoidable ignorance might generate. This paper develops this argument by extending it to cases where refusal of relevant information may generate greater demands on a publicly funded healthcare system. In such cases, patients may have an ‘obligation to know’. However, we cannot infer from the fact that (...) a patient has an obligation to know that she does not also have a right not to know. The right not to know is held against medical professionals at a formal institutional level. We have reason to protect patients’ control over the information that they receive, even if in individual instances patients exercise this control in ways that violate obligations. (shrink)

I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly (...) strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort. (shrink)

A clear and provocative introduction to the ethics of COVID-19, suitable for university-level students, academics, and policymakers, as well as the general reader. It is also an original contribution to the emerging literature on this important topic. The author has made it available Open Access, so that it can be downloaded and read for free by all those who are interested in these issues. Key features include: -/- A neat organisation of the ethical issues raised by the pandemic. An exploration (...) of the many complex interconnections between these issues. A succinct case for a continued lockdown until we develop a vaccine. An original account of the Deep Moral Problem of the Pandemic, and a Revolutionary Argument for how we should change society post-pandemic. References to, and engagement with, many of the best writings on the pandemic so far (both in popular media and academic journals). -/- ISBN: 978-0-6489016-0-0. (shrink)

Death has long been a pre-occupation of philosophers, and this is especially so today. The Oxford Handbook of Philosophy of Death collects 21 newly commissioned essays that cover current philosophical thinking of death-related topics across the entire range of the discipline. These include metaphysical topics--such as the nature of death, the possibility of an afterlife, the nature of persons, and how our thinking about time affects what we think about death--as well as axiological topics, such as whether death is bad (...) for its victim, what makes it bad to die, what attitude it is fitting to take towards death, the possibility of posthumous harm, and the desirability of immortality. The contributors also explore the views of ancient philosophers such as Aristotle, Plato and Epicurus on topics related to the philosophy of death, and questions in normative ethics, such as what makes killing wrong when it is wrong, and whether it is wrong to kill fetuses, non-human animals, combatants in war, and convicted murderers. With chapters written by a wide range of experts in metaphysics, ethics, and conceptual analysis, and designed to give the reader a comprehensive view of recent developments in the philosophical study of death, this Handbook will appeal to a broad audience in philosophy, particularly in ethics and metaphysics. (shrink)

In this article I defend a new argument against moralist theories of legitimacy and in favour of realist theories. Moralist theories, I argue, are vulnerable to ideological and wishful thinking because they do not connect the demands of legitimacy with the interests of rulers. Realist theories, however, generally do manage to make this connection. This is because satisfying the usual realist criteria for legitimacy – the creation of a stable political order that transcends brute coercion – is usually necessary for (...) rulers to preserve their rule. (shrink)

There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth might seem to enable us (...) to overcome—fairness of burdens and reliance on self-reporting—I note that these problems would only really be solved by unacceptably comprehensive forms of personal health surveillance which applies to all of us at all times. A more plausible model is to use personal health surveillance as a last resort for patients who would otherwise independently qualify for responsibility-based penalties. However, I note that there are still a number of ethical and practical problems that such a policy would need to overcome. The prospects of mHealth enabling a fair, genuinely cost-saving policy of patient responsibility are slim. (shrink)

It is often thought that some version of what is generally called the publicity condition is a reasonable requirement to impose on moral theories. In this article, after formulating and distinguishing three versions of the publicity condition, I argue that the arguments typically used to defend them are unsuccessful and, moreover, that even in its most plausible version, the publicity condition ought to be rejected as both question-begging and unreasonably demanding.

The idea of using responsibility in the allocation of healthcare resources has been criticized for, among other things, too readily abandoning people who are responsible for being very badly off. One response to this problem is that while responsibility can play a role in resource allocation, it cannot do so if it will leave those who are responsible below a “sufficiency” threshold. This paper considers first whether a view can be both distinctively sufficientarian and allow responsibility to play a role (...) even for those who will be left with very poor health. It then draws several further distinctions that may affect the application of responsibility at this level. We conclude that a more plausible version of the sufficientarian view is to allow a role for responsibility where failure to do so will leave someone else who is not responsible below the sufficiency threshold. However, we suggest that individuals must exhibit “sufficient responsibility” in order for this to apply, involving both a sufficient level of control and an avoidable failure to respond adequately to reasons for action. (shrink)

The introduction (about 6,000 words) to _The Cambridge Companion to Utilitarianism_, in three sections: utilitarianism’s place in recent and contemporary moral philosophy (including the opinions of critics such as Rawls and Scanlon), a brief history of the view (again, including the opinions of critics, such as Marx and Nietzsche), and an overview of the chapters of the book.

A considerable literature has emerged around the idea of using ‘personal responsibility’ as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as ‘responsibilisation’. This discussion focuses most prominently, but not exclusively, on ‘luck egalitarianism’, the view that deviations from equality are justified only by suitably free choices. A superficially separate issue in distributive justice concerns the two–way relationship (...) between health and other social goods: deficits in health typically undermine one's abilities to secure advantage in other areas, which in turn often have further negative effects on health. This paper outlines the degree to which this latter relationship between health and other social goods exacerbates an existing problem for proponents of responsibilisation (the ‘harshness objection’) in ways that standard responses to this objection cannot address. Placing significant conditions on healthcare access because of a person's prior responsibility risks trapping them in, or worsening, negative cycles where poor health and associated lack of opportunity reinforce one another, making further poor yet ultimately responsible choices more likely. It ends by considering three possible solutions to this problem. (shrink)

A book chapter (about 9,000 words, plus references) presenting an act-consequentialist approach to the ethics of climate change. It begins with an overview of act consequentialism, including a description of the view’s principle of rightness (an act is right if and only if it maximizes the good) and a conception of the good focusing on the well-being of sentient creatures and rejecting temporal discounting. Objections to act consequentialism, and replies, are also considered. Next, the chapter briefly suggests that act consequentialism (...) could reasonably be regarded as the default moral theory of climate change, in the sense that a broadly act-consequentialist framework often seems implicit in both scholarly and casual discussions of the ethics of climate change. The remainder of the chapter explores three possible responses to the threat of climate change: having fewer children to reduce the number of people emitting greenhouse gases; taxing greenhouse-gas (GHG) emissions (commonly called a “carbon tax”) to discourage GHG-emitting behavior; and reducing poverty to lessen personal, familial, and community vulnerability to the harms of climate change. (shrink)

Interactive robots are used increasingly not only in entertainment and service robotics, but also in rehabilitation, therapy and education. The work presented in this paper is part of the Aurora project, rooted in assistive technology and robot-human interaction research. Our primary aim is to study if robots can potentially be used as therapeutically or educationally useful ‘toys’. In this paper we outline the aims of the project that this study belongs to, as well as the specific qualitative contextual perspective that (...) is being used. We then provide an in-depth evaluation, in part using Conversation Analysis, of segments of trials where three children with autism interacted with a robot as well as an adult. We focus our analysis primarily on joint attention which plays a fundamental role in human development and social understanding. Joint attention skills of children with autism have been studied extensively in autism research and therefore this behaviour provides a relevant focus for our study. In the setting used, joint attention emerges from natural and spontaneous interactions between a child and an adult. We present the data in the form of transcripts and photo stills. The examples were selected from extensive video footage for illustrative purposes, i.e. demonstrating how children with autism can respond to the changing behaviour of their co-participant, i.e. the experimenter. Furthermore, our data shows that the robot provides a salient object, or mediator for joint attention. The paper concludes with a discussion of implications of this work in the context of further studies with robots and children with autism within the Aurora project, as well as the potential contribution of robots to research into the nature of autism. (shrink)

In this critique of longtermism, I attack its Heart, the idea that there is intrinsic value in the addition of each new happy being to the world. I provide new responses to longtermists' two main arguments for the Heart (The Argument from Extinction and The Argument from Miserable Beings). I then sketch an alternative view to longtermism, which I call Future Sentimentalism, a view that does a better job of explaining our future-regarding reasons. Finally, I consider an important objection to (...) my critique. (shrink)

Healthcare practitioners have access to a range of ethical guidance. However, the normative role of this guidance in ethical decision-making is underexplored. This paper considers two ways that healthcare practitioners could approach ethics guidance. We first outline the idea of deference to ethics guidance, showing how an attitude of deference raises three key problems: moral value; moral understanding; and moral error. Drawing on philosophical literature, we then advocate an alternative framing of ethics guidance as a form of moral testimony by (...) colleagues and suggest that a more promising attitude to ethics guidance is to approach it in the spirit of ‘critical engagement’ rather than deference. (shrink)

Greg Bognar has recently offered a prioritarian justification for ‘fair innings’ distributive principles that would ration access to healthcare on the basis of patients' age. In this article, I agree that Bognar's principle is among the strongest arguments for age-based rationing. However, I argue that this position is incomplete because of the possibility of ‘time-relative' egalitarian principles that could complement the kind of lifetime egalitarianism that Bognar adopts. After outlining Bognar's position, and explaining the attraction of time-relative egalitarianism, I suggest (...) various ways in which these two kinds of principle could interact. Since various options have very different implications for age-based rationing, proponents of such a rationing scheme must take a position on time-relative egalitarianism to complement a lifetime prioritarian view like Bognar's. (shrink)

There is a simple but powerful argument against the human practice of raising and killing animals for food (RKF for short). It goes like this: 1. RKF is extremely bad for animals. 2. RKF is only trivially good for human beings Therefore, 3. RKF should be stopped. While many consider this argument decisive, not everyone is convinced. There have been four main lines of objection to it. In this paper, I provide new responses to these four objections.

The non-identity problem is that some actions seem morally wrong even though, by affecting future people’s identities, they are worse for nobody. In this paper, I further develop and defend a lesser-known solution to the problem, one according to which when such actions are wrong, it is not because of what they do or produce, but rather just because of why they were performed. In particular, I argue that the actions in non-identity cases are wrong just when and because they (...) result from, or reflect in those who have performed them, a morally dubious character trait. (shrink)

Using Schelling's philosophy, Ben Woodard examines how an expanded form of naturalism changes how we conceive of the division between thought and world, mathematics and motion, sense and dynamics, experiment and materiality, as well as speculation and pragmatism. Nature, in Schelling's eyes, is not the great outdoors or some authentic pastoral realm, but the various powers, processes and tendencies which run through biology, chemistry, physics and the very possibility of thought itself.

Recent empirical literature suggests that some of the most prominent environmental policies that the Chinese government has pursued have involved at least some measure of participation from citizen...

Many believe that intended harms are more difficult to justify than are harms that result as a foreseen side effect of one's conduct. We describe cases of harming in which the harm is not intended, yet the harmful act nevertheless runs afoul of the intuitive moral constraint that governs intended harms. We note that these cases provide new and improved counterexamples to the so-called Simple View, according to which intentionally phi-ing requires intending to phi. We then give a new theory (...) of the moral relevance of intention. This theory yields the traditional constraint on intending harm as a special case, along with several stronger demands. (shrink)

According to welfarism about value, something is good simpliciter just in case it is good for some being or beings. In her recent Presidential Address to the American Philosophical Association, “Good-For-Nothings”, Susan Wolf argues against welfarism by appeal to great works of art, literature, music, and philosophy. Wolf provides three main arguments against this view, which I call The Superfluity Argument, The Explanation of Benefit Argument, and The Welfarist’s Mistake. In this paper, I reconstruct these arguments and explain where, in (...) my view, each goes wrong. (shrink)

Purpose Online violence has been rampant in the past decade, intensifying the victims’ suffering owing to its rapid dissemination to vast audiences. This study aims to focus on online gender-based violence directed against young Bedouin women who have left their male-dominated home territory for academic studies. This study examined how the backlash against these students, intended to stop changes in traditional gender roles, is reflected in offensive TikTok videos. Design/methodology/approach This research is based on a qualitative-thematic analysis of 77 questionnaires (...) and 30 semistructured in-depth interviews with first-year female Bedouin students aged 18–21 years. Findings The backlash was widespread, with young Bedouin men using offensive videos as “proof” that women have violated codes of honor and morality. The videos exhibited four types of gender-based violence: claims of immoral behavior, aggressive captions that take the footage out of context, allegations of immodest clothing and digital photo editing that produced fabricated results. Examining participants' reactions to the videos, this study revealed two patterns of response: passive acceptance of the situation and an active approach that included reaching out to powerful Bedouin men for solutions. Originality/value This research enriches the literature on online gender-based violence, particularly against women in traditional societies, and suggests practical steps: developing online media literacy in traditional societies, adopting a proactive approach and nurturing social self-competence in women who have been victims of online gender-based violence. (shrink)

We developed this study to examine the issue of parental refusal of treatment, looking at the issue through a cultural competence lens. Recent cases in Canada where courts have declined applications by clinicians for court orders to overrule parental refusal of treatment highlight the dispute in this area. This study analyses the 16 cases of a larger group of 24 cases that were selected by a literature review where cultural or religious beliefs or ethnic identity was described as important reasons (...) behind the refusal. The most significant finding was that nearly all of the cases cited unacceptable side effects as the main reason for declining treatment. We then analysed the detail of the cases and concluded that in the first instance a skilled clinical approach to develop an agreed management plan is by far the best approach. In the event that agreement cannot be reached we recommend engaging a mediator to help the clinician and parents/child to find an agreeable way forward. We argue that the option of se... (shrink)

Suppose you find yourself in a situation in which you can either save both A and B or save only C. A, B and C are relevantly similar – all are strangers to you, none is more deserving of life than any other, none is responsible for being in a life-threatening situation, and so on. John Taurek argued that when deciding what to do in such a situation, you should flip a coin, thereby giving each of A, B and C (...) a 50% chance of survival . Only by doing this can we treat each person with the appropriate degree of respect. Taurek seemed to be employing the “Equal Greatest Chance” principle , according to which, when deciding whom to save, one must give each person the greatest possible chance of survival consistent with everyone else having the same chance. An obvious alternative is the “Save the Greater Number” principle . I describe an example that shows that EGC is false. I show that the example also demonstrates the falsity of other related views, including Jens Timmermann’s “Individualist Lottery Principle.” I conclude that SGN is true. And I extend the argument to other kinds of cases, showing that which person should be saved may depend on whether some additional well-being may be gained for someone in the process. (shrink)

Behavior oftentimes allows for many possible interpretations in terms of mental states, such as goals, beliefs, desires, and intentions. Reasoning about the relation between behavior and mental states is therefore considered to be an effortful process. We argue that people use simple strategies to deal with high cognitive demands of mental state inference. To test this hypothesis, we developed a computational cognitive model, which was able to simulate previous empirical findings: In two-player games, people apply simple strategies at first. They (...) only start revising their strategies when these do not pay off. The model could simulate these findings by recursively attributing its own problem solving skills to the other player, thus increasing the complexity of its own inferences. The model was validated by means of a comparison with findings from a developmental study in which the children demonstrated similar strategic developments. (shrink)

This article considers attempts to include the issues of ageing and ill health in a Rawlsian framework. It first considers Norman Daniels’ Prudential Lifespan Account, which reduces intergenerational questions to issues of intrapersonal prudence from behind a Rawslian veil of ignorance. This approach faces several problems of idealisation, including those raised by Hugh Lazenby, because it must assume that everyone will live to the same age, undermining its status as a prudential calculation. I then assess Lazenby's account, which applies Rawls’ (...) general theory of justice more directly to healthcare. Lazenby suggests that we should apply Rawls’ difference principle – which claims that any inequalities in social goods must benefit the worst off – to conclude that we should significantly prioritise treatment of young patients. I argue first that the existence of young terminally ill patients undermines a number of Rawlsian arguments for the difference principle. I then argue that the structure of ageing undermines the Rawlsian decision mechanism of the ‘veil of ignorance’ on which Lazenby relies. I conclude that age and terminal illness present significant problems for any comprehensive Rawlsian account of justice. (shrink)

Pickeringet al’s paper argues that the capacity of the decision-maker is the sole consideration in whether a decision should stand, and that the risk of the decision should not be considered. This argument ignores the existence of the player who is of the view that a decision is not wise. This paper argues that patient autonomy is not the sole determinant of whether a person is able to make an unwise decision, particularly in healthcare where there are always others affected (...) by the patient decision. Rather than asserting that patients have an unfettered autonomous choice on clinical decisions this paper argues that these decisions should be looked at through the lens of quality in health care that has proposed four parameters to be balanced; the patient experience, wise use of resources, the effect on public health and the clinician experience. (shrink)