Clinical red blood cell transfusion guidelines have been widely adopted in clinical practice, resulting in standardized transfusion practices in hospitalized patients with anemia. Standardization of transfusion practice has been welcomed by clinicians and health systems as a mechanism for reducing unnecessary, harmful, and costly practice variation that results in healthcare disparities. However, overzealously applied guidelines can have deleterious consequences for individual patients, ultimately resulting in and/or exacerbating healthcare disparities, rather than resolving them. This article provides empirical examples of the adverse (...) consequences from the well-meaning attempt to standardize transfusion practice based on clinical practice guidelines and discusses the ethical implications of standardized transfusion practice. (shrink)

In a series of influential essays, Sharon Street has argued, on the basis of Darwinian considerations, that normative realism leads to skepticism about moral knowledge. I argue that if we begin with the account of moral knowledge provided by Aristotelian naturalism, then we can offer a satisfactory realist response to Street’s argument, and that Aristotelian naturalism can avoid challenges facing other realist responses. I first explain Street’s evolutionary argument and three of the most prominent realist responses, and I identify challenges (...) to each of those responses. I then develop an Aristotelian response to Street. My core claim is this: Given Aristotelian naturalism’s account of moral truth and our knowledge of it, we can accept the influence of evolutionary processes on our moral beliefs, while also providing a principled, non-question-begging reason for thinking that those basic evaluative tendencies that evolution has left us with will push us toward, rather than away from, realist moral truths, so that our reliably getting things right does not require an unexplained and implausible coincidence. (shrink)

A common objection to the idea of public reason is that it cannot resolve fundamental political issues because it excludes too many moral considerations from the political domain. Following an important but often overlooked distinction drawn by Gerald Gaus, there are two ways to understand this objection. First, public reason is often said to be inconclusive because it fails to generate agreement on fundamental political issues. Second, and more radically, some critics have claimed that public reason is indeterminate because it (...) cannot provide any citizen with sufficient reason(s) for making important political decisions. Against the first of these objections, I argue that the purpose of public reason is not to end reasonable disagreement. Rather, it is to provide a suitable framework of values and principles within which citizens may resolve their moral and political differences. Against the second objection, I argue, first, that the indeterminacy of public reason is much less common than its inconclusiveness; and, second, that there are second-order decision-making strategies that may enable citizens to cope with cases of indeterminacy. The incompleteness of public reason, whether it takes the form of inconclusiveness or indeterminacy, is not a reason for citizens to abandon their commitment to public justification. (shrink)

Predictive processing approaches to the mind are increasingly popular in the cognitive sciences. This surge of interest is accompanied by a proliferation of philosophical arguments, which seek to either extend or oppose various aspects of the emerging framework. In particular, the question of how to position predictive processing with respect to enactive and embodied cognition has become a topic of intense debate. While these arguments are certainly of valuable scientific and philosophical merit, they risk underestimating the variety of approaches gathered (...) under the predictive label. Here, we first present a basic review of neuroscientific, cognitive, and philosophical approaches to PP, to illustrate how these range from solidly cognitivist applications—with a firm commitment to modular, internalistic mental representation—to more moderate views emphasizing the importance of ‘body-representations’, and finally to those which fit comfortably with radically enactive, embodied, and dynamic theories of mind. Any nascent predictive processing theory must take into account this continuum of views, and associated theoretical commitments. As a final point, we illustrate how the Free Energy Principle attempts to dissolve tension between internalist and externalist accounts of cognition, by providing a formal synthetic account of how internal ‘representations’ arise from autopoietic self-organization. The FEP thus furnishes empirically productive process theories by which to guide discovery through the formal modelling of the embodied mind. (shrink)

This essay defends Aristotelian naturalism against the objection that it is naïvely optimistic, and contrary to empirical research, to suppose that virtues like justice are naturally good while vices like injustice are naturally defective. This objection depends upon the mistaken belief that our knowledge of human goodness in action and choice must come from the natural sciences. In fact, our knowledge of goodness in human action and character depends upon a practical understanding that is possessed by someone not qua scientist (...) but qua practically wise person. I spell out some key features of this knowledge of human form, including its relation to practical reasons and its similarity to the “know-how” of crafts-persons. My account of virtue as knowledge of human form sheds light on the Aristotelian thesis that humans live according to an understanding of their own form. My account also clarifies the kinship and the divergence between Aristotelian and Kantian ethics. (shrink)

The Bayesian brain hypothesis, as formalized by the free-energy principle, is ascendant in cognitive science. But, how does the Bayesian brain obtain prior beliefs? Veissière and colleagues argue that sociocultural interaction is one important source. We offer a complementary model in which “interoceptive self-inference” guides the estimation of expected uncertainty both in ourselves and in our social conspecifics.

Abstract: Recent years have witnessed a revival of interest in relativism. Proponents have defended various accounts that seek to model the truth-conditions of certain propositions along the lines of standard possible world semantics. The central challenge for such views has been to explain what advantage they have over contextualist theories with regard to the possibility of disagreement. I will press this worry against Max Kölbel’s account of faultless disagreement. My case will proceed along two distinct but connected lines. First, I (...) will argue that the sense of faultlessness made possible by his relativism conflicts with our intuitive understanding of disagreement. And second, that his meta-epistemological commitments are at odds with the socio-epistemic function of disagreement. This latter problem for relativistic accounts of truth has thus far been largely ignored in the literature. (shrink)

An influential strand of neo-Aristotelianism, represented by writers such as Philippa Foot, holds that moral virtue is a form of natural goodness in human beings, analogous to deep roots in oak trees or keen vision in hawks. Critics, however, have argued that such a view cannot get off the ground, because the neo-Aristotelian account of natural normativity is untenable in light of a Darwinian account of living things. This criticism has been developed most fully by William Fitzpatrick in his book (...) Teleology and the Norms of Nature . In this paper, I defend the neo-Aristotelian account of natural normativity, focusing on Fitzpatrick's arguments. I argue that a natural goodness view is not impugned by an evolutionary account. Nor can neo-Aristotelian life form judgments be replaced by an evolutionary view of living things. (shrink)

NoteThe following was written as a commentary on an article we published in our Spring 2023 issue, “’Comprehensive Healthcare for America’: Using the Insights of Behavioral Economics to Transform the U. S. Healthcare System,” by Paul C. Sorum, Christopher Stein, and Dale L. Moore. This commentary should have appeared alongside that article. We apologize to the authors and our readers for the error.

The central claim of Aristotelian naturalism is that moral goodness is a kind of species-specific natural goodness. Aristotelian naturalism has recently enjoyed a resurgence in the work of philosophers such as Philippa Foot, Rosalind Hursthouse, and Michael Thompson. However, any view that takes moral goodness to be a type of natural goodness faces a challenge: Granting that moral goodness is natural goodness for human beings, why should we care about being good human beings? Given that we are rational creatures who (...) can ‘step back’ from our nature, why should we see human nature as authoritative for us? This is the authority-of-nature challenge. In this essay, I state this challenge clearly, identify its deep motivation, and distinguish it from other criticisms of Aristotelian naturalism. I also articulate what I consider the best response, which I term the practical reason response. This response, however, exposes Aristotelian naturalism to a new criticism – that it has abandoned the naturalist claim that moral goodness is species-specific natural goodness. Thus, I argue, Aristotelian naturalists appear to face a dilemma: Either they cannot answer the authority-of-nature challenge, or in meeting the challenge they must abandon naturalism. Aristotelian naturalists might overcome this dilemma, but doing so is harder than some Aristotelians have supposed. In the final sections of the paper, I examine the difficulties in overcoming the dilemma, and I suggest ways that Aristotelians might answer the authority-of-nature challenge while preserving naturalism. (shrink)

Respiratory rhythms sustain biological life, governing the homeostatic exchange of oxygen and carbon dioxide. Until recently, however, the influence of breathing on the brain has largely been overlooked. Yet new evidence demonstrates that the act of breathing exerts a substantive, rhythmic influence on perception, emotion, and cognition, largely through the direct modulation of neural oscillations. Here, we synthesize these findings to motivate a new predictive coding model of respiratory brain coupling, in which breathing rhythmically modulates both local and global neural (...) gain, to optimize cognitive and affective processing. Our model further explains how respiratory rhythms interact with the topology of the functional connectome, and we highlight key implications for the computational psychiatry of disordered respiratory and interoceptive inference. (shrink)

An important objection to political liberalism is that it provides no means by which to decide conflicts between public and non-public reasons. This article develops John Rawls' idea of `reasoning from conjecture' as one way to argue for a commitment to public reason. Reasoning from conjecture is a form of non-public justification that allows political liberals to reason from within the comprehensive views of at least some unreasonable citizens. After laying out the basic features of this form of non-public justification, (...) this article responds to three objections based on concerns about insincerity, cultural imperialism, and the epistemic authority of those who reason from conjecture. (shrink)

While tens of thousands of people across the United States serve on hospital and other healthcare ethics committees, almost no carefully prepared educational material exists for HEC members. Ethics by Committee is a one volume collection of chapters developed exclusively for this educational purpose. Experts in bioethics, clinical consultation, health law, and social psychology from across the country contribute chapters on ethics consultation, education, and policy development.

Joshua Greene argues that cognitive (neuro)science matters for ethics in two ways, the “direct route” and the “indirect route.” Greene illustrates the direct route with a debunking explanation of the inclination to condemn all incest. The indirect route is an updated version of Greene’s argument that dual-process moral psychology gives support for consequentialism over deontology. I consider each of Greene’s arguments, and I argue that neither succeeds. If there is a route from cognitive (neuro)science to ethics, Greene has not found (...) it. (shrink)

John Locke's theory of toleration has been criticized as having little relevance for politics today because it rests on controversial theological foundations. Although there have been some recent attempts to develop secular; or publicly accessible, arguments out of Locke's writings, these tend to obscure and distort the religious arguments that Locke used to defend toleration. More importantly, these efforts ignore the role that religious arguments may play in supporting the development of a normative consensus on the legitimacy of liberal political (...) principles. Bracketing the search for publicly accessible justifications makes it possible to appreciate the continued relevance of Locke's religious arguments for toleration. (shrink)

Johnson and Hudecki argue that Bernard Suits fails to refute Wittgenstein’s ‘family resemblance’ view of games because Suits’s account of how games begin, how they are played, and the ends they involve, fails to match basic facts of player experience. In reply, the current paper describes three keys to interpreting The Grasshopper: (1) distinguishing the four perspectives from which Suits describes games, (2) recognizing Suits' dispositional view of rule following, and (3) understanding the geometrical metaphor Suits uses to describe rules. (...) In light of these, this paper argues that Johnson and Hudecki’s critiques are either mistaken or are actually affirmations of Suits' position. (shrink)

Background Inadequate knowledge among health care providers (HCPs) and parents of affected children limits the understanding and utility of secondary genetic findings (SFs) in under-represented populations in genomics research. SFs arise from deep DNA sequencing done for research or diagnostic purposes and may burden patients and their families despite their potential health importance. This study aims to evaluate the perspective of both groups regarding SFs and their choices in the return of results from genetic testing in the context of orofacial (...) clefts.Methods Using an online survey, we evaluated the experiences of 252 HCPs and 197 parents across participating cleft clinics in Ghana and Nigeria toward the return of SFs across several domains.Results Only 1.6% of the HCPs felt they had an expert understanding of when and how to incorporate genomic medicine into practice, while 50.0% agreed that all SFs should be returned to patients. About 95.4% of parents were willing to receive all the information from genetic testing (including SFs), while the majority cited physicians as their primary information source (64%).Conclusions Overall, parents and providers were aware that genetic testing could help in the clinical management of diseases. However, they cited a lack of knowledge about genomic medicine, uncertain clinical utility, and lack of available learning resources as barriers. The knowledge gained from this study will assist with developing guidelines and policies to guide providers on the return of SFs in sub-Saharan Africa and across the continent. (shrink)

_ Source: _Volume 13, Issue 3, pp 363 - 375 In _The Value of Living Well,_ Mark LeBar develops a position that he calls “virtue eudaimonism”. VE is both a eudaimonistic theory of practical reasoning and a constructivist account of the metaphysics of value. In this essay, I will explain the core of LeBar’s view and focus on two issues, one concerning VE ’s eudaimonism and the other concerning VE ’s constructivism. I will argue that, as it stands, VE does (...) not adequately address the charge of egoism, once that charge has been formulated in the strongest way. I will also argue that a substantive constructivism like VE must have considerably less explanatory power than any constructivism that appeals to a _formal_ characterization of agency. Although my remarks are largely critical, I offer them in a spirit of sympathetic engagement with LeBar’s impressive book. (shrink)

This article discusses an interdisciplinary and community-engaged public health law course that was developed as part of The Future of Public Health Law Education faculty fellowship program. Law and public health students worked collaboratively to assist a local health department in preparing for the law-related aspects of Public Health Accreditation Board review.

Invited review of the anthology of new papers _Philosophy of Chemistry: Growth of a New Discipline_.

Various theorists contend that we may live in a computer simulation. David Chalmers in turn argues that the simulation hypothesis is a metaphysical hypothesis about the nature of our reality, rather than a sceptical scenario. We use recent work on consciousness to motivate new doubts about both sets of arguments. First, we argue that if either panpsychism or panqualityism is true, then the only way to live in a simulation may be as brains-in-vats, in which case it is unlikely that (...) we live in a simulation. We then argue that if panpsychism or panqualityism is true, then viable simulation hypotheses are substantially sceptical scenarios. We conclude that the nature of consciousness has wide-ranging implications for simulation arguments. (shrink)

A very liberal sexual ethics now holds sway in Western culture, such that mutual consent alone is widely seen as morally legitimizing almost any sexual activity between adults. It is further commonly assumed by both philosophers and nonphilosophers that arguing for some alternative to liberal sexual ethics requires appeal to ethical commands specific to some religious tradition or other. The purpose of this paper is to challenge that assumption by suggesting some purely naturalistic and independently-plausible premises that can be used (...) to argue for a much more conservative system of sexual ethics than is widely accepted today. (shrink)

Many contemporary eudaimonists emphasize the role of agency in the good life. Mark LeBar, for example, characterizes his own eudaimonist view this way: “It is agentist, not patientist, because it emphasizes that our lives go well in virtue of what we do, rather than what happens, to us or otherwise”. Nicholas Wolterstorff, however, has argued that this prioritizing of agency over patiency is a fatal flaw in eudaimonist accounts of well-being. Eudaimonism must be rejected, Wolterstorff argues, because many life-goods are (...) “passivities” that are out of a person’s hands, including how she is treated by others. In this paper, I defend eudaimonism against this passivities objection. I argue that eudaimonism can maintain its agentist character while also capturing the element of truth in the passivities objection—namely, that human well-being is vulnerable and social. I also argue that eudaimonists should avail themselves of the notion of receptivity to capture important aspects of the good life. (shrink)

It appears that one of the aims of John Rawls' ideal of public reason is to provide people with good reason for exercising restraint on their nonpublic reasons when they are acting in the public political arena. I will argue, however, that in certain cases Rawls' ideal of public reason is unable to provide a person with good reason for exercising such restraint, even if the person is already committed to Rawls' ideal of public reason. Because it is plausible to (...) believe that such cases are widespread, the issue I am raising represents a serious problem for Rawls' account of public reason. After posing this problem, I consider potential responses on behalf of Rawls' view, and I reply to those responses. The moral of this story, as I see it, is that the kind of duty an ideal of public reason aims to place on citizens must be more modest than Rawls supposes. (shrink)

What is the Problem with the Rarity of the Virtues?An important strand of the situationist challenge to Aristotelian virtue ethics rests on the following claim:Rarity Thesis: On the basis of evidence from psychological research, we are justified in believing that possession of the Aristotelian virtues is very rare.The Rarity Thesis is sometimes regarded as a problem for virtue ethics, or as an embarrassing implication of claims made by virtue ethicists.See John Doris, Lack of Character (Cambridge, UK: Cambridge University Press, 2002), (...) 58–60, 110–112; John Doris and Stephen Stich, “As a Matter of Fact: Empirical Perspectives on Ethics” in The Oxford Handbook of Contemporary Philosophy (Oxford, UK: Oxford University Press, 2005), see esp. 120–123. Mark Alfano, Character as Moral Fiction (Cambridge, UK: Cambridge University Press, 2013). For the purposes of this essay, I will use “virtue ethics” to refer to broadly Aristotelian virtue ethics. However, as many people have pointed out, Ari. (shrink)

This paper surveys some ways in which the chemical realm can be described and outlined in terms of the concept of supervenience. The particular contours of general chemical theory provide a ready basis for interpretation of determination, covariance, and nonreduction—the characteristic metaphysical facets of the supervenience relation—in mutual terms. Building on this, the extent to which chemically characterized properties and entities can be described in terms of a supervenience-scaffolded structure represents a particularly vivid application that philosophers in general interested in (...) supervenience would do well to attend to. In addition, the model of chemical supervenience given here can be used as a rubric on which to decide on issues already raised by philosophers of chemistry. (shrink)

According to Congressional Budget Office projections, the Patient Protection and Affordable Care Act — assuming it survives the pending legal challenges and is fully implemented — will provide health insurance to 34 million additional Americans by 2021. This will increase the percentage of non-elderly Americans with health insurance from the current rate of 83 percent to 95 percent. Although enactment of the Affordable Care Act constitutes a historic step forward in the nearly century-long effort to ensure universal health insurance coverage, (...) relatively little in the Act focused on the potentially transformative impact of public health efforts that prevent disease. Chronic diseases such as heart disease, cancer, stroke, and diabetes are now responsible for more than 75 percent of health care costs, and reducing the incidence of these diseases — which are often entirely preventable — could dramatically improve the nation’s physical and fiscal health. (shrink)