The interrogation of Meletus in the Apology at 24c4–28al is not infrequently seen as a typical case of all that is intellectually and artistically dissatisfying in Plato's practice of the genre of philosophical dialogue: not only are we presented with a philosopher who makes some claim to being committed to setting a particularly stringent standard for honesty in argumentation making sophistical arguments, but we are presented also with a cardboard interlocutor who is forced by the hand of Plato to acquiesce (...) to those arguments in a fashion that is completely dissatisfying to the reader. The best anyone seems to do to save Plato from these charges of artistic incompetence and intellectual dishonesty is to appeal to such a level of historical accuracy for the text that the stupidity of Meletus' responses can be attributed to the stupidity of Meletus himself, or to point out features of the political and legal situation that might prevent Meletus from answering the questions by drawing on his true motivation—which is presumably more coherent. Taylor says of this passage:The humour of the situation is that the prosecutor cannot venture to say what he means by either of his charges without betraying the fact that, owing to the ‘amnesty’, the matters complained of are outside of the competency of the court… Hence, when Meletus is pressed to explain what he means, he has to take refuge in puerile nonsense. (shrink)

The interrogation of Meletus in the Apology at 24c4–28al is not infrequently seen as a typical case of all that is intellectually and artistically dissatisfying in Plato's practice of the genre of philosophical dialogue: not only are we presented with a philosopher who makes some claim to being committed to setting a particularly stringent standard for honesty in argumentation making sophistical arguments, but we are presented also with a cardboard interlocutor who is forced by the hand of Plato to acquiesce (...) to those arguments in a fashion that is completely dissatisfying to the reader. The best anyone seems to do to save Plato from these charges of artistic incompetence and intellectual dishonesty is to appeal to such a level of historical accuracy for the text that the stupidity of Meletus' responses can be attributed to the stupidity of Meletus himself, or to point out features of the political and legal situation that might prevent Meletus from answering the questions by drawing on his true motivation—which is presumably more coherent. Taylor says of this passage: The humour of the situation is that the prosecutor cannot venture to say what he means by either of his charges without betraying the fact that, owing to the ‘amnesty’, the matters complained of are outside of the competency of the court… Hence, when Meletus is pressed to explain what he means, he has to take refuge in puerile nonsense. (shrink)

Reflecting on Smith (2021) in this issue, this commentary extends our consideration of issues in carceral health and questions the dehumanizing language we sometimes use—including in public health and public health ethics—to talk about persons held in incarceration. Even the language we use for the carceral system itself (such as ‘criminal justice system’) is fraught: it casts a laudatory light on the system and papers over its role in compounding racial health inequities and in sustaining colonialism. A host of (...) issues call out for ethical analysis, using lenses that can encompass the tensions and contradictions experienced by people within the system who deliver healthcare and those within the system trying to access that care. Beyond access to health care (promotion, prevention, treatment and palliation), the societal commitment to dealing with social issues by depriving people of many key social determinants of health is at the heart of many of these tensions and contradictions. (shrink)

Contents include Language as a Means of Mental Culture and International Communication (1853; 2 vols) by Claude Marcel; The Mastery of Languages, or the Art of Speaking Foreign Tongues Idiomatically (1864) by Thomas Prendergast; Introduction to the Teaching of Living Languages without Grammar or Dictionary (1874) by Lambert Sauveur; and The Art of Teaching and Studying Languages (1880; English translation 1892) by Francois Goiun.

In Canada, laws and policies consistently reject the commodification of human organs and tissues, and Canadian practice is consistent with international standards in this regard. Until the Assisted Human Reproduction Act of 2004, gamete donation in Canada was an exception: Canadians could pay and be paid open market rates for gametes for use in in vitro fertilization. As sections of the AHR Act forbidding payment for gametes and permitting only reimbursement of receipted expenses gradually came into effect in 2005, Canada (...) did away with this anomaly. Medical practice and legal prohibitions in assisted human reproduction are now consistent with other areas of medicine where tissues and organs are taken from one person to benefit others: Altruistic donation, rather than selling and buying, will be the norm. (shrink)

Some ethicists assert that there is a consensus that maximising medical outcomes takes precedence as a principle of resource allocation in emergency triage of absolutely scarce resources. But the nature of the current severe acute respiratory syndrome-related coronavirus 2 pandemic and the history of debate about balancing equity and efficiency in resource allocation do not support this assertion. I distinguish a number of concerns with justice and balancing considerations that should play a role in critical care triage policy, focusing on (...) discrimination and on fundamental egalitarian and social justice concerns. (shrink)

Are the small and indolent cancers found in abundance in cancer screening normal variations, risk factors, or disease? Naturalists in philosophy of medicine turn to pathophysiological findings to decide such questions objectively. To understand the role of pathophysiological findings in disease definition, we must understand how they mislead in diagnostic reasoning. Participants on all sides of the definition of disease debate attempt to secure objectivity via reductionism. These reductivist routes to objectivity are inconsistent with the Bayesian nature of clinical reasoning; (...) when they appeal to the sciences, they are inconsistent with what philosophy of biology tells us about its natural kinds. Proposals that we narrow the scope of our claims in the disease definition debates are useful, but paradigms can still distort our reasoning in particular cases, even when we are self-conscious about their status. (shrink)

The seriousness of the risk that healthcare workers faced during SARS, and their response of service in the face of this risk, brings to light unrealistic assumptions about duty and risk that informed the debate on duty to care in the early years of HIV/AIDS. Duty to care is not based upon particular virtues of the health professions, but arises from social reflection on what response to an epidemic would be consistent with our values and our needs, recognizing our shared (...) vulnerability to disease and death. Such reflection underwrites a strong duty of care, but one not to be borne solely by the altruism and heroism of individual healthcare workers. (shrink)

Some argue that the concept of medical need is inadequate to inform the design of a universal health care system—particularly an institutional rather than a residual system. They argue that the concept contradicts the idea of comprehensiveness; leads to unsustainable expenditures; is too indeterminate for policy; and supports only a prioritarian distribution. I argue that ‘comprehensive’ understood as ‘including the full continuum of care’ and ‘medically necessary’ understood as ‘prioritized by medical criteria’ are not contradictory, and that UHC is a (...) solution to the problem of sustainability, not its cause. Those who criticize ‘medical need’ for indeterminacy are not transparent about the source of their commitment to their standards of determinacy: they promote standards that are higher than is necessary for legitimate policy, ignoring opportunity costs. Furthermore, the indeterminacy of concepts affects all risk-sharing systems and all systems that rely on medical standard of care. I then argue that the concept of need in itself does not imply a minimal sufficientist standard or a prioritarian distribution; neither does the idea of legitimate public policy dictate that public services be minimalist. The policy choice for a system of health care that is comprehensive and offers as good care as can be achieved when delivered on equal terms and conditions for all is a coherent option. (shrink)

: This paper examines the nature of the harm-benefit tradeoff in early clinical research for interventions that involve remote possibility of direct benefit and likelihood of direct harms to research participants with fatal prognoses, by drawing on the example of gene transfer trials for glioblastoma multiforme. We argue that the appeal made by the component approach to clinical equipoise fails to account fully for the nature of the harm-benefit tradeoff—individual harm for social benefit—that would be required to justify such research. (...) An analysis of what we label "collateral affective benefits," such as the experience of hope or exercise of altruism, shows that the existence of these motivations reinforces rather than mitigates the necessity of justification by reference to social benefit. Evaluations of social benefit must be taken seriously in the research ethics review process to avoid the exploitation of research participants' motivations of hope or altruism and to avoid the possibility of inadvertent exploitation of high-risk research participants and the harms that would associate with such exploitation. (shrink)

Temkin asks how we should distribute resources between the social determinants of health and health care; Sreenivasan argues that if our goal is fair opportunity, funding universal health coverage is the wrong policy. He argues that social equality in health has not improved under UHC and concludes that fair opportunity would be better served by using the resources to address the SDOH instead. His criticism applies more broadly than he claims: it applies to any argument for UHC based on health (...) equity. However, neither his strong causal conclusion nor his stark policy proposal is justified. I review methodological challenges for establishing the relative causal contributions of health care and social policy, concluding that we may never have a robust causal account to support a consequentialist choice. Fortunately, we may not need to answer the allocation question as a dichotomy. Given what Sen calls the multidimensional nature of health equity and the role of UHC in cost containment, UHC may not be a threat to health equity. I also argue against Sreenivasan's claim that the data he discusses should not trouble sufficientists and prioritarians. The worst-off are not simply lagging in improvement; rather, their health status is stagnating or worsening. (shrink)

Verweij and Dawson claim that population health has a distributive dimension; Coggon argues that this presupposes a normative commitment to equity in the very definition of population health, which should, rather, be neutral. I describe possible sources of the distributive view, several of which do not presuppose egalitarian commitments. Two relate to the nature of health as a property of individuals ; two relate to the epistemology and pragmatics of public and population health. A fifth source of the distributive view (...) is a critical stance on the concept of population health; I contrast this with Coggon’s account of the public as a shared political imaginary. None of these views is ‘neutral’: they exhibit several different kinds of normativity and quasi-normativity, but this is not problematic. I argue that the critical stance appropriately distinguishes and relates social justice and public health. (shrink)

I discuss some reservations about the exegetical power of the claim that the Tractatus is “anti-metaphysical.” The “resolute” reading has the virtue of fidelity to important and neglected features of the work, both its anti-metaphysical moves and its account of the nature of the activity of philosophy and its status. However, its proponents underestimate the barriers to maintaining a consistent fidelity to these features of the text. The image of a ladder suggests a mere instrumental means to arrive at a (...) place that can itself be characterized independently of our means of arrival; where we arrive via the process of the TLP is the conclusion of an argument, and so cannot be characterized independently of the argument that got us there. In his commitments about the process of logical analysis “within language,” he strives as much as in his statements about the world to return us to our ordinary ways of talking and making sense of what we say to one another. Given the internal relationship Wittgenstein is at pains to emphasize between language, thought, and reality, he could hardly have philosophical commitments about one of these terms (have a residual metaphysics of language) and isolate this from how he thinks about the others. In a discussion of “Senator, you’re no Jack Kennedy” and “Chairman Mao is rare,” I argue that, pace Conant and Diamond’s claims to the contrary, logical categories are being invoked to explain why one cannot mean what one thinks one means in this phrase, and that Wittgenstein is both more anti-metaphysical in his treatment of these logical categories (in contrast with Frege) than the resolute readers consider him to be, and less successful in his treatment of how logical categories rule our judgments of sense and nonsense than they imply he is. Finally, I question the sharp boundary between logic and psychology and the “claustrophobic” feel that is created by a narrow construal of what one can make sense of in another’s words and person that underwrites their account of nonsense via a conflict between the meaning words can contain and our confused desires. Throughout, I discuss relevant passages of the Investigations that resolute readers treat as a re-expression of the themes of the Tractatus, to contrast the “anti-metaphysical” treatment these themes express in the Tractatus with the less dogmatic treatment they receive in the Investigations. (shrink)

Systems of universal health coverage may aspire to provide care based on need and not ability to pay; the complexities of this aspiration call for normative analysis. This special issue arises in the wake of a judicial inquiry into preferential access in the Canadian province of Alberta, the Vertes Commission. I describe this inquiry and set out a taxonomy of forms of differential and preferential access. Papers in this special issue focus on the conceptual specification of health system boundaries and (...) on the normative questions raised by complex models of funding and delivery of care, where patients, providers, and services cross system boundaries. (shrink)

The professionalism movement has animated medical education and practice; an extensive literature expresses and categorizes many interpretations of the concept (Hafferty 2006a; Hafferty and Levinson 2008). The inception of the current wave of the movement was in the American Board of Internal Medicine's Project Professionalism. In the face of threats from the growth of managed care and public concerns about conflict of interest, the ABIM's "Physician Charter" called for the profession to publically commit to values of patient welfare, social justice, (...) and respect for patient autonomy (Brennan et al. 2002). The concept of professionalism, or the physician as occupying the role of professional, has taken hold in .. (shrink)

In Capital in the Twenty-First Century, Thomas Piketty argues that markets, absent political intervention, tend toward economic divergence and that this has deleterious consequences for democratic ideals of equal voice and meritocracy. His goal is to foster a public conversation about what a society dominated by wealth—which we already beginning to experience as the twenty-first century begins—would look like if we wish to maintain an egalitarian ethos. His work will contribute to and further motivate several discussions in feminist bioethics, namely, (...) on the funding and organization of care labor, reproductive rights, global health, and commodification. (shrink)

In Capital in the Twenty-First Century, Thomas Piketty argues that markets, absent political intervention, tend toward economic divergence and that this has deleterious consequences for democratic ideals of equal voice and meritocracy. His goal is to foster a public conversation about what a society dominated by wealth—which we already beginning to experience as the twenty-first century begins—would look like if we wish to maintain an egalitarian ethos. His work will contribute to and further motivate several discussions in feminist bioethics, namely, (...) on the funding and organization of care labor, reproductive rights, global health, and commodification. (shrink)

Scientism in medical education distracts educators from focusing on the content of learning; it focuses attention instead on individual achievement and validity in its measurement. I analyze the specific form that scientism takes in medicine and in medical education. The competencies movement attempts to challenge old “scientistic” views of the role of physicians, but in the end it has invited medical educators to focus on validity in the measurement of individual performance for attitudes and skills that medicine resists conceptualizing as (...) objective. Academic medicine should focus its efforts instead on quality and relevance of care. The social accountability movement proposes to shift the focus of academic medicine to the goal of high quality and relevant care in the context of community service and partnership with the institutions that together with medicine create and cope with health and with health deficits. I make the case for this agenda through a discussion of the linked histories of the opioid prescribing crisis and the professionalism movement. (shrink)

In bioethics and health policy, we often discuss the appropriate boundaries of public funding; how the interface of public and private purchasers and providers should be organized and regulated receives less attention. In this paper, I discuss ethical and regulatory issues raised at this interface by three medical practice models in which physicians provide insured services while requiring or requesting that patients pay for services or for the non-insured services of the physicians themselves or their associates. This choice for such (...) practice models is different from the decision to design an insurance plan to include or exclude user fees, co-payments and deductibles. I analyze the issues raised with regards to familiar health care values of equity and efficiency, while highlighting additional concerns about fair terms of access, provider integrity, and fair competition. I then analyze the common Canadian regulatory response to block fee models, considering their extension to wellness clinics, with regards to fiduciary standards governing the physician–patient relationship and the role of informed consent. I close by highlighting briefly issues that are of common concern across different fundamental normative frameworks for health policy. (shrink)

Lisa A. Eckenwiler, Long-term care, globalization, and justice, Baltimore: The Johns Hopkins University Press, 2012, reviewed by Lynette Reid.

Lisa A. Eckenwiler, Long-term care, globalization, and justice, Baltimore: The Johns Hopkins University Press, 2012, reviewed by Lynette Reid.

As we have now completed 15 years of journal content, it seems like a good time to take stock and reflect upon the development and nature of public health ethic.

In "Public Health and Precarity," Michael Doan and Ami Harbin have done important work extending Sherwin's concept of relational autonomy to encompass relational agency—including agents such as communities and states. This opens up new ways of thinking about responsibility for public health in long-standing debates about the role of the state in public health.The case studies Doan and Harbin analyze are also important for thinking of the account of relational solidarity that Sherwin developed together with Baylis and Kenny, one element (...) of relational public health. The discussion may even open the space for a reformulation of relational solidarity. I will use the... (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Reid defended common sense against scepticism by appeal to the claim that our faculties should be considered trustworthy until some argument proves them to be untrustworthy. He believed, of course, that no such argument would be forthcoming. In this paper, we shall investigate Reid's defense of the faculty of perception and the evidence of the senses by analogy with the faculty of language and the evidence of testimony. Reid argued that the evidence of testimony should be trusted (...) unless there is reason to think it untrustworthy and by analogy, that the evidence of the senses should be trusted unless there is reason to think it untrustworthy. He admitted the fallibility of such evidence but contended that such fallibility is characteristic of all our faculties. Moreover, and perhaps most important, Reid developed a psychological theory of the faculties of perception and language that showed the analogy between these two faculties to be very exact indeed. (shrink)

As the originator of the Scottish school of "common sense" philosophy and the foremost contemporary critic of David Hume's moral skepticism, Thomas Reid (1710-1796) played a hitherto unknown role in applying the tradition of natural law to morality and politics. When Reid succeeded Adam Smith as professor of moral philosophy in Glasgow in 1764, he taught a course covering pneumatology (theory of mind), practical ethics, and politics. In presenting for the first time the philosopher's manuscript lectures and (...) papers on practical ethics, Knud Haakonssen shows how these writings not only add depth to Reid's criticism of Hume but also clarify his own social, moral, and political thought. As a whole, Reid's Practical Ethics constitutes a most significant addition of source material for the study of the Scottish Enlightenment. The papers assembled here demonstrate the extent to which the moral philosophy of the Enlightenment was influenced by natural jurisprudence. At the same time they reveal Reid's involvement with republican, utopian, and radical themes and elucidate the relations between religion and politics in the Enlightenment. Haakonssen's introduction is the first substantial systematic treatment of Reid's moral-political thought, connecting it with his general philosophy and setting it in the context of his life and time. (shrink)

W dziełach Arystotelesa, lub z medievals, jak również w pismach późniejszych zdroworozsądkowe filozofów, takich jak Thomas Reid czy GE Moore’a, możemy znaleźć rodzinę różnych prób uporania się ze strukturami rozsądku i wspólnego -sense świat, który jest nam dany w normalnym, doświadczenie pre-teoretycznym. Będziemy argumentować, co wynika, że ​​teoria takich struktur stanowi ważny i dotychczas niedoceniany związek między wczesnym psychologii Gestalt z jednej strony, oraz współczesnych osiągnięć w filozofii i sztucznej inteligencji badań na innych.

It is now generally recognized that figures such as Reid, Peirce, and Reinach formulated theories of speech acts avant la lettre of Austin and Searle, in Reid and Reinach’s cases under the heading ‘theory of social acts’. Here we address the question as to what conditions would have to be satisfied for such theories to count as ‘theories of speech acts’ in the now familiar sense.

Historical research has recently made it clear that, prior to Austin and Searle, the phenomenologist Adolf Reinach (1884-1917) developed a full-fledged theory of speech acts under the heading of what he called "social acts". He we consider a second instance of a speech act theory avant la lettre, which is to be found in the common sense philosophy of Thomas Reid (1710-1796). Reid’s s work, in contrast to that of Reinach, lacks both a unified approach and the detailed (...) analyses of pertinent examples. But his writings leave no doubt that he is acutely aware of the very problems concerning language structure and use out of which contemporary speech act theory has evolved and that he goes a good way towards solving these problems in the spirit of the modern theory. (shrink)

My interest in gathering together a collection of this sort was generated by a fortuitous combination of historical studies under Professor Keith Lehrer and studies in cognitive science under Professor R. Michael Harnish at the University of Arizona. Work on the volume began there while I was an instructor in the Department of Linguistics and was greatly encouraged by participants in the Faculty Seminar on Cognitive Science chaired by Professor Lance J. Rips. I wish to express my appreciation to all (...) of these and to many other individuals with whom I discussed the possibility of contribution to this work. I am especially grateful to the authors of the essays included here, as they showed more patience than I could have hoped for in seeing me through a number of uncertain stages in development of the project. My thanks are also due to my colleague Charles Reid for assistance in reviewing submissions, to Tim McFadden for computer resources, and again, to Keith Lehrer for continuing advice in arrangements for publication. Financial support for manuscript preparation was provided in part under University Research Grant No. 617 from the University Research Council, Youngstown State University. (shrink)

This work locates the historical and conceptual foundations of cognitive science in the "commonsense" psychology of the philosopher Thomas Reid. I begin with Reid's attack on his rationalist and empiricist competitors of the 17th and 18th centuries. I then present his positive theory as a sophisticated faculty psychology appealing to innateness of mental structure. Reidian psychological faculties are equally trustworthy, causally independent mental powers, and I argue that they share nine distinct properties. This distinguishes Reidian 'intentionalism' from idealist (...) 'representationalism,' which derive cognitive content either from the inherited structure of faculties of from the occurrent structure of sensory activity. ;Next, I turn to consciousness and reflection for a contemporary Reidian response to traditional phenomenology. Unlike reflection, faculties of reason and remembrance are not causally mediated by consciousness. My interpretation of Reid is that 'Humean causation' of individual faculty structure accounts only for 'natural intentionality,' while 'efficient causation' of faculty interrelations accounts for cognitive 'personal intentionality.' ;I then proceed by adopting a form of computational description for reconstructing this view as a computational theory of mind. I contrast functional analyses in explanations of some capacities with computational and componential analyses in explanations of other, intentional capacities, in which some processes must be taken to semantically encode and govern the roles of others. This step reconstructs the Reidian notion of intentional operations as requiring an explanation of component faculties and their representation-governed interactions. I argue that properties of faculties delimiting these interactions under Reid's theory parallel those in Fodor's essay on the "modularity of mind," although the reasons given for individual criteria are often very different. Fodor also proposes a trichotomous mental structure, but I find that a third level of "central systems" is a myth engendered by causal information theory. Such an analysis cannot capture generalizations over the internal representation of semantic roles that determines the character of faculty relations. This requirement for any computational account of cognition is precisely the motivation for the reconstructed Reidian theory. Thus, it comports more favorably with the explanatory program constitutive of a computational cognitive science. (shrink)

Provides a survey of the development of speech act theory from Aristotle through Reid and Peirce to Edmund Husserl, Anton Marty, Johannes Daubert, Adolf Reinach, and finally to Austin and Searle. A special role is played by Husserl's theory of objectifying acts (meaning, roughly, acts of naming or stating) and of the efforts by his followers to extend this theory to cover phenomena such as questioning and commanding. These efforts culminated in the work of Adolf Reinach, who developed the (...) first systematic theory of speech acts in connection with his monograph of 1913 on “The A Priori Foundations of the Civil Law”. (shrink)

Provides a survey of the development of speech act theory from Aristotle through Reid and Peirce to Edmund Husserl, Anton Marty, Johannes Daubert, Adolf Reinach, and finally to Austin and Searle. A special role is played by Husserl's theory of objectifying acts (meaning, roughly, acts of naming or stating) and of the efforts by his followers to extend this theory to cover phenomena such as questioning and commanding. These efforts culminated in the work of Adolf Reinach, who developed the (...) first systematic theory of speech acts in connection with his monograph of 1913 on “The A Priori Foundations of the Civil Law”. (shrink)