Because the number of organs available for transplantation does not meet the needs of potential recipients, some have proposed that a potentially effective way to increase registration is to offer a self‐benefit incentive that grants a 'preferred status' or some degree of prioritization to those who register as potential donors, in case they might need organs. This proposal has elicited an ethical debate on the appropriateness of such a benefit in the context of a life‐saving medical procedure. In this (...) paper we review arguments and ethical concerns raised by scholars, and studies of views of members of the public regarding the prioritization incentive system. We also report on our study of the views of those involved in organ transplant and of other medical professionals in Israel, as over half a decade ago Israel implemented a prioritization incentive system. Bioethicists propose that key stakeholders' views can provide additional arguments and perspectives on controversial issues. Proponents justify the prioritization incentive drawing mainly on arguments related to its potential effectiveness, reciprocity and fairness. Opponents point to the fact that registering is not binding and not an actual donation, and raise concerns regarding equity, autonomy and gaming the system. Ethical concerns raised by the practitioners in the study were examined in light of scholars' arguments and actual registration and donation data. Practitioners involved in transplantation raised ethical concerns corresponding to those raised by scholars as well as additional concerns. They also challenged proponents' assumptions regarding the utility of the incentive system from their own experience and argued that proponents obscure the meaning of reciprocity. (shrink)

Epistemic burdens – the nature and extent of our ignorance (that and how) with respect to various courses of action – serve to determine our incentive structures. Courses of action that seem to bear impossibly heavy epistemic burdens are typically not counted as options in an actor’s menu, while courses of action that seem to bear comparatively heavy epistemic burdens are systematically discounted in an actor’s menu relative to options that appear less epistemically burdensome. That ignorance serves to determine (...) what counts as an option means that epistemic considerations are logically prior to moral, prudential, and economic considerations: in order to have moral, prudential, or economic obligations, one must have options, and epistemic burdens serve to determine our options. One cannot have obligations without doing some epistemic work. We defend this claim on introspective grounds. We also consider how epistemic burdens distort surrogate decision-making. The unique epistemology of surrogate cases makes the priority of the epistemic readily apparent. We then argue that anyone who accepts a principle similar to ought implies can is committed to the logical priority of the epistemic. We also consider and reject several possible counterarguments. -/- . (shrink)

Chronic shortage in organs for transplantation worldwide is leading many policy-makers to consider various incentives that may increase donation rates.1 These range from giving holders of donor cards some priority on the transplant waiting list or a discount on health insurance premiums, to giving families who consent to donation a medal of honour, reimbursement of funeral expenses, tax incentives or even financial compensation.2–4 Of the various proposed incentive mechanisms, the one that has consistently garnered the most criticism and (...) objection in the literature is that of paying families who consent to donate the organs of a deceased loved one.Arguments against such a policy abound: it could exploit the poor, influence the family to prematurely withdraw care, encourage families to withhold medical information that would result in transplant-transmission of disease, and finally, it would commercialise the value of human life and result in the perception of human organs as commodities. Indeed, to date no Western country has adopted a policy of financial compensation to families for consenting to organ donation.2Recently, a country suffering from severe shortage in organs has implemented a policy of financial incentives that uses cash payments. Wu and Fang5 describe a recent pilot programme in China that compensates families for postmortem donation, through an independent third party and based on consent or presumed consent of the deceased. The particular context within which this programme is implemented validates and even exacerbates some ethical concerns that have been voiced in the Western medical and bioethics …. (shrink)

The communist norm requires that scientists widely share the results of their work. Where did this norm come from, and how does it persist? Michael Strevens provides a partial answer to these questions by showing that scientists should be willing to sign a social contract that mandates sharing. However, he also argues that it is not in an individual credit-maximizing scientist's interest to follow this norm. I argue against Strevens that individual scientists can rationally conform to the communist norm, even (...) in the absence of a social contract or other ways of socially enforcing the norm, by proving results to this effect in a game-theoretic model. This shows that the incentives provided to scientists through the priority rule are sufficient to explain both the origins and the persistence of the communist norm, adding to previous results emphasizing the benefits of the incentive structure created by the priority rule. (shrink)

In the effort to address the persistent organ shortage it is sometimes suggested that we should incentivize people to sign up as organ donors. One way of doing so is to give priority in the allocation of organs to those who are themselves registered as donors. Israel introduced such a scheme recently and the preliminary reports indicate increased donation rates. How should we evaluate such initiatives from an ethical perspective? Luck egalitarianism, a responsibility-sensitive approach to distributive justice, provides one (...) possible justification: Those who decide against being organ donors limit the health care resources available to others. As such, a priority rule can be justified by a luck egalitarian approach to distributive justice. Furthermore, a priority rule inspired by luck egalitarianism is well equipped to avoid prominent criticisms of such a procurement system. Luck egalitarianism provides us with reaons to exempt people who are not responsible for their inability to donate from receiving lower priority, provide sufficient information about donation, and mitigate social and natural circumstances affecting people’s choice to donate. (shrink)

The U.S. Constitution employs a utilitarian view in authorizing Congress to establish patents and copyrights. Let us refer to this way of justifying copyright as the Incentives Argument, or more extensively, the Incentives Argument for Intellectual Property Rights. While seemingly straightforward, the Incentives Argument has been widely criticized in philosophical literature on intellectual property. Scholars have come to prefer Neo-Lockean labor-desert accounts, grounding intellectual property rights in the author's natural ownership claims over his creations. Neo-Lockean accounts are thought to avoid (...) some of the problems classically associated with utilitarian arguments, such as vulnerability to empirical evidence and an inability to make sense of rights or duties morally prior to consequential considerations. Fortunately, many criticisms articulated by opponents of the Incentives Argument can be answered by a strategic retreat to the version of utilitarianism found in the work of John Stuart Mill. I argue that not only does a Millian account of the Incentives Argument prove less vulnerable to oft-cited criticisms, but also allows for a more robust account of how the audience benefits from a proliferation of creative works. Mill's focus on the importance of critical self-development allows for a deeper analysis of how creative works benefit members of the audience as individuals and as a community. Within a Millian framework, viewing the audience as mere passive consumers of media fails to take into account the impact of expressive acts on an individual's critical self-development. Instead, one must see members of the audience as active participants in the creation of meaning and the common culture. Construing the community that receives creative works as an Active Audience alters the landscape of copyright, and the Incentives Argument, making balancing the desires of creators and the desires of audience members a key priority. (shrink)

This book provides the first systematic study on three types of incentives for organ donation. It covers extensive research conducted in four culturally different societies: Hong Kong, mainland China, Iran and the United States, and shows on the basis of the research that a new model of incentives can be constructed to enhance organ donation in contemporary societies. The book focuses on three types of incentives: honorary incentives, commonly adopted in the United States and other Western countries by offering things (...) such as a thank-you card and a memorial park for donors to encourage donations motivated by pure altruism; compensationalist incentives, adopted in the Islamic Republic of Iran to encourage donation by providing monetary compensation to unrelated living donors for appreciating their altruistic contribution of donation; and familist incentives, implemented in Israel and mainland China to provide priority to organ transplantation to donors and/or their family members. The book demonstrates that a new model of incentives must go beyond offering only one type of incentives and should rather include different types of incentives that are practically effective, politically legitimate and ethically justifiable for particular societies. This implies that suitable incentive measures may vary from society to society to optimize organ donation. This book provides a clear reference for both the scholars and practitioners in the field of organ transplantation, as well as for general readers interested in bioethics and health care policy. (shrink)

"The largest Ebola outbreak to date—first detected in December 2013 and still ongoing as of April 2015—has cast new light on the shortfalls of international public health systems.1 As in previous health crises, scrutiny has reemerged over the pharmaceutical industry’s ability and willingness to innovate new medicines for underserved disease areas. The public debate has intensified following revelations that promising drug candidates to treat Ebola had gone undeveloped despite compelling preclinical results.2 This lack of development is especially troubling because it (...) occurred after a recently implemented U.S. incentive scheme—the Food and Drug Administration’s (FDA) tropical disease priority review voucher program—designed to counteract exactly this problem. Taking Ebola as a case in point, it is useful to examine the short history and ongoing refinement of this voucher program, since it represents one of the most significant legislative efforts to systematically address the relative absence of com- mercial rewards for drugs targeting tropical diseases. This analysis evaluates the voucher program’s effectiveness for both stimulating private sector innovation and achieving positive health impacts among populations most severely burdened by tropical diseases. It then proposes specific recommendations for how law- makers can improve the program’s legislation to better achieve these objectives. ". (shrink)

Rare diseases pose a particular priority setting problem. The UK gives rare diseases special priority in healthcare priority setting. Effectively, the National Health Service is willing to pay much more to gain a quality-adjusted life-year related to a very rare disease than one related to a more common condition. But should rare diseases receive priority in the allocation of scarce healthcare resources? This article develops and evaluates four arguments in favour of such a priority. These (...) pertain to public values, luck egalitarian distributive justice the epistemic difficulties of obtaining knowledge about rare diseases and the incentives created by a higher willingness to pay. The first is at odds with our knowledge regarding popular opinion. The three other arguments may provide a reason to fund rare diseases generously. However, they are either overinclusive because they would also justify funding for many non-rare diseases or underinclusive in the sense of justifying priority for only some rare diseases. The arguments thus fail to provide a justification that tracks rareness as such. There are no data in this work. (shrink)

The need for new “pull” incentives to stimulate antibiotic R&D is widely recognized. Due to the global diversity of health systems, combined with different challenges faced by antibiotics used in different types of healthcare settings, there is no one-size-fits-all solution. Instead, different “pull” incentives should be tailored to local contexts, priorities, and antibiotic types. Policymakers and industry should collaborate to identify appropriate solutions at the local, regional, and global levels.

Priority setting remains a big challenge for health managers and planners, yet there is paucity of literature on evaluating priority setting. The purpose of this paper is to present a framework for evaluating priority setting in low and middle income countries. We conducted a qualitative study involving a review of literature and Delphi interviews with respondents knowledgeable of priority setting in low and middle income countries. Respondents were asked to identify the measures of successful priority (...) setting in low and middle income countries. Responses were grouped as: immediate internal or external/delayed internal or external. We also identified some pre-requisites for successful priority setting. The immediate internal measures included increased efficiency in decision making, improved quality of decisions and fairer priority setting. Immediate External measures included—improved public understanding and acceptance of decisions, increased public participation, increased trust. Delayed Internal measures included increased satisfaction, understanding, compliance, balanced budget, achievement of organization goals, and improved internal accountability. Delayed External measures include impact on policy and practice, improved population health and reduction of health inequalities, achievement of health system goals and strengthening of health care systems. Identified pre-requisites for successful priority setting included; the presence of credible priority setting institutions, incentives for participation and implementation and resources, capacity and political will to implement. These would be augmented in a conducive political, social and economic context. This framework, although not exhaustive, provides a practical basis for planning and evaluating priority setting in low and middle income countries. (shrink)

This essay is a comparative analysis of results reported in this volume from studies in mainland China, the United States, Iran, and Hong Kong regarding organ donation incentives. They reveal widespread (but not unanimous) support for honorary incentives (such as notes or ceremonies of gratitude) and significant support for familist incentives (offering a donor’s family members priority should they need an organ transplant in the future). Opinions on financial incentives were much more mixed, with significant worries expressed regarding potential (...) exploitation and unfairness. These interviews also reinforce the importance of culturally appropriate constructions of any steps to increase organ donation rates. And, in addition to their comments on various types of incentive, interviewees in these chapters also offer insight into other measures that could be taken to increase organ donation. (shrink)

This chapter provides conceptual and ethical comments on Hong Kong’s interview findings and survey results regarding the three types of incentive for organ donation. It focuses on three particular conceptual and ethical issues. First, it shows that there is not always a clear-cut distinction between an honorary and a compensationalist incentive measure for organ donation. Instead, a measure such as offering a public columbarium niche to a deceased donor in Hong Kong carries both honorary and compensationalist elements and (...) can, as a mixed type of incentive measure, be ethically justified for adoption in that society, even if purely monetary incentives cannot be similarly ethically justified. Moreover, in relation to the proposal to offer a familist incentive in Hong Kong (namely, to give patients with a first-degree family member who was a cadaveric donor, or who have themselves previously been live donors, a priority right for a transplant over other medically similar patients), it is argued that no proposed opposing reason is ethically convincing. Finally, the chapter demonstrates that there are legitimate considerations to support maintaining Hong Kong’s familist decision-making model regarding organ donation. (shrink)

The priority of secured credit has repeatedly and famously been attacked for allowing the exploitation of certain types of unsecured creditor. It has also been blamed for creating inefficiencies. This paper examines these arguments specifically as applied to this jurisdiction, and using both theoretical analysis and recent empirical data, suggests none of them can be sustained. It is argued that security is unlikely to lead to the exploitation of involuntary, ‘uninformed’, or ‘unsophisticated’ creditors, since the perverse incentives it allegedly (...) creates for the debtor's management are likely to be outweighed by the managers' liquidation‐related costs. It is then pointed out that both exploitation‐based and inefficiency‐based attacks on the priority of secured credit depend on the assumption that secured credit is generally cheaper than unsecured credit, and further, that this is why debtors prefer to borrow on a secured rather than unsecured basis. Recent evidence from this jurisdiction is used to challenge this assumption. This has dramatic implications for the attacks on security, which are discussed. The paper concludes with the demonstration that secured credit, by inducing creditors to lend when they would not do so without being offered priority, is mutually value‐enhancing for all types of creditor, including unsecured ones. (shrink)

The fair distribution of health resources is critical to health justice. But distributing healthcare equitably requires careful attention to the existing distribution of other resources, and the economic system which produces these inequalities. Health is strongly determined by socioeconomic factors, such as the effects of racism on the health of communities of colour, as well as the broader market-oriented healthcare and pharmaceutical systems that put the pursuit of profit above the alleviation of suffering. Two papers in this issue confront health (...) injustices at different scales, and make far-reaching recommendations for more just healthcare allocation policies. Orphan drugs are those that pharmaceutical companies are unwilling to develop unless they are offered financial incentives to do so. When a target patient group is very small, or very poor, producing drugs is unprofitable. If patients are to benefit from these drugs in a marketised pharmaceutical regime, governments must step in to provide incentives for research and development. Yet government spending ought to prioritise value for money, and is generally guided by a utilitarian framework. In the case of neglected tropical diseases, there is no moral conflict: large numbers of people would benefit greatly from these treatments. However, there are practical limitations: the governments of affected populations are often unable to fund incentives for research and development, and solidarity from elsewhere is limited.1 2 In the case of rare diseases, Global North governments usually can afford to incentivise the development of treatments to serve their populations, but given the small numbers of beneficiaries, doing so seems a questionable use of resources. Many Global North governments make an exception to the general utilitarian heuristic to accommodate the moral intuition that the claims of a person with a rare …. (shrink)

This article investigates what notions of “just health care” are found at three Swedish hospitals among health care personnel and whether these notions are relevant to what priorities are actually made. Fieldwork at all three hospitals and 114 in-depth interviews were conducted. Data have been subject to conceptual and ethical analysis and categorisation. According to our findings, justice is an important idea to health care personnel at the studied hospitals. Two main notions of just health care were found. The main (...) idea was the notion of “equal treatment according to need”, the basic idea being that differences in treatment should be justified by differences in needs. The competing idea that merit should affect the treatment received is occasionally encountered, the idea here being that patients, by acting irresponsibly, may no longer deserve to be treated strictly according to needs. In practice, priorities are made on grounds that only partly comply with the basic idea of justice in health care, as it is understood by staff at the studied hospitals. Exceptions are made due to regional differences, considerations of cost-effectiveness, economic incentives, tradition, the daily patient flow, research, private alternatives, patient influence and favouritism of health care personnel. (shrink)

Proposals for increasing organ donation are often rejected as incompatible with altruistic motivation on the part of donors. This paper questions, on conceptual grounds, whether most organ donors really are altruistic. If we distinguish between altruism and solidarity – a more restricted form of other-concern, limited to members of a particular group – then most organ donors exhibit solidarity, rather than altruism. If organ donation really must be altruistic, then we have reasons to worry about the motives of existing donors. (...) However, I argue that altruism is not necessary, because organ donation supplies important goods, whatever the motivation, and we can reject certain dubious motivations, such as financial profit, without insisting on altruism.Once solidaristic donation is accepted, certain reforms for increasing donation rates seem permissible. This paper considers two proposals. Firstly, it has been suggested that registered donors should receive priority for transplants. While this proposal appears based on a solidaristic norm of reciprocity, it is argued that such a scheme would be undesirable, since non-donors may contribute to society in other ways. The second proposal is that donors should be able to direct their organs towards recipients that they feel solidarity with. This is often held to be inconsistent with altruistic motivation, but most donation is not entirely undirected in the first place (for instance, donor organs usually go to co-nationals). While allowing directed donation would create a number of practical problems, such as preventing discrimination, there appears to be no reason in principle to reject it. (shrink)

The first book length study of property-owning democracy, Republic of Equals argues that a society in which capital is universally accessible to all citizens is uniquely placed to meet the demands of justice. Arguing from a basis in liberal-republican principles, this expanded conception of the economic structure of society contextualizes the market to make its transactions fair. The author shows that a property-owning democracy structures economic incentives such that the domination of one agent by another in the market is structurally (...) impossible. The result is a renovated form of capitalism in which the free market is no longer a threat to social democratic values, but is potentially convergent with them. It is argued that a property-owning democracy has advantages that give it priority over rival forms of social organization such as welfare state capitalism and market socialist institutions. The book also addresses the currently high levels of inequality in the societies of the developed West to suggest a range of policies that target the "New Inequality" of our times. For this reason, the work engages not only with political philosophers such as John Rawls, Philip Pettit and John Tomasi, but also with the work of economists and historians such as Anthony B. Atkinson, François Bourguignon, Jacob S. Hacker, Lane Kenworthy, and Thomas Piketty. (shrink)

The first book-length study of property-owning democracy, Republic of Equals, argues that a society in which capital is universally accessible to all citizens is uniquely placed to meet the demands of justice. Arguing from a basis in liberal-republican principles, this expanded conception of the economic structure of society contextualizes the market to make its transactions fair. It shows that a property-owning democracy structures economic incentives such that the domination of one agent by another in the market is structurally impossible. The (...) result is a renovated form of capitalism in which the free market is no longer a threat to social democratic values but is potentially convergent with them. It is argued that a property-owning democracy has advantages that give it priority over rival forms of social organization such as welfare-state capitalism and market socialist institutions. The book also addresses the currently high levels of inequality in the societies of the developed West to suggest a range of policies that target the “New Inequality” of the twenty-first century. For this reason, the work engages not only with political philosophers such as John Rawls, Philip Pettit, and John Tomasi but also with the work of economists and historians such as Anthony B. Atkinson, François Bourguignon, Jacob S. Hacker, Lane Kenworthy, and Thomas Piketty. (shrink)

Michael Ravvin, Department of Political Science, Columbia University, 420 W. 118th Street, New York, NY 10027 Email: mer2133{at}columbia.edu ' + u + '@' + d + ' '//--> Abstract The existing intellectual property regime discourages the innovation of, and access to, essential medicines for the poor in developing countries. A successful proposal to reform the existing system must address these challenges of access and innovation. This essay will survey the problems in the existing pharmaceutical patent system and offer critical analysis (...) of some reform proposals. I will argue that existing mechanisms that are intended to mitigate the harms of the current pharmaceutical patent system, such as bulk buying, differential pricing and compulsory licenses, are inadequate and perhaps even counter-productive over the long-term. Other incentive mechanisms based on push funding, such as government research grants, are inefficient and limited in scope. Pull mechanisms, which offer some reward for successful pharmaceutical innovations, offer a more promising incentive mechanism. I will evaluate three pull mechanisms -- Priority Review Vouchers, Advance Market Commitment (AMC) and the Health Impact Fund -- on the basis of their capacity to incentivize access and innovation, as well as their efficiency and political feasibility. Though the Health Impact Fund appears to be the most promising proposal, more work must be done to overcome challenges of its implementation. CiteULike Connotea Del.icio.us What's this? (shrink)

This essay indicates that Confucian family-based ethics is by no means a stumbling block to organ donation in China. We contend that China should not change to an opt-out consent system in order to enhance donation because a “hard” opt-out system is unethical, and a “soft” opt-out system is unhelpful. We argue that the recently-introduced familist model of motivation for organ donation in mainland China can provide a proper incentive for donation. This model, and the family priority right (...) that this model supports, is ethically justifiable in terms of Confucian family-based ethics. (shrink)

It is commonly hypothesized that scientists are more likely to engage in data falsification and fabrication when they are subject to pressures to publish, when they are not restrained by forms of social control, when they work in countries lacking policies to tackle scientific misconduct, and when they are male. Evidence to test these hypotheses, however, is inconclusive due to the difficulties of obtaining unbiased data. Here we report a pre-registered test of these four hypotheses, conducted on papers that were (...) identified in a previous study as containing problematic image duplications through a systematic screening of the journal PLoS ONE. Image duplications were classified into three categories based on their complexity, with category 1 being most likely to reflect unintentional error and category 3 being most likely to reflect intentional fabrication. We tested multiple parameters connected to the hypotheses above with a matched-control paradigm, by collecting two controls for each paper containing duplications. Category 1 duplications were mostly not associated with any of the parameters tested, as was predicted based on the assumption that these duplications were mostly not due to misconduct. Categories 2 and 3, however, exhibited numerous statistically significant associations. Results of univariable and multivariable analyses support the hypotheses that academic culture, peer control, cash-based publication incentives and national misconduct policies might affect scientific integrity. No clear support was found for the “pressures to publish” hypothesis. Female authors were found to be equally likely to publish duplicated images compared to males. Country-level parameters generally exhibited stronger effects than individual-level parameters, because developing countries were significantly more likely to produce problematic image duplications. This suggests that promoting good research practices in all countries should be a priority for the international research integrity agenda. (shrink)

The system for awarding credit in science—the priority rule—functions, I have proposed elsewhere, to bring about something close to a socially optimal distribution of scientists among scientific research programs. If all goes well, then, potentially fruitful new ideas will be explored, unpromising ideas will be ignored, and fashionable but oversubscribed ideas will be deprived of further resources. Against this optimistic background, the present paper investigates the ways in which things might not go so well, that is, ways in which (...) the priority rule might fail to realize its full potential as an incentive for scientists to work on the right things. Several possible causes of herding—an outcome in which a single research program ends up with a number of researchers well in excess of the optimum—are considered. (shrink)

Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year while waiting for a kidney transplant. Advocates of financial incentive programs or “regulated markets” in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie—at least in part—in (...) facilitating so-called “altruistic donation;” harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Strategies designed to minimize financial barriers to donation and the use of paired kidney exchange programs are increasingly enabling donation, and now, an innovative program designed to address what has been termed “chronologically incompatible donation” is being piloted at the University of California, Los Angeles, and elsewhere in the United States. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program; in return, a commitment is made to the specified recipient that priority access for a living-donor transplant in a paired exchange program will be offered when or if the need arises in the future. We address here potential ethical concerns related to this form of organ “banking” from living donors, and argue that it offers significant benefits without undermining the well-established ethical principles and values currently underpinning living donation programs. (shrink)

Although universities have undergone changes since the dawn of their existence, the speed of change started to accelerate remarkably in the 1960s. Spectacular growth in the number of students and faculty was immediately followed by administrative reforms aimed at managing this growth and managing the demands of students for democratic reform and societal relevance. Since the 1980s, however, an entirely different wind has been blowing along the academic corridors. The fiscal crisis of the welfare states and the neoliberal course of (...) the Reagan and Thatcher governments made the battle against budget deficits and against government spending into a political priority. Education, together with social security and health care, were targeted directly. As the eighties went on, the neoliberal agenda became more radical—smaller state and bigger market—attacking the public sector itself through efforts to systematically reduce public expenditure by privatizing public services and introducing market incentives. At the same time the societal relevance of the universities demanded by critical students was turned on its head to become economic relevance to business and industry in the knowledge society. (shrink)

Objectives: To describe the concerns and priorities of key stakeholders in a developing country regarding ethical obligations held by researchers and perceptions of equity or “what is fair” for study participants in an HIV/AIDS clinical drug trial. Design: Qualitative study with focus groups. Setting: Teaching and referral hospital and rural health centre in western Kenya. Participants: Potential HIV/AIDS clinical trial participants, clinician researchers, and administrators. Results: Eighty nine individuals participated in a total of 11 focus groups over a four month (...) period. The desire for continued drug therapy, most often life long, following an HIV/AIDS clinical trial was the most common priority expressed in all focus groups. Patients with and without HIV/AIDS also thought subsidisation of drug therapies and education were critical forms of compensation for clinical trial participation. Financial incentives were considered important primarily for purchasing drug therapy as well as obtaining food. Patients noted a concern for the potential mismanagement of any money offered. Clinician researchers and administrators felt strongly that researchers have a moral obligation to participants following a trial to provide continued drug therapy, adverse event monitoring, and primary care. Finally, clinician researchers and administrators stressed the need for thorough informed consent to avoid coercion of study participants. Conclusions: Kenyan patients, clinician researchers, and administrators believe that it would be unfair to stop antiretroviral therapy following an HIV/AIDS clinical trial and that researchers have a long term obligation to participants. (shrink)

This work empirically tests the concept of the ‘whistleblowing triangle,’ which is modeled on the three factors encapsulated by the fraud triangle, in the Indonesian context. Anchored in the proposition of an original research framework on the whistleblowing triangle and derived hypotheses, this work aims to expand the body of knowledge on this topic by providing empirical evidence. The sample used is taken from audit firms affiliated with both the big 4 and non-big 4 companies operating in Indonesia. The results (...) of analysis using the PLS-PM method found a significant relationship between the components of the whistleblowing triangle and the intention of blowing the whistle. We found that financial incentives are the most significant predictor of auditors’ intention to blow the whistle in Indonesia. Other components, such as opportunity and rationalization, also play an important role in supporting auditors’ intention to blow the whistle. Our findings also suggest that related pressures are the top priority for audit firms in Indonesia to consider in increasing whistleblowing intention. We expand the previous literature on whistleblowing which has been derived from the components of the fraud triangle :28–56, 2016; Smaili and Arroyo in J Bus Ethics, https://doi.org/10.1007/s10551-017-3663-7, 2017) by adding empirical evidence. (shrink)

Although the thesis that equal basic liberties take priority over increases in wealth is one of the two most important theses in the rawlsian theory of justice, The argumentation for it is obscure. This article emphasizes the centrality of self-Respect in rawls' treatment of liberty, Specifies five particular assumptions he makes, And constructs a deductive argument from the rawlsian assumptions to the rawlsian conclusion about liberty. Of special interest are the premises of economic adequacy for the worst-Off man and (...) the incentive value of economic inequality, Which reveal the relation between the difference principle and the priority of liberty. (shrink)

This work empirically tests the concept of the ‘whistleblowing triangle,’ which is modeled on the three factors encapsulated by the fraud triangle (pressure or financial incentives, opportunity and rationalization), in the Indonesian context. Anchored in the proposition of an original research framework on the whistleblowing triangle and derived hypotheses, this work aims to expand the body of knowledge on this topic by providing empirical evidence. The sample used is taken from audit firms affiliated with both the big 4 and non-big (...) 4 companies operating in Indonesia. The results of analysis using the PLS-PM method found a significant relationship between the components of the whistleblowing triangle and the intention of blowing the whistle. We found that financial incentives are the most significant predictor of auditors’ intention to blow the whistle in Indonesia. Other components, such as opportunity and rationalization, also play an important role in supporting auditors’ intention to blow the whistle. Our findings also suggest that related pressures are the top priority for audit firms in Indonesia to consider in increasing whistleblowing intention. We expand the previous literature on whistleblowing which has been derived from the components of the fraud triangle (Brown et al. in Account Public Interest 16(1):28–56, 2016; Smaili and Arroyo in J Bus Ethics, 10.1007/s10551-017-3663-7, 2017) by adding empirical evidence. (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)

The Human Organ Transplantation Act came into officially force in Bangladesh on April 13, 1999, allowing organ donations from both living and brain-dead donors. The Act was amended by the Parliament on January 8, 2018, with the changes coming into effect shortly afterwards on January 28. The Act was revised to extend a living donor pool from close relatives to include certain other relatives such as grandparents, grandchildren, and first cousins. The Act was also revised to allow individuals to prioritize (...) family members in receiving their organs after their death. The aim of this paper is not to carry out an ethical analysis of the Act as a whole but only to focus on aspects relating to priority access for family members to organs. Despite Islam encouraging Muslims to be sympathetic, and to save the life of any member of humankind, saving the life of a relative through organ donation is even more highly valued. The collective and extended structure of the family impacts on the provisions of the Act that only allows Bangladeshis to legally donate their organs to save the lives of relatives and allows individuals to prioritize family members. Recent progress in the practice of organ transplantation raises a number of ethical dilemmas around the allocation of available organs in the context of organ scarcity. A key purpose of introducing incentive into the system of organ allocation is to increase the number of donations from living relatives and initiation of vital organ donations from brain-dead donors. However, allocation criteria based on a living organ donation incentive system would appear to be unethical because there is no provision in the Act with regard to financial compensation for a distant relative donor’s post-operative care in the absence of healthcare coverage. Receiving organs from a distant relative without giving financial compensation for post-operative care places them in a grave health condition and violates the biomedical principle of non-maleficence. An incentive system around brain-dead donors would appear to be ethical as the amended Act allows individuals to prioritize relatives in receiving their organs after death. This provision is intended to initiate the transplantation of vital organs from brain-dead donors as families might bear the cost of keeping the organs alive for transplantation. Regular reassessment of the impact of the Act is necessary to maximize the donation rate of transplantable organs using ethical means. (shrink)

In a modern economy, “equilibrium” means that supply and demand is equal. It is at this point that the allocation of goods and services is at its most efficient, this being because the amount of goods and the amount of goods in demand are equally balanced. The market equilibrium therefore is determined by supply and demand. This paper looks at the concept of “equilibrium” in some of the early Confucian texts and its possible implications in economic activities. In the Confucian (...) context equilibrium, or what can be termed as the ultimate equilibrium, is to be understood in a broader sense where balances and harmony at different levels (e.g. individual and society) need to be sought in order to achieve a model of sustainable development. The ultimate equilibrium may provide an alternative approach to social welfare and economic prosperity creating universal harmony and better living for humans. In Confucian ideology, governing for the welfare of the people is not merely a question of increasing personal income and wealth; it requires implementation on a priority basis, taking into consideration the formation of an orderly society based on the enforcement of moral and ethical standards with the existence of a benevolent government which appropriates things according to the principles of harmony and order to achieve what can be termed as the “great equilibrium”—equilibrium that is not simply defined by balanced economic forces as in modern economic theory; but rather is used to suggest an ideal state of harmony in self fulfilment and socio-political order through incentives and by appropriate means. (shrink)

Introduction: There is currently no binding, internationally accepted and successful approach to ensure global equitable access to healthcare during a pandemic. The aim of this ethical analysis is to bring into the discussion a legally regulated vaccine allocation as a possible strategy for equitable global access to vaccines. We focus our analysis on COVAX (COVID-19 Vaccines Global Access) and an existing EU regulation that, after adjustment, could promote global vaccine allocation. -/- Methods: The main documents discussing the two strategies are (...) examined with a qualitative content analysis. The ethical values reasonableness, openness and transparency, inclusiveness, responsiveness and accountability serve as categories for our ethical analysis. -/- Results: We observed that the decision-making processes in a legal solution to expand access to vaccines would be more transparent than in COVAX initiative, would be more inclusive, especially of nation states, and the values responsiveness and accountability could be easily incorporated in the development of a new regulation. -/- Discussion: A legal strategy that offers incentives to the pharmaceutical industry in return for global distribution of vaccines according to the Fair Priority Model is an innovative way to achieve global and equitable access to vaccines. However, in the long term, achieving the Sustainable Development Goals will require from all nations to work in solidarity to find durable solutions for global vaccine research and development. Interim solutions, such as our proposed legal strategy for equitable access to vaccines, and efforts to find long-term solutions must be advanced in parallel. (shrink)

As part of a multifactorial approach to address weak incentives for innovative antimicrobial drug development, market entry rewards are an emerging solution. Recently, the Duke-Margolis Center for Health Policy released the Priority Antimicrobial Value and Entry Award proposal, which combines a MER with payment reforms, transitioning from volume-based to “value-based” payments for antimicrobials. Here, the PAVE Award and similar MERs are reviewed, focusing on further refinement and avenues for implementation.

Emotions imply a revision of our beliefs inasmuch as they are triggered by a discrepancy between our expectancies and new situations. I will study the converse relation: how emotions, particularly recurrent emotions that reappear in similar situations in the long term, are incentives to revise not only our beliefs but also the order of priorities between their related desires. Understanding how affects can revise both beliefs—under their committing aspect—and the order of desires, implies seeing the dynamics of affects as interacting (...) with external dynamics and the order of priorities as a weak one. These philosophical considerations shed new light on the diversity of emotions, on their different temporalities, and on the paradox of emotional sharing. (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)

How do “international” epistemic communities shape regulatory contests between transnational firms and civil society organizations in the Global South? With the establishment of the World Trade Organization, member states committed to basing trade-restrictive national regulations on science-based “international” standards set by “international” standard-setting bodies. Yet we know little about how the WTO regime has shaped the operation of epistemic communities within standard-setting bodies and, in turn, how standard-setting bodies articulate with national policy-making processes in the Global South. Building on work (...) in the new political sociology of science, I argue that neoliberal globalization and the establishment of the WTO have created incentives for Western epistemic communities to at once cast themselves as “international” under the WTO regime and orient their scientific agendas toward the priorities of transnational firms. Moreover, this transformation of epistemic communities has created opportunities for transnational firms facing contentious policy environments in the Global South to effectively outsource regulatory decision-making to “international” epistemic communities that can claim legal status under the WTO regime. Empirically, I focus on the case of one Western epistemic community—the Association of Analytical Communities International—and its claim to epistemic jurisdiction over pesticide residue standards for soft drinks in India. (shrink)

This paper interrogates the growing pervasiveness of affect recognition tools as an emerging layer human-centric automated management in the global workplace. While vendors tout the neoliberal incentives of emotion-recognition technology as a pre-eminent tool of workplace wellness, we argue that emotional AI recalibrates the horizons of capital not by expanding outward into the consumer realm (like surveillance capitalism). Rather, as a new genus of digital Taylorism, it turns inward, passing through the corporeal exterior to extract greater surplus value and managerial (...) control from the affective states of workers. Thus, empathic surveillance signals a profound shift in the ontology of human labor relations. In the emotionally quantified workplace, employees are no longer simply seen as physical capital, but conduits of actuarial and statistical intelligence gleaned from their most intimate subjective states. As a result, affect-driven automated management means that priority is often given to actuarial rather than human-centered managerial decisions. (shrink)

Regarding the relation of Plato’s early and middle period dialogues, scholars have been divided to two opposing groups: unitarists and developmentalists. While developmentalists try to prove that there are some noticeable and even fundamental differences between Plato’s early and middle period dialogues, the unitarists assert that there is no essential difference in there. The main goal of this article is to suggest that some of Plato’s ontological as well as epistemological principles change, both radically and fundamentally, between the early and (...) middle period dialogues. Though this is a kind of strengthening the developmentalistic approach corresponding the relation of the early and middle period dialogues, based on the fact that what is to be proved here is a essential development in Plato’ ontology and his epistemology, by expanding the grounds of development to the ontological and epistemological principles, it hints to a more profound development. The fact that the bipolar and split knowledge and being of the early period dialogues give way to the tripartite and bound knowledge and benig of the middle period dialogues indicates the development of the notions of being and knowledge in Plato’s philosophy before the dialogues of the middle period. -/- Keywords Plato; early dialogues; middle dialogues; being; knowledge; development -/- Introduction The differences between two groups of the early and middle period dialogues have always been a matter of dispute. Whereas the developmentalists like Vlastos, Silverman (2002), Teloh (1981), Dancy (2004) and Rickless (2007) think that from the early to the middle dialogues Plato’s philosophy changes, at least in some essential points, the unitarists like Kahn, Cherniss and Shorey believe that there happens no development and the differences must be taken as natural, ignorable and even pedagogic. In his well-known article, Socrates contra Socrates in PLATO, Vlastos lists ten theses of difference between two groups of dialogues. The first group which includes Plato’s early dialogues he divides to 'elenctic' (Apology, Charmides, Crito, Euthyphro, Gorgias, Hippias Minor, Ion, Laches, Protagoras and Republic I) and 'transitional' (Euthydemus, Hippias Major, Lysis, Menexenus and Meno) dialogues. These transitional come after all the elenctic dialogues and before all the dialogues of the second group which compose Plato’s middle period dialogues, including (with Vlastos' chronological order) Cratylus, Phaedo, Symposium, Republic II-X, Phaedrus, Parmenides and Theaetetus (1991, 46-49). Vlastos asserts strictly that his list of differences are 'so diverse in content and method that they contrast as sharply with one another as with any third philosophy you care to mention, beginning with Aristotole’s' (ibid, 46). Vlastos’ list of differences between two Socrateses is considered a view breaking sharply between the early and the middle dialogues. Besides all ten differences between the two Socrateses in Vlastos’ list that can be supportive for our doctrine here, we intend to focus on some ontological as well as epistemological distinctions that have not completely been discussed hitherto. Contrary to the developmentalist theory of Vlastos, unitarian theory of Charles Kahn wishes to eliminate any substantial difference between the early and the middle dialogues. He distinguishes seven 'pre-middle' or 'threshold' dialogues including Laches, Charmides, Euthyphro, Protagoras, Meno, Lysis and Euthydemus from the other Socratic dialogues which he calls 'earliest group' (1996, 41). The threshold dialogues, Kahn thinks, 'embarke upon a sustained project' that is to reach to its climax in the middle period dialogues, namely Phaedo, Symposium and Republic. Believing in that there is no 'fundamental shift'between the early and middle dialogues (ibid, 40), Kahn thinks the Socratic dialogues are just the 'first stage' with a 'deliberate silence' towards the theories of later periods (ibid, 339). One of the reasons of the surprising fact that Plato gives no hint of the metaphysics and epistemology of the Forms in the early dialogues, he thinks, is the pedagogical advantages of aporia. He thinks that Plato 'obscurely', and mostly because of education, hinted to some doctrines and conceptions in his early dialogues and with the aim of clarifying them only in the later ones (ibid, 66). The seven threshold dialogues, Kahn asserts, 'had been designed from the first' to prepare the pupils and readers for the views expounded in the middle period dialogues (ibid, 59-60). To show that the differences of the two Socrateses of the early and middle period dialogue are in their onto-epistemological grounds and thence cannot be explained by a unitaristic view, we try to draw the ontological and epistemological principles of the early dialogues in the first part below in order to show, in the second part, that those principles have been developed in the middle period dialogues. -/- A. The Onto-Epistemologic Principles of the Early Dialogues Socratic dialogues are paradoxical about knowledge because while being knowledge-oriented always searching for knowledge, they deny it and even never discuss it directly. Three elements of Socrates’ way of searching Knowledge throughout the early dialogues, i.e. Socratic 'what is X?' question, his disavowal of knowledge and his elenctic method combined together produce something like a circle which works, more or less, in the same way in these dialogues. Though this circle is an embaressing inquiry always resulting in ignorance instead of knowledge, its motivation is surprisingly Socrates’ passionate enthusiasm for knowledge, an intensive love of wisdom. The starting point of this circle is Socrates’ confession of having no knowledge which might be explicitly asserted or presupposed, maybe because it was one of the famous characteristics of Socrates; a confession always paradoxically accompanied with his intense longing for knowledge (e.g., Gorgias 505e4-5). Every time Socrates encounters with someone who thinks he knows something (οἴεταί τι εἰδέναι) (Apology 21d5) and tries to examine him. This examination seems to be the simplest one asking just what it is that he knows. Socrates’ elenchus, therefore, is always connected with 'what is X?' (τίς ποτέ ἐστιν) question, a question that most of the early dialogues of Plato are concerned with; 'what is courage?' in the Laches, 'what is piety?' in Euthydemus, 'what is temperance?' in Charmides and 'what is beauty?' in Hippias Major. This question we call here 'Socratic question' and probably is the very question the historical Socrates used to employ, is tightly interrelated with both his disavowal and his elenchus. He disclaims knowledge because he cannot find the answer to the question himself and he rejects others’ since they cannot offer the correct answer too. Every interlocutor can claim he knows X, if and only if he can answer the Socratic question. Otherwise, he is more of an ignorant than of a knower of τί ποτέ ἐστι X. Knowing the answer to this question is, thus, knowledge’s criterion for Socrates. Having found out that he cannot answer what it is which he would claim to know, the interlocutor comes to the point Socrates was there at the beginning. The least advantage of this circle is that he becomes as wise as Socrates does about the subject, becoming aware that he does not know it. At the end of the circle they are both still at the beginning, not knowing what X is. So let us first take a glance at these three elements. Socratic disavowal of knowledge is strictly asserted in some passages. At Apology 21b4-5, Socrates says: -/- I do not know of myself being wise at all (οὔτε μέγα οὔτε σμικρὸν σύνοιδα ἐμαυτῷ σοφὸς ὤν) -/- Moreover, at 21d4-6: -/- None of us knows anything worthwhile (καλὸν κἀγαθὸν εἰδέναι) …. I do not know (οἶδα) neither do I think I know. -/- In Charmides Socrates speaks about a fear about his probable mistake of thinking that he knows (εἰδέναι) something when he does not (166d1-2). The somehow generalization of this disavowal can be seen in Gorgias. After calling his disavowal 'an account that is always the same' (509a4-5), Socrates continues (a5-7): -/- I say that I do not know (οἶδα) how these things are, but no one I have ever met, like now, who can say anything else without being absurd. -/- At the end of Hippias Major (304d7-8), Socrates affirms his disavowal of knowledge of 'what is X?' this time about the fine: -/- I do not know (οἶδα) what that is itself (αὐτὸ τοῦτο ὅτι ποτέ ἐστιν). Some other passages, however, made a number of scholars dubious about Socrates’ disavowal. Vlastos mentions Apology 29b6-7 as an evidence : 'that to do wrong and to disobey one’s master, both god and men, I know (οἶδα) to be evil and shameful'. He thinks that if we give this single text 'its full weight' it can suffice to show that Socrates does claim knowledge of a moral truth (1985, 7). Vlastos’ claim is not admittable since it would be too strange, I think, for a man like Socrates to violate his disavowal claim just after emphasizing it. We can see his claim just before the already mentioned passage: -/- And surely it is the most blameworthy ignorance to believe that one knows what one does not know. It is perhaps on this point and in this respect, gentlemen, that I differ from the majority of men and if I were to claim that I am wiser than anyone in anything it world be in this, that, as I have no adequate knowledge (οὐκ εἰδὼς ἱκανῶς) of things in the underworld, so I do not think I have (οὐκ εἰδέναι) (Apology 29b1-6) Vlastos tries to solve what he calls the 'paradox' of Socrates’ disavowal of knowledge distinguishing the 'certain' knowledge from 'elenctic' knowledge (1985, 11) and thinking that when Socrates avows knowledge, we must perceive it as an elenctic knowledge, a knowledge its content 'must be propositions he thinks elenctically justifiable' (ibid, 18). Irwin’s solution is the distinction of knowledge and belief. He approves that Socrates does not 'explicitly' make such a distinction, but still thinks that Socrates’ 'test for knowledge would make it reasonable for him to recognize true belief without knowledge, and his own claims are easily understood if they are claims to true belief alone' (1977, 40). While I agree with Vlastos up to a point, I strongly disagree with Irwin about the early dialogues. As I will try to show below, we are not permitted to consider any kind of distinction within knowledge in Socratic dialogues because only one category of knowledge is alluded to there and the distinction of knowledge and belief thoroughly belongs to the second Sorcates. Although no kind of distinction can be admittable here, I think Vlastos’ distinction can be accepted only if we regard it as a distinction between knowledge, which is unique and without any, even incomparable, rival, and a semi-idiomatic and ordinary one that is a necessary requirement for any argument, and thus, unavoidable even for someone who does not claim any kind of knowledge. An apparent evidence of this is Gorgias 505e6-506a4: -/- I go through the discussion as I think it is (ὡς ἄν μοι δοκῇ ἔχειν), if any of you do not agree with admissions I am making to myself, you must object and refute me. For I do not say what I say as I know (οὐδὲ γάρ τοι ἔγωγε εἰδὼς λέγω ἃ λέγω) but as searching jointly with you (ζητῶ κοινῇ μεθ᾽ ὑμῶν). -/- The minimal degree of knowledge everyone must have to take part in an argument, conduct it and use the phrase "I know" when it is necessary is what Socrates cannot deny. We can call it elenctic knowledge only if we agree that it is not the kind of knowledge that Socrates has always been searching, the one that can be accepted as the answer of Socratic 'what is X?' question. His disavowal of knowledge is applied only to the knowledge which can truly be the answer of Socratic question and pass the elenctic exam; a knowledge that, I believe, is never claimed by first Socrates. Socrates conducts his method of examining his interlocutors’ knowledge, our second element here, by almost the same method repeated in Socratic dialogues. That whether we are allowed to regard all the examinations of Socrates in the early dialogues as based on the same or not has been a matter of dispute. Vlastos himself (1994, 31) distinguished Euthydemas, Lysis, Menexenns and Hippias Major from the other Socratic dialogues because he thinks Socrates has lost his faith to elenchus in there. Irwin (1977, 38) distinguishes Apology and Crito where Socrates’ own convictions is present. Contrary to some scholars like Benson (2002, 107) who take elenchus in all the Socratic dialogues as a unique method, Michelle Carpenter and Ronald M. Polansky (2002, 89-100) argue pro the variety of methods of elenchus. Thomas C. Brickhouse and Nicholas D. Smith (2002, 145-160) even reject such a thing as Socratic elenchus which can gather all of the Socrates’ various arguments under such a heading. There can be no solution for the problem of elenchus, they think, is due to 'the simple reason that there is no such thing as 'the Socratic elenchos"'(p.147). Though we consider elenchus a somehow determined process and a part of Socratic circle in the early dialogues, all we assume is that whatever differences it might have in different dialogues, it has the same onto-epistemological principles and, thus, we are not going to take it necessarily as a unique method. This method sets out to prove that the interlocutors are as ignorant as Socrates himself is. That whether elenchus is constructive, capable of establishing doctrines as Vlastos (1994) or Brickhouse and Smith (1994, 20-21) believe or not is another issue to which this paper is not to claim anything. What is crucial for our discussion here is that elenchus does not reach to the very knowledge Socrates is looking for. This is strictly against Irwin who thinks that not only elenchus leads to positive results, 'it should even yield knowledge to match Socrates’ conditions'(1977, 68, cf. 48). He does not explain where and how they really yield to that kind of knowledge. He explains his elenctic method in his apology in the court (Apology 21-22), that how he used to examine wise men, politicians, poets and all those who had the highest reputation for their knowledge and every time found that they have no knowledge. If we accept, as I strongly do, that Socrates’ disavowal of his knowledge is not irony, it might seem more reasonable to agree that the process that has that disavowal as its first step cannot be irony as well. The key of the circle which can explain why Socrates disclaims knowledge and how he can reject others’ claim of having any kind of knowledge lies in the third element, Socratic question. In Hippias Major (287c1-2), Socrates asks: 'Is it not by Justice that just people are Just? (ἆρ᾽ οὐ δικαιοσύνῃ δίκαιοί εἰσιν οἱ δίκαιοι). He insists at 294b1 that they were searching for that by which (ᾧ) all beautiful things are beautiful (cf. b4-5, 8). At Euthyphro 6d10-11 it is said that the Socratic question is waiting for 'the form itself (αὐτὸ τὸ εἶδος) by which (ᾧ) all the pious actions are pious; and at 6d11-e1: -/- Through one form (που μιᾷ ἰδέᾳ) impious actions are impious and pious actions pious. -/- Since the X itself is that by which X is X, knowing 'X itself' is the only way of knowing X. It is probably because of this that Socrates makes the distinction between the ousia as a right answer to the question and effect as a wrong one: -/- I am afraid, Euthyphro, that when you were asked what piety is (τὸ ὅσιον ὅτι ποτ᾽ ἐστίν) you did not wish to make clear its nature itself (οὐσίαν … αὐτοῦ) to me, but you said some effect (πάθος) about it. (Euthp. 11a6-9) -/- 1. Knowledge of what X is Now it is time to look for the onto-epistemological principles of Socratic circle and its three elements. It cannot reasonably be expected from the first Socrates to present us explicitly and clearly formulated principles of his onto-epistemology when such explications cannot be found even in the second Socrates who has some obviously positive theoris. Since there must be some principles underlying this first systematic inqury of knowledge, we must seek to them and be satisfied with elicitation of the first Socratas’ principle. What will be drawn out as his principles cannot and must not, thus, be taken as very fix and dogmatic principles. Some very slightest principles and grounds suffice for our purposes here. The first principle that is the prima facie significance of the Socratic question and his implementation of all those elenctic arguments I call the principle of 'Knowledge of What X is' (KWX): -/- KWX To know X, it is required to know what X is. -/- Aristotle (Metaphysics 1078b23-25, 27-29, 987b4-8) takes Plato’s τί ἐστι question as seeking the definition of a thing that is the same as historical Socrates’ search but applying to a different field. That Plato’s 'what is X?' question was a search for definition became the prevailed understanding of this question up to now. I am going neither to discuss the answer of Socratic question nor to challenge taking it as definition. What I am to insist is that knowledge is attached firmly to the answer of the question: Knowledge of X is not anything but the knowledge of what X is. It entails, certainly, the priority of this knowledge to any other kind of knowledge about X but it also has something more fundamental about the relation of knowledge and Socratic question. Socrates’ exclusive focus on the answer of his question can authorize the consideration of such an essential role for KWX in his epistemolgoy. The total rejection of his interlocutors’ knowledge when they are unable to answer the question can be regarded as a strong evidence for it. Socrates’ elenctic method and his rejection of others’ knowledge in the early dialogues, which all end aporetically with no one accepted as knower and nothing as knowledge, prevent us from finding any positive evidence for this. We have to be content, therefore, of negative evidences which, I think, can be found wherever Socrates rejects his interlocutors’ knowledge when they are not able to give an acceptable answer to his 'what is X?' question. 2. Bipolar Epistemology Socrates’ rejection of his interlocutors’ knowledge has another epistemological principle as its basis. Let me call this principle Bipolar Epistemology' (BE): BE There is no third way besides knowledge and Ignorance. -/- BE says that about every object of knowledge there are only two subjective statuses: knowledge and Ignorance. Socrates’ disavowal, however, says nothing but that he is ignorant of knowledge of X because he does not know what X is. This means that BE is presupposed here. Socrates’ elenchus and his rejection of interlocutors’ having any kind of knowledge are the necessary results of the fact that he does not let any third way besides knowledge and ignorance. The first Socrates never let anyone partly know X or have a true opinion about it, as he would not let anyone know anything about X when he did not know what X is. -/- 3. Bipolar Ontology The principle of BE in first Socrates’ epistemology is parallel to another principle in his ontology. Plato’s bipolar distinction between being and not being is as strict and perfect as his distinction between knowledge and ignorance. This principle I shall call the principle of 'Bipolar Ontology' (BO): BO Being is and not being is not. BO is apparently the same with the well-known Parmenidean Principle of being and not being (cf. Diels-Kranz (DK) Fr. 2.2-5). Euthydemus’ statement against the possibility of false knowledge can be good evidence for this principle: -/- The things which are not surely do not exist (τὰ δὲ μὴ ὄντα … ἄλλο τι ἢ οὐκ ἔστιν). (Euthydemus 284b3-4) -/- He continues (b4-5): -/- There is nowhere for not being to be there (οὖν οὐδαμοῦ τά γε μὴ ὄντα ὄντα ἐστίν). -/- That BE does not let true opinion as a third option besides knowledge and ignorance seems to be related to BO’s rejecting a third option besides being and not being, which is itself the basis of the impossibility of false belief. Socrates’ elaborate discussion of the problem of false belief in Theatetus that leads to a more decisive discussion and finally to some solutions in Sophist can make our consideration of BO for the first group of dialogues authentive. -/- 4. &5. Split Knowledge and Split Being The fourth principle I shall call the principle of 'Split Knowledge' (SK): -/- SK Knowledge of X is separated from any other knowledge (of anything else) as if the whole knowledge is split to various parts. -/- This Principle is hinted and criticized as Socrates’ way of treating with knowledge in Hippias Major: -/- But Socrates, you do not contemplate the entireties of things, nor do people you have used to talk with (τὰ μὲν ὅλα τῶν πραγμάτων οὐ σκοπεῖς, οὐδ᾽ ἐκεῖνοι οἷς σὺ εἴωθας διαλέγεσθαι). (301b2-4) -/- Contrary to Rankin who regards the passage as 'antilogical, almost eristic in tone rather than presenting a serious philosophy of being' (1983, 54), I think it can be taken as serious. Hippias criticizes Sorcates that he does not contemplate (σκοπεῖς) the entireties of things (ὅλα τῶν πραγμάτων), a critique which Socrates is not its only subject but all those whom Socrates accustomed to talk with (ἐκεῖνοι οἷς σὺ εἴωθας διαλέγεσθαι). This last phrase, I think, extends this critic beyond this dialogue to other Socratic dialogues. Hippias’ use of the perfect tense of the verb ἔθω (to be accustomed) is a good evidence of this extension. We can get, thus, these ἐκεῖνοι as Socrates’ interlocutors in his other dialogues that hints that this criticism has the epistemological groundings of the previous dialogues as its subject. What ἐκεῖνοι οἷς σὺ εἴωθας διαλέγεσθαι points to is that Hippias does not have in mind Socrates’ way of treating things only in this dialogue, but he is also criticizing Socrates’ way throughout his dialogues. At 301b4-5, Socrates and his interlocutors’ way of beholding things is described as such: -/- You people knock (κρούετε) at the fine and each of the beings (ἕκαστον τῶν ὄντων) by taking each being cut up in pieces (κατατέμνοντες) in words (ἐν τοῖς λόγοις). This leads us to our next principle that is parallel to, and the ontological side of, SK, the principle of 'Split Being'(SB): -/- SB Everything (being) is separated from any other thing as if the whole being is split to many beings. -/- Socrates and his interlocutors and thus, as we saw, the Socratic dialogues are accused to regard everything as it is separated from all other things. This separation is en tois logois that, I think, can reasonably be taken as saying that Socratic dialogues (it refers of course to the dialogues before Hippias Major) cut up all things which have the same name/definition from all other things and try to understand them separately, without considering other things that are not in their logos. They, for example in Hippias Major, are cutting up to kalon and try to understand what it and all others inside this logos are by separating it from all other things. This is directed straightly against Socratic question and the way Socratic dialogues follow to find its answer, every time separating one logos. As Meyer (1995, 85) points out, every question 'presupposes that the X in question in a logos is something' and 'every answer to every question aims at unity' (84). The critique of Hippias Major is, therefore, at the same time a critique of SK and SB. It is also a critique of KWX because it is only based on KWX that Socratic dialogues could search for the answer of 'what is X' question supposing that knowing what X is is enough for the knowledge of X. SK and KWX are absolutely interdependent. What Socrates and all his previous interlocutors have neglected in Socratic dialogues, Hippias says, was 'continuous bodies of being' (διανεκῆ σώματα τῆς οὐσίας) (301b6). Either this theory actually belongs to the historical Hippias as it is being said or not, it is strictly criticizing SB. We have the same phrase with changing sūma to logos some lines later at 301e3-4: διανεκεῖ λόγῳ τῆς οὐσίας. Although this theory that can be observed as both an ontological and an epistemological theory is rejected by Socrates (301cff.), it is still against first Socrates’ onto-epistemological principles and might let us look at what is rejected as Socratic prineple. -/- 6. Knowledge is of Being The sixth principle that I think is presupposed by the first Socrates, is the 'Knowledge of Being' Principle (KB): -/- KB Knowledge is of Being. -/- This principle is obviously the source of the problem of false knowledge, a very important problem throughout Plato’s philosophy. We face this problem maybe for the first time in Euthydemus. In less than 20 Stephanus’ pages, 276-295, we are encountered with different interwoven problems about knowledge , all grounded in the problem of false opinion. Having challenged the obvious possibility of telling lies at 283e, at 284 Euthydemus discusses it saying that the man who speaks is speaking about 'one of those things that are (ἓν μὴν κἀκεῖνό γ᾽ ἐστὶν τῶν ὄντων)' (284a3) and thus speaks what is (λέγων τὸ ὄν) (a5). He must necessarily be saying truth when he is speaking what is because he who speaks what is (τὸ ὄν) and the things that are (τὰ ὄντα) speaks truth (τἀληθῆ λέγει) (a5-6). This is based on Parmenidean principle of the impossibility of being of not being which Euthydemus restates (284b3-4) and we mentioned discussing BO principle above. The things that are not are nowhere (οὐδαμοῦ) and there is no possibility for anyone to do (πράξειεν) anything with them because they must be made as being before anything else can be done, which is impossible (b5-7). The words, then, are of things that exist (εἰσὶν ἑκάστῳ τῶν ὄντων λόγοι) (285e9) and as they are (ὡς ἔστιν) (e10). The result is that no one can speak of things as they are not. It is this impossibility of false speach that is extended to thinking (δοξάζειν) at 286d1 and leads to the impossibility of false opinion (ψευδής … δόξα) (286d4). The general conclusion is asserted at 287a extending this impossibility to actions and making any kind of mistake. Not only knowledge is of being but speech, thought and action are of being simply because of the fact that nothing can be of not being. -/- B. First Socrates’ Principles in the Middle Period Dialogues Out of what were presupposed or criticized mostly in five dialogues, Euthyphro, Euthydemus, Hippias Major, Laches and Charmides, we tried to draw the first Socrates’ principles. Our inquiry here is directed to find out the fate of these principles in the three dialogues of the middle period, Meno, Phaedo and Republic. To do this, first we ought to check the situation of Socratic circle in these dialogues. The Socratic circle that was predominant in the early dialogues, does not look like a circle here anymore though they certainly have some features in common. Meno, Phaedo and Republic II-X are not committed to the principles of the circle and the whole circle in disrupted in them. The difference of the two Socrateses towards acquiring knowledge is obvious. The Socrates of Meno, Phaedo and Republic is evidently more self-confident that he can get to some truths during his arguments as he does. They are in their first appearance, as almost all other dialogues, committed to Socrates’ disavowal. All of them try to keep the shape of the Socratikoi Logoi genre, which is committed to the historical Socrates’ way of discussion; a dramatic personage who is to challenge his interlocutors, ask them and refuse the answers. Nevertheless, the fact is that what we have in common between two groups of dialogues is mostly a dramatic structure. Whereas the first group’s arguments are based on Socrates’ disavowal and lead to no positive results, the second group is decisively going to achieve some positive results. The aim of the first Socrates was to show others that they are ignorant of what they thought they knew. The new Socrates of Meno, on the opposite, makes so much efforts to show that the slave boy has within himself true opinions (ἀληθεῖς δόξαι) about the things that he does not know (οἶδε) (85c6-7). Despite his lack of knowledge, he has true opinions nevertheless. The way from these true opinions to knowledge, as Socrates states, is not so long. These true opinions are now like a dream but 'can become knowledge of the same things not less accurate than anyone’s' (οὐδενὸς ἧττον ἀκριβῶς ἐπιστήσεται περὶ τούτων) (c11-d1), if they be repeated by asking the same questions. The most outstanding text regarding Socrates’ disavowal is Meno 98b where he explicitly claims knowledge: -/- And indeed I also speak as (ὡς) one who does not know (εἰδὼς) but is guessing (εἰκάζων). However, [about the fact] that true opinion and knowledge are different, I do not altogether expect (δοκῶ) myself to be guessing (εἰκάζειν), but if I say about anything that I know (εἰδέναι) -which about few things I say- this is one of the things that I know (οἶδα). (98b1-5) This passage is very significant about Plato’s disavowal of knowledge. There can hardly be found, I think, anywhere else in Plato’s corpus where Socrates speaks about his knowledge of something as such. He says first that he speaks as someone who does not know. This ὡς οὐκ εἰδὼς λέγω comparing with what he used to say in the first group, οὐκ οἶδα, has this added ὡς. Socrates does not claim strongly anymore that he does not know anything but speaks only as someone who does not know. He needs this ὡς not only because he is going to accept that he does know some, though few, things immediately after this sentence, but also because he needs his previous disavowal to be loosened from Meno on. He does not merely say here that he knows something. It is then different from the examples mentioned before which could be taken as idiomatic or at least not emphatic. Socrates’ remarkable emphasis on distinguishing εἰδέναι from εἰκάζειν departs it from all other passages where he says only he knows something. Moreover, he claims definitely that he has knowledge about few (ὀλίγα) things. From the early to the middle dialogues, Socrates’ attitude to knowledge has totally renewed its face. He brings forth a new concept, true opinion, and he does not speak of knowledge as he used to before; the rough, perfect and unachievable knowledge of the first group has turned to something more smooth, realistic and achievable. Comparing with the early dialogues that did not set out from the first to reach positive results, the middle ones are extraordinarily and surprisingly positive and hence destroy the basis of the Socratic circle. The questions and answers are purposely directed to some specific new theories; most of them are not directly related to the topics or the main questions of the dialogues. They are suggested when Socrates draws the attention of the interlocutor away from the main question because of the necessity of another discussion. Even if the main question remains unanswered, we have still many positive theories, prominently of metaphysical type. These theories are so abundant and dominant in these dialogues, especially Phaedo and Republic, that one might think that they may appear to be arbitrarily sandwiched in there. This helps dialogues to keep their original Socratic structure while they are suggesting new theories. Hence, the Socratic question of 'what is X?', though is still used to launch the discussion, is loosened and is forgotten for most part of the dialogues. Meno that has first a differently formulated question, 'can virtue be taught?', leads finally to the Socratic question of 'What is virtue?'. Phaedo is dedicated to the demonstration of the immortality of soul and the life after death without having a central Socratic question. The case of Republic is more complicated. The first book, on the one hand, has all the criteria of a Socratic circle: its 'what is justice?' question, Socrates’ strong disavowal (e.g. 337d-e), his rejection of all answers and coming back to the first point without finding out any answer. This Book, considered alone, is a perfect Socratic dialogue, as many scholars regard it as early and separated from other books. The books II-X are, on the other hand, far from implementing a Socratic circle. They have still the 'what is justice?' question as their incentive leading question, but they are, in most of the positive doctrines and methods that encompass the main parts, ignoring the question. Even these books that, I believe, are the farthest discussions from the Socratic circle are so cautious not to break the Socratic structure of the dialogue as long as it is possible. What is changed is not the structure of the dialogue but the ontological and epistemological grounds based on which new theories are suggested. -/- 1. Knowledge of the Good We can clearly see in the second group of dialogues that the KWX principle loses the place it had before in our first group. It is not, of course, rejected, but still we cannot say that it has the same situation. KWX that was based on Socratic question, as we discussed before, was the leading principle of the first Socrates’ epistemology and of the highest position. Other epistemological principles, SK directly and BE indirectly, were relying on Socratic question and therefore on KWX. Such a position does not belong to KWX from Meno on. What makes it different in the second Socrates is another principle that is needed it not only as its complementary principle but also as what is more fundamental. Plato, then, does not reject KWX in this period, but, it seems, he transcends to another more basic principle; a principle we shall call the principle of 'Knowledge of the Good' (KG): -/- KG Knowledge of X requires knowledge of the Good. -/- Whereas all the dialogues of our first group are free from any discuscon about KG, it bears a very important role in the second group so as becomes the superior principle of knowledge in Republic. Trying to solve the problem of teachability of virtue, Socrates says that it can be teachable only if it is a kind of knowledge because nothing can be taught to human beings but knowledge (ἐπιστήμην) (Meno 87c2). The dilemma will be, then, whether virtue is knowledge or not (c11-12) and since virtue is good, we can change the question to: whether is there anything good separate from knowledge (εἰ μέν τί ἐστιν ἀγαθὸν καὶ ἄλλο χωριζόμενον ἐπιστήμης) (d4-5). Therefore, the conclusion will be that if there is nothing good which knowledge does not encompass, virtue can be nothing but knowledge (d6-8). What let us discuss KG as an epistemological principle for the second Secrates is the relation he tries to establish between knowledge and the Good which, though is alongside with the mentioned thesis and the idea of virtue as knowledge, goes much deeper inside epistemology asking to regard the Good as the basis of knowledge. The effort of Phaedo cannot succeed in establishing the Good as the criterion of explanation and knowledge since, I think, it needs a far more complicated ontology of Republic where Socrates can finally announce KG. What is said in Republic is totally compatible with Phaedo 99d–e and the metaphor of watching an eclipse of the sun. In spite of the fact that we do not have adequate knowledge of the Idea of the Good, it is necessary for every kind of knowledge: 'If we do not know it, even if we know all other things, it is of no benefit to us without it' (505a6-7). The problem of our not having sufficient knowledge of the Idea of Good is tried to be solved by the same method of Phaedo 99d-e, that is to say, by looking at what is like instead of looking at thing itself (506d8-e4). It is this solution that leads to the comparison of the Good with sun in the allegory of Sun (508b12-13). What the Good is in the intelligible realm corresponds to what the sun is in the visible realm; as sun is not sight, but is its cause and is seen by it (b9-10), the Good is so regarding knowledge. It has, then, the same role for knowledge that the sun has for sight. Socrates draws our attention to the function of sun in our seeing. The eyes can see everything only in the light of the day being unable to see the same things in the gloom of night (508c4-6). Without the sun, our eyes are dimmed and blind as if they do not have clear vision any longer (c6-7). That the Good must have the same role about knowledge based on the analogy means that it must be considered as a required condition of any kind of knowledge: -/- The soul, then, thinks (νόει) in the same way: whenever it focuses on what is shined upon by truth and being, understands (ἐνόησέν), knows (ἔγνω) and apparently possesses understanding (νοῦν ἔχειν). (508d4-6) -/- Socrates does not use agathon in this paragraph and substitutes it with both aletheia and to on. He links them with the Idea of the Good when he is to assert the conclusion of the analogy: -/- That which gives truth to the objects of knowledge and the power of knowing to the knower, you must say, is the Idea of the Good: being the cause of knowledge and truth (αἰτίαν δ᾽ ἐπιστήμης οὖσαν καὶ ἀληθείας) so far as it is known (ὡς γιγνωσκομένης μὲν διανοοῦ). (508e1-4) Knowledge and truth are called goodlike (ἀγαθοειδῆ) since they are not the same as the Good but more honoured (508e6-509a5). KG, which had been implicitly contemplated and searched in Phaedo, is now explicitly being asserted in Republic. As what was quoted clearly proves, this principle is the very one which we can observe as the most fundamental principle of the second Socrates in Republic, corresponding to the role KWX had in the first Socrates. The Form of the Good in Republic, of which Santas speaks as 'the centerpiece of the canonical Platonism of the middle dialogues, the centerpiece of Plato’s metaphysics, epistemology, ethics and …' (1983, 256) much more can be said. Plato’s Cave allegory in Book VIII dedicates a similar role to the Idea of the Good. The Idea of the Good is there as the last thing to be seen in the knowable realm, something so important that its seeing equals to understanding the fact that it is the cause of all that is correct and beautiful (517b). Producing both light and its source in visible realm, it controls and provides truth and understanding in the intelligible realm (517c). -/- 2. Tripartite Epistemology BE is thoroughy rejected in the second Socrates and substituted by its opposite, the principle of 'Tripartite Epistemolgy' (TE): -/- TE Opinion is an epistemological status between knowledge and ignorance. BE of the first Socrates was denying any third way besides knowledge and ignorance which was the foundation of Socratic circle without which Socrates could not reject his interlocutors’ possessing any kind of knowledge. We cannot say, however, that the first Socrates had a third epistemological status in mind but rejected it. Such a status was unacceptable for him so that one can say that he would reject any kind of such status if suggested. There were only two possibilities about knowledge: either one knows something or he does not know it. TE, thus, was not the first Socrates’ discovery and, I think it is not the second Socrates’discovery. All we can see in our second group of dialouges is that he uses this principle as an already demonstrated one. Having examined the slave boy in Meno for the prupose of showing the working of recollection, it truns out that he has some opinions in him while he still does not know. Without trying to prove it, Socrates takes this as the distinction between knowledge and opinion: -/- So, he who does not know (οὐκ εἰδότι) about what he does not know (περὶ ὧν ἂν μὴ εἰδῇ) has within himself true opinions (ἀληθεῖς δόξαι) about the same things he did not know (περὶ τούτων ὧν οὐκ οἶδε) (85c6-7). -/- The same distinction is set between ὀρθὴν δόξαν and ἐπιστήμην at 97b5-6 ff. (also cf. 97b1-2: ὀρθῶς μὲν δοξάζων … ἐπιστάμενος). He connects then their difference to the myth of Daedalus, the statue that would run away and escape. So are true opinions, not willing to remain long in mind and thus not worthy until one ties them down by αἰτίας λογισμῷ (98a3-4). Socrates says that this tying down is anamnesis. We face, in Phaedo, the same relation is settled between knowledge as the process of being tied down and getting the capability to give an account, on the one hand, and anamnesis, on the other hand. When a man knows, he must be able to give an account of what he knows (Phaedo 76b5-6) and since not all people are able to give such an account, those who recollect, recollect what once they learned (76c4). Although the distinction between knowledge and opinion is not explicitly used in Phaedo, referring to the parallel link between knowledge plus account and anamnesis in Phaedo and Meno, one can say that those who cannot recollect are not able to give account and, thus, are in a state of opinion. What is said at Phaedo 84a, though not yet a definite distinction between knowledge and opinion, makes a distinction between their objects so as we can agree that it is presupposed. The soul of the philosopher, Socrates says, follows reason, stays with it forever and contemplates the divine, which is not the object of opinoin (ἀδόξαστον) (84a8, cf. Meno 98b2-5). The distinction of knowledge and belief in Republic has a significant difference with what we discussed in Meno and Phaedo since the distinction of Meno was based on anamnesis and thus more an epistemological distinction. Even in Phaedo that we do not have any elaborate discussion about the distinction, the only hint to the matter at 76 is bound to the theory of anamnesis. In addition to the relation of the distinction with this theory, there is another evidence that does not permit us to consider the distinction as an ontological distinction. Let’s see Meno 85c6-7: -/- So, he who does not know about what he does not know has within himself true opinions about the same things he did not know (τῷ οὐκ εἰδότι ἄρα περὶ ὧν ἂν μὴ εἰδῇ ἔνεισιν ἀληθεῖς δόξαι περὶ τούτων ὧν οὐκ οἶδε). (85c6-7) -/- This last sentence persists that the objects of knowledge and true opinion are the same. What Socrates is to say here is that whereas he does not know X he has true opinion about the same X. I think Socrates’ sentence that the slave boy οὐκ εἰδότι ἄρα περὶ ὧν ἂν μὴ εἰδῇ and his restatement of it by saying περὶ τούτων ὧν οὐκ οἶδε is because he wants to emphasize that the slave boy who does not know, has true opinion about the same thing. Socrates could say this just with using τούτων and there would be no necessity to bring περὶ ὧν ἂν μὴ εἰδῇ for οὐκ εἰδότι if he did not want to emphasize. -/- 3. Tripartite Ontology The distinction between knowledge and true opinion in Republic, on other side, has nothing to do with recollection, but is based on an ontological principle, 'Tripartite Ontology' (TO): -/- TO There are things that both are and are not. -/- This principle I confine, among our three dialogues of the second group, to Republic not extended to Meno and Phaedo, is obviously the opposite of BO. Speaking about the lovers of sights and sounds in the fifth book, Socrates distinguishes them from philosophers because their thought is unable to understand the nature of beautiful itself besides beautiful things (476a6-8) and hence they can only have opinions. The philosopher who, on the contrary, believes in beautiful itself and can distinguish it from beautiful things (476c9-d3), has knowledge because he knows, contrasting others who have opinion because they only opine (d5-6). Since those whose knowledge were degraded as opinion will complain about Socrates’ such calling their thought, he provides them the following argument (476e7-477b1): -/- - Does the person who knows, knows (γιγνώσκει) something (τὶ) or nothing (οὐδέν)? - He knows something (τί). - Something that is (ὂν) or is not (οὐκ ὄν)? - Something that is (ὂν) for how could something that is not be known (πῶς γὰρ ἂν μὴ ὄν γέ τι γνωσθείη)? - Then we have an adequate grasp of this: No matter how many ways we examine it, what completely is (παντελῶς ὂν) is completely knowable (παντελῶς γνωστόν) and what is in no way (μὴ ὂν δὲ μηδαμῇ) is in every way unknowable (πάντῃ ἄγνωστον). - A most adequate one. - Good. Now, if anything is such as to be and also not to be (ὡς εἶναί τε καὶ μὴ εἶναι), won’t it be intermediate (μεταξὺ) between what purely is (εἰλικρινῶς ὄντος) and what in no way is (μηδαμῇ ὄντος)? - Yes, it’s intermediate. - Then as knowledge (γνῶσις) is set over what is (τῷ ὄντι), while ignorance (ἀγνωσία) is of necessity set over what is not (μὴ ὄντι) mustn’t we find an intermediate between ignorance (ἀγνοίας) and knowledge (ἐπιστήμης) to be set over the intermediate, if there is such a thing? -/- From the third status of being we must reach to the third status of knowledge. The simple reading of this text can be an existential reading, taking the "is" of the mentioned sentences as existence. The problem is that when it is said that there is something that both is and is not reading "is" existentially, it sounds too bizarre to be acceptable. It cannot easily be understandable to have something as both existent and non-existent at the same time. This problem arose so many debates and led many scholars to reject the existential reading of "is" and suggest some other readings like predicative or veridical readings. I think though Plato’s complicated ontology of Republic cannot be correctly understood by a simple existential reading, this "is" cannot be free from existential sense of being and, thus, cannot be reduced to just a predicative or veridical sense of being. -/- 4. Bound Knowledges In addition to KG, the Good is also the basis of another principle in the second Socrates, namely the principle of 'Bound Knowledge' (BK): -/- BK Knowledge of everything is bound to the knowledge of the Good. -/- We distinguished BK from KG because we want to insist, in BK, on what had not been insisted upon in KG, that is, the binding role that the Good plays in the second Socrates, contrasting the absence of such a role in the first Socrates. Socrates remembers, in Phaedo, his wonderful keen on natural philosophers' wisdom when he was young. The origin of this enthusiasm was Socrates’ hope to know the cause of everything as they used to claim. When he was searching the matters of his interest on their basis, Socrates says, he became convinced he can get no acceptable answer from them and found himself blind even to the things he thought he knew before. One day he hears Anaxagoras’ theory that 'it is Mind that arranges and is the cause of everything (ὡς ἄρα νοῦς ἐστιν ὁ διακοσμῶν τε καὶ πάντων αἴτιος)' (Phd. 97c1-2 cf. DK, Fr.15.8-9, 11-12, 12-14) and thinks that he can finally find what he has always expected, i.e. something which can explain all things. What I intend to show here is that what makes Socrates hopeful is that Anaxagoras’ theory tries 1) to explain all things by one thing and 2) this explanation is understood by Socrates as if it is based on the concept of the Good. That Socrates was searching for one explanation for all things can be proved even from what he has been expecting from natural philosophers. The case is, nonetheless, more clearly asserted when he speaks about Anaxagoras’ theory. In addition to διακοσμῶν τε καὶ πάντων αἴτιος of 97c2 mentioned above, we have τὸ τὸν νοῦν εἶναι πάντων αἴτιον (c3-4) and τόν γε νοῦν κοσμοῦντα πάντα κοσμεῖν (c4-5) all emphasizing on the cause of all things (πάντα) which can clearly prove that one of the reasons which caused Socrates to embrace it delightfully was its claim to provide the cause of all things by one thing. Another reason was that Anaxagoras’ Mind, at least in Socrates’ view, was attempting to explain everything by the concept of the Good. This connection between Mind and Good belongs more to the essential relation they have in Socrates’ thinking than Anaxagoras’ theory because there are almost nothing about such a relation in Anaxagoras. The reason for Socrates’ reading can be that Mind is substantially compatible with Socrates’ idea of the relation between good and knowledge. Both the thesis 'no one does wrong willingly' and the theory of virtue as knowledge we pointed to above are evidences of this essential relation. Nobody who knows that something is bad can choose or do it as bad. The reason, when it is reason, that means when it is as it should be, when it is wise or when it knows, works only based on good-choosing. In this context, when Socrates hears that Mind is considered as the cause of everything, it sounds to him like this: good should be regarded as the basis of the explanation of all things. We see him, thus, passing from the former to the latter without any proof. This is done in the second sentence after introducing Mind: -/- I thought that if this were so, the arranging Mind would arrange all things and put each thing in the way that was Best (ὅπῃ ἂν βέλτιστα ἔχῃ). If one then wished to find the cause of each thing by which it either perishes or exists, one needs to find what is the best way (βέλτιστον αὐτῷ ἐστιν) for it to be, or to be acted upon, or to act. On these premises then it befitted a man to investigate only, about this and other things, what is the most excellent (ἄριστον) and best (βέλτιστον). The same man must inevitably also know what is worse (χεῖρον), for that is part of the same knowledge. (97c4-d5) This passage is a good evidence of Socrates’ leap from Anaxagoras’ Mind to his own concept of the Good that can explain why Socrates found Anaxagoras theory after his own heart (97d7). Mind is welcomed because of its capability for explanation on the basis of good to 'explain why it is so of necessity, saying which is better (ἄμεινον), and that it was better (ἄμεινον) to be so' (97e1-3). What Socrates thought he had found in Anaxagoras can indicate what he had been expecting from natural scientists before. Socrates could not be satisfied with their explanations because they were unable to explain how it is the best for everything to be as it is. It can probably be said, then, that it was the lack of the unifying Good in their explanation that had disappointed him. We must insist that we are discussing what Socrates thought that Anaxagoras’ theory of Mind should have been, not about Anaxagoras’ actual way of using Mind. Phaedo 97c-98b, is not about what Socrates found in Anaxagoras but what he thought he could find in it. On the contrary, it should also be noted that it was not this that was dashed at 98b, but Anaxagoras’ actual way of using Mind. It was Anaxagoras’ fault not to find out how to use such an excellent thesis (98b8-c2, cf. 98e-99b). Socrates gives an example to show how not believing in 'good' as the basis of explanation makes people be wanderers between different unreal explanations of a thing. His words δέον συνδεῖν (binding that binds together) as a description for the Good we chose as the name of BK principle: They do not believe that the truly good and binding binds and holds them together (ὡς ἀληθῶς τὸ ἀγαθὸν καὶ δέον συνδεῖν καὶ συνέχειν οὐδὲν οἴονται). (99c5-6) -/- Having in mind Plato’s well-known analogy of the sun and the Good at Republic 508-509, we can dare to say that his warning of the danger of seeing the truth directly like one watching an eclipse of the sun in Phaedo (99d-e) is more about the difficulty of so-called good-based explanation than its insufficiency, a difficulty which is precisely confirmed in Republic (504e-505a, 506d-e). Moreover, BK is asserted in a more explicit way in the Republic, where the Good is considered not only as a condition for the knowledge of X, as was noted above discussing KG, but also as what binds all the objects of knowledge and also the soul in its knowing them. At Republic VI, 508e1-3, when Socrates says that the Form of the Good 'gives truth to the things known and the power to know to the knower (τοῦτο τοίνυν τὸ τὴν ἀλήθειαν παρέχον τοῖς γιγνωσκομένοις καὶ τῷ γιγνώσκοντι τὴν δύναμιν ἀποδιδὸν)', he wants to set the Good at the highest point of his epistemological structure by which all the elements of this structure are bound. This binding aspect of the Good is by no means a simple binding of all knowledges or all the objects of knowledge, but the most complicated kind of binding as it is expected from the author of the Republic. The kind of unity the Good gives to the different knowledges of different things is comparable with the unity which each Form gives to its participants in Republic: as all the participants of a Form are united by referring to the ideas, all different kinds of knowledge are united by referring to the Good. If we observe Aristotle's assertion that for Plato and the believers of Forms, the causative relation of the One with the Forms is the same as that of the Forms with particulars (e.g. Metaphysics 988a10-11, 988b4), that is to say the One is the essence (e.g., ibid, 988a10-11: τοῦ τί ἐστὶν, 988b4-6: τὸ τί ἢν εἶναί) of the Forms besides his statement that for them One is the Good (e.g., ibid, 988b11-13) the relation between the Good and unity may become more understandable. Since the quiddity of the Good (τί ποτ᾽ ἐστὶ τἀγαθὸν) is more than discussion (506d8-e2), we cannot await Socrates to tell us how this binding role is played. All we can expect is to hear from him an analogy by which this unifying role is envisaged, the sun. The kind of unity that the Good gives to the knowledge and its objects in the intelligible realm is comparable to the unity that the sun gives to the sight and its objects in the visible realm (508b-c). The allegory of Line (Republic VI, 509d-511), like that of the Sun, tries to bind all various kinds of knowledges. The hierarchical model of the Line which encompasses all kinds of knowledge from imagination to understanding can clearly be considered as Plato’s effort to bind all kinds of knowledges by a certain unhypothetical principle. The method of hypothesis starts, in the first subsection of the intelligible realm, with a hypothesis that is not directed firstly to a principle but a conclusion (510b4-6). It proceeds, in the other subsection, to a 'principle which is not a hypothesis' (b7) and is called the 'unhypothetical principle of all things' (ἀνυποθέτου ἐπὶ τὴν τοῦ παντὸς ἀρχὴν) (511b6-7). This παντὸς must refer not only to the objects of the intelligible realm but to the sensible objects as well. Plato does posit, therefore, an epistemological principle for all things, a principle that all things are, epistemologically, bound and, thus, unified by. -/- 5. Bound Beings The ontological aspect of BK we shall call the principle of 'Bound Beings' (BB): -/- BB Being of all things are bound by the Good. -/- We saw in our principle of Split Being (SB) how the first Socrates was criticized because of his approach to split being and separate each thing from other things. The principle of Bound Beings intends to make the things more related, a duty which is done again by the Good. In the allegory of Sun, there are two paragraphs that evidently and deliberately extend the binding role of the Good to the ontological scene: -/- You will say that the sun not only makes the visible things have the ability of being seen but also coming to be, growth and nourishment. (509b2-4) -/- This clearly intends to remind the ontological role the sun plays in bringing to being all the sensible things in order to display how its counterpart has the same role in the intelligible realm (b6-10): -/- Not only the objects of knowledge (γιγνωσκομένοις) owe their being known (γιγνώσκεσθαι) to the Good, but also their existence (τὸ εἶναί) and their being (οὐσίαν) are due to it, though the Good is not being but superior to it in rank and power. That the Good is here represented as responsible for being of things in addition to their being known means, in my opinion, that Plato wants to posit BB in addition to BK. The allegory of Cave at the very beginning of the seventh Book (514aff.) can be taken as another evidence. The role of the Good, one might say, is confined to the intelligible realm because it is asserted that the role the Good plays in this realm is corresponding to that of the sun in the visible realm. The fact that Plato wants to observe the Good also as the ontological cause of the sensible things is obvious from his saying, in the allegory of Cave, that the Form of the Good 'produces light and its source (τὸν τούτου κύριον) [i.e. the sun] in the visible realm' (517c3). We can conclude, then, that the ontological function of the Good is not confined to the intelligible realm in which it is the lord and provides truth and understanding (c3-4) because it is also responsible to produce τὸν κύριον of light. 6. Proportionality of Being and Knowledge Insofaras BE and BO principles of the first Socrates gave way to TE and TO principles of the second Socrates, we cannot expect him to preserve KB in the same way as it was in the first Socrates. The new tripartite ontology and epistemology necessitates some modifications in KB which results in the principle of 'Proportionality of Being and Knowledge' (PBK): -/- PBK To every class of being there is a proportionate category of knowledge. -/- This principle, of course, does not entail the refutation of KB and thus is not kind of rejecting PBK but only a more complicated version of it. Based on PBK, we can still agree that knowledge is of being (KB) but the issue is that since none of the concepts of knowledge and being in the second Socrates are as simple as they were for the first Socrates, we need a more complicated principle for their relation here. Although from Meno 97a where the distinction of knowledge and true opinion is drawn out in the second group of the dialogues, we can expect a new relation, it is articulated in its most complete way in Republic and specifically in the allegory of Line. All the beings are divided there hierarchically to four classes, to each of them belongs a class of knowledge: imagination to images, belief to the sensible things (more correctly: the things of which they[in previous class] were images (ᾧ τοῦτο ἔοικεν)), thought to mathematical objects (?) and understanding to the Forms and the first principle. The degree of clarity that each of the classes of knowledge shares in (σαφηνείας ἡγησάμενος μετέχειν) is proportionate to the degree that its object shares in truth (ἀληθείας μετέχει). (511e2-4) -/- Conclusion From the six onto-epistemilogical principles of the first Socrates, four principles turn to their opposite in the middle period dialogues. While bipolar epistemology and ontology of the early dialogues give place to tripartite epistemology in the middle period dialogues and tripartite ontology in Republic, the split knowledge and being of the first Socrates are inclined to be substituted by bound knowledges and bound beings in the second Socrates and specifically in Republic. Not all our system of principles in this article is necessarily determinative. Either they are rightly formulated or not, our result would not be vulnerable if we accept that 1) making the distinction of knowledge and belief, 2) accepting the being of not being and 3) trying to bind both being and knowledge by the concept of the Good happens only in middle period dialogues, having been absent in the early ones. These are the favourite results all those somehow arbitrary and even oversimplified principles were to illustrate; that there is kind of a development in the epistemological as well as the ontological grounds of Plato’s philosophy. -/- Notes . (shrink)

In lieu of an abstract, here is a brief excerpt of the content:IntroductionStuart J. Youngner (bio), Laura A. Siminoff (bio), and Renie Schapiro (bio)This issue of the Kennedy Institute of Ethics Journal (KIEJ) centers on a piece of empirical research. The motivation behind the study of Laura Siminoff, Christopher Burant, and Stuart Youngner (2004) was to find out more about what the general public understands and believes about when a person is dead. More specifically, the study tried to determine how (...) members of the public define death, especially their acceptance and interpretation of the medical concept of "brain death," and their attitudes toward the so-called "dead donor rule," an informal but powerful social and legal norm insisting that the taking of organs for transplantation not cause the death of the source of those organs.As the demand for organs increases and the waiting list grows, the United States has explored multiple ways to expand the pool of potential donors. One approach has been to gerrymander (coherently or not) the line between life and death to shift patients who are extremely compromised but traditionally considered to be in the living category into the dead category. In this way, the dead donor rule remains technically intact. This reasoning is explicit in the report of the Harvard Medical School Ad Hoc Committee (1968) that "introduced" "brain death" to the American culture. Since then, other efforts to redraw the line have been proposed and rejected.One alternative to gerrymandering is to consider under what conditions, if any, it is morally acceptable to violate the dead donor rule. Some would argue that this alternative is the more "honest" approach. Rather than sidestepping moral problems by calling people dead, it brings the moral problems to the surface where the necessity of sticking to the rule can be considered on its own merits. However, when the Journal of the American Medical Association printed a position paper that proposed making anencepahlic newborns an exception to the dead donor rule, along with arguments about why this was acceptable, the outcry was so great that the proposal was retracted (AMA 1995).Clearly, our society has identified organ transplantation as a priority, although two papers in this volume (those by Courtney Campbell and by Megan Crowley-Matoka and Robert Arnold) take issue with that prioritization. The fact that the donor pool has remained relatively stable (and inadequate) despite massive efforts [End Page 211] to increase it speaks, at least in part, to the cultural and legal resistance to "new" ways to procure more organs. Voluntarism seems to have peaked. Financial incentives clash with the heavily endorsed notion of the "gift of life" and seem to many to violate the dignity of the human body. Presumed consent or eminent domain, in which the community has a greater claim to a person's organs than that person or his/her family, go against the grain of American individual freedom and the ethos of patient autonomy.Abandoning the dead donor rule generally is regarded as an even tougher sell to the American public and its legislators. The study by Siminoff and colleagues attempts, among other things, to gauge just how tough this sell would be. What the data actually demonstrate is a matter of interpretation, and this issue of the KIEJ is devoted to some of those interpretations. The authors, with the exception of Daniel Hausman, came together for a meeting in Cleveland, Ohio, during which the study's methods and data were presented with time for questions, clarifications, and general discussion. The authors then worked with the editors to generate the papers printed in this volume.The issue begins with a presentation of the study conducted by Siminoff and colleagues. The same paper also appears in the journal Social Science and Medicine, where it includes the conclusions of the authors (Siminoff, Burant, and Youngner 2004). In the current volume, we present only the methodology of and data from the study, allowing a number of distinguished commentators to offer their own conclusions and reflections.The first response comes from Tracy Schmidt, Executive Director of Intermountain Donor Services, one of our nation's organ procurement organizations (OPOs). For years, organ procurement professionals have reported anecdotal stories about families who wished to donate organs of... (shrink)

Purpose. The paper considered the explication of the concept of "Sinn des Lebens" within the framework of Western philosophy and psychology of the ХІХ-ХХІ centuries. On the basis of this, the role of this concept in contemporary theoretical discussions and psychological and psychotherapeutic practices is understood. Theoretical basis. The authors believe that understanding the concept of "Sinn des Lebens" is possible only based on the synthesis of modern analytical philosophy methods with the methodological guidelines of modern psychology, in particular logotherapy. (...) Originality. The authors have proved that the problem of "meaning of life" is not an "eternal problem" of philosophy, but arises only in the early nineteenth century as a reflection on European secularization and widespread individualistic values and becomes extremely relevant gaining different interpretations at the beginning of the twentieth century based on the crisis of the sensory values of modern man. Conclusions. The concept of "Sinn des Lebens" originated in the philosophy of the German Romantics and gained philosophical significance only in the works by Schopenhauer, Kierkegaard and Nietzsche. Russian philosophy and literature give priority to the meaning of life in ethical and anthropological studies, focusing on its religious intentions. Analytical philosophy and existentialism appear to be diametrically opposed to the life-purpose anthropological problems, but they attempt to solve this problem by understanding the absurdity of human existence and language from different angles of view. The most reasonable concept of meaning in psychology can be considered Frankl’s logotherapy, which, despite certain drawbacks, remains the most significant in modern Western psychology. Modern philosophical studies on the problems of the meaning of life, despite their prudent analyticity and systematic nature, have not found credible criteria and means of human life self-reflection yet and have further incentives to develop their methodological and philosophical considerations. However, the diversity of interpretations of the concept of "meaning of life" that exists in modern scientific literature needs further reflection. (shrink)

In the last two decades, prizes in the sciences have proliferated and, in particular, rich prizes with large honoraria. These developments raise several questions: Why have rich prizes proliferated? Have they greatly changed the reward system of science? What effects will such prizes have on scientists and on science? The proliferation of such prizes derives from marked limitations on the numbers and types of scientists eligible for Nobel prizes and consequent increases in the number of uncrowned laureate-equivalents. These would-be surrogates (...) for Nobel prizes extend the reward system of science in its upper reaches but this change is not fundamental. The spread of rich prizes to new fields provides added incentives to potential winners, which has its own disutilities; it reinforces competitiveness, concern for priority and attendant secrecy, all this amplifying ambivalence toward the reward system in science. There may also be modest positive effects of such new awards in the form of heightened popular esteem for science and interest in it. (shrink)

The first edition of A Better World, Inc. showed how companies can profit by solving global problems. Increasingly, companies and investors are capitalizing on these opportunities. The three factors necessary for success were revealed to be effective corporate governance, stakeholder engagement, and collaboration. Racial equity and justice, and gender equity, were also themes in the original edition. By drawing on new research and case studies, this updated edition shows that inclusion and sustainability are in fact fundamental prerequisites for prosperity for (...) companies and society. Specifically, racial inequity and injustice, and gender inequity, are systemic problems that impede businesses from achieving their greater potential in the global marketplace; in the meantime, society suffers as well. The second edition of A Better World, Inc. builds on the first by showing that companies have the power and incentives – and their boards of directors have the responsibility and the authority – to drive solutions to social, economic, and environmental challenges. Readers will learn how companies and their boards, together with nonprofits and governments, can drive prosperity by centering equity and sustainability. This edition is organized to address environmental, social, and governance practices, which are priority interests for investors, media, the public, government, and others to assess company practices and profitability. (shrink)

In an age in which the regulatory state frequently deals with spending, licensing, and employment, the use of allocating powers is perceived as an appealing means by which to prevent discriminatory practices against individuals within illiberal communities. In addition to its easy availability, conditional funding is regarded as both an effective and—in comparison with legal prohibitions—less drastic tool for the prevention of discrimination. Such conditions are thought to be efficient because they increase the relative cost of the discriminatory practice and (...) in doing so create an economical incentive to avoid discrimination. Moreover, these conditions are thought to be less-coercive , because they still allow those subject to them to choose between the more expensive option of discrimination and the cheaper option of non-discrimination. In other words, these conditions are perceived as "Less Drastic Means." In this Article, I will argue that such a perception is false. When applied to the poor such conditionality is not less coercive than prohibitions in criminal law. It is more than reasonable to assume that attempts to rectify this flaw by exempting poor people from conditional funding will render such funding ineffective in preventing discrimination. In the final analysis—when one takes into account both the problem of the commodification of values and the inequality between rich and poor—the use of conditional finding as a means of promoting liberal values will, in most cases, be unjust. If we believe that the antidiscrimination principle has a lexical priority over a parent’s right to educate their children in accordance to their culture, we should choose the path of prohibition and abandon that of conditional funding. (shrink)

John Stuart Mill commented on the relationship between equality and liberty in general terms, and he also discussed the relationships between equality and four more concrete social goals: equality vs. diversity and individual spontaneity, equality vs. freedom of trade and entrepreneurial activity, equality vs. economic incentives for workpeople, and equality vs. welfare. In his more general statements he wrote off potential conflicts between equality and liberty, claiming that only those liberties that can be enjoyed by all are real liberties—or at (...) least they are the only ones worth defending. However, in several of his more concrete discussions he gave higher priority to various liberty-related goals than to equality. This seeming contradiction can be resolved if we assume that he distinguished between valuing a liberty per se and valuing it as a means to achieve something else. (shrink)

Data access and data sharing are vital to advance medicine. A growing number of public private partnerships are set up to facilitate data access and sharing, as private and public actors possess highly complementary health data sets and treatment development resources. However, the priorities and incentives of public and private organizations are frequently in conflict. This has complicated partnerships and sparked public concerns around ethical issues such as trust, justice or privacy—in turn raising an important problem in business and data (...) ethics: how can ethical theory inform the practice of public and private partners to mitigate misaligned incentives, and ensure that they can deliver societally beneficial innovation? In this paper, we report on the development of the Swiss Personalized Health Network’s ethical guidelines for health data sharing in public private partnerships. We describe the process of identifying ethical issues and engaging core stakeholders to incorporate their practical reality on these issues. Our report highlights core ethical issues in health data public private partnerships and provides strategies for how to overcome these in the Swiss health data context. By agreeing on and formalizing ethical principles and practices at the beginning of a partnership, partners and society can benefit from a relationship built around a mutual commitment to ethical principles. We present this summary in the hope that it will contribute to the global data sharing dialogue. (shrink)

Researchers and practitioners have devoted considerable attention to firms'' policies regarding discretionary disclosures. Prior studies argue that firms increase demand for their debt and equity issues and, thus, lower their cost of capital, by providing more informative disclosures. However, empirical research has generally not been able to document significant benefits from increased disclosure.This paper proposes an alternative explanation – firms disclose because it is the socially responsible thing to do. We argue that companies have incentives to engage in stakeholder management (...) by undertaking socially responsible activities and that providing extensive and informative disclosures is one such practice.We examine the relationship between firms'' disclosures and measures of social responsibility. We use ratings provided by the Council on Economic Priorities as proxies for the degree of social responsibility adopted by the sample firms. Disclosure rankings provided by the annual Association for Investment Management and Research Corporate Information Committee Reports (AIMR Reports) are used to measure disclosure level.Our results indicate that there is a positive relationship between disclosure level and corporate social responsibility. That is, firms that engage in socially responsive activities provide more informative and/or extensive disclosures than do companies that are less focused on advancing social goals. In addition, we find that socially responsible firms are more likely to provide this increased disclosure through better investor relations practices. These results support our contention that increased disclosure is a form of socially responsible behavior. (shrink)

The NANOCAN project aims to enhance our understanding of the behavior of nanomaterials in the body, focusing on biodegradable nanoparticles for cancer diagnostics, and targeted cancer drug delivery. There is a range of available and potentially useful nanoparticles and drugs that might be of interest to such a project. In this paper, we make values implied in—and relevant to—choices between these alternatives explicit, thereby offering a case study of how values enter research processes in this area. From a project centered (...) perspective, we observe that values often play their role implicitly, as a result of funding incentives, regulations, and structural and organizational features of the research process. Based on our observations and categorization of relevant values, we turn to a broader discussion of how responsible research and innovation can be facilitated by making value priorities, value conflicts, and biases explicit targets of normative assessment. (shrink)

This article analyses the results of a series of interviews conducted among leading firms in agrofood designed to assess the strategic importance of biotechnologies. Earlier analyses have emphasized either the revolutionary character of these technologies or the ability of oligopoly structure to contain the potential within existing market patterns. Our interviews would suggest that biotechnologies must be situated within the shift to a demand oriented food system. This has led on the on hand to a preoccupation with quality rather than (...) cost-cutting applications. It has also highlighted the inter-connectedness of the different phases of the agrofood system, since the incentive and the capacity to introduce innovations at any one point in the system depends on their acceptability to other actors in the agrofood chain.Biotechnologies have now become integrated into the competitive strategies of the leading actors but they remain ambiguously placed within the emerging “biotechnology” paradigm. The peculiarities of the agrofood system and the limitations of its industrialization have opened the way to strong consumer pressure based on the demand for quality and “natural” food and agriculture. It remains to be seen whether advanced biotechnologies can be assimilated within these priorities. (shrink)