Two principles form the basis for much priority setting in health. According to the greater benefit principle, resources should be directed toward the intervention with the greater health benefit. According to the worse off principle, resources should be directed toward the intervention benefiting those initially worse off. Jointly, these principles accord with so-called prioritarianism. Crucial for its operationalisation is the specification of the worse off. In this paper, we examine how the worse off can be defined as those with the (...) fewer lifetime Quality-Adjusted Life Years (QALYs). We contrast this proposal with several alternative specifications. (shrink)

The ethical origins of James's pragmatism -- Religion and the refinement of James's pragmatism -- The ethical republic -- Citizen James -- Legacies and prospects.

This volume is a Norwegian/German collaboration lead by Trygve Wyller and Hans-Gunter Heimbrock.

The European Council called for a period of reflection in each of the member states of the European Union (EU) after the people of France and the Netherlands rejected the Constitutional Treaty in referendums in 2005. The present article offers a contribution to this process by reflecting on the prospects for institutional design and redesign in the EU, a topic that became even more relevant after the Irish ?no? to the Lisbon Treaty in June 2008. The discussions are based on (...) a historical perspective, and the article discusses what lessons can be drawn from Jean Monnet, viewed as an institutional designer on the European stage. The article argues that the successful establishment of the European Coal and Steel Community (ECSC) was a product of a robust deontological design in a constitutional moment for Europe, and that prospective designers in the EU can learn important lessons from how Monnet identified and exploited available spaces for institutional design. (shrink)

This article points out problems in current dynamic treatments of anaphora and provides a new account that solves these by grafting Muskens' Compositional Discourse Representation Theory onto a partial theory of types. Partiality is exploited to keep track of which discourse referents have been introduced in the text (thus avoiding the overwrite problem) and to account for cases of anaphoric failure. Another key assumption is that the set of discourse referents is well-ordered, so that we can keep track of the (...) order in which they have been introduced, allowing a semantic characterization of anaphoric accessibility across stretches of discourse. Unlike other dynamic approaches, the system defines semantic values for unresolved anaphors. This leads to a clear separation of monotonic and non-monotonic content (in this case anaphoric resolution) and arguably provides a sound basis for a non-monotonic theory of anaphoric resolution. (shrink)

No philistine, Thorstein Veblen thought humankind's innate impulse to imbue experience with aesthetic unity advanced all knowledge, and that the most beautiful objects, ideas, and actions met a standard of communal benefit reflecting humanity's naturally selected sociability. Though German idealism was an early influence, it clashed with Veblen's historicist critique of Western institutions, and it was William James's psychology that refined his ideas into a coherent aesthetics with ethical and political applications, by clarifying how instinct, habit, and environment could interact (...) to institutionalize standards of beauty subverting the native altruism of the aesthetic impulse. Over years of association with John Dewey, Veblen concluded that a redeemed and reflective will to behold and create beauty in and through selfless activity could advance a more efficient and egalitarian society, and that humans cooperatively shaping their environments for the common good could approximate the German tradition's ideal of harmonizing personal freedom and external reality. (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)

In lieu of an abstract, here is a brief excerpt of the content:William James’s Ethical RepublicTrygve ThrontveitFor William James (1842–1910), all philosophical problems were ultimately ethical. In Pragmatism (1907), James invoked the logical theory of his friend Charles Peirce to argue that the “meaning” of any belief consisted solely in “what conduct it is fitted to produce.” There was “no difference in abstract truth,” he elaborated, “that doesn’t express itself in a difference in concrete fact and in conduct consequent upon (...) that fact, imposed on somebody, somehow, somewhere, and somewhen.” Indeed, James concluded that truth was not just reflected in the consequences of conduct but shaped by them: “Truth is made,” he wrote, “just as health, wealth, and strength are made, in the course of experience.”1 This major thesis of Pragmatism distilled a career spent describing an unfinished world, in which human thoughts and actions made differences for which thinkers and actors were responsible. As early as 1878, James insisted that beliefs imply action to advance goals, creating effects valued in light of those goals. The mind, he reiterated in his 1890 masterpiece The Principles of Psychology, is a “fighter for ends,” and thinking, a “moral act.” Later, in “The Will to Believe” (1896), James argued that when evidence is inconclusive, belief might create conditions in which hypotheses could be verified and potential goods realized—or lost. That frank (if often overlooked) assessment of the moral risks as well as rewards of intellectual life echoed James’s most explicitly ethical work, “The Moral Philosopher and the Moral Life” [End Page 255] (1891), where he asserted that when choosing what to believe, it is “simply our total character and personal genius that are on trial; and if we invoke any so-called philosophy, our choice and use of that also are but revelations of our personal aptitude or incapacity for moral life.”2In short, James, as John Dewey elegized in 1910, “was everywhere and always the moralist.”3 Yet for much of the twentieth century critics deemed James’s philosophy ethically vacuous, a warrant for moral solipsism. In 1909, Bertrand Russell criticized James for privileging belief over suspension of judgment, and thus encouraging people to live in private moral universes rather than seek objective grounding for common values. Today, some intellectual historians continue to echo Russell and likeminded contemporaries, judging ethical pragmatism tantamount to moral relativism, even moral apathy.4 Others, acknowledging James’s impassioned pronouncements on lynching, industrial conflict, imperialist expansion, and other public moral issues, have interpreted them as expressing a particularly cosmopolitan but otherwise unremarkable American liberalism, rather than a coherent moral philosophy.5These criticisms are unfounded, but understandable. They reflect a general [End Page 256] antipathy toward James’s broader conceptions of knowledge, truth, and experience, and frustration with his unorthodox mode of philosophizing. In Pragmatism, James followed Peirce in arguing that beliefs are not copies of reality, but “rules for action” resembling the probabilistic predictions guiding scientific inquiry. James, however, extended Peirce’s argument, claiming there is no static reality that beliefs can once-for-all describe. A self-proclaimed “radical empiricist,” James held that the universe is pluralistic, and the only reality accessible to human minds is constantly changing—not least through the ceaseless flux of human consciousness, a fact as natural and consequential as any other.6 This blurring of subject-object distinctions scandalized contemporaries. It also underpinned James’s equally scandalous claim that ideas not only demonstrate their meaning through conduct, but derive both meaning and value from their origins and verification in human activity. To ask what is true in such a world was to ask which ideas, moral or otherwise, allow people to navigate it successfully—which “carry us prosperously from any one part of our experience to any other part”—and which do not.7 Because of these commitments James never made hard distinctions between ethics and other branches of inquiry, or defined his ethics as a separable component of his philosophy easily analyzed on its own terms. Meanwhile, his further refusal to dislodge theory from practice has frustrated those conceiving ethics as a logically and temporally consistent program of conduct. Instead, James insisted that ethical principles emerge organically from individuals’ collective experience in... (shrink)

Much is known about the phenomenon of dignity, yet there is still a need for implementing this understanding in clinical practice. The main purpose of this study was to find out how persons suffering from multiple sclerosis experience and understand dignity and violation in the context of a rehabilitation ward. A phenomenological-hermeneutic approach was used to extract the meaningful content of narratives from 14 patients with multiple sclerosis. Data were collected by personal research interviews. The findings revealed three main themes: (...) (1) ‘invisibly captured in fatigue’; (2) ‘fighters’ law: one who does not ask will not receive’; and (3) ‘dignity is humanity’. The essence of the findings in this study is that dignity is humanity. According to the participants, dignity requires time and is experienced only in a context of empathy and mutual confidence. (shrink)

This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.

In this essay I respond to critical readers of my book, William James and the Quest for an Ethical Republic. I argue that James’s ultimate preoccupations are ethical, and that his ethical and moral writings constitute a rich resource for pluralistic societies seeking democratic tools for negotiating deep ideological, cultural, and religious differences, and for building a thriving commons.

Few remember Thorstein Veblen (1857-1929) as a connoisseur of beauty or champion of beauty’s importance to an institutionally modern and technologically sophisticated society. Similarly few credit Veblen with any constructive theory of politics. Yet Veblen’s conception of the beautiful, his account of its role in human cultural evolution, and his critique of its perversion in the industrialized societies of the nineteenth and early twentieth centuries are invaluable to contemporary social-aesthetic aims of political and economic reconstruction. In contrast to the Veblen (...) of memory, the real Veblen devoted significant intellectual energy to building a theory of what political thinkers today call public work: creative, negotiated, open-ended production of shared goods by individuals alert both to self-interest and collective needs. Partaking of the rich tradition of philosophical pragmatism, Veblen's social aesthetics also points to that tradition's continuing value for contemporary aesthetic, social, and political theory. Indeed, further augmented by recent advances in cultural evolutionary theory, Veblen’s pragmatist, public-work aesthetics suggests a vision of democratic citizenship defined by cooperative imagination, production, critique, and re-creation of a moral and material commonwealth. The so-called “bard of savagery,” therefore, is better understood as a “bard of democracy,” narrating the travails and affirming the ideals of a culture aspiring to self-government. His is a vision that might lend the fragmented field of social aesthetics a common, compelling narrative of its own. (shrink)

We offer a summary of the WHO Report "Making Fair Choices on the Path to Universal Health Coverage".

We reply to critics of the World Health Organisation's Report "Making Fair Choices on the Path to Universal Health Coverage". We clarify and defend the report's key moral commitments. We also explain its role in guiding policy in the face of both financial and political constraints on making fair choices.

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

La cobertura universal de salud está en el centro de la acción actual para fortalecer los sistemas de salud y mejorar el nivel y la distribución de la salud y los servicios de salud. Este documento es el informe fi nal del Grupo Consultivo de la OMS sobre la Equidad y Cobertura Universal de Salud. Aquí se abordan los temas clave de la justicia (fairness) y la equidad que surgen en el camino hacia la cobertura universal de salud. Por lo (...) tanto, el informe es pertinente para cada agente que infl uye en ese camino y en particular para los gobiernos, ya que se encargan de supervisar y guiar el progreso hacia la cobertura universal de salud. (shrink)

This report from the WHO Consultative Group on Equity and Universal Health Coverage offers advice on how to make progress fairly towards universal health coverage.

BackgroundIn precision medicine biomarkers stratify patients into groups that are offered different treatments, but this may conflict with the principle of equal treatment. While some patient characteristics are seen as relevant for unequal treatment and others not, it is known that they all may influence treatment decisions. How biomarkers influence these decisions is not known, nor is their ethical relevance well discussed.MethodsWe distributed an email survey designed to elicit treatment preferences from Norwegian doctors working with cancer patients. In a forced-choice (...) conjoint analysis pairs of hypothetical patients were presented, and we calculated the average marginal component effect of seven individual patient characteristics, to estimate how each of them influence doctors’ priority-setting decisions.ResultsA positive biomarker status increased the probability of being allocated the new drug, while older age, severe comorbidity and reduced physical function reduced the probability. Importantly, sex, education level and smoking status had no significant influence on the decision.ConclusionBiomarker status is perceived as relevant for priority setting decisions, alongside more well-known patient characteristics like age, physical function and comorbidity. Based on our results, we discuss a framework that can help clarify whether biomarker status should be seen as an ethically acceptable factor for providing unequal treatment to patients with the same disease. (shrink)

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in (...) this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life. (shrink)

Questions on what it means to live and die well are raised and discussed in the hospice movement. A phenomenological lifeworld perspective may help professionals to be aware of meaningful and important dimensions in the lives of persons close to death. Lifeworld is not an abstract philosophical term, but rather the opposite. Lifeworld is about everyday, common life in all its aspects. In the writings of Cicely Saunders, known as the founder of the modern hospice movement, facets of lifeworld are (...) presented as important elements in caring for dying patients. Palliative care and palliative medicine today are, in many ways, replacing hospices. This represents not only a change in name, but also in the main focus. Hospice care was originally very much about providing support and comfort for, and interactions with the patients. Improved medical knowledge today means improved symptomatic palliation, but also time and resources spent in other ways than before. Observations from a Nordic hospice ward indicate that seriously ill and dying persons spend much time on their own. Different aspects of lifeworld and intersubjectivity in the dying persons’ room is presented and discussed. (shrink)

The aim of the study was to compare the acute effects of traditional resistance training and superset training on training duration, training volume and different perceptive measures. Twenty-nine resistance-trained participants performed a whole-body workout traditionally and as supersets of exercises targeting different muscle groups, in a randomized-crossover design. Each session was separated by 4–7 days, and consisted of eight exercises and three sets to failure. Training duration and number of repetitions lifted were recorded during the sessions. Rate of perceived exertion (...) for effort, rate of perceived exertion for discomfort, session displeasure/pleasure, and exercise enjoyment were measured 15 min after each session. Forty-eight hours after the final session participants reported which session they preferred. The superset session led to significantly higher values for RPE and RPD and tended to be higher for sPDF, i.e., more pleasurable, compared to the traditional session. There was no difference in EES. The traditional session led to significantly increased training volume and lasted 23 min longer than the superset session. Eighteen of the participants preferred the superset session, while 11 preferred the traditional session. In conclusion, performing a whole-body workout as a superset session was more time-efficient, but reduced the training volume and was perceived with greater exertion for effort and discomfort than a traditional workout. (shrink)

Countermeasures for mpox (formerly known as monkeypox), primarily vaccines, have been in limited supply in many countries during outbreaks. Equitable allocation of scarce resources during public health emergencies is a complex challenge. Identifying the objectives and core values for the allocation of mpox countermeasures, using those values to provide guidance for priority groups and prioritisation tiers, and optimising allocation implementation are important. The fundamental values for the allocation of mpox countermeasures are: preventing death and illness; reducing the association between death (...) or illness and unjust disparities; prioritising those who prevent harm or mitigate disparities; recognising contributions to combating an outbreak; and treating similar individuals similarly. Ethically and equitably marshalling available countermeasures requires articulating these fundamental objectives, identifying priority tiers, and recognising trade-offs between prioritising the people at the highest risk of infection and the people at the highest risk of harm if infected. These five values can provide guidance on preferable priority categories for a more ethically sound response and suggest methods for optimising allocation of countermeasures for mpox and other diseases for which countermeasures are in short supply. Properly marshalling available countermeasures will be crucial for future effective and equitable national responses to outbreaks. (shrink)

The study was conducted in East Shewa, central Ethiopia, where durum wheat landraces were once popular, but were displaced and re-introduced. Combinations of survey techniques are employed to document the different home uses of durum wheat landraces and to assess whether these serve as an incentive to on-farm conservation. The findings reveal that wheat landraces have multiple dietary and sociocultural uses that contribute to the maintenance of landraces on-farm. Temporal analysis of historical information showed that (1) richness in food traditions (...) is associated with a high level of landrace diversity on-farm; (2) food traditions in East Shewa did not change radically as a result of the integration of farmers into the market economy; and (3) farm households still have an appreciation of, and a preference for, the home-use related qualities of the landraces, this despite their long term disappearance and the subsequent availability of several improved wheat varieties. The study illustrates the relationship between the local availability of landrace wheats and their on-farm survival. The home uses of landraces plays an instrumental role in the promotion of on-farm (in situ) conservation. Augmenting conservation activities with non-breeding approaches (e.g., awareness-creation) would support the survival of wheat landraces for the foreseeable future. (shrink)

This World Bank Report offers a new conception of fair decision processes in health financing. It argues that such procedural fairness can contribute to fairer outcomes, strengthen the legitimacy of decision processes, build trust in authorities, and promote the sustainability of reforms on the path to health coverage for all.

Due to constraints on institutional capacity and financial resources, the road to universal health coverage (UHC) involves difficult policy choices. To assist with these choices, scholars and policy makers have done extensive work on criteria to assess the substantive fairness of health financing policies: their impact on the distribution of rights, duties, benefits and burdens on the path towards UHC. However, less attention has been paid to the procedural fairness of health financing decisions. The Accountability for Reasonableness Framework (A4R), which (...) is widely applied to assess procedural fairness, has primarily been used in priority-setting for purchasing decisions, with revenue mobilization and pooling receiving limited attention. Furthermore, the sufficiency of the A4R framework’s four criteria (publicity, relevance, revisions and appeals, and enforcement) has been questioned. Moreover, research in political theory and public administration (including deliberative democracy), public finance, environmental management, psychology, and health financing has examined the key features of procedural fairness, but these insights have not been synthesized into a comprehensive set of criteria for fair decision-making processes in health financing. A systematic study of how these criteria have been applied in decision-making situations related to health financing and in other areas is also lacking. This paper addresses these gaps through a scoping review. It argues that the literature across many disciplines can be synthesized into 10 core criteria with common philosophical foundations. These go beyond A4R and encompass equality, impartiality, consistency over time, reason-giving, transparency, accuracy of information, participation, inclusiveness, revisability and enforcement. These criteria can be used to evaluate and guide decision-making processes for financing UHC across different country income levels and health financing arrangements. The review also presents examples of how these criteria have been applied to decisions in health financing and other sectors. (shrink)

Conceptualized within the framework of self-determination theory, the aim of the current study was to investigate the relation between perfectionistic concerns and (a) controlled (non-self-determined) motivation and (b) performance anxiety through basic psychological need frustration (frustration of competence, autonomy, and realtedness), and if these relations would be moderated by controlling teaching/coaching conditions. We used a cross-sectional moderated mediation design and purposefully selected Norwegian elite junior performers (N = 171; Mage = 17.3; SDage= 0.94) from talent development schools, who completed an (...) online questionnaire to report their perceptions of the study variables. Associations were examined using structural equation modeling. The results showed that perfectionistic concerns were positively associated with controlling conditions, basic needs frustration, controlled motivation, and performance anxiety. Reported controlling teaching/coaching conditions moderated the positive indirect relationship between perfectionistic concerns and (a) controlled motivation and (b) performance anxiety through competence need frustration. Specifically, these indirect associations were evident for performers reporting moderate or high levels of controlling teaching/coaching conditions. In contrast, there were no indirect associations via competence need frustration for those performers who reported low levels of controlling conditions. In conclusion, the results indicate that perfectionistic concerns appear to be a vulnerability factor that exposes elite junior performers to higher risks of entering a debilitative motivational process. This seems especially likely when exposed to controlling teaching/coaching conditions. Coaches and teachers working with elite junior performers should avoid using controlling mechanisms and instead foster autonomous functioning. (shrink)

The goal of achieving Universal Health Coverage (UHC) can generally be realized only in stages. Moreover, resource, capacity and political constraints mean governments often face difficult trade-offs on the path to UHC. In a 2014 report, Making fair choices on the path to UHC, the WHO Consultative Group on Equity and Universal Health Coverage articulated principles for making such trade-offs in an equitable manner. We present three case studies which illustrate how these principles can guide practical decision-making. These case studies (...) show how progressive realization of the right to health can be effectively guided by priority-setting principles, including generating the greatest total health gain, priority for the worse off, and financial risk protection. They also demonstrate the value of a fair and accountable process of priority setting. (shrink)

Progress towards Universal Health Coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the WHO Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases and how should one adjudicate between them when their demands conflict? This paper by some (...) members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three principal dimensions of progress towards UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to pre-payment with pooling of funds. Our cases are simplified to highlight common trade-offs. While we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC. (shrink)

Because of his unwavering commitment to fight disciplinary and mental closure, William James is an author who has invited scholars from the most disparate fields to review aspects of his eclectic and far-reaching body of work. Not only philosophers, psychologists, historians of medicine and religion, but also artists, political theorists, and social activists have productively engaged James’s rich and variegated writings with the goal to reconstructing seminal portions of our intellectual, cu...

Trygve Haavelmo's 1944 article ‘The Probability Approach in Econometrics’ is considered by most to have provided the foundations for present day econometrics (Morgan, 1990, Chapters 8 and 9). Since Haavelmo (1944), extraordinary advances have been made in econometrics. However, over the last two decades the efficacy and scientific status of econometrics has become questionable. Not surprisingly, the growing discontent with econometrics has been accompanied by a growing interest in econometric methodology.