Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and (...) disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

The standard Kratzerian analysis of modal auxiliaries, such as ‘may’ and ‘can’, takes them to be univocal and context-sensitive. Our first aim is to argue for an alternative view, on which such expressions are polysemous. Our second aim is to thereby shed light on the distinction between semantic context-sensitivity and polysemy. To achieve these aims, we examine the mechanisms of polysemy and context-sensitivity and provide criteria with which they can be held apart. We apply the criteria to modal auxiliaries and (...) show that the default hypothesis should be that they are polysemous, and not merely context-sensitive. We then respond to arguments against modal ambiguity. Finally, we show why modal polysemy has significant philosophical implications. (shrink)

This book presents a collection of original essays by leading thinkers in political theory, philosophy, and bioethics on key issues concerning global justice and bioethics. It is the first collection to comprehensively address these pressing theoretical and practical questions about international distributive justice, humans rights, health care and medical research.

Emanuel Copilaș ABSTRACT: The present article aims to offer a synoptic picture of communist Romania’s relations with Third World countries during the Ceaușescu regime. Within these relations, economic and geopolitical motivations coexisted along with ideological ones, thus making the topic one of the most interesting and relevant key for understanding RSR’s complex and cunning international...

We argue that the ethical case for instituting vaccine benefit programs is justified by 2 widely recognized values: (1) reducing overall harm from COVID-19 and (2) protecting disadvantaged individuals. We then explain why they do not coerce, exploit, wrongfully distort decision-making, corrupt vaccination's moral significance, wrong those who have already been vaccinated, or destroy willingness to become vaccinated. However, their cost impacts and their effects on public perception of vaccines should be evaluated.

The current prevailing view is that participation in biomedical research is above and beyond the call of duty. While some commentators have offered reasons against this, we propose a novel public goods argument for an obligation to participate in biomedical research. Biomedical knowledge is a public good, available to any individual even if that individual does not contribute to it. Participation in research is a critical way to support an important public good. Consequently, all have a duty to participate. The (...) current social norm is that individuals participate only if they have a good reason to do so. The public goods argument implies that individuals should participate unless they have a good reason not to. Such a shift would be of great aid to the progress of biomedical research, eventually making society significantly healthier and longer lived. (shrink)

Volume 19, Issue 9, September 2019, Page 1-4.

In this article, we explore whether cross-linguistic differences in grammatical aspect encoding may give rise to differences in memory and cognition. We compared native speakers of two languages that encode aspect differently (English and Swedish) in four tasks that examined verbal descriptions of stimuli, online triads matching, and memory-based triads matching with and without verbal interference. Results showed between-group differences in verbal descriptions and in memory-based triads matching. However, no differences were found in online triads matching and in memory-based triads (...) matching with verbal interference. These findings need to be interpreted in the context of the overall pattern of performance, which indicated that both groups based their similarity judgments on common perceptual characteristics of motion events. These results show for the first time a cross-linguistic difference in memory as a function of differences in grammatical aspect encoding, but they also contribute to the emerging view that language fine tunes rather than shapes perceptual processes that are likely to be universal and unchanging. (shrink)

Global health is at a crossroads. The 2030 Agenda for Sustainable Development has come with ambitious targets for health and health services worldwide. To reach these targets, many more billions of dollars need to be spent on health. However, development assistance for health has plateaued and domestic funding on health in most countries is growing at rates too low to close the financing gap. National and international decision-makers face tough choices about how scarce health care resources should be spent. Should (...) additional funds be spent on primary prevention of stroke, treating childhood cancer, or expanding treatment for HIV/AIDS? Should health coverage decisions take into account the effects of illness on productivity, household finances, and children's educational attainment, or just focus on health outcomes? Does age matter for priority setting or should it be ignored? Are health gains far in the future less important than gains in the present? Should higher priority be given to people who are sicker or poorer? Global Health Priority-Setting provides a framework for how to think about evidence-based priority-setting in health. Over 18 chapters, ethicists, philosophers, economists, policy-makers, and clinicians from around the world assess the state of current practice in national and global priority setting, describe new tools and methodologies to address establishing global health priorities, and tackle the most important ethical questions that decision-makers must consider in allocating health resources. (shrink)

We consider an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? We argue that it is ethical to consider local resource constraints when deciding what interventions to provide. The provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.

Certifications of immunity are sometimes called “immunity passports” but are better conceptualized as immunity-based licenses. Such policies raise important questions about fairness, stigma, and counterproductive incentives but could also further individual freedom and improve public health. Immunity licenses should not be evaluated against a baseline of normalcy, ie, uninfected free movement. Rather, they should be compared to the alternatives of enforcing strict public health restrictions for many months or permitting activities that could spread infection, both of which exacerbate inequalities and (...) impose serious burdens. This Viewpoint presents a framework for analyzing the ethics of immunity licenses. (shrink)

Many guidelines for international research require that studies be responsive to host community health needs or health priorities. Although responsiveness possesses great intuitive and rhetorical appeal, existing conceptions are confusing and difficult to apply. Not only are there few examples of what research the responsiveness requirement permits and what it rejects, but its application can lead to contradictory results. Because of the practical difficulties in applying responsiveness and the danger that misapplying responsiveness could harm the interests of developing countries, we (...) argue that responsiveness should be refocused in three ways: in terms of (1) who enforces it, (2) under what standard, and (3) in what cases. We conclude that responsiveness should be applied by host country officials at the policy level with the exercise of judgment when externally funded research threatens to displace scarce local resources. (shrink)

Alfred Schutz is, without a doubt, one of the phenomenologists that contributed the most to the reflection on how to apply insights from phenomenological philosophy to the, empirical and theoretical, human and social sciences. However, his work tends to be neglected by many of the current advocates of phenomenology within these disciplines. In the present paper, I intend to remedy this situation. In order to do so, I will systematically revisit his mundane and social-scientifically oriented account of phenomenology, which, as (...) I shall show, emerges from a theoretical confrontation with the Husserlian distinction between transcendental phenomenology and phenomenological psychology. (shrink)

This book was inspired originally by the debates at the turn of the century about placebo controlled trials of antiretrovirals in HIV positive pregnant women in developing countries. Moving forward from this one limited example, the book includes several additional controversial cases of clinical research conducted in developing countries, and asks probing philosophical questions about the ethics of such trials. All clinical research by its very nature uses people to acquire generalizable knowledge to help future people. But what sorts of (...) "use" are morally permissible? What is it to exploit people? Suppose that a trial conducted in a developing country would not be ethically permissible in the developed world. Can we automatically conclude from this that the trial is unethical, that some sort of morally problematic double standard is in operation? Or might the differences in the two settings justify differences in trial design? This collection of philosophical essays examines these important questions about what exploitation is and when clinical research counts as exploitative. -/- "This is an outstanding contribution to the growing literature on the ethics of research with human subjects and a fine example of what bioethics can offer at its best. Anyone with a serious interest in these issues will need to read this book from start to finish." -Daniel Wikler, Harvard School of Public Health "This book contributes significantly to the literature on exploitation in clinical research conducted in the developing world."--Patricia Marshall, Case Western Reserve University . (shrink)

Modern generative AI systems have shown the capacity to produce remarkably fluent language, prompting debates both about their semantic understanding and, less prominently, about whether they can perform speech acts. This paper addresses the latter question, focusing on assertion. We argue that to be capable of assertion, an entity must meet two requirements: it must produce outputs with descriptive functions, and it must be capable of being sanctioned by agents with which it interacts. The second requirement arises from the nature (...) of assertion as a norm-governed social practice. Pre-trained large language models that have not been subject to fine-tuning fail to meet the first requirement. Language models that have been fine-tuned for ‘groundedness’ or ‘correctness’ may meet the first requirement, but fail the second. We also consider the significance of the point that AI systems can be used to generate proxy assertions on behalf of human agents. (shrink)

Una de las características predominantes en la obra de Nicos Poulantzas es su marcada subjetividad, la cual estuvo atravesada por el momento histórico en que transcurrió su vida, pues se trataba de una época en donde los procesos revolucionarios perdían vigencia y quedaban amargas, pero al mismo tiempo, importantísimas lecciones; donde a pesar de la constante inestabilidad, el capitalismo lograba restaurarse y transformarse a expensas del Estado. El presente escrito explora la vigencia teórica de la obra intelectual de Poulantzas, su (...) originalidad distinguida por pertenecer a un marxismo heterodoxo más preocupado por la cuestión del Estado; al mismo tiempo, se incluyen explícitamente elementos de análisis como la dependencia, el desarrollo y la gestión global neoliberal del capital en la actualidad. Esto a partir de la lectura de su obra desde y con una perspectiva latino-mericana que permita concluir con algunos elementos teóricos para la construcción y actualización de una teoría del Estado que tenga en cuenta las particularidades de esta parte del mundo. (shrink)

This article examines a fundamental question of justice in global health. Is it ethically preferable to provide a larger number of people with cheaper treatments that are less effective (or more toxic), or to restrict treatments to a smaller group to provide a more expensive but more effective or less toxic alternative? We argue that choosing to provide less effective or more toxic interventions to a larger number of people is favored by the principles of utility, equality, and priority for (...) those worst-off. Advocates are mistaken to demand that medical care provided in low-income and middle-income countries should be the same as in high-income countries. (shrink)

The 2010 Patient Protection and Affordable Care Act was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance. Opponents of the mandate argue that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Rather than appeal to the collective good, this Viewpoint argues for a duty to buy health insurance based on the moral duty individuals have to reduce certain burdens (...) they pose on others. When some people have a duty to rescue, others may have a duty to take rescue precautions, in this case, to purchase health insurance to cover acute and emergency care needs. Requiring that individuals meet this obligation is consistent with respect of individual liberty. (shrink)

We’re grateful for the thoughtful and incisive commentaries on our article, “Ethical Responsibilities for Companies that Process Personal Data” (McCoy et al. 2023). In the article, we propose the E...

El término competencias profesionales se define en la actualidad, como la posesión por parte del individuo de los conocimientos, destrezas y actitudes necesarias para realizar su actividad. El actual estudio tiene como objetivo profundizar en el análisis de la literatura sobre las competencias profesionales con un enfoque de formación y desarrollo de la expresión escrita en las universidades médicas. Con la revisión documental, se corroboró que en estas instituciones, el tratamiento de los contenidos de los programas de las asignaturas, no (...) garantizan el desarrollo de las competencias profesionales, atendiendo a que los currículos están diseñados por habilidades lo que trae como resultado que sus egresados no cuenten con el desarrollo adecuado de tales competencias, en particular las que garantizan la práctica afectiva de la expresión escrita. Professional competencies are currently defined as an individual's knowledge, skills and attitudes required to work in a specific profession. The current study aimed to further examine the literature related to professional skills with a focus on the development of writing in medical universities. Through document review, it was confirmed that in these institutions, the syllabi do not ensure the development of professional competencies since curricula are skills based. This in turn hinders the proper development of professional competencies, particularly those that guarantee strong writing practices. (shrink)

Nietzsche's reflections on German education and culture of his time arise in the context in which he, as a teacher, is directly involved with these issues. They can be found especially in two works from this period: nas Anti-Education: On the Future of Our Educational Institutions, de 1872, e na Schopenhauer as Educator, de 1874. In these texts, we are interested in identifying the criticisms that Nietzsche makes to the education of his time and to analyze his “educational proposal” in (...) which education, life and culture are closely linked to the point of promoting an authentic culture. (shrink)

Traz depoimentos dirigidos de filósofos brasileiros sobre temas clássicos e contemporâneos da filosofia, processos de formação intelectual e a vida cultural brasileira. Ao final, apresenta breve biografia do depoente e lista das suas principais publicações.

In this paper two systems of AGM-like Paraconsistent Belief Revision are overviewed, both defined over Logics of Formal Inconsistency (LFIs) due to the possibility of defining a formal consistency operator within these logics. The AGM° system is strongly based on this operator and internalize the notion of formal consistency in the explicit constructions and postulates. Alternatively, the AGMp system uses the AGM-compliance of LFIs and thus assumes a wider notion of paraconsistency - not necessarily related to the notion of formal (...) consistency. (shrink)

El problema del principio de razón suficiente puede hallar sus primerosindicios en Spinoza; no obstante, es hasta que Leibniz trata de definirlocuando toma cierto rango y cierta importancia filosófica. El problema essi todo tiene una razón (o causa) y si todo tiene una causa, ¿por qué? Ysi no todo tiene una causa, ¿qué razones tenemos para pensar en ello?

Célebre por um tipo de filosofia que se caracteriza pelas linhas de fuga e pela desterritorialização de um pensamento nômade, Deleuze se reconhece como um filósofo sistemático. Como todo sistema, uma filosofia sistemática se define por um conjunto de elementos que se compõem e se alinham de modo a conferir a ele uma coerência. O presente artigo pretende demonstrar como o conjunto da filosofia de Deleuze confere uma organicidade e verosimilhança a seu sistema de pensamento a partir da articulação entre (...) a imanência, o acontecimento e o conceito. Esta tríade atravessa todo o seu trabalho e irá caracterizar aquilo que Deleuze chama de heterogênese; uma tentativa de fazer com que a filosofia se desprenda dos estados de coisas e vá na direção das intensidades, levando o pensamento ao limite e à máxima potência. Queremos demonstrar o modo como Deleuze opera em seu sistema de forma a associar e criar aproximações entre elementos mais ou menos heterogêneos, ora criando zonas de aproximação, ora provocando afastamentos. (shrink)

Communication Studies currently undergoes a crisis of paradigms that requires an ontological review that must begin with a debate about the conditions of possibility of every communicational phenomena. In this article we argue that semiosis offers a conceptual framework that allows for the study of communication as qualitative action. Semiosis, or the action of the sign, is here defined as a fundamental process based on perception that models the world of species, creating cognition and culture. At the core of semiosis (...) are dynamic structures that the authors have defined as ‘ontological diagrams’. The first purpose of Semiotics of Communication is to understand how these modeling systems evolve ontologically and phylogenically, producing, in the case of human culture, means of communication ever more varied and technologically advanced. (shrink)

The aim of this paper is to systematically analyze Schutz’s phenomenological account of the typicality and habituality of everyday cognitive experience, and to identify the Husserlian leitmotifs that inform it. In order to do so, I will proceed in three steps. First, I will briefly present the main lines of Schutz’s theoretical project; second, I will scrutinize his Husserlian account of typification as a passive sort of interpretation; and finally, I will examine his –also Husserl-inspired– analysis of the structure and (...) genesis of the habitualized stock of knowledge at hand. (shrink)

Although it is commonly believed that the concept of brain death was developed to benefit organ transplants, it evolved independently. Transplantation owed its development to advances in surgery and immunosuppressive treatment; BD owed its origin to the development of intensive care. The first autotransplant was achieved in the early 1900s, when studies of increased intracranial pressure causing respiratory arrest with preserved heartbeat were reported. Between 1902 and 1950, the BD concept was supported by the discovery of EEG, Crile’s definition of (...) death, the use of EEG to demonstrate abolition of brain potentials after ischaemia, and Crafoord’s statement that death was due to cessation of blood flow. Transplantation saw the first xenotransplant in humans and the first unsuccessful kidney transplant from a cadaver. In the 1950s, circulatory arrest in coma was identified by angiography, and the death of the nervous system and coma dépassé were described. Murray performed the first successful kidney transplant. In the 1960s, the BD concept and organ transplants were instantly linked when the first kidney transplant using a brain-dead donor was performed; Schwab proposed to use EEG in BD; the Harvard Committee report and the Sydney Declaration appeared; the first successful kidney, lung and pancreas transplants using cadaveric donors were achieved; Barnard performed the first human heart transplant. This historical review demonstrates that the BD concept and organ transplantation arose separately and advanced in parallel, and only began to progress together in the late 1960s. Therefore, the BD concept did not evolve to benefit transplantation. (shrink)

Although it is commonly believed that the concept of brain death was developed to benefit organ transplants, it evolved independently. Transplantation owed its development to advances in surgery and immunosuppressive treatment; BD owed its origin to the development of intensive care. The first autotransplant was achieved in the early 1900s, when studies of increased intracranial pressure causing respiratory arrest with preserved heartbeat were reported. Between 1902 and 1950, the BD concept was supported by the discovery of EEG, Crile’s definition of (...) death, the use of EEG to demonstrate abolition of brain potentials after ischaemia, and Crafoord’s statement that death was due to cessation of blood flow. Transplantation saw the first xenotransplant in humans and the first unsuccessful kidney transplant from a cadaver. In the 1950s, circulatory arrest in coma was identified by angiography, and the death of the nervous system and coma dépassé were described. Murray performed the first successful kidney transplant. In the 1960s, the BD concept and organ transplants were instantly linked when the first kidney transplant using a brain-dead donor was performed; Schwab proposed to use EEG in BD; the Harvard Committee report and the Sydney Declaration appeared; the first successful kidney, lung and pancreas transplants using cadaveric donors were achieved; Barnard performed the first human heart transplant. This historical review demonstrates that the BD concept and organ transplantation arose separately and advanced in parallel, and only began to progress together in the late 1960s. Therefore, the BD concept did not evolve to benefit transplantation. (shrink)

Commentators often claim that medical research subjects are coerced into participating in clinical studies. In recent years, such claims have appeared especially frequently in ethical discussions of research in developing countries. Medical research ethics is more important than ever as we move into the 21st century because worldwide the pharmaceutical industry has grown so much and shows no sign of slowing its growth. This means that more people are involved in medical research today than ever before, and in the future (...) even more will be involved. However, despite the pressing need for reflection on research ethics, it is important to carefully identify the concerns we have about research. Otherwise we run the risk that the moral language we use, and which we hear other people use, may do our moral thinking for us. We argue that many recent claims about the occurrence of coercion in medical research are misguided and misuse the word "coercion." We try to identify the real problems, and urge people to attend carefully to the implications of their descriptions of moral problems in research. (shrink)