The flu has an interesting history with respect to health care rationing in the United States. Consider that just about two years ago, the American public faced a shortage of influenza vaccine. Dire predictions were made about how many people might perish, and rationing protocols were created. However, many of the rationing protocols were ignored. Luckily, that flu season did not result in the horrible fatalities that were predicted. For these reasons, problems of health care rationing around issues of (...) the flu were postponed, rather than resolved.Over the last year, the public has focused its anxious attention on the possible avian influenza pandemic. Last week I noticed that at least once each day I heard mention in some discussion or another of the threat of this disease becoming easily transmissible from human to human. (shrink)

Why is it important for people to agree on and articulate shared reasons for just laws, rather than whatever reasons they personally find compelling? What, if any, practical role does public reason play in liberal democratic politics? We argue that the practical role of public reason can be better appreciated by examining the confluence of normative and positive political theory; the former represented here by liberal social contract theory of John Rawls and others, and the latter by rational (...) choice or game theory. Citizens in a diverse society face a practical as well as a moral problem. How can they have confidence that others will reciprocate their commitment to supporting governing principles that depart from their own ideal conceptions of truth and value in order to be reasonable to all? Citizens face a practical problem of mutual assurance that public reason helps them solve, and solve as a matter of common knowledge. The solution, on both views, requires citizens’ reciprocal commitment to basing law on a system of shared reasons. Both views place public reason at the core of liberal democratic politics in conditions of diversity, and for quite similar reasons. Our argument illustrates the complementary roles of positive and values-based analysis in constitutional design. (shrink)

The "grassroots turn" in bioethical discussions about justice in allocation of health care resources has attracted a great deal of support; in the absence of a convincing theory of justice in rationing, democratic decisionmaking concerning priority setting emerges with a kind of inevitability. Yet there remain suspicions about this approach – most importantly, worries about the socially corrosive impact of explicit, public decisionmaking that in effect sets a price on the lives of persons. These worries have been quieted, particularly (...) by the work of Leonard Fleck, but not altogether stilled. I explore more sympathetically the ideals to which concerns about public rationing somewhat dimly respond, and suggest constraints on priority setting discussions which might accommodate those ideals rather better. Keywords: "grassroots" decisionmaking, publicity principle, pricing life, rationing health care CiteULike Connotea Del.icio.us What's this? (shrink)

ABSTRACT Benjamin Page's thoughtful critique of my book, The Illusion of Public Opinion, strives to reassure readers that all is well—despite the book's extensive documentation of measurement‐error artifacts in numerous public opinion surveys. Page's own careful polling practices are not followed outside of elite academic survey centers. Moreover, even in such well‐run surveys, the respondents are often ignorant of the issues being probed. The fact that nonrandom reasons of some sort must be determining on‐the‐spot survey responses may allow (...) us to call the respondents “rational” in a loose sense. But the responses still don't represent actual opinions about the specific policy issues being probed—let alone well‐informed answers. Finally, while Page argues that measurement errors are most likely random, and should cancel out in the aggregate, the “miracle of aggregation” doesn't occur when the form, wording, and context of questions varies from survey to survey. And even when wording and context are held constant, the respondents' understanding of the same words can vary dramatically or subtly over time, due to new political events and their changing interpretation. (shrink)

Rationalization is the adjustment of one's beliefs about politically relevant information, the better to fit one's political behavior or one's political attitudes. This reverses the usual causal order, in which it is assumed that people start with values, add what little factual information they have, and produce policy, partisan, or ideological “attitudes” as a result. If people actually work backwards from their political behavior to their attitudes, and from their attitudes to their beliefs about “the facts,” there are obvious and (...) troubling implications for democratic legitimacy, as well as for the academic study of democratic competence. I confine myself here to exploring some of the empirical evidence for rationalization, and to thinking about how to solve the resulting research problems, bracketing the normative issues. (shrink)

Existing ethical frameworks for public health provide insufficient guidance on how to evaluate the risks of public health programs that compromise the best clinical interests of present patients for the benefit of others. Given the relevant similarity of such programs to clinical research, we suggest that insights from the long‐standing debate about acceptable risk in clinical research can helpfully inform and guide the evaluation of risks posed by public health programs that compromise patients’ best clinical interests. We (...) discuss how lessons learned regarding the ethics of risk in one context can be fruitfully transferred to the other, using the example of a so‐called ‘rational antibiotic use’ guideline that limits antimicrobial prescribing in order to curb antimicrobial resistance. (shrink)

The quest for a decent political order in many societies is imperative today because of the heterogeneous nature of our social existence and the complexity of our ever increasing socio-economic and political experiences. Since the public sphere is a domain of freedom exemplified by dialogical engagements, the outcome of such encounter must involve the intelligible thoughts of all discussants with the sole aim of dealing with the concerns and commanding the commitment of all to the decisions reached. In this (...) study, it is argued that Deweyan democracy as an alternative theory of rational inquiry is relevant for engaging the present sordid condition of many Africans democratic practice and policy outcomes. As a rational procedure, it is averred that John Dewey’s emphasis on epistemic properties of democratic discourse makes the proceduralist account of democracy superfluous and exposes the weakness of the content of democratic discourse in political actions and decisions. The study also contend that given the consensual state of Dewey’s epistemic thought, Jürgen Habermas theory rather than expanding the space of epistemic democracy stifled it because of his insistence on the force of a better argument in the resolution of conflicting concerns of dialoguers. The study therefore, argues for Dewey’s democracy as an alternative mode of political order since it does not undermine the views of the citizens but gives room for the activation a certain set of attitude that can challenge prevailing opinions and accepts the views that do not embrace conventional wisdom—a procedure that is necessary for the growth and development of our democratic space. (shrink)

Gillian Hadfield and Stephen Macedo argue that late-Rawlsian stability for the right reasons, that is, stability based on participants’ reciprocal cooperation, can arise even if participants start out only economically rational and indifferent to justice. As they explain, even purely rational actors have an interest in having a neutral “shared logic” to coordinate decentralized enforcement of social cooperation and in internalizing that logic. Once developed and internalized, they add, that logic renders their reasoning public, and their persons, reasonable and (...) responsive to Rawlsian justice considerations. Hadfield and Macedo’s account seeks to lend Rawlsian contractualism a contractarian foundation. I raise five challenges to their account, focusing on the sense in which actors “start out” purely rational; on illiberal means that may serve rational citizens’ joint ends; on the counterexample of Martin Luther King; on the difficulty of specifying the mechanism for shared logic-internalization; and on the further counterexample of a medical student who internalizes compassion, only upon the condition that it serves his rational aims. (shrink)

In the context of more and more project-based research funding, commercialization and economic growth have increasingly become rationalized concepts that are used to demonstrate the centrality of science for societal development and prosperity. Following the world society tradition of organizational institutionalism, this paper probes the potential limits of the spread of such rationalized concepts among different types of research funders. Our comparative approach is particularly designed to study the role and position of nonprofit research funders, a comparison that is relevant (...) as NPF could potentially be shielded from such rationalized pressures given their lack of profit gaining motives. By making a qualitative interview-based investigation we are able to describe how research funders rationalize their contributions to society at large, as well as their obligations to the researchers they fund. Four types of research funders are compared—independently wealthy philanthropists, fundraising dependent nonprofits, public agencies, and industry. We find that NPF, and especially philanthropists, are the least commercially geared type of funder, but that philanthropists also express least obligations to researchers funded. This is in sharp contrast to public research funders who, even more than industry, employ commercially geared rationalizations. We also find that both public and corporate funders express obligations to the researchers they fund. Our results indicate that there are limits to the spread of commercially tinted rationalizations among NPF, but that this does not necessarily mean an increased sense of obligations to the researchers funded, and by extension to the integrity of scientific pursuit. (shrink)

The nudge approach seeks to improve people’s decisions through small changes in their choice environments. Nudge policies often work through psychological mechanisms that deviate from traditional notions of rationality. Because of that, some critics object that nudging treats people as irrational. Such treatment might be disrespectful in itself and might crowd out more empowering policies. I defend nudging against these objections. By defending a nonstandard, ecological model of rationality, I argue that nudging not only is compatible with rational (...) agency but can even support it. Accordingly, a concern with rationality speaks for more rather than less public policy nudging. (shrink)

Jürgen Habermas has argued that religious views form a legitimate background for contributions to an open public debate, and that religion plays a particular role in formulating moral intuitions. Translating religious arguments into “generally accessible language” (Habermas, Eur J Philos 14(1):1–25, 2006) to enable them to play a role in political decisions is a common task for religious and non-religious citizens. The article discusses Habermas’ view, questioning the particular role of religion, but accepting the significance of including such counter-voices (...) to the predominant views. Furthermore it is pointed out that not only religious but also numerous secular views stand in need of translation to be able to bear on policy matters. Accepting Habermas’ general framework, I raise the question whether experts (such as clinicians working in relevant specialised areas of care) participating in political debates on biomedical issues have a duty to state their religious worldview, and to what extent the American government decision to restrict embryo stem cell research is an illegitimate transgression of the State-Church divide. (shrink)

The chief concern of the paper is to initiate discussion on the difference between the private and public power of judgement. The inspiration comes from Kant and his conception of the power of judgement, customs, morality and provisional law.

Even though globalization is not necessarily a modern phenomenon, quantitatively id does exceed anything which we could observe in the past. In its modern form it entails certain side effects and brings news risks which often involves direct encounters of people representing different or conflicting worldviews and systems of values. To speak of “a clash of civilizations” or “a war of civilizations” would be a misunderstanding, probably motivated politically. What is really pertinent is, however, the question to what extent conflicting (...) systems of values (i.e. people representing or subscribing to conflicting systems of values and lifestyles) can coexist or enter in a dialogue, which should be a requirement for any strategy to solve or manage a conflict. In this context, it proves extremely fruitful to distinguish two kinds of rationality: of the first and second level. Such distinction helps, first of all, to understand to what degree, e.g., deeply religiouspeople and secular scientists are rational, and in what context a dialogue or exchange of ideas between such divergent parties is possible. These results can easily be transferred onto a wide range of other conflicting systems of values. Further, the paper claims that it is not cultures or civilizations, the identity which being extremely complex, heterogeneous and multi-layered, as such enter into a conflict but cultural / civilizational subgroups. The conclusion is that a dialogue between two systems of values is in most cases possible, with one exception. (shrink)

Even though globalization is not necessarily a modern phenomenon, quantitatively id does exceed anything which we could observe in the past. In its modern form it entails certain side effects and brings news risks which often involves direct encounters of people representing different or conflicting worldviews and systems of values. To speak of “a clash of civilizations” or “a war of civilizations” would be a misunderstanding, probably motivated politically. What is really pertinent is, however, the question to what extent conflicting (...) systems of values (i.e. people representing or subscribing to conflicting systems of values and lifestyles) can coexist or enter in a dialogue, which should be a requirement for any strategy to solve or manage a conflict. In this context, it proves extremely fruitful to distinguish two kinds of rationality: of the first and second level. Such distinction helps, first of all, to understand to what degree, e.g., deeply religiouspeople and secular scientists are rational, and in what context a dialogue or exchange of ideas between such divergent parties is possible. These results can easily be transferred onto a wide range of other conflicting systems of values. Further, the paper claims that it is not cultures or civilizations, the identity which being extremely complex, heterogeneous and multi-layered, as such enter into a conflict but cultural / civilizational subgroups. The conclusion is that a dialogue between two systems of values is in most cases possible, with one exception. (shrink)

Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. (...) Participants identified four strategies associated with NPM which add to workload after‐hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care. (shrink)

A powerful critique of nudge theory and the paternalist policies of behavioral economics, and an argument for a more inclusive form of rationality.

In the public sphere and especially in the media, the discourse on the Church and about the Church on faith and religion is often tainted by the confusion of meaning due, among other things, to the mutual borrowing less rigorous – epistemologically and methodologically – of the concepts which engage various disciplines (theology, sociology, anthropology, political science, information and communication science, and so on) who take possession of problematic centered on the relation between mankind and divinity. This article presents (...) some basic benchmarks for analyzing and understanding the construction of meaning as well as the rationality or irrationality of these issues by convening the disciplinary distinction between the content of the concepts of organization and that of the institution. (shrink)

There are three broad ethical issues related to handling public health emergencies. They are the three R's - rationing, restrictions and responsibilities. Recently, a severe shortage of annual influenza vaccine in the US, combined with the threat of pandemic flu, has provided an opportunity for policy makers to think about rationing in very concrete terms. Some lessons from annual flu vaccination likely will apply to pandemic vaccine distribution, but many preparatory decisions must be based on very rough estimates. What (...) ethical principles should guide rationing decisions, what data should inform these decisions, how to revise decisions as new data emerge, and how to implement rationing decisions on the ground are all important considerations. In addition, ethicists might be able to help policy makers think through the importance of international cooperation in surmounting global rationing dilemmas and to accept the inevitable responsibilities of government in making and implementing rationing decisions. (shrink)

In personal and public affairs alike we constantly confront the need for deciding among available alternatives. Sensible Decisions synthesizes Nicholas Rescher's contribution to this discussion over the years. Rescher's prime aim is to illuminate some of the theoretical complications and perplexities that characterize rational procedure in matters of decision making at the public policy level.

Book review - Bounded Rationality: Heuristics, Judgement, and Public Policy Sanjit Dhami and Cass R. Sunstein. MIT Press, 2022, 533 pp.

Socially and politically significant Muslim communities are posing a challenge to the public spheres of Western Europe: can public reason in a liberal democracy be so conceived as to accommodate the religious reasons of Muslims and other religiously motivated citizens? This question, often discussed from the perspective either of political philosophy or of particular religious traditions, is addressed here instead by drawing on the theory and practice of inter-religious dialogue. The dialogue movement known as ‘scriptural reasoning’ is analysed (...) for its potential to provide a way of conceptualising the nature of reasoning in the public sphere. ‘Reasoning with texts’, it is argued, is a way of describing much of the reasoning that takes place within the public sphere and not just religious reasoning. This approach to understanding public reasoning is established through a combination of example and theory. A model of communicative hermeneutics as public reason based on an textual rationality is proposed. As well as providing space for textually based religious arguments, this textual imagination can be situated alongside and complement postmodern developments of Jürgen Habermas’s conception of the public sphere. Whilst this approach to reasoning in the public sphere initially appears very different from the classic statement of the idea of public reason in John Rawls’s political liberalism, it is shown to have significant continuity with Rawls’s theory when this is viewed through the lens of the Supreme Court as exemplar of public reason. This highest level of public reason involving legislation is also a form of reasoning with texts. But in order for religious and more popular levels of public discourse and deliberation to impact on the political and legislative processes, these too must be conceived as modes of reasoning having some continuity with higher levels of public reasoning. It is such continuity that this thesis seeks to theorise. (shrink)

This article holds that ability to support one’s opinions with arguments, awareness of the arguments for other opinions, and insight into the superiority of some arguments are basic requirements for rational discourse. Based on a content analysis of Swiss Italian newspaper coverage of a controversy over a smoke-free law introduced and finally implemented in the canton of Ticino in 2007 and on a five-wave panel survey of public opinion on the issue, the article describes elements of the argumentative structure (...) of news coverage of this issue and relates them to rationality requirements. It finds that the newspapers offered a wide variety of arguments to readers (articulation function) when political activity to introduce a ban intensified, and especially when arguments mattered as a referendum approached. Papers displayed a reasonable and differentiated picture of arguments, contributing to a unique pattern of weighting and evaluating them. Neither newspaper coverage nor public opinion showed much sign of change, which speaks against a reaction to superior arguments. Finally, the newspaper bias towards arguments for the ban and their inclination to publish objections to arguments against may have contributed to a widespread lack of awareness of arguments against the ban among people favouring it. Thus, evidence of the rationality of argumentative structures is mixed, and further enquiry into this subject is encouraged. (shrink)

Paradigmatic cases of disagreement seem not to be compatible with a widespread kind of solution to Kripke’s celebrated Pierre puzzle. As a result, the classical puzzle about rational belief is shown to be also a puzzle about public disagreement/agreement phenomena. In this paper, I defend that the new public version of the puzzle is substantial and challenging and conclude that a full solution to Kripke’s considerations must offer a satisfactory account of both the rational and public character (...) of belief attributions. I then argue that a notion of non-belief-individuating understanding is plausibly the key notion that would allow us to arrest both versions of the Pierre puzzle. (shrink)

Based on empirical data from a qualitative study, this paper explores the complexity of ‘real world’ management in Hong Kong’s public sector, as contrasted with various paradigmatic claims under ‘new public management’ (NPM). A plurality of sub-worlds within the broad public sector is identified, which makes the management roles and responsibilities much less ‘homogenised’ than depicted in NPM exhortations. The instrumental rationality underpinning NPM is identified as too restrictive in understanding the way in which public (...) managers reach decisions. When the daily challenges of reconciling values and practices arising from the complexities of politics, policies and service delivery are considered it is necessary to incorporate ideas related to procedural and expressive rationality to fully appreciate the nature of management in public organisations. (shrink)

In the original publication of the article, the paragraph beginning “We begin with two steps or lawyers…” should read as “We begin with two steps or layers privileging jurisdictio as potestas.

Beauchamp and Childress (1994) elaborated an approach to bioethical deliberations based on four universalistic principles. This framework of ‘principlism’ has been criticized from within biomedical ethics as insufficient and problematic. However, this article considers a more radical sociological critique by John Evans (2002) that rejects the entire approach of defining ‘principles’ a priori. This sociological critique is based on classical sociologist Max Weber's (1925) distinction between instrumental (‘thin’) and substantive (‘thick’) rationality. As an exploratory assessment of Evans' critique, his (...) conceptualization of ‘thin’ versus ‘thick’ rationalization is applied to a large sample of Anglo-American press coverage (n = 5126) of the bioethical controversy surrounding therapeutic cloning. Given the role of mainstream news media as a key arena for the discursive framing of biomedical research and its ethical implications, the findings raise important questions about principlism and the mediation of bioethical debates on issues such as therapeutic cloning. (shrink)

In their new book Escaping Paternalism, Glen Whitman and Mario Rizzo try to persuade readers to be skeptical of behavioral paternalism. Rizzo and Whitman describe behavioral...

In his recent article in Philosophy and Public Affairs, 'The Paradox of Voting and Ethics of Political Representation', Alexander A. Guerrero argues it is rational to vote because each voter should want candidates they support to have the strongest public mandate possible if elected to office, and because every vote contributes to that mandate. The present paper argues that two of Guerrero's premises require correction, and that when those premises are corrected several provocative but compelling conclusions follow about (...) the rationality of voting and duties of elected officials: (A) Voting is typically rational for the members of a political party’s base; (B) Voting is often (but not always) irrational for “swing” voters (i.e. independent voters who are not affiliated with any political party, as well as “undecided” voters who are considering voting across party lines); and (C) Elected officials have a moral duty to respond to changing levels of popular support once in office, as indicated by properly monitored and corroborated public opinion polls of constituents, functioning more as delegates the lower their level of popular support. Finally, I suggest that the last of these conclusions has wide-ranging implications for political ethics. I illustrate these implications by focusing on the questions -- under debate in the 2016 US Presidential election cycle -- of whether a sitting President has a moral duty to nominate or not nominate a new Supreme Court justice during his or her final year in office, and similarly, whether US Senators have a moral duty to obstruct, or not obstruct, confirmation of the President’s eventual nominee. (shrink)

Having its seeds in the 2nd International Lauener Symposium held in honour of Dagfinn Follesdal, the present collection contains a rich, kaleidoscopic ensemble of previously unpublished contributions by leading authors, representing diverse approaches to a variety of philosophical themes on which Follesdal has had a longstanding, formative impact. Follesdal himself contributes an orientating essay continuing to develop his pioneering theory of reference as well as in-depth commentaries on each of the other authors elaborated papers plus candid answers in the added (...) interview. The volume assembles a wealth of original articles containing in part direct discussions of Follesdal s work and covering a broad range of topics like subjectivity, intersubjectivity, objectivity, rationality, logics and mathematics, choice theory, values, modalities, intentionality, individuation, perception, communication, meaning, reference, the slingshot, one- and two-sorted semantics, evidence, neuropsychology, space and time, science and society, methodology, fallibilism, the relative a priori, justification, holism, the life-world, reflective equilibrium, empathy, and ethics. Moreover the book includes an incisive memoir of Follesdal the philosopher as well as a spanning interview with him, which are both critically directing toward Follesdal s subtly differentiated understanding of the dynamic philosophical horizon he shares in. With contributions from Dagfinn Follesdal, Charles Parsons, Patrick Suppes, Jon Elster, John Perry, Michael Friedman, Dag Prawitz, Wilhelm K. Essler, David Woodruff Smith, Olav Gjelsvik, Graciela De Pierris, Nils Roll-Hansen, Christian Beyer, Oystein Linnebo, Michael Frauchiger. Excerpt Open publication". (shrink)

Robert Hannas The Rational Human Condition is a five-volume book series, including: Volume 1. Preface and General Introduction, Supplementary Essays, and General Bibliography Volume 2. Deep Freedom and Real Persons: A Study in Metaphysics Volume 3. Kantian Ethics and Human Existence: A Study in Moral Philosophy Volume 4. Kant, Agnosticism, and Anarchism: A Theological-Political Treatise Volume 5. Cognition, Content, and the A Priori: A Study in the Philosophy of Mind and Knowledge The fifth volume in the series, Cognition, Content, and (...) the A Priori, was published by Oxford University Press in 2015. So, with the present publication of the first four volumes in the series by Nova Science in 2019, all five volumes of The Rational Human Condition are now available in hard-copy and as e-books. All five books share a common aim, which is to work out a true general theory of human rationality in a thoroughly nonideal natural and social world. This philosophical enterprise is what Hanna calls rational anthropology. In the eleventh and most famous of his Theses on Feuerbach, Marx wrote that philosophers have only interpreted the world in different ways; the point is to change it. Hanna completely agrees with Marx that the ultimate aim of philosophy is to change the world, not merely interpret it. So, Marx and Hanna are both philosophical liberationists: that is, they both believe that philosophy should have radical political implications. But, beyond Marx, Hanna also thinks that the primary aim of philosophy (understood as rational anthropology) and its practices of synoptic reflection, writing, teaching, and public conversation is to change lives for the betterand ultimately, for the sake of the highest good. Then, and only then, can the human race act upon the world in the right way. The four volumes of The Rational Human Condition will therefore appeal not only to philosophers, but also to any other philosophically-minded person interested in the intellectual and practical adventure of synoptic, reflective thinking about the nature of our rational, but still ineluctably human, all-too-human lives. (shrink)

Rationing healthcare is a difficult task, which includes preventing patients from accessing potentially beneficial treatments. Proponents of implicit rationing argue that politicians cannot resist pressure from strong patient groups for treatments and conclude that physicians should ration without informing patients or the public. The authors subdivide this specific programme of implicit rationing, or “hidden rationing”, into local hidden rationing, unsophisticated global hidden rationing and sophisticated global hidden rationing. They evaluate the appropriateness of these methods of rationing from the perspectives (...) of individual and political autonomy and conclude that local hidden rationing and unsophisticated global hidden rationing clearly violate patients’ individual autonomy, that is, their right to participate in medical decision-making. While sophisticated global hidden rationing avoids this charge, the authors point out that it nonetheless violates the political autonomy of patients, that is, their right to engage in public affairs as citizens. A defence of any of the forms of hidden rationing is therefore considered to be incompatible with a defence of autonomy. (shrink)