This anthology presents recent philosophical analyses of the moral, political, and legal responsibility of groups and their members. Motivated by reflection on such events as the Holocaust, the exploding Ford Pintos, the May Lai massacre, and apartheid in South Africa, the essays consider two questions - what collective efforts could have prevented these large-scale social harms? and is some group to blame and, if so, how is blame to be apportioned? The essays in the first half consider the concept of (...) collective responsibility in light of the debate between individualists and collectivists. In the second half these theoretical discussions are applied to cases involving harms in professional and business contexts, health care, wartime, and racial relations. Collective Responsibility represents the first comprehensive collection on the subject, bringing together a wide diversity of philosophical perspectives. Its theoretical and applied essays should make this collection of interest to both scholars and students interested in ethics and political philosophy. (shrink)

Letheby’s naturalistic theory of psychedelic therapy argues that the therapeutic power of psychedelics lies in their ability to allow individuals “to discover the contingency, mutability and simulatory nature of their own sense of identity and habitual modes of attention.” The general shape of this project is persuasive; it is hard to see how the claim that successful therapy must involve changes to the self could be objected to, and Letheby sketches a consistent, if speculative, picture of psychedelic experience. But the (...) role of affect in psychedelic therapy is insufficiently explored by Letheby as a comparison to MDMA-assisted therapy indicates. This comparison further suggests that Letheby’s reliance on a particular conceptualization of ego dissolution experiences is in need of further explanation and justification. (shrink)

An international legal agreement governing the global antimicrobial commons would represent the strongest commitment mechanism for achieving collective action on antimicrobial resistance (AMR). Since AMR has important similarities to climate change—both are common pool resource challenges that require massive, long-term political commitments—the first article in this special issue draws lessons from various climate agreements that could be applicable for developing a grand bargain on AMR. We consider the similarities and differences between the Paris Climate Agreement and current governance structures for (...) AMR, and identify the merits and challenges associated with different international forums for developing a long-term international agreement on AMR. To be effective, fair, and feasible, an enduring legal agreement on AMR will require a combination of universal, differentiated, and individualized requirements, nationally determined contributions that are regularly reviewed and ratcheted up in level of ambition, a regular independent scientific stocktake to support evidence informed policymaking, and a concrete global goal to rally support. (shrink)

Antimicrobial resistance (AMR) is an urgent threat to global public health and development. Mitigating this threat requires substantial short-term action on key AMR priorities. While international legal agreements are the strongest mechanism for ensuring collaboration among countries, negotiating new international agreements can be a slow process. In the second article in this special issue, we consider whether harnessing existing international legal agreements offers an opportunity to increase collective action on AMR goals in the short-term. We highlight ten AMR priorities and (...) several strategies for achieving these goals using existing “legal hooks” that draw on elements of international environmental, trade and health laws governing related matters that could be used as they exist or revised to include AMR. We also consider the institutional mandates of international authorities to highlight areas where additional steps could be taken on AMR without constitutional changes. Overall, we identify 37 possible mechanisms to strengthen AMR governance using the International Health Regulations, the Agreement on the Application of Sanitary and Phytosanitary Measures, the Agreement on Trade-Related Aspects of Intellectual Property Rights, the Agreement on Technical Barriers to Trade, the International Convention on the Harmonized Commodity Description and Coding System, and the Basel, Rotterdam, and Stockholm conventions. Although we identify many shorter-term opportunities for addressing AMR using existing legal hooks, none of these options are capable of comprehensively addressing all global governance challenges related to AMR, such that they should be pursued simultaneously with longer-term approaches including a dedicated international legal agreement on AMR. (shrink)

In March 2015, the Dag Hammarskjöld Foundation convened a workshop in Uppsala, Sweden to address questions about antibiotic resistance, in partnership with the Global Strategy Lab, the Journal of Law, Medicine & Ethics, the Norwegian Institute of Public Health, and ReAct – Action on Antibiotic Resistance. Eleven concise articles were commissioned to explore whether ABR depended on global collective action, and if so, what tools could help states and non-state actors to achieve it. This article introduces that collection, which is (...) found in an online-only symposium at aslme.org. (shrink)

This article assesses which policies for addressing antibiotic resistance as part of a multi-pronged approach would benefit from legalization through an international legal agreement. Ten candidate policies were identified based on a review of existing literature, especially The Lancet Series on Antimicrobial Resistance, The Lancet Infectious Diseases Commission on AMR, and the World Health Organization Global Action Plan for AMR. These policies were then grouped under the headings of access, conservation, and innovation.Each of the ten policies were assessed using four (...) criteria developed by Hoffman, Røttingen, and Frenk to help consider why their legalization may be helpful, necessary and/or justified. These criteria are: the problem has a significant transnational dimension; the goal justifies the coercive nature of law; the outcome is likely to be beneficial; and legalization represents the best commitment mechanism among competing alternatives. (shrink)

Most proposals for new international agreements aim to address important global challenges. If the goal is to solve problems, then the value of these agreements depends on their ability to influence the world — to shape norms, constrain behavior, facilitate cooperation, and mobilize action. A recent review of empirical studies has suggested that many international agreements fail to achieve their aspirations. The review indicates that the form in which states make commitments to each other — through an international legal agreement (...) or through other means — may not be as important as commonly thought. It is the content of the commitments and how these are supported by mechanisms to encourage implementation that matter the most. When developing proposals for new international agreements, like the one that has recently been proposed to address antibiotic resistance, attention to implementation mechanisms should therefore be equal to if not greater than the attention paid to its form. (shrink)

The nature and effectiveness of any international legal agreement is heavily shaped by the forum in which it is negotiated and implemented. This includes both the substantive content that global policymakers agree upon and the subsequent state compliance with those provisions. Forums differ in their institutional characteristics, thereby providing unique opportunities and costs for participating actors. Forums may have different mandates, capacities, cultures, members, and legal processes — all of which ultimately affect distributions of power and influence. These differences then (...) shape how issues are framed, the content of agreements as they are negotiated, and the incentives states have to comply with any obligations. (shrink)

Kitcher urges us to think of mathematics as an idealized science of human operations, rather than a theory describing abstract mathematical objects. I argue that Kitcher's invocation of idealization cannot save mathematical truth and avoid platonism. Nevertheless, what is left of Kitcher's view is worth holding onto. I propose that Kitcher's account should be fictionalized, making use of Walton's and Currie's make-believe theory of fiction, and argue that the resulting ideal-agent fictionalism has advantages over mathematical-object fictionalism.

Many research-intensive universities have moved into the business of promoting technology development that promises revenue, impact, and legitimacy. While the scholarship on academic capitalism has documented the general dynamics of this institutional shift, we know less about the ground-level challenges of research priority and scientific problem choice. This paper unites the practice tradition in science and technology studies with an organizational analysis of decision-making to compare how two university artificial intelligence labs manage ambiguities at the edge of scientific knowledge. One (...) lab focuses on garnering funding through commercialization schemes, while the other is oriented to federal science agencies. The ethnographic comparison identifies the mechanisms through which an industry-oriented lab can be highly adventurous yet produce a research program that is thin and erratic due to a priority placed on commercialization. However, the comparison does not yield an implicit nostalgia for federalized science; it reveals the mechanisms through which agency-oriented labs can pursue a thick and consistent research portfolio but in a strikingly myopic fashion. (shrink)

Antimicrobial resistance is one of the greatest public health crises of our time. The natural biological process that causes microbes to become resistant to antimicrobial drugs presents a complex social challenge requiring more effective and sustainable management of the global antimicrobial commons—the common pool of effective antimicrobials. This special issue of Health Care Analysis explores the potential of two legal approaches—one long-term and one short-term—for managing the antimicrobial commons. The first article explores the lessons for antimicrobial resistance that can be (...) learned from recent climate change agreements, and the second article explores how existing international laws can be adapted to better support global action in the short-term. (shrink)

The accelerating adoption of electronic health record systems will have profound impacts on clinical care. It will also have far-reaching implications for public health research and surveillance, which in turn could lead to changes in public policy, statutes, and regulations. The public health benefits of EHR use can be significant. However, researchers and analysts who rely on EHR data must proceed with caution and understand the potential limitations of EHRs.Much has been written about the risk of EHR privacy breaches. This (...) paper focuses on a different set of concerns, those relating to data quality. Unlike clinical trial data, EHR data is not recorded primarily to meet the needs of researchers. Because of clinicians’ workloads, poor user-interface design, and other factors, EHR data is surprisingly likely to be erroneous, miscoded, fragmented, and incomplete. Although EHRs eliminate the problem of cryptic handwriting, other kinds of errors are more common with EHRs than with paper records. (shrink)

: Protection of human subjects from investigators' conflicts of interest is critical to the integrity of clinical investigation. Personal financial conflicts of interest are addressed by university policies, professional society guidelines, publication standards, and government regulation, but "intrinsic conflicts of interest"—conflicts of interest inherent in all clinical research—have received relatively less attention. Such conflicts arise in all clinical research endeavors as a result of the tension among professionals' responsibilities to their research and to their patients and both academic and financial (...) incentives. These conflicts should be disclosed to research subjects and managed as assiduously as are financial conflicts of interest. (shrink)

A rise of academic capitalism over the past four decades has been well documented within many research-intensive universities. Largely missing, however, are in-depth studies of how particularly situated academic groups manage the uncertainties that come with intermittent and fickle commercial funding streams in their daily research practice and problem choice. To capture the strategies scientists adopt under these conditions, this article provides an ethnographically detailed (and true) story about how a single project in Artificial Intelligence grew over several years from (...) a peripheral idea to the very center of an academic lab’s commercial portfolio. The analysis theorizes an epistemic form—nimble knowledge production—and documents three of its lab-level features: 1) rapid prototyping to keep sunk costs low, 2) shared search for “real world problems” rather than “theoretical” ones, and 3) nimble commitment to research problem choice. While similar forms of academic knowledge transfer have been lauded as “mode 2,” “innovative,” or “hybrid” for initiating cross-institutional collaboration and pushing science beyond disciplinary silos, this case suggests it can rely on fleeting attention to problems resistant to a quick fix. (shrink)

Comparative effectiveness research (CER) is one of the Patient Protection and Affordable Care Act's significant initiatives that aims to improve treatment outcomes and lower health care costs. This article takes CER a step further and suggests a novel clinical application for it. The article proposes the development of a national framework to enable physicians to rapidly perform, through a computerized service, medically sound personalized comparisons of the effectiveness of possible treatments for patients' conditions. A treatment comparison for a given patient (...) would be based on data from electronic health records of a cohort of clinically similar patients who received the treatments previously and whose outcomes were recorded. This framework has unique potential to simultaneously improve the quality of health care, reduce its cost, and alleviate public concerns about rationing and “one size fits all” medicine. (shrink)

The unsustainable growth in U.S. health care costs is in large part attributable to the rising costs of pharmaceuticals and medical devices and to unnecessary medical procedures. This fact has led health reform advocates and policymakers to place considerable hope in the idea that increased government support for research on the comparative effectiveness of medical treatments will eventually help to reduce health care expenses by informing patients, health care providers, and payers about which treatments for common conditions are effective and (...) which are not. Comparative effectiveness research has shown in some cases that expensive but commonly used treatments are significantly less effective than relatively inexpensive alternatives. Critics warn, however, that CER will homogenize patient care, limit patient choices, and lead to improper health care rationing and even to the denial of lifesaving treatments. (shrink)

Several accounts of the nature of fiction have been proposed that draw on speech act theory. I argue that speech act theory is insufficient for this task. Martinich’s, Searle’s and Currie’s accounts are considered and rejected. However dependent fiction may be on the intentional structure of communication, focus on this structure diverts attention from works themselves in an unhelpful way. The weakness inherent in speech act theory is that it does not have the resources to capture the most interesting processes (...) of interpretation in our engagement with fictions, those by which we construct their content and those through which they achieve their intended effects. (shrink)

The justification for harm reduction as an approach to drug use and addiction is seen by many to be consequentialist in form and it has been claimed that as a deontologist Kant would reject harm reduction. I argue this is wrong on both counts. A more nuanced understanding of harm reduction and Kant shows them compatible. Kant’s own remarks about intoxication reinforce this. Moreover, there is a Kantian argument that harm reduction is not only morally permissible but more consistent with (...) the Kantian duty of respect for autonomy than mandatory abstinence approaches. (shrink)

Among the many components of legal preparedness for public health emergencies is the assurance that the public health workforce and its private sector partners are competent to use the law to facilitate the performance of essential public health services and functions. This is a significant challenge. Multiple categories of emergencies, stemming from natural disasters to emerging infectious diseases, confront public health practitioners. Interpreting, assessing, and applying legal principles during emergencies are complicated by the changing legal environment and differences in governmental (...) organization of emergency management functions. While law and legal competencies are essential to routine public health practices, once government declares a state of public health emergency or disaster, the legal landscape changes. Typical legal responses to protect the public's health may no longer be the norm. Public health practitioners, legal counsel, health care partners, and others need to be able to assess changing laws and policies and apply them in real-time. (shrink)

Not long ago I visited the Personal Genome Project's website. The PGP describes its mission as “creating public genome, health, and trait data.” In the “Participant Profiles” section, I found several entries that disclosed the names of individuals along with their date of birth, sex, weight, height, blood type, race, health conditions, medications, allergies, medical procedures, and more. Other profiles did not feature names but provided all of the other details. I had no special access to this information. It is (...) available to absolutely anyone with Internet access. The PGP is part of a trend known as “open data.” Many government and private entities have launched initiatives to compile very large data resources and to make them available to the public. President Obama himself has endorsed open data by issuing a May 2013 executive order directing that, to the extent permitted by law, the federal government must release its data to the public in forms that make it easy to locate, access, and use. (shrink)

Among the many components of legal preparedness for public health emergencies is the assurance that the public health workforce and its private sector partners are competent to use the law to facilitate the performance of essential public health services and functions. This is a significant challenge. Multiple categories of emergencies, stemming from natural disasters to emerging infectious diseases, confront public health practitioners. Interpreting, assessing, and applying legal principles during emergencies are complicated by the changing legal environment and differences in governmental (...) organization of emergency management functions. While law and legal competencies are essential to routine public health practices, once government declares a state of public health emergency or disaster, the legal landscape changes. Typical legal responses to protect the public's health may no longer be the norm. Public health practitioners, legal counsel, health care partners, and others need to be able to assess changing laws and policies and apply them in real-time. (shrink)

Born to secular Jewish parents and raised in Camden, New Jersey, Andrea Dworkin became a radical second-wave feminist. By Dworkin’s own account, her work is informed by a series of negative personal experiences, including sexual assault at age nine, again by doctors at the Women's House of Detention in New York in 1965, work as a prostitute, and marriage to a battering husband whom she left in 1971. While Dworkin self-identified as a lesbian, since 1974 she lived with a gay (...) male partner, writer John Stoltenberg, whom she married in 1998. Understandably, the main theme of Dworkin's work is male violence against women. This violence is a defining feature of our male-supremacist culture, in which rape, prostitution, and pornography are inevitable expressions of gender norms. Dworkin's writings are primarily aimed at social change rather than intellectualizing. She describes her first book as "a political action where revolution is the goal". What one finds in her writings is not so much philosophical theorizing as calls to action. Thus it is difficult to summarize the abstract theory to which she is committed and from which she draws arguments against the sexism she finds in our culture. What is clear is her desire to eliminate binary concepts of gender and their oppressive effects. In particular, Dworkin urges the destruction of a female gender role that involves masochism, self-hatred, and passivity. She sees male supremacy constructed and reinforced in our culture through the sexist structuring of public institutions and private interactions, locating three crucial foci of male supremacy in action: pornography, sexual intercourse, and rape. These are her central concerns. Her work includes seven monographs, three collections of essays and speeches, a memoir, two novels, and a book of short stories, all of which explore these themes. (shrink)

Any philosophy of science ought to have something to say about the nature of mathematics, especially an account like constructive empiricism in which mathematical concepts like model and isomorphism play a central role. This thesis is a contribution to the larger project of formulating a constructive empiricist account of mathematics. The philosophy of mathematics developed is fictionalist, with an anti-realist metaphysics. In the thesis, van Fraassen's constructive empiricism is defended and various accounts of mathematics are considered and rejected. Constructive empiricism (...) cannot be realist about abstract objects; it must reject even the realism advocated by otherwise ontologically restrained and epistemologically empiricist indispensability theorists. Indispensability arguments rely on the kind of inference to the best explanation the rejection of which is definitive of constructive empiricism. On the other hand, formalist and logicist anti-realist positions are also shown to be untenable. It is argued that a constructive empiricist philosophy of mathematics must be fictionalist. Borrowing and developing elements from both Philip Kitcher's constructive naturalism and Kendall Walton's theory of fiction, the account of mathematics advanced treats mathematics as a collection of stories told about an ideal agent and mathematical objects as fictions. The account explains what true portions of mathematics are about and why mathematics is useful, even while it is a story about an ideal agent operating in an ideal world; it connects theory and practice in mathematics with human experience of the phenomenal world. At the same time, the make-believe and game-playing aspects of the theory show how we can make sense of mathematics as fiction, as stories, without either undermining that explanation or being forced to accept abstract mathematical objects into our ontology. All of this occurs within the framework that constructive empiricism itself provides the epistemological limitations it mandates, the semantic view of theories, and an emphasis on the pragmatic dimension of our theories, our explanations, and of our relation to the language we use. (shrink)

Recent advances in digital technology including internet, email and smartphones has revolutionised clinical photography and medical record data storage. The use of smartphones is becoming ubiquitous among medical professionals and the use of clinical photography has become an integral component of the management of patients in a variety of visually orientated specialties. Although clinical photography has its benefits, with this evolving technology also emerge new ethical, legal and social issues, which clinicians must be aware of.

Over one-third of the white working class in America vote for Republicans. Some scholars argue that these voters support Republican economic policies, while others argue that these voters’ preferences on cultural and moral issues override their economic preferences. We draw on in-depth interviews with 120 white working-class voters to defend a broadly “economic” interpretation: for this segment of voters, moral and cultural appeals have an economic dimension, because these voters believe certain moral behaviors will help them prosper economically. Even the (...) very word “conservative” is understood as referencing not respect for tradition generally, but avoidance of debt and excessive consumption specifically. For many respondents, the need to focus on morality and personal responsibility as a means of prospering economically—what we call “walking the line”—accords with the rhetoric they associate with Republicans. Deindustrialization may have heightened the appeal of this rhetoric. (shrink)

The inclusion of antimicrobial resistance (AMR) and increased research and development (R&D) capabilities in the most recent outline of the World Health Organization’s (WHO’s) international pandemic instrument signals an opportunity to reshape pharmaceutical R&D system in favour of antimicrobial product development. This article explains why the current innovation ecosystem has disadvantaged the creation of antimicrobial products for human use. It also highlights how the COVID-19 pandemic experience can inform and stimulate international cooperation to implement innovative R&D incentives to bring new, (...) life-saving antimicrobial products to the market. (shrink)

The notion of welfare has historically been related to the notion of satisfying individual preferences or wants. This point of view was proposed by Bentham in the eighteen century. Following Bentham, welfare is thought to depend on satisfaction of those preferences. We shall try to show how this no..

This best-selling volume examines the nature, morality, and social meanings of contemporary sexual phenomena. Updated and new discussion questions offer students starting points for debate in both the classroom and the bedroom.

This best-selling volume examines the nature, morality, and social meanings of contemporary sexual phenomena. Updated and new discussion questions offer students starting points for debate in both the classroom and the bedroom.

Community energy based on a mix of distributed technologies offers a serious alternative to the current energy system. The nature of community energy and the role that such initiatives might play in the general fabric of civic life is not, however, well understood. Community energy initiatives might involve only those citizens who prefer to be actively and continuously involved in intense, democratic debate. A more robust conceptualization of community energy might, on the other hand, be guided by Benjamin Barber’s notion (...) of “strong democracy,” in which community energy initiatives would draw upon a much broader citizen base, involving people from many walks of life and from quarters not generally presumed to be part of a sustained democratic process. The history of community energy is explored and a number of case studies are presented to illustrate the problems, prospects, and limitations of a socially and technologically decentralized energy system. (shrink)

The American Medical Association Council on Ethical and Judicial Affairs (CEJA) has written a position paper on physicians’ ethical responsibilities in the event that the security of patients’ electronic health information has been breached. The report offers compelling ethical and practical justifications for notification requirements and articulates guidelines for clinicians. This commentary addresses a gap in the report. It outlines the new legal duty to disclose security breaches, established by the 2009 HITECH Act, which is only briefly mentioned in the (...) report. The commentary also analyzes the CEJA recommendations in light of the legal mandate and suggests that the guidance would benefit from further clarification. (shrink)

Contemporary developments in reproductive technology hold great promise for those who have difficulty conceiving naturally. However, they have generated extensive debate among lawyers, ethicists, legislators, the media, and the public. Concern has intensified recently in light of claimed attempts to clone human beings. One implication of the new reproductive technologies upon which few commentators have focused is their effect on inheritance rights and on the notorious Rule Against Perpetuities. For example, what impact should the possible existence of frozen sperm or (...) frozen embryos have upon the execution of wills and implementation of the Rule? If one leaves property to one’s children but has frozen sperm or embryos that might produce children the Rule? If one leaves property to one’s children but has frozen sperm or embryos that might produce children decades after one’s death, what should be done about the distribution of the estate? These difficult questions can no longer be ignored. (shrink)

Contemporary developments in reproductive technology hold great promise for those who have difficulty conceiving naturally. However, they have generated extensive debate among lawyers, ethicists, legislators, the media, and the public. Concern has intensified recently in light of claimed attempts to clone human beings. One implication of the new reproductive technologies upon which few commentators have focused is their effect on inheritance rights and on the notorious Rule Against Perpetuities. For example, what impact should the possible existence of frozen sperm or (...) frozen embryos have upon the execution of wills and implementation of the Rule? If one leaves property to one’s children but has frozen sperm or embryos that might produce children the Rule? If one leaves property to one’s children but has frozen sperm or embryos that might produce children decades after one’s death, what should be done about the distribution of the estate? These difficult questions can no longer be ignored. (shrink)

Antimicrobial resistance is a global collective action problem with dire consequences for human health. This article considers how domestic and international legal mechanisms can be used to address antimicrobial resistance and overcome the governance and political economy challenges that accelerate it.

One way to study ontology is to assess how people differentiate real activities from others, and a good case is how groups organize simulation. However, social scientists have tended to discuss simulation in more limited ways, either as a symptom of postmodernism or as an instrumental artifact. Missing is how groups organize simulations to prepare for the future. First, I formulate a definition of simulation as a group-level technique, which includes the qualities of everyday ontology, playfulness, risk and consequence reduction, (...) constrained innovation, and transportability. Next, I use ethnographic data collected at an amateur boxing gym to argue that simulations simplify the most risky, unpredictable, and interpersonal aspects of a consequential performance. The problem is that a simulation can rarely proceed exactly like the reality it is derived from. For example, boxers hold back in sparring but should not in competition. The effectiveness of a simulation therefore depends on how robust the model is and how well members translate the imperfect fit between the contextual norms of the simulation and its reality. (shrink)

In law school we often focus on the importance of carefully crafting statutory and regulatory language. Textual ambiguities or sloppiness can significantly impair the efficacy of laws and regulations. Just as important as meticulous drafting, however, is the government’s ability to enforce its rules. In the absence of adequate enforcement resources, the government’s regulatory initiatives may well fail. The ability to promote public welfare depends as much on regulatory compliance as it does on the text of the regulations themselves.