Application of egalitarian and prioritarian accounts of health resource allocation in low‐income countries have both been criticized for implying distribution outcomes that allow decreasing/undermining health gains and for tolerating unacceptable standards of health care and health status that result from such allocation schemes. Insufficient health care and severe deprivation of health resources are difficult to accept even when justified by aggregative efficiency or legitimized by fair deliberative process in pursuing equality and priority oriented outcomes. I affirm the sufficientarian argument that, (...) given extreme scarcity of public health resources in low‐income countries, neither health status equality between populations nor priority for the worse off is normatively adequate. Nevertheless, the threshold norm alone need not be the sole consideration when a country's total health budget is extremely scarce. Threshold considerations are necessary in developing a theory of fair distribution of health resources that is sensitive to the lexically prior norm of sufficiency. Based on the intuition that shares must not be taken away from those who barely achieve a minimal level of health, I argue that assessments based on standards of minimal physical/mental health must be developed to evaluate the sufficiency of the total resources of health systems in low‐income countries prior to pursuing equality, priority, and efficiency based resource allocation. I also begin to examine how threshold sensitive health resource assessment could be used in the Philippines. (shrink)

We defend a scalar theory of the relationship between material scarcity and justice. As scarcity increases beyond a specified threshold, we argue that deontological egalitarian constraints should be gradually relaxed and consequentialist considerations should increasingly determine distributions. We construct this theory by taking a bottom-up approach that is guided by principles of medical triage. Armed with this theory, we consider the range of conditions under which justice applies. We argue that there are compelling reasons for thinking that justice (...) applies under a far broader range of conditions than is standardly supposed, including those that could sensibly be labelled as conditions of extreme rather than moderate scarcity. (shrink)

Occasionally, doctors and health providers have to choose whom they save from death and this is an extremely hard decision to take. Here, I work on what I deem to be a crucial caveat: scarcity of resources should never be used as an alibi for bad, and sometimes wicked, public policies. In other words, if scarcity is somewhat produced or at least induced, it should never serve as a pretext to put the blame or the responsibility on medical (...) doctors, nurses and other people who are at the front of the war against COVID-19. During the COVID-19 pandemic, an ethical question was often raised: if resources are scarce (and they often have been), whom should you prioritize? Should we protect first of all those who are young and can then have a long life before them? Or should we rather prioritize those who have rendered important services to health, or broadly to mankind, and could, therefore, bring other good results to society? This discussion is of course important, but it leaves aside something more fundamental: the fact that resources are not simply scarce, they have been made scarce in the last years by a series of public policies nourished by an economic view that sacrificed social welfare on behalf of neoliberal beliefs. (shrink)

One of the most important motifs within (medical) ethics is scarcity: where essential (health) resources are scarce, urgent ethical questions arise. Over the last decade, at least 250 papers addressing the allocation of scarce health resources have been published in the Journal of Medical Ethics alone.1 In the typical set-up, the authors introduce a situation of scarcity and then review and adjudicate the available or recommended courses of action, sometimes through the lens of a pet normative ethical theory. (...) It is much less common for (medical) ethicists to focus their enquiries on the origins of scarcity. Why aren’t there sufficient health resources to go around? Who caused the scarcity, and how should they be held responsible? These questions are also firmly within the remit of the discipline. Discussions of scarcity tend to circumvent these difficult questions by focussing on exceptional cases in Global North settings, where scarcity is relatively rare, and is sometimes defensible or insoluble. For example: it would be wasteful for a hospital to overstock expensive, bulky, energetically intensive, specialist equipment whose supply would only be challenged under the most extreme and unforeseen circumstances (eg, a pandemic), and there may never be sufficient usable donor organs to meet the demand for transplants. Much less attention is given to under-resourced settings, generally in the Global South, where scarcity is common, and is often both indefensible and soluble. The literature appears to favour what is ‘unusual’ and ‘interesting’ in some contexts, rather than what is commonplace, and by that fact more worrying, in others. This division of attention entrenches the idea that scarcity is a fixed feature of certain places and lives. Why do medical ethicists so often fight shy of these meta-questions? They are, of course, harder and messier. More work and greater care are needed to contextualise …. (shrink)

The past 15 years of exceptionally severe water scarcity in the Islamic Republic of Iran have resulted in the desertification and salinity of formerly arable lands, drying out of Iranian lakes and rivers, and quickly shrinking groundwater resources, while water demand has risen, along with the size of the Iranian population, of which over 70% lives in urban areas now. We have aimed to discover the causes of water scarcity in the IR Iran and evaluated its social and (...) economic impacts. First, we computed the Weighted Anomaly Standardized Precipitation (WASP) Index for the period of 1979-2014. To illustrate the social impact of water scarcity, we analyzed the current water risk for the twenty most populous Iranian cities, by employing the composite index approach to translate hydrological data into comprehensible indicators of water related risks, and made a projection for 2020-2030, by modeling potential changes in the future demand and supply of water. To demonstrate the economic impact of water scarcity, we evaluated the overall agricultural contribution to the IR Iran GDP. We have found that the 1999 severe drought in the IR Iran commenced a period of unusually dry conditions that is still ongoing. The rapidly growing Iranian urban populations presently experience a medium to extremely high overall water risk, with extremely high baseline water stress that, in part, is due to the lack of upstream protected lands. The relationship between baseline water stress and drought severity has been determined as weak, confirming that other factors than drought are equally or more important contributors to the existing water risk. Our projection calculations indicate that Iranian urban populations will continue to experience an extremely high water stress for the coming decade. Due to the fast growth of these populations as well as considerable rise of value added to the IR Iran GDP by other sectors of the national economy, the contribution of agricultural production to the national GDP has declined from about 25% to under 10% (although its total yield has risen considerably) during the past 30 years. This decrease has been directly proportional to the increased foreign food imports, dependency on the IR Iran oil exports and reduction in the non-oil exports. The main causes of water scarcity in the IR Iran appear to be due to climatic factors, insufficient environmental protection, and over-exploitation and mismanagement of water resources, especially by the agricultural sector. In conclusion, our study proposes anti-wasting water management action plan that recommends shifting the IR Iran government response to water scarcity from reactive survival strategies to proactive crisis prevention, with emphasis on safeguarding, monitoring, early warning, and effective step-by-step preparedness and readiness, and by laterally integrating water management between all levels of the IR Iran government, including local, regional and national, for a sustainable, resilient and prosperous economy of the Islamic Republic of Iran now and in the future. (shrink)

How do people survive under extreme conditions? Will selfish, non-cooperating free-rider types – the solo players – have the best chances of surviving? Or would cooperating, hard-working types – the team players – have higher chances? All morale put aside, it is interesting to know whether non-cooperation or cooperation pays off in a game characterized by scarcity and hard competition for survival. A study of people in such a Hobbesian state of nature can also teach us important lessons (...) about social dynamics in contemporary, prosperous societies. An interesting case of ‘The survival game’ can be found in Solzhenitsyn’s (1963 [1962]) self-biographical book, One Day in the Life of Ivan Denisovich, depicting life in a Soviet Gulag prison camp in Siberia January 1951. We use Solzhenitsyn’s work as evidence of the interplay between five player types among prisoners: Cooperative blind-riders (BRs), hard-riders (HRs) and tough-riders (TRs), i.e. the so-called ‘toilers’; non-cooperative easy-riders (ERs), looked upon by the toilers as ‘bastards’, ‘screws’ and ‘errand boys’; and finally Low-riders (LRs), comprising ‘goners’ and ‘jackals’. The main research question addresses the successfulness of the survival strategies of the five player types. Apart from a Multiple Player Approach (MPA) that may be seen as a further development of second-generation theory of collective action (Ostrom & Ahn, 2009), we apply Goffman’s (1959) dramaturgical theory on our case. Hence, we argue that impression management at two different ‘stages’ – the Brigade stage and the Camp stage – is crucial for survival for hard-riding as well as for easy-riding players, in particular strategic masking. Seeking to unite Goffman and game-theoretic MPA, our overall purpose is to make a theoretical contribution to “game-related sociology” (Swedberg, 2001). (shrink)

Although the number of women in middle management has grown quite rapidly in the last two decades, the number of female CEOs in large corporations remains extremely low. This article examines many explanations for why women have not risen to the top, including lack of line experience, inadequate career opportunities, gender differences in linguistic styles and socialization, gender-based stereotypes, the old boy network at the top, and tokenism. Alternative explanations are also presented and analyzed, such as differences between female leadership (...) styles and the type of leadership style expected at the top of organizations, feminist explanations for the underrepresentation of women in top management positions, and the possibility that the most talented women in business often avoid corporate life in favor of entrepreneurial careers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume XXIV, Number 1, April 1998, pp. 53-70 Hume on Justice to Animals, Indians and Women ARTHUR KUFLIK I. The Circumstances of Humean Justice For Hume, the virtue of justice is its "usefulness" to the support of society.1 To help prove this point, he guides us through a series of imaginative thought-experiments. Suppose that resources were infinitely available or that human beings were generous and kind without (...) limit: in such unusual circumstances, nobody would have even "dreamed of" the various property restrictions associated with justice. If the supposition seems too fanciful, the same point can be illustrated, at least to some extent, by special real-life circumstances as well: e.g., by the way that air or water or land go unregulated in those places where they are super-abundant or the way in which the line between what is "mine" and "thine" blurs in loving families or between intimate friends. Moving to the opposite extreme: suppose that resources were so scarce as to render it impossible for most people (regardless of their cooperative exertions) even to subsist. Or suppose that people were not merely limited in their benevolent concern but "perfectly malicious"! Once again, there would be little or no point to the observance of rules of justice. On Hume's account, such rules define a scheme of social cooperation. But by hypothesis, extreme scarcity makes even well-meaning cooperative effort unproductive. Extreme villainy makes it pointlessly dangerous. Indeed, in a world wholly villainous, just cooperative schemes would be altogether impossible. Arthur Kuflik is at the Department of Philosophy, The University of Vermont, 70 South Williams Street, Burlington, Vermont 05401-3404 USA. email: [email protected] 54 Arthur Kuflik What can we conclude? There is a range of circumstances within which schemes of justice make sense: (1) moderate scarcity (resources are adequate to sustain people, but not so extensive that everyone could have as much as might be desired); and (2) limited benevolence (people are neither saintly nor satanic; though clearly concerned about themselves, they are not incapable of caring about what happens to others). John Rawls has dubbed these conditions "the Humean circumstances of justice."2 Hume wants us to notice that they are the very conditions under which justice is both practically possible and socially necessary. Fortunately, they are also the conditions that most commonly prevail. ("The common situation of society is a medium amidst all these extremes" [EPM 188].) II. A More Puzzling Thought-experiment Suppose we grant that the foundation of justice is its usefulness to society. This raises a certain worry: aren't there groups whose members ought to be treated justly even though "society" could flourish just as well if they weren't? (Another way to put the point is to ask: just who are the members of "society"?) This very issue underlies one more puzzling, and even disturbing, Humean thought-experiment: Were there a species of creatures intermingled with men, which, though rational, were possessed of such inferior strength, both of body and mind, that they were incapable of all resistance, and could never, upon the highest provocation, make us feel the effects of their resentment; the necessary consequence, I think, is that we should be bound by the laws of humanity to give gentle usage to these creatures, but should not, properly speaking, lie under any restraint of justice with regard to them, nor could they possess any right or property, exclusive of such arbitrary lords. Our intercourse with them could not be called society, which supposes a degree of equality; but absolute command on one side, and servile obedience on the other.... And as no inconvenience ever results from the exercise of a power, so firmly established in nature, the restraints of justice and property, being totally useless, would never have place in so unequal a confederacy. (EPM 190-191) What can we learn from this thought-experiment? What insight into justice do we gain by imagining a "species of creatures intermingled" among us who, though endowed with some ability to think and to reason, are: (i) greatly inferior to us both physically and mentally; (ii) "incapable of all resistance" to our provocations; and... (shrink)

The article examines whether realist theory should adopt a philosophical anarchist position concerning political obligation. The conclusions are mixed. Drawing on a distinction between strong and weak theories of political obligation (in the terminology of the paper, strong theories are committed to morality-based theorizing while weak theories depart from it), the article argues that philosophical anarchism and realist theory are natural allies against strong theories of political obligation but they must part company when it comes to weak theories because it (...) is exactly their departure from morality-based theorizing that can make weak theories especially appealing to realists. In addition, two further objections can be raised against philosophical anarchism on realist grounds: first, philosophical anarchists are drawn to undesirably sweeping conclusions about the non-existence of legitimate political authority or the extreme scarcity of genuine political relations by their Kantian or Lockean background assumptions and, second, Simmons seems to have an implicit weak theory of political obligation which could be, ironically, much more appealing to realists than his overall Lockean anarchism or his sweeping criticism of weak theories. All in all, can a realist be an anarchist? Probably, but definitely not on philosophical anarchist grounds. (shrink)

Received interpretation. As far as I have been able to determine, all scholars who have dealt with this fragment have followed Plutarch in holding that and are synonyms for ‘body’ and ‘void’ respectively, and the purport of the pronouncement is simply that ‘even void has a nature and substantiality of its own’ . But is included in Aristotle's dictionary of Atomist jargon, while is put better in the celebrated Fragment 125 . In consequence, Fragment 156 has been deemed more curious (...) than important. Despite the extreme scarcity of Democritean fragments other than moralizings, Kirk and Raven do not even print it. No doubt this assumed unimportance explains why it has not been noticed how unsatisfactory Plutarch's exegesis is. (shrink)

The first reported successful kidney transplantation occurred in 1954, between twins. Since then, organ donation and transplantation has become less a medical marvel than a common expectation of patients with a variety of diseases resulting in organ failure. Those expectations have caused demand for organs to skyrocket far beyond available supply, fueling an organ shortage and resulting in over 60,000 patients on transplant waiting lists. In this special issue, our contributors attempt to shed new light on some of the many (...) old ethical questions raised by transplant in the contemporary context of extreme scarcity. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS I. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[i] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[ii] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. II. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[iii] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[iv] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[v] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[vi] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[vii] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[viii] In democratic societies, one must take into consideration community morals and values.[ix] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[x] III. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[xi] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[xii] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[xiii] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[xiv] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. IV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[xv] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[xvi] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[xvii] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[xviii] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[xix] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[xx] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[xxi] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. VI. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[xxii] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[xxiii] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[xxiv] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. VII. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [i] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [ii] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [iii] Moss, p. 1295-1298. [iv] Moss, p. 1296. [v] Moss, p. 1295-1298. [vi] Moss, p. 1295-1298. [vii] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [viii] Cohen, p. 1299-1301. [ix] Moss, p. 1297. [x] Cohen, p. 1300. [xi] Cappelen, p. 478-480. [xii] Cappalen, p. 478-480. [xiii] Cappelen, p.479. [xiv] Cappelen, p. 479. [xv] Cappelen, p. 479 [xvi] Cohen, p. 1301. [xvii] Cappelen, p. 478. [xviii] Cohen, p. 1299-1301. [xix] Cohen, p. 1301. [xx] Cappelen, p. 476-480. [xxi] Cappelen, p. 476-480. [xxii] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [xxiii] Kawachi, p. 18-33. [xxiv] Kawachi, p. 18-33. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all-purpose primary (...) goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs. (shrink)

Discussion of Wittgenstein's philosophy has suffered from a scarcity of commentators who understand his work well enough to explain it in their own words. Apart from certain notable exceptions, all too many advocates and critics alike have tended merely to repeat slogans, with approval or ridicule as the case may be. The result has been an unusual degree of polarization and acrimony—some philosophers abandoning normal critical standards, falling under the spell and becoming fanatical supporters; and others taking an equally (...) extreme opposite view, deriding the absence of analytic technique, and refusing to see anything of value in Wittgenstein's work. (shrink)

This chapter argues that people have a human right to immigrate to other states. People have essential interests in being able to make important personal decisions and engage in politics without state restrictions on the options available to them. It is these interests that other human rights, such as the human rights to internal freedom of movement, expression and association, protect. The human right to immigrate is not absolute. Like other human freedom rights , it can be restricted in certain (...) extreme circumstances. Outside these circumstances, however, immigration restrictions are unjust. Having presented the argument for a human right to immigrate, the chapter responds to objections from distributive justice, culture and scarcity. (shrink)

The rule of rescue describes the moral impulse to save identifiable lives in immediate danger at any expense. Think of the extremes taken to rescue a small child who has fallen down a well, a woman pinned beneath the rubble of an earthquake, or a submarine crew trapped on the ocean floor. No effort is deemed too great. Yet should this same moral instinct to rescue, regardless of cost, be applied in the emergency room, the hospital, or the community clinic? (...) -/- In health care, the desire to save lives at any cost must be reconciled with the reality of resource scarcity. As one example, the estimated cost for prophylactic Factor VIII to treat one patient with hemophilia for one year is $300,000. Costs of this magnitude have been accepted by public and private insurers in the developed world, even though, in principle, these sums could provide greater overall health benefit if allocated to pay for the unmet health care needs of many other patients. Looking forward, however, broad application of the rule of rescue will be increasingly untenable. But the moral instinct will remain: the desire to help those weakest among us, especially when their small numbers allow us to see them as unique individuals. What, then, is the ethical framework that can guide coverage and reimbursement decisions for orphan drugs into the future? (shrink)

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, (...) the psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors. An "opting in" paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An "opting in" program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of "organ takers" who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who "opt in" would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive. An "opting in" paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an "opting in" paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an "opting in" policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity. (shrink)

"Kapitał społeczny ludzi starych na przykładzie mieszkańców miasta Białystok" to książka oparta na analizach teoretycznych i empirycznych, która przedstawia problem diagnozowania i używania kapitału społecznego ludzi starych w procesach rozwoju lokalnego i regionalnego. Kwestia ta jest istotna ze względu na zagrożenia i wyzwania związane z procesem szybkiego starzenia się społeczeństwa polskiego na początku XXI wieku. Opracowanie stanowi próbę sformułowania odpowiedzi na pytania: jaki jest stan kapitału społecznego ludzi starych mieszkających w Białymstoku, jakim ulega przemianom i jakie jest jego zróżnicowanie? Ludzie (...) starzy są tu postrzegani jako kategoria społeczna, czyli zbiór osób podobnych do siebie pod względem społecznie istotnych cech (takich jak wiek, posiadane role społeczne i świadomość korzystania ze świadczeń społecznych), którzy są świadomi tego podobieństwa i swojej odrębności od innych. Przyjmuje się ponadto, iż osoby takie przekroczyły 60. rok życia. Zakłada się też, że w zasobach ludzkich skumulowany jest kapitał ludzki, społeczny i kulturowy. Kapitał społeczny jest tu ujmowany szeroko jako potencjał współdziałania osadzony w powiązaniach międzyludzkich i normach społecznych, który może przynosić korzyści osobom, grupom i społeczeństwom. W części teoretycznej przedstawiono informacje o starości jako etapie w życiu jednostki, wyjaśniono pojęcie ludzi starych, omówiono społeczne teorie starzenia się, historyczne czynniki oddziaływające na położenie kategorii społecznej ludzi starych, zmiany ich miejsca w społeczeństwie polskim w trakcie transformacji ustrojowej i na początku XXI wieku, możliwe konsekwencje wzrostu długości życia w warunkach demokracji i kapitalizmu oraz charakterystykę problemu starzenia się ludności Białegostoku jako miasta pogranicza. Zaprezentowano też różnorodne koncepcje kapitału społecznego, sfery jego oddziaływania na rozwój społeczno-gospodarczy, jego stan w Polsce oraz wytyczne do strategicznego budowania jego zasobów. Przybliżono również wybrane informacje o aktywności ludzi starych w życiu publicznym, społecznym i gospodarczym jako kluczowych cechach ich kapitału społecznego. Porządkując różne stanowiska teoretyczne, wyniki badań i dane statystyczne, dążono do powiązania wielu rozproszonych źródeł w przekonaniu, iż jest to istotne w celu określenia i zagospodarowania zasobów kapitału społecznego seniorów, jak również niwelacji opóźnienia polskiej socjologii w zakresie badań nad ludźmi starymi. Pomimo, iż za podstawową perspektywę teoretyczną publikacji uznana została koncepcja kapitału P. Bourdieu, autor bierze również pod uwagę propozycje badawcze J.S. Colemana, R.D. Putnama, F. Fukuyamy, A. Giddensa, P. Sztompki i A. Sadowskiego. Drugi rozdział zawiera określenie ram metodologicznych badań przeprowadzonych na potrzeby tej publikacji. Omówiono przyjęte założenia badawcze oraz przybliżono sposób i przebieg realizacji badań. Przede wszystkim zdecydowano się na korzystanie z metody jakościowej i zastosowanie techniki wywiadu swobodnego ukierunkowanego. Uznano, iż podmiotowy kontakt z ludźmi starymi umożliwi dokładniejsze rozpoznanie kontekstu, w którym znajdują się zasoby ich kapitału społecznego. Jest to ważne, gdyż przenoszenie na rodzimy grunt opracowanych za granicą interpretacji działań ludzi starych i rozwiązań aktywizujących, może okazać się nieskuteczne lub wywołać negatywne efekty zewnętrzne. Ponadto w literaturze przedmiotu zwraca się uwagę na niedostatek badań gerontologicznych zgodnych z paradygmatem interpretatywnym. Badaniu poddano 26 respondentów w wieku od 60 do 89 lat żyjących w mieście Białystok związanych z jedną z dwóch różnych instytucji: Domem Pomocy Społecznej i Uniwersytetem Trzeciego Wieku. Poprzez porównywanie osób znajdujących się na dwóch biegunach aktywności społecznej możliwe było dostrzeżenie podobieństw i różnic w ich wyposażeniu kapitałowym, a zarazem w osiągniętych w ciągu życia pozycjach w strukturze klasowej i zasobach służących pomyślnej starości6. W trzecim rozdziale przedstawiona została część wyników analiz empirycznych. Przybliżono tu sposób, w jaki ludzie starzy myślą o podobnych sobie przodkach i osobach współczesnych, a także czynniki, w zależności od których zmienia się ich pozycja społeczna w mieście oraz problemy społeczne, jakie uznają za najważniejsze dla ludzi starych. Analizie poddano opinie o ich czasie wolnym, szansach i barierach aktywności ekonomicznej. Wyróżniono typy kapitału społecznego ludzi starych w zależności od instytucji, z którymi są związani oraz podejścia do postrzegania i wykorzystywania zróżnicowania wewnętrznego seniorów. Omówiono wizerunek seniorów w środkach masowego przekazu. Publikacja nie zawiera ścisłego zakończenia. W ostatnim rozdziale wskazano jedynie na główne wnioski płynące z badań oraz na potencjalne dalsze kierunki analiz. Uzupełnienie tego podejścia stanowią zamieszczone w aneksie zestawienia oddolnych technik budowania kapitału społecznego oraz podstawowych cech Miast Przyjaznych Starszemu Wiekowi. Z opracowania tego z pewnością będą mogli skorzystać nie tylko naukowcy zajmujący się tematyką ludzi starych, ale i pracownicy socjalni, politycy, pracodawcy, przedstawiciele mediów i organizacji pozarządowych oraz obywatele Białegostoku i innych miast. ** "Social Capital of Old People on the Example of Bialystok Residents" is a book based on theoretical and empirical study, which presents an issue of diagnosing and using of old people social capital in the local and regional development processes. This issue is significant because of the threats and challenges associated with process of rapid ageing of Polish society at the beginning of 21st century. Publication, in particular, is an attempt to give answers to the following questions: what is the state of old people social capital in Bialystok, what transformations it undergoes and how is it differentiated? In this study old people are viewed as a social category, which is a set of people similar to each other in terms of socially significant features (such as age, possessed social roles and awareness of received social benefits), who are aware of these similarities and differences between each other. Moreover, it is assumed, that such persons exceeded the 60 years of age. It is also assumed that human, social and cultural capital is accumulated in the human resources. Social capital is recognized here broadly as a potential for collaboration embedded in interpersonal relationships and social norms that may benefit individuals, groups and societies. The book consists of three chapters. The first, which is the theoretical part of work, includes information about: old age as a stage of individual life and explanation of the old people notion. It discusses social theories of ageing, historical factors affecting on the social position of old people category, changes in their place in Polish society during the system transformation and in the early 21st century. It describes the possible consequences of increased life expectancy for democracy and capitalism - including the concepts of society for all ages, silver economy. It also features ageing population issue, as well as social policy towards the elderly and old age in Bialystok as the borderland city. A variety of social capital concepts were presented; the spheres of its influence on socio-economic development, its status in Poland and guidelines for strategic building of its resources. Selected information on the activity of old people in public, social and economic life as key features of their social capital was brought closer. Putting various theoretical positions, results of research and statistical data in order was aimed to link many dispersed sources considering that it is relevant to identify and develop seniors' social capital resources, as well as leveling the delay of Polish sociology research on the elderly. Fundamental theoretical perspective of publication is the concept of capital according to P. Bourdieu. However, the proposals of J.S. Coleman, R.D. Putnam, F. Fukuyama, A. Giddens, P. Sztompka and A. Sadowski were also used. The second chapter contains a methodological framework for the purposes of study. Research assumptions, method and course of implementation of studies were discussed. The study is based on the qualitative method and the application of in-depth interview techniques. It was considered that the personal contact with old people will be more accurate than other research techniques to identify the context in which they social capital resources can be found. It is important because the transfer of developed abroad activating solutions and interpretations of old people actions may be ineffective or have negative external effects in the Polish context. Moreover, in the Polish science literature attention is paid to scarcity of gerontological research in accordance with the interpretive paradigm. Study involved 26 respondents aged 60 to 89 years living in Bialystok associated with one of two different institutions: nursing home for the elderly and University of the Third Age. By comparing the persons on two extremes of social activity it was possible to see similarities and differences in their capital equipment, and also in achievements of the life positions in the class structure and resources aimed at successful ageing. The third chapter presents the empirical analysis of the research results. This part outlines the way in which old people think about their ancestors and contemporary people. It also shows factors according to changes in their social position in the city, social issues which they consider most important for old people, their opinions about leisure time, opportunities and barriers of economic activity and types of old people social capital depending on the institution with which they are associated. Approach to the perception and use of internal disparities of seniors were also discussed. The analysis additionally contains the evaluation of senior citizens image in the polish mass media. This publication does not contain a strict ending. It only identifies the main conclusions of the research and potential directions of future analysis. Above all, older people could improve their position not by demanding increases in social benefits from which major parts are often taken away by their family members, but by highlighting their human, social and cultural capital. It is necessary to create favorable conditions for social and professional life of old people and their cooperation with members of local communities. Important role in this regard is played by institutions implementing three tasks: stimulating senior citizens' desire to satisfy previously unrealized needs; creating relationships between them so that they can solve their own problems and work for the others; and providing legal, social and vocational guidance. Stimulating cooperation between existing public, commercial and non-governmental sector organizations may serve to achieve these goals. The dissemination of bottom-up techniques of social capital building and checklist of essential features of Age-friendly Cities may also be important. -/- . (shrink)

In this introductory article we explore the relationship between statehood and governance, examining in more detail how non-state actors like MNCs, international NGOs, and indigenous authorities, often under conditions of extreme economic scarcity, ethnic diversity, social inequality and violence, take part in the making of rules and the provision of collective goods. Conceptually, we focus on the literature on Areas of Limited Statehood and discuss its usefulness in exploring how business-society relations are governed in the global South, and (...) beyond. Building on insights from this literature, among others, the four articles included in this special issue provide rich illustrations and critical reflections on the multiple, complex and often ambiguous roles of state and non-state actors operating in contemporary Syria, Nigeria, India and Palestine, with implications for conventional understandings of CSR, stakeholders, and related conceptualizations. (shrink)

Build the skills you need to understand and resolve ethical problems! Ethical Dimensions in the Health Professions, 7th Edition provides a solid foundation in ethical theory and concepts, applying these principles to the ethical issues surrounding health care today. It uses a unique, six-step decision-making process as a framework for thinking critically and thoughtfully, with case studies of patients to illustrate ethical topics such as conflict of interest, patient confidentiality, and upholding best practices. Written by Regina F. Doherty, an educator (...) and occupational therapist, this book will help you make caring and effective ethical choices that improve patient care and outcomes. UNIQUE! Ethical decision-making process provides an organizing framework to use in making the best decisions when faced with ethical problems. Patient stories depict real-life situations and demonstrate the ethical decision-making process. Reflection boxes depict important concepts and stimulate critical thinking. Summary boxes highlight the most important information in each section. Coverage of interprofessional team decision-making reflects this important, expanding movement in healthcare nationally and internationally. Questions for thought and discussion encourage students to apply the ethical decision-making process to different situations. NEW! Updated content throughout the book reflects the changes in the growing interprofessional movement. NEW! Expanded content on clinician well-being includes tools for supporting moral resilience and preventing burnout in health professionals. NEW! Updated content addresses the topics of social justice, health disparities, intersectionality, and health outcomes. NEW! Updated national standards and regulations are provided for electronic health communications, data protections, and clinical research. NEW! Coverage of scientific literature is expanded with studies on the effects of compassion on patient outcomes, patient safety, and provider and organizational well-being. NEW! Coverage of ethical issues impacting healthcare and society includes topics such as medical scarcity due to healthcare supply chain shortages and extreme weather events due to climate change. (shrink)

ABSTRACT In a Living Donor List Exchange program, the donor makes his kidney available for allocation to patients on the postmortal waiting‐list and receives in exchange a postmortal kidney, usually an O‐kidney, to be given to the recipient he favours. The program can be a solution for a candidate donor who is unable to donate directly or to participate in a paired kidney exchange because of blood group incompatibility or a positive cross‐match. Each donation within an LDLE program makes an (...) additional organ available for transplantation. But because most of the pairs making use of the program will be A/o incompatible, it will also tend to increase the waiting time for patients with blood group O, who already have the longest waiting time. It has therefore been objected that the program is materially unjust, because it further disadvantages the least advantaged. This objection appeals to John Rawls’ difference principle. However, the context for which Rawls proposed that difference principle, is significantly different from the present one. Applying the principle here amounts to a lop‐sided trade‐off between considerations of need and considerations of overall utility. Considerations of formal justice, however, may lead to a stronger objection to LDLE programs. Such a program means that one O‐patient on the waiting list is exempted from the application of the general criteria used in constructing the list because he has a special bargaining advantage. This objection is spelled out and weighed against the obvious attraction of LDLE in a situation of (extreme) organ scarcity. (shrink)

The facts are dismal. One out of five inhabitants of the earth lives in absolute poverty, while one out of seven is afflicted by hunger. Extreme poverty exists alongside extreme abundance. Empirical evidence points not to scarcity but to poor politics as the primary cause. The urgency of the situation as well as the intertwined nature of human misery and politics would lead one to expect global justice to be a major component of any respectable study of (...) world affairs. Quite to the contrary, theories of world politics are generally silent on these issues. The poor and the oppressed remain invisible, even in accounts of our brand new 'global village'. ;This dissertation aims to rectify the normative deficit of international theory by analyzing closely John Rawls's latest book: The Law of Peoples . Rawls takes on the challenge raised by global inequality and develops a theory of global justice that places moral judgment and action at the heart of world politics. The substance of this theory is filled out by using the famous original position, with its veil of ignorance, this time to generate global principles that regulate relations among peoples. The result is reassuring: human misery requires a response wherever it is experienced. In nonideal theory, the Law of Peoples necessitates global engagement for the eradication of the great evils that have historically followed from political injustice. ;In stark contrast to this global activism, Rawls defends nonintervention and rejects redistribution in ideal theory. This has provoked a heated debate in political philosophy, leading to cosmopolitan criticism of the Rawlsian enterprise. In light of such cosmopolitan objections, I assess the contributions and limitations of the Rawlsian project for global justice. I argue that the fundamental ideas of Rawls's broader thought necessitate the endorsement of Rawls's procedure, while at the same time requiring the revision of the substantive principles of the Law of Peoples. Thus reaching cosmopolitan conclusions without cosmopolitan premises, I claim that my reformulated Law of Peoples is more Rawlsian in spirit than the versions offered by either Rawls himself or his cosmopolitan critics. (shrink)

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, (...) the psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors. An “opting in” paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An “opting in” program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of “organ takers” who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who “opt in” would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive. An “opting in” paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an “opting in” paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an “opting in” policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity. (shrink)

Books and articles about the acceleration of daily life are themselves accelerating. A theoretical basis for expecting the inevitability of these trends has been traced in the writings of major sociologists including Durkheim, Marx, Weber and Sorkin. As deTocqueville observed more than 150 years ago, “The American is always in a hurry.” Economists have also weighed in on these issues of time compression, perhaps starting with Linder’s insightful treatise The Harried Leisure Class, predicting the frantic pace of modern life and (...) leisure. As specialized work led to higher rates of productivity, accelerated consumption led to an acceleration of the pace of life and a harried leisure class. Much of what Linder discussed in regard to time scarcity was perceived scarcity. Interestingly, his conclusions were not that people would work longer, but rather that they would attempt to increase the yield on a unit of time in all areas of life—minimizing activities such as singing or political debate, which could not easily have their yield on time spent increased. The value of efficiency and increased productivity, carried to extremes, he argued, produced a kind of decadence in which the goal of economic growth is never questioned. More recently, economists have played down the seriousness of concerns over a speeded up lifestyle, characterizing it in large part as “Yuppie Kvetch.” Not that higher income couples are making irrational decisions, they are simply facing the inevitable constraints on their ability to enjoy their wealth. This article reviews various of these philosophical issues in the context of US national survey data concerning trends in the time pressures and stress in the activities of Americans over the last 30+ years. It focuses both on the measurable amounts of free time Americans have and on the specific activities done in that free time. It also reviews survey data on Americans’ perceptions of and attitudes toward time and stress. It brings together data from different survey sources that often show conflicting trends and conclusions. (shrink)

Discussion of Wittgenstein's philosophy has suffered from a scarcity of commentators who understand his work well enough to explain it in their own words. Apart from certain notable exceptions, all too many advocates and critics alike have tended merely to repeat slogans, with approval or ridicule as the case may be. The result has been an unusual degree of polarization and acrimony—some philosophers abandoning normal critical standards, falling under the spell and becoming fanatical supporters; and others taking an equally (...) extreme opposite view, deriding the absence of analytic technique, and refusing to see anything of value in Wittgenstein's work. (shrink)

continent. 1.2 (2011): 129-135. Introduction Vincent W.J. van Gerven Oei Successions of words are so agreeable. It is about this. —Gertrude Stein Nachoem Wijnberg (1961) is a Dutch poet and novelist. He also a professor of cultural entrepreneurship and management at the Business School of the University of Amsterdam. Since 1989, he has published thirteen volumes of poetry and four novels, which, in my opinion mark a high point in Dutch contemporary literature. His novels even more than his poetry are (...) criticized for being inaccessible, which I generally take to be a compliment. It would be like saying that Fernando Pessoa is inaccessible, which he is not. Neither is Wijnberg. When we think of the combination economist-poet we are immediately reminded of the American poet Wallace Stevens, who, as the story goes, had two stacks of paper on his desk, one for contracts, one for poems. We also know that Stevens wrote on the economy and that questions of economy and insurance surface at multiple points in his poems. The following text is a very preliminary attempt to point at the intersections between poems, novels, business, and poetry in Wijnberg’s work. On the back cover of his novel De opvolging ( The Succession , 2005), Wijnberg states the following: “[This is] a novel for whomever is interested in the workings of a company as much as in the workings of a poem.” Wijnberg thus claims that the way in which a company “works” may be similar to the way in which a poem “works.” The question is the obvious one, what does this similarity consist in? De opvolging tells the story of company in which bosses and company doctors, secretaries, children, clowns, and beggars have tons of meetings, recite poems, perform plays, tell jokes, and succeed each other, climbing up and down in the company’s hierarchy. De opvolging is a novel in which the career of people follows the career of words. It resonates with Gertrude Stein's sentences, "Grammar. What is it. Who was it" (1975, 50). The words in Wijnberg's poems are like he characters in his novel. And if we keep in mind this allegorical reading of De opvolging , which is obviously only one of the possible readings, we may be able to understand some aspects of Wijnberg’s poetry. A repetition is already a pun. Look, that word is trying it again, as if it is afraid that by not doing it it would give up the hope that it will ever be able to do something. A pun is the opposite of the first word coming to the mind of someone who shouts it when he suddenly discovers something. (104) The repetition, the succession of the same word, is already a pun, a joke. The succession of the father by the son after the revolution is a joke. "Look he's trying it again!" The essence of a joke is a repetition. Archimedes’ “Eureka!” is its opposite. Poems can easily become jokes, depending on the way the words follow and repeat each other. In De opvolging , the careers of the bosses, good and bad secretaries, and company doctors easily become jokes, as they are “afraid that by not doing it [they] would give up the hope that [they] will ever be able to do something.” Not only the repetition, but also the distance and difference between the words in a poem, their cause and effect relations can be read as company relations. This becomes clear when we, for example, read the first lines of the poem “Cause, sign” from Het leven van ( The Life Of , 2009). A sign lets know what is going to happen, a cause lets it happen. If the sign also lets happen there is no reason to isolate it, because then I would isolate some- thing only because it’s different for me. If I didn’t have to write this myself, but would have secretaries to whom I could dictate it, I would be able to say more about it. (49) Upon reading the first two lines we can already conclude that any word may be cause or sign or both. If a sign is also a cause there is no reason to discriminate it, yet to the poet they are still different. This difference only becomes expressible the moment he would have a secretary. Just like in De opvolging , the secretary introduces a distance; not in a company but in a poem. Hence the difference between “good” and “bad” secretaries in a company, where the good secretary of one boss may be the bad secretary of another one. The more we can say about the bosses of the company, or signifiers of the poem, the greater the distance we introduce between them and us. We should take serious the relation between Wijnberg’s novels and poems. Although they operate on different scales, they explain and converse with each other. Another example may be the novel Politiek en liefde ( Politics and Love , 2002), which deals with the relation, precisely, between politics and love. In the novel, Nicolai, a lieutenant in the Dutch army, is sent to Africa on a military mission. Upon leaving a receives a letter from his father. Dear son, Don’t do anything stupid before your father has advised you to do so. Your mother asked me to write a wise letter. I have been looking for wisdom for half a day and haven’t found much. If you borrow a small amount from a bank you become the bank’s slave, but if you borrow a couple of millions and spend them as quickly as possible the bank becomes your slave. What I want to say is that you have to return from Africa in good health, and before you know it the world will be your slave [....] Signed with a kiss from your father. (88) The line, “If you borrow a small amount from a bank you become the bank’s slave, but if you borrow a couple of millions and spend them as quickly as possible the bank becomes your slave,” returns as the title of poem in Het leven van: “If I borrow enough money the bank becomes my slave” (12-3), which elaborates this theme. So both in the way that these poems are structured and in their subject matter, they refer to the structures of our economy, to the ever-continuing line of CEOs succeeding each other like words, to the distance between them introduced by bureaucracy, and giving and receiving as economical and poetical acts. Poem and economy map onto each other, as in another episode from De opvolging : Edward reads two of the beggar’s poems about presents. Of a holiday nothing remains, except for memories, and if some of them are bad I’d rather forget them all; if I get a present I’d rather get something that’s useful to me for a long time. If I may choose, I choose what I can use longest, long enough to partially forget that this was the present, because it feels bad when nothing is left of it. […] Giving away becomes destruction in the stock destruction economy [ voorraadvernie -tigings-economie ], that is a gift economy [ geschenkeneconomie ], encountering for the first time an economy in which there’s selling and buying on markets. Instead of destroying supplies someone can also quickly say that they aren’t worth anything anymore; if someone wants to take them I’d gladly give him something extra. In a stock destruction economy he is someone who each day wants to work more hours than his colleagues. If around a company there is a gift economy in which someone’s rank is determined and made visible by the gifts someone can give someone else, a company will be more often character- ized by an invisible or unclear system of ranks. (152) Two poems about gifts present two different economical models, described by Wijnberg with the terms “stock destruction economy” and “gift economy.” Here we immediately recall the opposition introduced by George Bataille’s work on the concept of expenditure in The Accursed Share , where a “general economy” would surpass the stock destruction economy based on scarcity (capitalism) and become a gift economy (potlatch) and an egalitarian (communist) society. These claims are made both on the level of the poems and in their discursive explanation. They follow each other and on each other. I would like to finish this introduction to Wijnberg’s writing with a translation from his novel De joden ( The Jews , 1999), which develops the story of Hitler abdicating as chancellor of the Third Reich, appointing philosopher Martin Heidegger as his successor. In a conversation with two Russian actor-spies, sent by Stalin to figure out the situation, philosopher Walter Benjamin describes the abdication scene. Maimon: You were there when Hitler resigned? Benjamin: In the room we’re right now. The desk and the chairs are new. After his resignation Hitler would like to take his furniture to his new house. Martin naturally agrees. It is a sunny day. Martin is very nervous and complains about the heat. Martin is wearing his best dark blue suit, not his professor’s robe. Hitler is wearing his uniform. We enter the room and Hitler gets up and embraces Martin. Martin is not very good at embracing. Hitler shakes his hand. Hitler’s cap is on the desk. The cap has a metal lining. Hitler has strong neck muscles. Hitler says: A man is unclean. He takes a bath. Does he make the bath water unclean? I say: a man is unclean. He steps into a river. A little further a man steps into the river; does he become unclean? Hitler nods. I say: a man is standing in music. Another man hears the music but also sees the first man moving on the beat of the music in a way that he is certain that the music would excite different feelings in him if he wouldn’t to see the first man. Hitler says: a man is clean, listens to music, is suddenly touched and he doesn’t know by what. The conversation ends in the way you know it ends. Hitler picks up his cap from the desk and puts it on Martin’s head. (73-4) Aware of the never ending debate on the question of Heidegger’s involvement in the Nazi regime, Wijnberg has the audacity to present the arguments of complicity in the religious terminology of cleanliness and uncleanliness, while at the same time recalling overtones of Hitler’s supposed love for Wagner, suggesting a relation between Benjamin and Hitler, and so on. The space of this introduction is to small to treat a novel like De joden , a reading of which together with passages from Philippe Lacoue-Labarthe's Heidegger, Art, and Politics: The Fiction of the Political , Jacques Derrida's Of Spirit , Christopher Fynsk's Heidegger: Thought and Historicity , and Avital Ronell's The Telephone Book would be extremely elucidating and potentially open new avenues in thinking Heidegger's emphasis on poetry after the fall of the Nazi empire. But at this point we will have to curb our curiosity and follow the poet himself. The themes of the relation between business and poetry, but also Chinese landscape painting, love, Indian and Japanese poetry, and Western philosophy are analyzed and assimilated in Wijnberg’s work without ever losing the clarity of expression. It may be that, according to Alain Badiou, the “Age of the Poets” is over, but its end (Paul Celan) has exactly brought a new balance between philosophy and poetry, and it is this playful, but nonetheless serious balance that makes one hope that one day Wijnberg’s complete oeuvre might become available to readers across the planet. Tiranë, Albania February 15, 2011 English translations (all of them translated by David Colmer, who is preparing an English collection of Wijnberg’s poems entitled Advanced Payment ): Poetry International Words Without Borders Green Integer Review from Het leven van ( The Life of ) THE LIFE OF KANT, OF HEGEL As if every day he takes a decision that is as good as when he’d been able to think about it all his life. The life of Kant, of Hegel, the days of the life of, select three or four of them. Tell what he has discovered during those days as if he were the last one who knew so little. Give me something that I can cancel against then I can prepare myself for it. The reward is that I may continue with what I’m doing, it doesn’t matter how long it takes. This has nothing to do with everything remaining the same if I say that I no longer want anything else. I wouldn’t be able to say in which one and the other occur in a way that I if I knew something to cancel that one against it wouldn’t be possible now. The stars above my head and being able to say what belongs to what if I’ve let them in. FOLLOWING MY HEART WITHOUT BREAKING THE RULES Observing the rules without observing the rules by going where the rules no longer apply. I could also observe the rules there by applying them to what at great distance may resemble what the rules are about. But why would I do that, not to confuse someone who is seeing me from a great distance? Behind this morning the morning prepares itself when the rules are everything I have. IF I BORROW ENOUGH MONEY THE BANK BECOMES MY SLAVE A bank lends me money, if I don’t pay it back they tell my boss that he has to pay them my salary. But they have to leave me enough to eat and sleep and an umbrella when it’s raining. They can also empty my house, the furniture isn’t worth a lot, but every little helps. Each morning I leave for work, if I don’t start early they’ll soon get someone else, no bank will lend me money when the sun is shining. My boss has given me a cat to raise as a dog. Of course I know that it won’t work out, but I’ve asked for a week—maybe the cat gets lucky, maybe I get lucky. My hands around a cup of coffee, before I leave for work, warm-empty, cold-empty, as if hidden in the mist over a lawn. What I make when there’s no work left for me, I’m ashamed to say how little it is. Once I’m outside I check it, if they watch out of the window they can see me doing it. Suppose it is so much that I’d stay counting for hours, it’s getting dark and I’m still there. They stay watching for a while once they’ve finished their work, but have to go home, I get that, sure, I could also go home and continue counting there. If it’s too little running back immediately won’t help, because nobody’s there anymore, and if I come back tomorrow I may have spent what’s missing tonight. Going somewhere where it’s warm enough to walk around without clothes during daytime, it helps me to know that something’s more there than here. For someone like me there’s work anywhere, it shouldn’t take a week to find work for me there. Three times work and a home close to work, I may choose one and try for a week whether I want to stay there. If at the end of the week I don’t want to stay I’m back on the next day, then it was a week’s holiday. RULES If that’s against a rule, it’s yet another one that I cannot observe, or only so briefly that I cannot re- member it later. Anyways the rules are only there to help me remember what I need in order to do better what I do. In that respect there’s no difference between the rules that I find in a book and the rules that I think of early in the morning. I know that because I’ve made a rule just now nothing has yet to observe it. CAUSE, SIGN A sign lets know what is going to happen, a cause lets it happen. If the sign also lets happen there is no reason to isolate it, because then I would isolate something only because it’s different for me. If I didn’t have to write this down myself, but would have secretaries to whom I could dictate it, I could to say more about it. If something is taken away from me I consider how it would be if the opposite had been taken from me. That is what causes or signifies what is farthest away from what is caused or signified by what has been taken away from me. note: For the translations of “The life of Kant, of Hegel” and “If I borrow enough money the bank becomes my slave” I was able to consult David Colmer’s wonderful translations. (shrink)

By way of a thought experiment, make the following pessimistic assumptions about the near and far future. Assume that within the next century we will gradually lose the struggle to sustain the environment and that moderately scarce natural resources will become extremely scarce, due both to increased levels of expectations by the privileged and to increased population. Assume that within the next fifty years the world’s population will double but begin to level off. The best scientific assessment of our prospects (...) for saving the environment in a way that will sustain even a quarter of that population over time (say, several centuries) turns out to be that it cannot be done. The damage to the environment by industry and other sources of pollution will have taken us past the threshold of possible recovery on the most optimistic projections of voluntary population control. The decline will be slow, but it is clear to everyone that the course is irreversible. Assume also that we will gradually lose the battle with disease and that it will be clear to everyone that medical research cannot compete with the deteriorating conditions of scarcity and the mutation rates among the viral and bacterial sources of disease. Gradually, what cannot be accomplished through voluntary population control can and will be accomplished through disease, regardless of the best scientific efforts to prevent it. Scientists reliably tell us that the earth will slowly begin to recover at a rate that will sustain the remaining population, and that in the far distant future there will in all likelihood be centuries with patterns of human flourishing and suffering that resemble our past. Finally, it becomes clear that hopes of finding other intelligent life in the universe and other habitable environments are futile. Scientists confirm that the speed of light and the distance between here and other possible sources of life preempt any rational hope in extra-terrestrial solutions. What we can be sure of is that after a number cycles of human flourishing and suffering, there will be a cataclysmic end to the earth and all its history.. (shrink)

continent. 1.1 (2011): 22-25. The Author gratefully acknowledges the financial support of CAPES (Coordenação de Aperfeiçoamento do Ensino Superior), Brazil. From the multifarious subdivisions of semiotics, be they naturalistic or culturalistic, the realm of semiotics of value is a ?eld that is getting more and more attention these days. Our entire political and economic systems are based upon structures of symbolic representation that many times seem not only to embody monetary value but also to determine it. The connection between monetary (...) and linguistic exchanges is self-evident: the former requires the latter and develops in direct relation to it. Creative experimentation and design of digital systems of value exchange are blossoming on the web. Dr. Gilson Schwartz, an economist turned media theorist and professor at the University of São Paulo, adopted the concept of Iconomics, originally created by Michael Kaplan, an author concerned with the linguistics of economic value. Empowering local communities and unlocking new levels of value creation and representation via digital technologies are the main goals of Dr. Schwartz’s projects, aiming at the re-designing of our relationship to the economic value of imagination and the social control of property. Schwartz is Assistant Professor at the School of Communication and Arts of the University of São Paulo, a former Chief Economist at BankBoston, Brazil and Advisor to the President of the National Social and Economic Development Bank (BNDES). FURTHER READING: Kaplan, Michael. “Iconomics: The Rhetoric of Speculation.” Public Culture . 15.3 (2003): 477-493. Renata Lemos-Morais: You have recently produced and directed a short documentary about Creative Currencies in Latin America. Could you tell us a bit about its process and its findings? Gilson Schwartz: The “Creative Currencies” project is a work-in-progress platform which unfolds as an action research agenda connected both to the production of audiovisual content and the development of social currency software. The initiative dates back to 2003 when I led an experimental project supported by the Presidency of Brazil. At that time, we issued paper currency in a small, touristic village in the Northeast Region which stimulated local cultural projects. But it was only in 2009 that the Central Bank of Brazil acknowledged “social currencies” as a legitimate economic agenda, calling for more debate at the I Financial Inclusion Forum. This year, the monetary authorities organized a second forum that also opened the room to discussions on mobile payment systems and new perspectives on poverty alleviation via State subsidies. The Ministry of Culture funded the “Creative Currencies” project in 2009-2010 and our next stage in this discovery process is to be supported by the National Social and Economic Development Bank (BNDES). In short, there is genuine interest among public officials in different areas and public funding for social currencies is on the rise in Brazil. However, after all these years we are still at a very early stage of research and practice. Some of the most successful initiatives (such as Banco Palmas) actually evolved out of local monetary creation to become correspondent banking operations for commercial banks and other financial groups. After eight years of price stability and social inclusion, Brazil stands out as a major opportunity for social experimentation, even the Grameen Bank is now entering the Brazilian market and many NGOs are geared towards different forms of entrepreneurialism in the base of the pyramid, riding solidarity economic models, microfinance and microcredit for local development. It is yet to be seen, however, whether these developments are just one more stage of “bankarization”, that is to say, an extension of regular banking services or actually a new form of social and symbolic self-determination at the local level. So far, the Central Bank of Brazil is open to new forms of credit and local finance as long as they are strictly territorial and very close to barter among the poor. In other words, whether the process of monetary creation could be made to fit an open source paradigm is yet to be seen. Community banking and social currencies might as well end up as just another channel for access to and use of banking services. The “Creative Currencies” project aims at promoting the discussion of more fundamental issues, such as the limits of central banking, the prospects for local financial development and the possibility of creating and managing financial icons as cultural assets. The purpose of this project is to produce short documentaries that will bear testimony to this evolving regulatory framework while inducing more discussion about the fundamental iconomic issues concealed in the process of money and wealth creation. RLM: What new potential is there in applying digital technologies to currency creation? GS: Globalization is a result of the virtualization of money, that is, the overcoming of illusions such as the “gold standard”. Money is an icon created by institutions, not on supposedly natural or material foundations but out of political and financial interests. The “dollar standard” is an outstanding evidence of this phenomenon and Kaplan´s paper, the first to use the expression “iconomics”, insists on the rhetoric and semiotic effects associated to a supposedly scientific model of money creation and management. This is a fundamental change that was perceived and discussed much before the digitalization of the world by unorthodox economists such as John Maynard Keynes since the early 20th century. The digitalization of global financial flows accelerated this immateriality and the creation of the Euro was yet another evidence of the political foundations of currencies. The banking establishment, however, is keen on the idea that scientific formulae hold the key to sound money creation. Keynesianism has been repeatedly associated to “inflationism” while the supposedly sound monetary policies of the Orthodoxy serve well the political and financial interests of a technocratic elite. Corporate media also serve this fictitious depiction of the monetary process despite the cyclical bust of monetary rules and financial regulations. The internet, however, has created numerous opportunities for the disintermediation in industries such as film, music and commodities. There is no reason to doubt that the financial industry can also be transformed by Peer-to-Peer (P2P) infrastructures. Money is media as well. Credit is but confidence. Once people realize that the distributed computing power of networks can also be the platform to weave new monetary and credit operations, there is room for grassroots emancipation out of the established owners of monetary institutions. So far, however, there has been a privatization of monetary management and there is not a clear path or model for the emergent (P2P) property democratization that is inherent to the internet. Digital assets, however, clearly have an inherent potential to escape central control and proprietary regulatory frameworks. RLM: How are social networks transforming the ways in which we exchange value? Do you believe that online influence and reputation might be translated into a new kind of currency? GS: The foundation for social currencies as envisaged by solidarity economics is the territory. Authorities are willing to concede local monetary creation as long as it is restricted to poor neighborhoods, as a proxy to barter. In this relevant but limited context, reputation, personal knowledge and informal ties form the matrix of local or “proximity” finance which are expected to keep credit and leverage to a sustainable level. Anything beyond that should and would lead to an integration of local finance into the established banking system. However, inasmuch as the internet promotes virtual territories and reputation is now subject to all sorts of digital manipulation and stardom becomes an everyday cultural process among teenagers and elders alike, the territorial “foundation” is substituted for more complex patterns of solidarity, cooperation and exchange that reach beyond the physical territory and even the “human.” Digital assets embody knowledge, technology, cultural and educational values that are exchanged at a global scale beyond the control of democratic States (Chinese-like intervention is the exception, not the rule). Hacktivism is unstoppable and so is monetary hacktivism. Especially in the Third World, mobile communications fast became conveyors of money transfers and other appropriation strategies. Banking and telecom sectors already battle for the control of these emerging markets and, as a matter of fact, have so far contributed to the containment of these processes. Governments serve these moguls and have usually adopted a wait-and-see attitude. If open source hardware and grassroots social movements combine to challenge these proprietary battles, then social networks may evolve into new forms of social capital and thus form the ground on which to design and implement social currencies. The global financial crisis, as well as the dollar demise, are an event of such a proportion that social networks may open the path for emancipator subjects to seize the opportunity. RLM: What are some of the social experiments that you think are revolutionizing the way in which value is exchanged? GS: There is a broad evolution of economic systems towards the valuation of intangible assets such as knowledge, reputation and sustainability. There are many examples of local as well as global events that call the traditional systems of exchange into question, from carbon credits to educational bonuses, digital barter frameworks and locally based solidarity and fair trade networks. These emerging examples, no matter how different in nature or scale, represent a challenge to the traditional value creation schemes and theories which are based on use and exchange value, supply and demand. This is not to say that utility and labour or scarcity are to be totally dismissed, but there is now an emerging perception that value is also a function of behavioral codes, symbolic patterns and the energy of institutional frameworks. The plasticity of digital platforms is relevant insofar as intellectual property becomes the central source of value creation. But when you discuss the property rights of public goods such as the environment or basic social rights (of minorities or localities), then a new paradigm seems to emerge. RLM: Are gaming and online storytelling digital practices that might have an impact on the way new currencies are created and developed? GS: “Play money” has been one of the early and most intriguing phenomena associated to the diffusion of virtual worlds. These virtual currencies have also been prone to “boom and bust” dynamics, speculation and pure theft (Second Life scams were common and led to “intervention” by the owners of the game). Storytelling is a major source of value, that is, the value of attention and the markets for audience. There are plenty of private monies created and managed by corporate entertainment groups, telecom operators (via mobile virtual network operators) and marketing frameworks. The casino economy, as already depicted by Keynes and other unorthodox economists, is always storytelling about future states of the world, confidence building and leverage of animal spirits. The novelty of current events is not the fictitious nature of any form of capital, but the potential for digital democratization of controls over the imaginary nature of value creation. But this is just a potential, a possibility, a figment that more often than not is appropriated by centralized and opaque private powers. The game industry is a testbed for new connections between storytelling and money creation. RLM: Monetary value was originally connected to the scarcity of precious metals, such as gold. Our entire monetary system seems therefore to function according to a logic of scarcity. Do you believe it is possible to reverse this logic into a logic of abundance? GS: The gold standard was a fiction itself, the “scarcity” is always produced by institutions that regulate confidence and access to credit. The key issue is not to fabricate abundance, but to question the institutions which produce scarcity out of any standard, gold or whatever. Central banks are at the service of private banks in the creation and management of scarcity. RLM: The promise that nanotechnology holds for our future is one of radical abundance (or so say transhumanists). The possibility of creating any kind of material substance through nanoengineering seems each day more feasible. What would this possibility entail in terms of systems of value exchange? GS: Nanotechnology, environmental concerns and grassroots appropriation of distributed knowledge are the frontiers of a new horizon of energy creation and management. Social groups in charge of managing scarcity for the sake of wealth and power concentration must be held accountable for the destruction of our future. Once this key political conundrum is accounted for, new systems of value exchange and even a non-mercantile society will come into existence. Revolutionary theorists such as Marx envisaged transformation via the extreme clash of contradictions between capital and labour. This approach has never led to a change in the systemic logic of scarcity for the sake of social control. We are once again facing the threshold of large scale societal change, but the outcome of the current crisis should come from our imagination, not from yet another paradox of abundance and scarcity. As long as we remain attached to the materiality of value, the illusion of freedom will but reinforce the massive manipulation of necessity. RLM: What do you think is the role of crowdfunding in this context? GS: Crowdsourcing as well as crowdfunding are examples of the peer to peer opportunities that come along with distributed computer power. However, the power structure behind wealth and scarcity creation may or may not be changed by crowd management. But it should not be taken at face value, so to speak. The stock market of course is an early form of crowdfunding without calling into question the proprietary framework of the companies offering their investment projects to the market. Any market is a form of crowdsourcing, that is to say, of distributed forms of supply and demand matchmaking. The wealth of networks, however, depends on the contractual ecosystem, the institutional framework, the channeling of social imagination, not on the purely quantitative distribution of bids and offers. I see economics as supply, demand and code. Once you have access to the code, once openness becomes part of the game, then there is a chance of crowd behavior becoming collective intelligence and sustainable imagination. RLM: Is the development of digital currencies headed towards a pluralistic ecology in which many micro currency systems co-exist, or is it penetrating the mainstream monetary system? If it is affecting the mainstream financial system, what would be its effect in the long-term? GS: The same issue is at stake both at local and global levels. The global system is, as a matter of fact, an unstable ecosystem of “micro currencies” whereas the dollar has so far exerted an overwhelming influence. Local currencies and private monies coexist with national currencies only to the extent that the Central Bank admits, for instance, that grassroots monetary emissions remain territorial and strictly connected to poverty. However, the question of how new developments in digital technologies and nanotechnologies might alter not only our current monetary systems but also our understanding of value in itself, is still an open question. (shrink)

In critical care medicine, teaching and mentoring practices are extremely important in regard to attracting and retaining young trainees and faculty in this important subspecialty that has a scarcity of needed personnel in the USA. To this end, we argue that Foucault’s Technologies of the Self is critical background reading when endeavoring to effect the positive transformation of faculty into effective teachers and mentors.

Consider waiting in lines. On the one hand, they offer an ad hoc illustration of how the scarcity of commodities relates to supply and demand. In this respect, they recall what neoclassical economics posit as the general law of the market. On the other hand, queuing is often referred to as a basic form of social interaction among those who wait. In this perspective, waiting is not about individuals waiting for something, but about waiting together, social gatherings, collectives, or (...) communities. On a more conceptual level, L’empire de la valeur. Refonder l’économie pushes these opposing positions to their extremes and clearly opts for the latter . Rejecting neoclassical frameworks for treating scarcity as a reality prior to exchange it holds that value results from a social process . As indicated by the book’s subtitle, this is not a minor operation. According to André Orléan, economist (Paris School of Economic .. (shrink)

From the earliest days of its history, Brazil has been a favoured ‘laboratory’ for ethnic, cultural and religious hybridization. The absence or scarcity of white women and the temptations of sexual exoticism drove the Portuguese discoverers, and with them sailors from Normandy, Brittany and Poitou, to have relations with Indian women they chanced to meet, thus creating a race of coloured people, oddly called mamelucos, later cabocles (of mixed white and Indian ethnicity). Afterwards, the very substantial recourse to the (...) Negro slave trade and to manpower of African slave origin because of the requirements of the sugarcane economy (which remained predominant for a long time, especially in the Nordeste region of Bahia and Pernambuco), as well as the numerical imbalance of the sexes, characterized by a great predominance of men, popularized concubinage - all the more so because the Catholic Church was extremely reluctant to sanction interethnic unions with the sacrament of marriage. The Jesuits even recommended the despatch of white prostitutes or women condemned by common law (degredadas), for whom Brazil would furnish the opportunity for redemption, in order to avoid or reduce the number of unions of this kind. Thus, concubinage was the most common vehicle of miscegenation in Brazil. (shrink)

Baumard's perspective asserts that “opportunity is the mother of innovation,” in contrast to the adage ascribing this role to necessity. Drawing on behavioral ecology and cognition, we propose that both extremes – affluence and scarcity – can drive innovation. We suggest that the types of innovations at these two extremes differ and that both rely on mechanisms operating on different time scales.

Imagining super rich women in the real and fictional world has long been a struggle. Those few depictions that do exist are scattered across time periods and literary genres, reflecting the legal restrictions that, at different points in time, would not allow women to accumulate assets independent of the patriarchal forces in their lives. The scarcity of extremely wealthy women in literature and film is confirmed by Forbes magazine’s list of the fifteen richest fictional characters that features forty different (...) fictional men and only nine women, with never more than two female characters nominated in a single year. This article explores the depiction of three exceptionally wealthy women: Cruella de Vil in The Hundred and One Dalmatians (1956) by Dodie Smith, Miss Havisham in Great Expectations (1861) by Charles Dickens, and the figure of the stepmother in various adaptations of “Cinderella.” I demonstrate how the protagonists’ wealth allows them to manipulate others and disconnect themselves from patriarchal and societal expectations. Further, I argue that these affluent antagonists are “rogued” by their respective narratives, highlighting their perceived anti-feminine and emasculating behaviour resulting in a mode of narration that greedily gazes at and shames their appearances and supposed unattractiveness. While this genealogy of rich rogues reiterates the narrow scope of imagining wealthy women on the page and on the screen, there are moments in the narratives that disrupt stereotypical depictions of these wealthy characters who defy the labels imposed on them. (shrink)

Rare earth elements have become increasingly important because of their relative scarcity and worldwide increasing demand, as well as China’s quasi-monopoly of this market. REEs are virtually not substitutable, and they are essential for a variety of high-tech products and modern key technologies. This has raised serious concerns that China will misuse its dominant position to set export quotas in order to maximize its own profits at the expense of other rare earth user industries. In fact, export restrictions on (...) REEs were the catalyst for the U.S. to lodge a formal complaint against China in 2012 at the World Trade Organization. This paper analyzes possible wealth transfer effects by focusing on export quota announcements by China, and the share price reactions of Chinese REE suppliers, the U.S. REE users, and the rest of the world REE refiners. Overall, we find limited support for the view of a wealth transfer in connection with MOFCOM announcements only when disentangling events prior to and post the initiation of the WTO trial, consistent with the trial triggering changes to China’s REE policy and recent announcement to abolish quotas. We do find, however, that extreme REE price movements have a first-order effect on all companies in the REE industry consistent with recent market trends to enable hedging against REE price volatility. (shrink)

This paper deals with the challenges of rationing of existential goods due to scarcity and conflicting interests (at the latest in the question of costs). The legal-political example pursued in this paper is rationing in the health care system, i. e. in curative and partly also in preventive measures. In each case - and in everyday life and by no means only in extreme corona pandemic situations - it is a question of whether there are absolute, ponder-proof claims (...) to certain goods. Ultimately, this is to be denied, even if rationing, especially in Germany, is usually concealed behind vague concepts such as the medical necessity and economic efficiency of treatment. But the public authorities cannot escape the weighing process - even if its consequences are often fatal in industrial society. In particular, misunderstandings of human dignity as well as skewed accusations of utilitarianism and a misleading pseudo-controversy between deontology and consequentialism have for a long time obscured the fact that in liberal democracies a balancing of different aspects of freedom and freedom preconditions is inevitable. Due to parliamentary reservations, however, this weighing must not be outsourced to administrative committees. Caution is called for in all of this with the economic cost-benefit analysis, which is hardly tenable in its foundations, with egalitarian approaches, and with the traditional but unfounded idea that fundamental rights are primarily (or exclusively) protected in single situations and are not relevant in the case of mass concern. Based on the latter point, it can also be shown that the previous tendency is not convincing to judge areas such as curative health treatment, preventive corona hazard control and fine dust or climate policy as being completely different from each other in terms of fundamental rights. (shrink)

Summary In The Origin of Species, Charles Darwin famously accounted for the lack of fossil evidence in support of species evolution on the grounds that the fossil record is naturally incomplete. This essay examines a similar argument that Darwin applied to his analogy between natural and artificial selection: the scarcity of data about the historical backgrounds of domestic breeds was the natural by-product of an extremely gradual change process. The point was to enhance the ability of the artificial selection (...) analogy to suggest that nature's species had undergone a similar transformation. Darwin did not depend on this negative inference alone, however, for in his writings he included whatever information he could find about the actual histories of particular breeds. A comparison with Darwin's treatment of the fossil record suggests the reasonableness of this combined use of opposite kinds of evidence to establish a single point. The comparison also suggests the unique qualities of negative inference as applied to the breeding analogy. (shrink)

A large section of the population (70%) of Uttarakhand largely depends upon agricultural based activities for their livelihood. Rural community of the mountains has developed several indigenous and traditional methods of farming to conserve the crop diversity and rejoice agrodiversity with religious and cultural vehemence. Traditional food items are prepared during occasion, festivals, weddings, and other religious rituals from diversified agrodiversity are a mean to maintain agrodiversity in the agriculture system. Agrodiversity is an insurance against disease and extreme climatic (...) fluctuations, as a coping mechanism in times of scarcity, as a means to enhance overall productivity of farms, as a source of critical nutrition and medicine in the Himalayan region. The different traditional system of agriculture and indigenous method of maintaining soil fertility, socio-cultural and religious rituals has saved many crops that are under threatened category. But all these system and practices are ignored nauseatingly in hill agriculture policy, where more emphasis was given for plain areas. Less emphasis is being put on local systems that rely on existing natural, human, and social assets such as biodiversity, traditional knowledge, and social capital underpinning collective action to ensure food security. Of late, development planners have realized the importance of appropriate technologies and therefore have stressed the need for on-site training, and capacity building of user groups in rural areas of the region. Rural technology demonstration and training center have been supposed as a means disseminating technologies enabling improvement in the yield potential of farms, income generation from off-farm activities, and conservation and efficient use of natural resources. There is a strong need to bring desirable changes in the agricultural policy, research, and development in reference to mountainous regions. The present paper describe present scenario of agriculture, traditional, and socio-cultural practices of retaining soil fertility and agrodiversity, policy dimensions, and strategies for management of the Himalayan agroecosystems. (shrink)

Eckhartian studies in English have recently taken a large step forward. In addition to the present volume, two other books and a special issue of The Thomist have since 1977 been devoted to the Rhineland mystic who for so long lay in oblivion. Schürmann’s study first appeared in French in 1972. It is here translated by the author himself, who now teaches at the New School. Schürmann’s format in each of the three chapters is to offer a translation of a (...) key sermon of the Meister, and then to weave the main themes of his teachings in a detailed analysis and commentary upon each sermon. At the end of each chapter, and sometimes within it, five other sermons which treat of a cognate theme are also translated. The translations alone are quite welcome in view of the scarcity of good English renderings of Meister Eckhart. And Schürmann’s commentary is extremely valuable as well. The American edition follows the French edition quite closely. Schürmann has added a short conclusion to the third chapter, excerpted from a previous article. And he has added an additional sermon, "Blessed are the Poor," at the end of the book. This is a happy choice, for the sermon in question is to my mind Eckhart’s greatest, and it serves as an excellent transition to the appendix, which is also new in the American edition, and treats of the Eckhart interpretation proposed by Suzuki in Mysticism: Christian and Buddhist. The subtitle of the book has also been changed; the French read "la joie errante," the wandering joy. (shrink)

I argue that, because of scarcity, the right to life cannot imply an obligation on others to save the life of the right-holder, and that collectivising resources for health care not only ensures that resources are used inefficiently and inappropriately but also removes from people the authority to make decisions for themselves about matters of health, life and death.

Moral philosophers have often felt the need of a concept which would cover all those cases where we are prevented from achieving our ends through no fault of our own: a criterion for saying when failure is not blameworthy. The deontologists thought we were not to blame for actions done in genuine ignorance of the facts. Kant declared in a famous passage that we were not morally responsible for failures due to the “niggardliness of stepmother nature.” In this article I (...) want to introduce into moral philosophy a new concept for clarifying the failures for which we are not to blame: the notion of scarcity, taken from economic theory. (shrink)

It is often argued, most recently by Samuel Scheffler, that we should reconcile with our mortality as constitutive of our existence: as essential to its temporal structure, to the nature of deliberation, and to our basic motivations and values. Against this reconciliatory strategy, I argue that there is a kind of immortal existence that is coherently conceivable and potentially desirable. First, I argue against the claim that our existence has a temporal structure with a trajectory that necessarily culminates in an (...) ending. This claim is based on two false assumptions: that a life as a whole calls for narrative structure, and that narratives necessarily require closure as temporal endings. Second, I reject the proposal that temporal finitude is constitutive of the basic elements of diachronic agency, including the nature of deliberation and of our values. I argue that only finitude as scarcity of opportunities is constitutive of these elements. Additionally, scarcity might be present in an endless existence. Therefore, it is not incoherent to conceive of a recognizable and potentially desirable immortality that grounds the core features of diachronic agency. Thus, against the reconciliatory strategy, I conclude that we might never fully reconcile with mortality. Although we might embrace our inescapable mortality as essential to a fuller range of features of our existence, we can still justifiably regret our missing on an immortal existence. (shrink)

This book focuses on resource allocation in military and humanitarian medicine during times of scarcity and austerity. It is in these times that health systems bend, break, and even collapse and where resource allocation becomes a paramount concern and directly impacts clinical decision-making. Such times are challenging and this book covers this very important, yet, scarcely researched topic within the field of bioethics. This work brings together experts and practitioners in the fields of military health care, philosophy, ethics, and (...) other disciplines to provide analysis on a variety of related topics ranging from case studies and first-hand experiences to policy and philosophical analysis. It is of great interest to to academics, practitioners, policy makers and students who are looking for analyses and guidance regarding the fair provision of medical care and the use of medical rules of eligibility under adverse conditions. (shrink)

The scarcity of women’s writings in antiquity presents an intractable problem for feminists intending to integrate women’s perspectives into the existing philosophical canon. One way to undo the erasure of women is for feminists to look to the east; in China, there is an abundance of well-preserved women’s writings, along with their biographical records, as early as the 6th century BCE. This essay will provide a survey of those women’s records, focusing on the 6th century BCE to the 4th (...) century CE, as a way to reimagine the discipline of Philosophy and its canon. (shrink)

Are extreme beliefs constitutive of echo chambers, or only typically caused by them? Or are many echo chambers unproblematic, amplifying relatively benign beliefs? This paper details the conceptual relations between echo chambers and extreme beliefs, showing how different conceptual choice-points in how we understand both echo chambers and extreme beliefs affects how we should evaluate, study, and engage with echo chambering groups. We also explore how our theories of extreme beliefs and echo chambers shape social scientific (...) research and contribute in a practical way when treating these phenomena, focusing on examples of climate change scepticism. (shrink)

The COVID-19 pandemic has created or revealed scarcities in many domains: medical, civic, economic, and ideological. Responses to these are analyzed in the framework of a map of justice and an imperative of openness. The main argument is that whatever the view of justice chosen by public health authorities, they should be able and willing to disclose it to the citizens. Objections are considered and qualifications added, but the general conclusion is that in liberal democracies, truth-telling by those in power, (...) although politically hazardous, would be ethically advisable. (shrink)

We study the effect of scarcity on decision making by low income Swedes. We exploit the random assignment of welfare payments to study their borrowing decisions within the pawn and mainstream credit market. We document that higher educated borrowers borrow less frequently and choose lower loan to value ratios when their budget constraints are exogenously tighter. In contrast, low-educated borrowers do not respond to temporary elevated levels of scarcity. This lack of response translates into a significantly higher probability (...) to default and an 11.6% increase in borrowing cost. We show that a difference in access to liquidity and/or buffer stocks cannot explain our results. Instead a framework, where the awareness of self-control problems is positively correlated with education can explain that high-educated consumers choose a lower LTV as a commitment device to increase their likelihood to repay. Analogously, low-educated with less awareness of their future self-control problems, do not tie themselves to the mast and thus ignore the consequences of their credit decisions when focusing on solving acute liquidity problems. Our findings highlight that increased levels of scarcity risk reinforcing the conditions of poverty through overborrowing. (shrink)