Uterus transplantation (UTx) is an experimental surgery likely to face the issue of organ shortage. In my article, I explore how this issue might be addressed by changing the prevailing practices around live uterus donor recruitment. Currently, women with children – often the mothers of recipients – tend to be overrepresented as donors. Yet, other potentially eligible groups who may have an interest in providing their uterus – such as transgender men, or cisgender women who do not wish to gestate (...) or to have children – tend to be excluded as potential donors. Moving forward, I recommend that donor inclusion criteria for UTx be broadened to be more inclusive of these latter groups. (shrink)

In the rabbinic literature from the land of Israel the poor are depicted not as passive recipients of gifts and support, but as independent agents who are responsible for their own behaviour. Communal care for the needy was expected to go beyond their basic needs for food, clothing and shelter; the physical safety of the poor and the value of their time as well as their dignity and self-worth were also included in the scope of charity. In this monograph, Yael (...) Wilfand offers a comprehensive and contextual analysis of major rabbinic texts on poverty and charity composed during the first five centuries of the Common Era in the land of Israel, principally the Mishnah, the Tosefta, the Palestinian Talmud and midrashim. She shows that, for the rabbis, the poor were not necessarily considered outsiders; indeed, some students and rabbis in Palestine may have personally experienced poverty. Wilfand claims that such socio-economic diversity contributed to the thinking of these rabbis, who rarely saw poverty as a result of transgression (in contrast to the Babylonian Talmud). This book presents a number of contrasting viewpoints held by Palestinian rabbis over such questions as: Must communal administrators ensure applicants' eligibility for alms? Should the newly indigent from wealthy families receive exceptional levels of support? Might neighbouring gentiles qualify for economic assistance from Jewish communal sources? By examining Palestinian rabbinic sources within the contexts both of the hegemonic Greco-Roman (later, Christian) milieu and of the biblical heritage, this volume offers an absorbing account of some ancient approaches to timeless social challenges. (shrink)

Drawing on Dutch mortgage orientation consultations, the present study uncovers how mortgage advisors communicate information packages to laypersons. These information packages are jointly constructed by advisors and customers as a distinct activity within a professional advisory setting. We name this activity ‘explicative telling’. Through a systematic analysis of 57 of such explicative tellings we will demonstrate that this explicative telling activity consists of doing preliminary work; a body in which general, official information about a specific mortgage topic is given and (...) information is applied to the customer’s situation; and closing sequences. Essential to the explicative telling activity is the recipient orientation of mortgage information, and also the advisors’ display of accountability for providing eligible information. This is supported by the irreversibility of the preliminary phase and by the presence of news deliverer upshot formulations during the body of the telling. (shrink)

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. (...) We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)

In light of recent successful uterus transplantations, it is reasonable to expect that womb transplants will become more commonplace in the future. If this happens, important questions emerge about who should receive the donated wombs. Some arguments have been advanced that suggest that potential recipients should be screened for their anticipated childrearing capacity, as one component of a comprehensive process for determining eligibility. The main arguments provided in support of this position have to do with the presumed responsibility of (...) the state to protect future children from harm, and with avoiding complicity for any resulting harm experienced by the child born through the transplanted uterus. The purpose of this paper is to reject this position, based on two main criticisms: (1) screening potential uterus recipients for anticipated childrearing ability, but not also screening other kinds of morally equal family builders, is unjustly discriminatory; and (2) with respect to actions performed in good faith (e.g. providing a transplantable uterus to someone for the purpose of having a child), one is not morally blameworthy for the consequences of those actions (a) that one did not intend, and (b) that were directly caused by someone else, and (c) where others are directly responsible for making sure that those consequences do not come about. These criticisms are sufficient for concluding that the state is not justified in assessing the anticipated childrearing capacity of potential uterus recipients, and this is so regardless of whether or not there is a scarcity of transplantable uteruses available. (shrink)

“I think there’s a big strong belief in [...] the community … and maybe it’s in the world at large that somehow the doctors are more concerned about harvesting the organs than what’s best for the patient.”1 In the past 45 years, organ and tissue recovery and transplantation have moved from the occasional and experimental to a standard of care for end-stage organ failure; receiving an organ transplant is for many the only opportunity for increased quantity and/or quality of life. (...) The increasing prevalence of diseases such as viral hepatitis, diabetes, and hypertension has significantly increased the incidence of end-organ failure. Additionally, surgical advances have permitted less stringent qualification criteria, so that people of advanced age or patients who may be in a physiologically fragile state are now eligible to be organ recipients. These changes have created a significant demand for organs. (shrink)

Sometimes, people who are otherwise eligible to donate blood are unduly deferred from donating. “Unduly” indicates a gap where a deferral policy misstates what exposes potential donors to risk and so defers more donors than is justified. Since the error is at the policy-level, it’s natural and understandable to focus criticism on reformulating or eliminating the offending policies. Policy change is undoubtedly the right goal because the policy is what prevents otherwise safe eligible donors from donating needed blood. But focusing (...) exclusively at the policy-level passes over a largely undiscussed question: if policy change takes time and there is an urgent need for blood now, then what should unduly deferred donors do in the meanwhile? Blood banks and federal agencies recommend that deferred donors donate their time or money until they become eligible, but blood is a non-fungible good: donated cash or volunteered time cannot replace a transfusion. Further, this request ignores that otherwise eligible donors could safely donate their blood in addition to their time and money. Here is the central question I will focus on in this paper: is a donor morally justified in lying on a questionnaire to donate blood if they justifiably believe that their blood poses no risk to a recipient and knows that honestly answering a donor questionnaire would unduly defer them from donating? (shrink)

One rationale policy-makers sometimes give for declining to fund a service or intervention is on the grounds that it would be ‘unaffordable’, which is to say, that the total cost of providing the service or intervention for all eligible recipients would exceed the budget limit. But does the mere fact that a service or intervention is unaffordable present a reason not to fund it? Thus far, the philosophical literature has remained largely silent on this issue. However, in this article, we (...) consider this kind of thinking in depth. Albeit with certain important caveats, we argue that the use of affordability criteria in matters of public financing commits what Parfit might have called a ‘mistake in moral mathematics’. First, it fails to abide by what we term a principle of ‘non-perfectionism’ in moral action: the mere fact that it is practically impossible for you to do all the good that you have reason to do does not present a reason not to do whatever good you can do. And second, when used as a means of arbitrating between which services to fund, affordability criteria can lead to a kind of ‘numerical discrimination’. Various attendant issues around fairness and lotteries are also discussed. (shrink)

The world’s first living donor liver transplant from an HIV-positive mother to her HIV-negative child, performed by our team in Johannesburg, South Africa in 2017, was necessitated by disease profile and health system challenges. In our country, we have a major shortage of donor organs, which compels us to consider innovative solutions to save lives. Simultaneously, the transition of the HIV pandemic, from a death sentence to a chronic illness with excellent survival on treatment required us to rethink our policies (...) regarding HIV infection and living donor liver transplantation. Although HIV infection in the donor is internationally considered an absolute contraindication for transplant to an HIV-negative recipient, there have been a very small number of unintentional transplants from HIV-positive deceased donors to HIV-negative recipients. These transplant recipients do well on antiretroviral medication and their graft survival is not compromised. We have had a number of HIV-positive parents in our setting express a desire to be living liver donors for their critically ill children. Declining these parents as living donors has become increasingly unjustifiable given the very small deceased donor pool in SA; and because many of these parents are virally suppressed and would otherwise fulfil our eligibility criteria as living donors. This paper discusses the evolution of HIV and transplantation in SA, highlights some of the primary ethical considerations for us when embarking on this case and considers the new ethical issues that have arisen since we undertook this transplant. (shrink)

A proposal to allow prisoners to save their lives or to be eligible for commutation of sentence by donating kidneys for transplantation has been a subject of controversy in the Philippines. Notwithstanding the vulnerabilities associated with imprisonment, there are good reasons for allowing organ donations by prisoners. Under certain conditions, such donations can be very beneficial not only to the recipients but to the prisoners themselves. While protection needs to be given to avoid coercion and exploitation, overprotection has to be (...) avoided. The prohibition on the involvement of prisoners in organ transplantation constitutes unjustified overprotection. Under certain conditions, prisoners can make genuinely independent decisions. When it can be reasonably ascertained that they are able to decide freely, society should recognise an obligation to help them implement their decisions, such as when they intend to donate an organ as a way of asserting their religious faith and performing a sacrifice in atonement for their sins. (shrink)

Typical philosophical discussions of physician-assisted death have focused on whether the practice can be permissible. We address a different question: assuming that pad can be morally permissible, how far does that permission extend? We will argue that granting requests for pad may be permissible even when the pad recipient can no longer speak for themselves. In particular, we argue against the ‘competency requirement’ that constrains pad-eligibility to presently-competent patients in most countries that have legalized pad. We think pad (...) on terminally ill, incapacitated patients can be morally permissible in cases where advance directives or suitable surrogate decision-makers are available, and should be legally permissible in such cases as well. We argue that this view should be accepted on pain of inconsistency: by allowing surrogate decision-makers to request withdrawal of life-sustaining care on behalf of patients and by allowing patients to request pad, we rule out any plausible justification for imposing a competency requirement on pad. (shrink)

Uterus transplantation (UTx) is an experimental surgery likely to face the issue of organ shortage. In my article, I explore how this issue might be addressed by changing the prevailing practices around live uterus donor recruitment. Currently, women with children – often the mothers of recipients – tend to be overrepresented as donors. Yet, other potentially eligible groups who may have an interest in providing their uterus – such as transgender men, or cisgender women who do not wish to gestate (...) or to have children – tend to be excluded as potential donors. Moving forward, I recommend that donor inclusion criteria for UTx be broadened to be more inclusive of these latter groups. (shrink)

National Institutes of Health’s policies for Responsible Conduct of Research (RCR) instruction for individual career development awards (K-awards) stress appropriateness to the career stage and tailoring to the individual’s needs. Early-career faculty have unique needs for RCR instruction. While our institution requires RCR education for ALL graduate students and postdoctoral trainees, we found that many K-awardees 1) are early-career faculty not eligible to participate in postdoc programs, and 2) many had received formal RCR instruction at only basic or intermediate levels. (...) We identified 45 K-award recipients with active grants, 26 of whom needed RCR instruction. We developed a program specifically designed for early-career faculty researchers. Through the first three iterations of the course, we had a total of 24 participants, ranging from senior postdoctoral and clinical fellows to instructor-level and assistant professors. This paper describes our experience and challenges in developing and conducting this course. (shrink)

The stipulation of living organ transplantation policy and practice in Bangladesh is family-oriented, with relatives being the only people legally eligible to donate organs. There have been very few transplantations of bone marrows, liver lobes, and kidneys from related-living donors in Bangladesh. The major question addressed in this study is why Bangladesh is not getting adequate organs for transplantation. In this study, I examin the stipulations of the policy and practice of living organ donation through the lens of 32 key (...) stakeholders including physicians and nurses, a health administrator, organ donors and recipients, and their family members, as they can shed light on the realities and problems of organ donation for transplantation in Bangladesh. My ethnography reveals that the family members are always encouraged to donate organs for transplantation, and saving the lives of relatives through organ donation is seen as a moral obligation. Many view saving the life of a relative by donating one’s organs as equivalent to saving one’s own life. An assessment of the dynamics of biomedicine, religion, and culture leads to the conclusion that the family-oriented organ donation policy and practice have been widely endorsed and accepted in Bangladesh, and Islamic ethical principles and collective family ethos undergird that policy and practice. However, the unavailability of medical resources, lack of post-operative coverage for organ donors, religious misconceptions and unawareness of the general public, and the absence of posthumously donated vital organs for transplantation are perceived to be the most common barriers to a successful living donor-recipient pair organ transplantation. By overcoming these obstacles, Bangladesh can develop a successful living donor-recipient pair organ transplantation program that will ensure improved healthcare outcomes, promote altruism and solidarity among Bangladeshi families, and protect the poor from having their organs sold to wealthy patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.1 (2003) 51-52 [Access article in PDF] Congress Considers Incentives for Organ Procurement Alexander S. Curtis [Tables]During the 108th Congressional session, several bills pertaining to ethical incentives for organ donation likely will be introduced. In some cases, they will be similar to bills before the 107th Congress (see Table 1). Bills in both the House of Representatives and the Senate address the establishment and (...) maintenance of donor registries, financial reimbursements for medical and nonmedical expenses incurred by qualifying donors, the presentation of commemorative medals, and tax credits.A bill entitled "Gift of Life Congressional Medal Act" (introduced last year by Senate majority leader Bill Frist (R-TN) as Senate Bill 325), and its corresponding bill of the same title (passed in the House of Representatives last year as H.R. 708), would establish a congressional commemorative medal honoring "any organ donor, or the family or family member of any organ donor." The medal is to be designed and struck with "suitable emblems, devices, and inscriptions" by the Secretary of the Treasury. The eligible donor or donor's family member would be presented with the medal by the Secretary of Health and Human Services. This bill would establish qualifying donations as those of human kidneys, livers, hearts, lungs, pancreases, or any other organ, but excludes corneas and eyes.Another bill, introduced by Representative Michael Bilirakis (R-FL) entitled "Organ Donation Improvement Act" (H.R. 624), would award grants or contracts to states, transplant centers, and qualified organ procurement organizations for the purpose of providing travel, subsistence, and incidental nonmedical expenses to individuals who make living donations. In order to receive reimbursement, the donating individuals must reside in states other than the states in which the intended recipients reside and the annual income of those receiving the organs cannot exceed $35,000. The bill also would appropriate $15,000,000 to make grants to states and public and nonprofit entities for the purpose of carrying out studies, public education demonstrations, and outreach activities "designed to increase the number of organ donors within the state." The bill would be effective from time of enactment through 2005. [End Page 51]Two other bills proposed within the House of Representatives in 2002 called for amendment to the Internal Revenue Code. The "Gift of Life Tax Credit Act (introduced as H.R. 1872 by Representative James Hansen (R-UT)) and the "Help Organ Procurement Expand Act" (introduced as H.R. 2090 by Representative Chris Smith (R-NJ)) present a refundable credit to individuals or to the estates of those who agree either to be living donors or to donate their organs upon death. The "Gift of Life Tax Credit Act" refunds $10,000 to the estates of eligible individuals "for the taxable year which includes the date of the individual's death." The "Help Organ Procurement Expand Act" offers a refund of $2,500 to qualified persons. Donations of kidneys, livers, pancreases, islet cells, lungs, and intestines are accepted, however several conditions restrict permissible donors. The "Gift of Life Tax Credit Act" requires that the legally competent individual's death not be due to a suicide and that the intention to donate was clearly declared. The "Help Organ Procurement Expand Act" prohibits donations from individuals who were killed with physician assistance, died as a result of a suicide, have been indicted or convicted of a felony or a misdemeanor offense, or are actively under criminal investigation for a possible felony offense. The "Help Organ Procurement Expand Act" also restricts procuring organs from unborn children or human fetuses and under circumstances in which the living donor would be subject to "unacceptable levels of medical risk of death or permanent debilitation." Alexander S. Curtis is a research assistant at the Kennedy Institute of Ethics, Georgetown University, Washington, DC. He received his bachelor's degree from Miami University.... (shrink)

Jehovah’s Witnesses should be required to sign transfusion contracts in order to be eligible for transplant.Human donor organs continue to be in short supply, and many potential transplant recipients die while waiting for an allograft to become available.1 Because the organ supply is so limited and the offering of organs is based on the generosity of patients and families, proper stewardship of these organs is an ethical obligation for transplant teams, as well as organ recipients. Preventable graft loss must be (...) protected against, and factors that foster preventable graft loss—for example, non-compliance must be proactively contemplated when patients are reviewed as potential transplant candidates. Post-transplant treatment refusal is one example of behaviour that can compromise transplant success.JEHOVAH’S WITNESSES AS TRANSPLANT RECIPIENTSIt is widely known that one of the most significant teachings of the Jehovah’s Witness church is abstinence from receiving blood transfusions.2 Believers derive this tenet from the Bible verse: “You are to abstain from …blood”.3 While blood loss is a risk of transplant surgery, some centres do not view patient refusal of blood transfusion as a transplant exclusion criterion. The first published case of transplantation of a Jehovah’s Witness appeared in 1986 from the University of California Los Angeles heart transplant team.4 Since then, numerous other cases have been published, including liver,5 kidney,6 pancreas,6 and lung.7 For experienced centres with superior blood management skills, transplant can indeed be a surgical success; however, optimal blood management before and during surgery are only two thirds of the patient’s clinical time clock. In the remaining third, the post-transplant period, the patient has received his/her organ, yet the potential for clinical need of blood transfusion remains.THE DILEMMAWhether due to postoperative complication, or future illness or trauma, all transplant recipients have …. (shrink)

Annual Reports on Medical Assistance in Dying (MAID) issued by Health CanadaCanada on behalf of the Government of Canada strive to make essential information public, on this large national program that over five years has provided death to over 30,000 Canadians. The source of the information is self-reporting by physicians and nurse practitioners who offer to act as MAID assessors and providers, as well as self-reporting by cooperating pharmacists. Focus of this discussion is the latest available document in this series, (...) the Third Annual Report on MAID published in July 2022 and providing data on 10,064 deaths by MAID in 2021. In addition to reviewing essential information about MAID recipients and MAID providers, the discussion is centered on the method of data collection, the rapid and unexpected annual increase of cases, the underlying medical conditions, the nature of suffering reported by MAID applicants, the use of palliative care, the decision-making about one’s eligibility, the role of the reflection period, necessary requirement to obtain informed consent and the denial of assisted dying. In each case, the attention is drawn to missing or indeterminate elements, and essential but unavailable analysis of data, in order to identify further information that ought to be collected and used to generate future annual reports and to refine the delivery of MAID program and its oversight. (shrink)

Early in 2018, the Trump administration's Centers for Medicare and Medicaid Services issued a guidance letter outlining a new and controversial kind of Medicaid waiver proposal. The administration invited states to propose waivers that would impose work (or other “community engagement”) requirements as a condition of eligibility for Medicaid. The Trump administration and state proponents of work requirements want to force able‐bodied Medicaid beneficiaries into the workplace. Critics allege that this is because they mistakenly believe that low‐income individuals are (...) not working because they're lazy or because aid programs provide them with a disincentive to work. Proponents respond that the requirements can lower the public programs' costs while helping its recipients. Medicaid data seems to show that the work‐requirement proposals are a solution in search of a real‐life problem. (shrink)

Living in poverty is associated with high levels of protracted stress associated with health problems. Economic and food insecurity are particularly poignant aspects of poverty and condition the work of securing basic daily needs of families. Recent studies suggest that levels of stress increase as family food needs rise. This paper presents new findings which clarify the relationship of food provisioning to stress levels, by examining actual food provisioning strategies and food insecurity among the Northern Cheyenne Indians of southeastern Montana. (...) Results clearly show that stress varies by types of food acquisition strategies. Contrary to our expectations, more complex strategies, including relatively unpredictable and cumbersome food provisioning activities, are not linked to higher stress levels in our analysis. Controlling for food security levels, households using a combination of local programs and informal subsistence sources are the least stressed, despite the demands of managing a large number of food sources. Households primarily using Food Stamps are the most likely to experience high levels of stress. Interviews with Food Stamp recipients show that potential sources of stress include inadequate allocations of Food Stamps, difficulty achieving and maintaining eligibility, challenges to complying with paperwork and appointment requirements, as well as personal obstacles and community barriers to making food stamps last. Analyses indicate that contradictions between local cultural norms for food provisioning and the realities of food insecurity in this context promote strategies emphasizing greater independence from federal food programs. (shrink)

Inscrutability arguments threaten to reduce interpretationist metasemantic theories to absurdity. Can we find some way to block the arguments? A highly influential proposal in this regard is David Lewis’ ‘ eligibility ’ response: some theories are better than others, not because they fit the data better, but because they are framed in terms of more natural properties. The purposes of this paper are to outline the nature of the eligibility proposal, making the case that it is not ad (...) hoc, but instead flows naturally from three independently motivated elements; and to show that severe limitations afflict the proposal. In conclusion, I pick out the element of the eligibility response that is responsible for the limitations: future work in this area should therefore concentrate on amending this aspect of the overall theory. (shrink)

A long‐standing debate in the study of human communication centers on the degree to which communicators tune their communicative signals (e.g., speech, gestures) for specific addressees, as opposed to taking a neutral or egocentric perspective. This tuning, called recipient design, is known to occur under special conditions (e.g., when errors in communication need to be corrected), but several researchers have argued that it is not an intrinsic feature of human communication, because that would be computationally too demanding. In this (...) study, we contribute to this debate by studying a simple communicative behavior, communicative pointing, under conditions of successful (error‐free) communication. Using an information‐theoretic measure, called legibility, we present evidence of recipient design in communicative pointing. The legibility effect is present early in the movement, suggesting that it is an intrinsic part of the communicative plan. Moreover, it is reliable only from the viewpoint of the addressee, suggesting that the motor plan is tuned to the addressee. These findings suggest that recipient design is an intrinsic feature of human communication. (shrink)

People meeting a robot for the first time do not know what it is capable of and therefore how to interact with it—what actions to produce, and how to produce them. Despite social robotics’ long-standing interest in the effects of robots’ appearance and conduct on users, and efforts to identify factors likely to improve human–robot interaction, little attention has been paid to how participants evaluate their robotic partner in the unfolding of actual interactions. This paper draws from qualitative analyses of (...) video-recorded interactions between a robot and groups of participants, in the framework of ethnomethodology and conversation analysis. We analyse the particular ways in which participants shape their embodied actions, how they can reproduce a prior action that failed to obtain a response from the robot; and how they explore the robot’s embodied nature. We find a set of recurrent methods or practices, showing that robot-recipient design displays not only participants’ initial assumptions about the robot’s competences, but also more importantly perhaps their continuous assessment of the robot’s behaviour, and their attempts to adapt to it. Participants locally produce and constantly revise their understanding of the robot as a more or less competent co-participant, drawing from its past, current, and projected conduct and responsiveness. We discuss the implications of these findings for research in robotics and human–robot interactions, and the value of the approach to shed new light on old questions by paying attention to the quality of gesture and the sequential organisation of interaction. (shrink)

Moral perception has made something of a comeback in recent work on moral epistemology. Many traditional objections to the view have been argued to fail upon closer inspection. But it remains an open question just how far moral perception might extend. In this paper, I provide the beginnings of an answer to this question by assessing the relationship between the metaphysical structure of different normative properties and a plausible constraint on which properties are eligible for perceptual awareness which I call (...) the Counterfactual Strengthening Test. Along the way I consider and reject a few other possible constraints on perceptual awareness. I defend the view that moral perception is restricted to the perception of evaluative and pro tanto deontic properties. I conclude with a few gestures toward what this limitation on moral perception may mean for broader moral epistemology. (shrink)

Downie and Schuklenk1 provide a clear narrative of the development of Canadian policy on medically assisted dying. This is very helpful for considering specific aspects of the continuing deliberations in Canada. This commentary presents an alternative perspective on the authors’ argument that narrow eligibility criteria for medical assistance in dying are discriminatory and unjustified. I argue that disability or mental illness as sole reason for accessing MAiD removes protections for all people who have times in their life when they (...) have mental illness or disability combined with intolerable suffering. I claim that individuals do not make their best, self-actualising decisions at those times and the supposed protections of vague terms such as incurable, advanced and decline are not clinically useful for evaluating eligibility for individuals with chronic health conditions. Within discussion of the impact of social determinants of health on access to MAiD, the authors present the argument that decisionally capable people with mental illness or disabilities as their sole underlying condition should be allowed to access MAiD. The authors state that opposing this access sacrifices patient rights and strips people of their agency. To support their argument, they embrace the idea that people with mental illness or disabilities belong to an identifiable cohort. They claim that …. (shrink)

Perhaps the two main contemporary formulations of ethical naturalism – Synthetic Ethical Naturalism (SEN) and Analytical Descriptivism – seem to conflict with plausible views about cases where moral debate and disagreement is possible. Both lack safeguards to avoid divergence of reference across different communities, which can scupper the prospects for genuine moral disagreement. I explore the prospects for supplementing both views with Lewis's notion of eligibility, arguing that this can solve the problem for a modified form of analytical descriptivism, (...) and for a modified form of SEN too (though perhaps more controversially). I close by considering the appropriateness of using the notions of eligibility and joint-carving in ethics. (shrink)

In their analysis of the eligibility criteria for assisted dying in Canada, Downie and Schuklenk put forward a strong argument for the ethical defensibility of including mental illnesses and disabilities as underlying conditions driving a person’s request for assisted dying.1 In this commentary, we add a view on these debates from our home state of Victoria, Australia, where voluntary assisted dying has been legal since June 2019. We highlight the more conservative approach to eligibility in our setting compared (...) with Canada, and argue for debates about eligibility criteria to be conceptualised as part of a broader discussion about access to assisted dying that includes clinicians’ roles and perspectives. In our view, clinicians’ perspectives may have a significant impact on individuals’ ability to access assisted dying, regardless of legislative or other changes made to any system. ‘Voluntary assisted dying’ is the terminology used in our context, rather than Medical Assistance in Dying, so we will use that term when referring to the Victorian system. There are several key differences between the Canadian and Victorian approaches that are important in relation to the debates addressed by Downie and Schuklenk. First, the emphasis in Victoria is on patient self-administration of the VAD …. (shrink)

When a belief set is contracted only some beliefs are eligible for removal. By introducing eligibility for removal as a new semantic primitive for contraction and combining it with epistemic entrenchment we get a contraction operator with a number of interesting properties. By placing some minimal constraint upon eligibility we get an explicit contraction recipe that exactly characterises the so called interpolation thesis, a thesis that states upper and lower bounds for the amount of information to be given (...) up in contraction. As a result we drop the controversial property of recovery. By placing additional constraints on eligibility we get representation theorems for a number of contraction operators of varying strength. In addition it is shown that recovery contraction is a special case that we get if eligibility is explicitly constructed in terms of logical relevance. (shrink)

As multiparty interactions with single courses of coordinated action, workplace meetings place particular interactional demands on participants who are not primary speakers as they work to initiate turns and to interactively coordinate with displays of recipiency from co-participants. Drawing from a corpus of 26 hours of videotaped workplace meetings in a midsized US city, this article reports on multimodal practices – phonetic, prosodic, and bodily-visual – used for coordinating turn transition and for consolidating recipiency in these specialized speech exchange systems. (...) Practices used by self-selecting non-primary speakers as they secure turns in meetings include displays of close monitoring of current speakers’ emerging turn structure, displays of heightened interest as current turns approach possible completion, and turn initiation practices designed to pursue and, in a fine-tuned manner, coordinate with displays of recipiency on the parts of other participants as well as from reflexively constructed ‘target’ recipients. By attending to bodily-visual action, as well as phonetics and prosody, this study contributes to expanding accounts for turn taking beyond traditional word-based grammar. (shrink)

According to the eligibility theory of meaning, often attributed to David Lewis, the referent of a predicate is the property that best balances the twin constraints of charity and eligibility, where eligibility is a function of metaphysical naturalness. This sort of metasemantics, which is motivated by its ability to resolve problems of indeterminacy and secure shared reference between disputing parties, can be somewhat friendly towards revisionary theories, since highly natural properties can act as “reference magnets,” securing our (...) reference despite some mismatch with usage. In this paper, I apply these considerations to normative ethics and argue that the theory of rule utilitarianism achieves a high balance of charity and eligibility. I proceed by comparing rule utilitarianism to two of its well-known rivals, act utilitarianism and Rossian pluralism. I show how the former achieves a high degree of eligibility but only at a significant cost of charity, while the latter does the opposite, fitting very nicely with our considered judgments but at the price of very low eligibility. Rule utilitarianism, on the other hand, strikes a good balance between these extremes; it assigns to our core moral term a relatively natural property without doing too much damage to our moral convictions. Thus, rule utilitarianism should be regarded as a promising moral theory by any philosopher who takes seriously considerations of eligibility and naturalness. (shrink)

Preclinical xenotransplantation research using genetically engineered pigs has begun to show some promising results and could one day offer a scalable means of addressing organ shortage. While it is a fundamental tenet of ethical human subject research that participants have a right to withdraw from research once enrolled, several scholars have argued that the right to withdraw from xenotransplant research should be suspended because of the public health risks posed by xenozoonotic transmission. Here, we present a comprehensive critical evaluation of (...) the claim that xenotransplant recipients should be required to waive their right to withdraw from lifelong biosurveillance. We conclude that if xenotransplantation requires participants to waive their right to withdraw, then clinical trials may not be justifiable, given the ethical and legal obstacles involved with doing so. Consequently, if clinical trials are permitted with a right to withdraw, then they may pose a significant public health risk. (shrink)

This chapter outlines David Lewis's favored foundational account of linguistic representation, and outlines and briefly evaluates variations and modifications. It gives an opinionated exegesis of Lewis's work on the foundations of reference: his interpretationism. The author looks at the way that the metaphysical distinction between natural and non‐natural properties came to play a central role in his thinking about language. Lewis's own deployment of this notion has implausible commitments. The chapter briefly considers a buck‐passing strategy involving fine‐grained linguistic conventions. Lewis (...) was no fan of primitive intentionality. Much of the Lewisian framework remains attractive. The overall select‐and‐project method, with its promise to deal even‐handedly with all linguistic intentionality, and its epistemic tractability, should be retained. Post‐Lewisian interpretationism results from emphasizing and retaining some of the virtues of Lewis's original proposal promises (e.g. universality and epistemic tractability), while compromising on others (e.g. metaphysical principle). (shrink)

Deciding whether to grant an expanded access request for a child whose sibling is enrolled in a gene therapy trial involves a number of complex factors: considering the best interests of the child, the psychosocial and economic impact on the family, and the concerns and obligations of researchers. Despite the challenges in coming to a substantively fair outcome in cases of discordant eligibility, creating a procedurally fair decision-making process to adjudicate requests is essential.

In emergency situations and while medical resources are sufficient, doctors are expected to prioritize and treat patients according to medical criteria only. In MASSCAL situations and when medical resources become insufficient, patient selection and prioritization changes. Rules of triage are applied with the aim of getting the best result possible under the circumstances, e.g., saving the largest number; collective health outweighs individual health. Still, according to the standard ethical principles, non-medical criteria should never influence the doctors’ decision of who will (...) be treated. In military contexts, so-called medical rules of eligibility (MROE) provide rules that include non-medical criteria. This chapter aims to analyze if, why, and under what circumstances it may be ethically acceptable to prioritize patients according to non-medical criteria. (shrink)

The scarcity of human organs requires the transplant community to make difficult allocation decisions. This process begins at individual medical centers, where transplant teams decide which patients to place on the transplant waiting list. Each transplant center utilizes its own listing criteria to determine if a patient is eligible for transplantation. These criteria have historically considered preexisting affective and psychotic disorders to be relative or absolute contraindications to transplantation. While attitudes within the field appear to be moving away from this (...) practice, there is no data to confirm that eligibility criteria have changed. There are no nationwide guidelines detailing the manner in which affective and psychotic disorders should impact transplant eligibility. Individual transplant centers thus form their own transplant eligibility criteria, resulting in significant inter-institution variability. Data from the 1990s indicates that the majority of transplant programs considered certain psychiatric illnesses, such as active schizophrenia, to be absolute contraindications to transplantation. A review of literature reveals that no comprehensive data has been collected on the topic since that time. Furthermore, the limited data available about current practices suggests that psychiatric illness continues to be viewed as a contraindication to transplantation at some transplant centers. In light of this finding, we review psychiatric literature that examines the impact of affective and psychotic disorders on transplant outcomes and conclude that the presence of these disorders is not an accurate predictor of transplant success. We then discuss the requirements of justice as they relate to the creation of a just organ allocation system. We conclude that transplant eligibility criteria that exclude patients with affective and psychotic disorders on the basis of their psychiatric diagnosis alone are unjust. Just listing criteria must incorporate only those factors that have a causative effect on posttransplant morbidity and mortality. Justice also demands that we eliminate current inter-institution practice variations in favor of national transplant eligibility criteria. Given the limited data available about current practices, we call for an updated study investigating the manner in which affect and psychotic disorders impact transplant eligibility determinations. (shrink)

Standard test questions allow the questioner to confirm an answer as correct, displaying their greater epistemic authority over the answerer. But the instructional power of test questions may prompt their use even when that asymmetry is neutralized or reversed, and the recipient ought to know as much as, or indeed more than, the questioner. I describe how staff who support clients with intellectual impairment use what I call ‘recipient-side’ test questions, where the questioner claims final authority over matters (...) in the recipient’s experience, even though it is the recipient who has prior entitlement and access to it. When recipient-side test questions fail, questioners may revert to the standard test question asymmetry by hinting at, or openly asserting, their own epistemic authority. (shrink)

Psychological stress can be both a help and a hindrance to wellbeing and performance in sport. The provision and receipt of social support is a key resource for managing adaptations to stress. However, extant literature in this area is largely limited to the recipient’s perspective of social support. Furthermore, social support is not always effective, with evidence suggesting it can contribute to positive, negative, and indifferent adaptations to stress. As such, we do not know how social support influences adaptations (...) to stress in sport. The social identity approach may explain how social support can lead to both positive and negative adaptations to stress. Our purpose in this study was to explore how social support and social identities influence adaptations to stress in a Rugby Academy Programme. Using qualitative methods within a naturalistic research paradigm, semi-structured interviews were conducted with Rugby Academy co-ordinators and players, and four focus groups were conducted with teams of support staff. Data were analyzed using reflexive thematic analysis, which generated seven sub-themes categorized into two higher-order analytical themes. Our results demonstrate that group-based perceptions of social support influence adaptations to stress. Specifically, whether social support influences positive, negative, or indifferent adaptations to stress depended on social factors influencing the nature of social support, and social factors influencing the provision and receipt of social support. These findings advance our understanding of how adaptations to stress are influenced by social support. Implications are offered for how organizations, teams, and practitioners can facilitate positive adaptations to stress in sport. (shrink)

A substantial part of Marion’s project in Being Given turns on a “triple epoché” wherein Marion brackets each part of the tripartite structure of the gift – the giver, the recipient and the given itself – to show that none of them is essential for thinking about the gift. In three separate variations, each element of the gift is bracketed individually, and in each of these instances the other two elements are specifically not bracketed. Indeed, Marion admits that the (...) reduction he proposes “demands, de jure, that one of the two [recipient or giver] remain in position of the transcendental I.” In this paper, I will argue that the rule is misleading and should be reformulated to indicate that a recipient is always required. I conclude with some suggestions for future work. (shrink)

This paper continues the discussion of three values of sport (safety, fairness, inclusion) that has developed around the theme of inclusion of transwomen in the female category in World Rugby, as discussed by Pike, Burke and Imbrišević. In contrast to their discussion, in which these three values have been seen from the limited perspective of the inclusion of one group of athletes into a specific category of one sport, they are here discussed in the context of the categorization in sport (...) in general, with a focus on constitutive and eligibility rules. Constitutive rules give a strong foundation for eligibility rules. From the perspective of eligibility rules, the value of inclusion is identified as the underlying main value, while fairness and safety are its functions. This view rehabilitates the value of inclusion and has implications for how we think about the inclusion of athletes in sport, and for the creation of categories. (shrink)

Open peer commentary on the article “Investigating Extended Embodiment Using a Computational Model and Human Experimentation” by Yuki Sato, Hiroyuki Iizuka & Takashi Ikegami. Upshot: The target article’s findings on the focus of attention in extending an agent’s body schema are consistent with those in developmental psychology and neuroscience on goal-directed action. The consequences of these findings are that embodiment can be extended in a variety of ways, not all of which require direct physical manipulation.

This paper outlines Lewis’s favoured foundational account of linguistic representation, and outlines and briefly evaluates variations and modifications. Section 1 gives an opinionated exegesis of Lewis’ work on the foundations of reference—his interpretationism. I look at the way that the metaphysical distinction between natural and non-natural properties came to play a central role in his thinking about language. Lewis’s own deployment of this notion has implausible commitments, so in section 2 I consider variations and alternatives. Section 3 briefly considers a (...) buck-passing strategy involving fine-grained linguistic conventions. (shrink)

We studied changes in eligibility criteria--the largest impediment to patient accrual--in two samples of clinical trials. Trials from the NSABP (National Surgical Adjuvant Breast and Bowel Program) and POG (Pediatric Oncology Group) were analyzed. After eliminating duplications, the criteria in each protocol were enumerated and classified according to a novel schema. NSABP trials contained significantly more criteria than POG trials, and added precision criteria (making study populations homogeneous) at a faster rate than POG studies. The difference between NSABP studies (...) (explanatory trials) and POG studies (pragmatic trials) suggest that large numbers of eligibility criteria are not necessary for quality studies. We recommend that: (1) the inclusion/exclusion criteria distinction be abandoned; (2) eligibility criteria be explicitly justified; (3) the need for each criterion be assessed when new trials are planned; (4) criteria in phase III trials restricting patient accrual be minimized; and (5) further research be done to assess the impact of criteria on generalizability. (shrink)

It is a common assumption in ethics that everyone is due equal access to basic human goods. In our modern society, at least since the French Revolution, healthcare is counted along with food, shelter, and security as such a basic good. Anyone suffering from a treatable life-threatening disease can therefore, be seen as having a prima facie claim on medical treatment.