In recent work, Louis deRosset (Philosophical Studies 149:73–97, 2010) has argued that priority theorists, who hold that truths about macroscopic objects can be metaphysically explained without reference to such things, cannot meet an independently motivated constraint upon good explanation. By clarifying the nature of the priority theorist’s project, I argue that deRosset’s argument fails to establish its conclusion.

There is ongoing ethical and legal debate about withdrawing life sup- port for patients with disorders of consciousness (DOCs). Frequently fu- eling the debate are implicit assumptions about the value of life in a state of impaired consciousness, and persistent uncertainty about the quality of life (QoL) of these persons. Yet there are no validated methods for assessing QoL in this population, and a significant obstacle to doing so is their inability to communicate. Recent neuroscientific discoveries might circumvent that problem (...) and help shed light on QoL in DOCs. There is an ethical imperative to prioritize QoL research in this patient population, to provide evidence to inform treatment, research, and end of life decisions. A minimalist and pragmatic model of QoL is proposed, targeting positive and negative affect as domains for which there is po- tential to reach across the communication gap, and restore to these voiceless persons some measure of control. (shrink)

Michail Peramatzis presents a new interpretation of Aristotle's view of the priority relations between fundamental and derivative parts of reality, following ...

Recently, Jonathan Tallant has argued that we should reject priority views, which hold that some objects are fundamental and others are dependent. Tallant’s argument relies on two proposed mereological possibilities: a gunky world, where everything has a proper part, and a junky world, where everything is a proper part. In this paper, I criticise Tallant’s argument and argue that neither of these possibilities threaten priority views per se; at most, they threaten only particular forms of priority views (...) that contain a certain independently controversial assumption. First, I defend priority pluralism against the gunk argument: the genuine conceivability of gunk can be plausibly doubted on the basis of a certain principle concerning metaphysical possibility, and even if this principle is false, the possibility of a gunky world poses no devastative problem for pluralism per se because it can be considered to be consistent with nonatomism. Second, I defend priority monism against the junk argument: the possibility of a junky world poses no devastative problem for monism per se because it can be considered to be consistent with nonholism in a twofold sense. Finally, I show that even monism as defined as genuinely holistic can be plausibly defended against the junk argument once the claim of the possible nonexistence of the maximal whole is reinterpreted based on the priority-based conception of existence. (shrink)

Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: Ethical approval (...) granted by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

Market crises amplify fear, disrupting rational decision-making of stock investment. This study examines the relationship between investors’ information priorities—such as intuition, company performance, technical analysis, and other factors—and their fear responses (freeze, flight, and hiding) during market crashes. Using the Bayesian Mindsponge Framework (BMF) to analyze data from 1,526 investors in China and Vietnam, the findings reveal complex dynamics. We found positive associations between investors’ prioritization of social influence and intuition for investment decision-making with being freeze (i.e., not knowing what (...) to do with the owned stock), between prioritization of professionals’ evaluation and intuition with fleeing (i.e. giving up stock investment permanently), and between prioritization of professionals’ evaluation and social influence with hiding (i.e., stopping investing in stock for a while). In contrast, prioritization of companies’ performance metrics (e.g., net profit, debt, etc.) was negatively associated with being freeze, fleeing, and hiding. Meanwhile, prioritization of professionals’ evaluation, technical analysis, and liquidity was negatively associated with being freeze, fleeing, and hiding, respectively. The study highlights the importance of disseminating transparent, accurate information through government and media channels, along with implementing financial education programs, to promote rational investment decisions and reduce fear-driven behaviors. (shrink)

John Rawls’s thesis that a certain package of basic liberties should be given lexical priority is of great interest for legal and political philosophy, but it has received relatively little defense from Rawls or his supporters. In this paper, I examine three arguments for the thesis: the first is based on the two ‘moral powers’; the second, on the social bases of self-respect; and the third, on a Kantian notion of autonomy. I argue none of these accounts successfully establishes (...) 1) the distinct claim of lexical priority, 2) for the complete package of basic liberties, on the basis of reasons that are appropriately public. In turn, I propose an alternative argument, in support of those two claims, based on the social or ‘relational’ conception of equality. (shrink)

According to some views of reality, some objects are fundamental and other objects depend for their existence upon these fundamental objects. In this article, I argue that we have reason to reject these views.

I address an intuition commonly endorsed by metaphysicians, that there must be a fundamental layer of reality, i.e., that chains of ontological dependence must terminate: there cannot be turtles all the way down. I discuss applications of this intuition with reference to Bradley’s regress, composition, realism about the mental and the cosmological argument. I discuss some arguments for the intui- tion, but argue that they are unconvincing. I conclude by making some suggestions for how the intuition should be argued for, (...) and discussing the ramifications of giving the justification I think best. (shrink)

Testimonial injustice occurs when bias against the credibility of certain social identities results in discounting of their contributions to deliberations. In this analysis, we describe testimonial injustice against women and how it figures in macroallocation procedure. We show how it harms women as deliberators, undermines the objective of inclusivity in macroallocation and affects the justice of resource distributions. We suggest that remedial action is warranted in order to limit the effects of testimonial injustice in this context, especially on marginalised and (...) disadvantaged groups, and propose three areas for action, whose implementation might feasibly be achieved by those immediately involved in macroallocation. (shrink)

One‐third of all human deaths are due to poverty‐related causes, to malnutrition and to diseases that can be prevented or cured cheaply. Yet our politicians, academics, and mass media show little concern for how such poverty might be reduced. They are more interested in possible military interventions to stop human rights violations in developing countries, even though such interventions – at best – produce smaller benefits at greater cost. This Western priority may be rooted in self‐interest. But it engenders, (...) and is sustained by, a deeply flawed moral presentation of global economic cooperation. The new global economic order we impose aggravates global inequality and reproduces severe poverty on a massive scale. On any plausible understanding of our moral values, the prevention of such poverty is our foremost responsibility. (shrink)

I will defend two claims. First, Schaffer's priority monism is in tension with many research programs in quantum gravity. Second, priority monism can be modified into a view more amenable to this physics. The first claim is grounded in the fact that promising approaches to quantum gravity such as loop quantum gravity or string theory deny the fundamental reality of spacetime. Since fundamental spacetime plays an important role in Schaffer's priority monism by being identified with the fundamental (...) structure, namely the cosmos, the disappearance of spacetime in these views might undermine classical priority monism. My second claim is that priority monism can avoid this issue with two moves: first, in dropping one of its core assumptions, namely that the fundamental structure is spatio-temporal, second, by identifying the connection between the non-spatio-temporal structure and the derivative spatio-temporal structure with mereological composition. (shrink)

The aim of this article is to study the relationship between Epicureanism and pandemic priority-setting and to explore whether Epicurus's philosophy is compliant with the later developed utilitarianism. We find this aim interesting because Epicurus had a different way of valuing death than our modern society does: Epicureanism holds that death—understood as the incident of death—cannot be bad (or good) for those who die (self-regarding effects). However, this account is still consistent with the view that a particular death can (...) be bad for everyone else but those who die, such as family, friends, and society (other-regarding effects). During the pandemic, the focus has been on the number of deaths more than on the suffering and reduced well-being of those infected and the rest of society. However, since the pandemic requires prioritization, it is, on a utilitarian account, important to consider priorities that do the most good overall. In this article, we approach the harm of death from an Epicurean point of view, seeking to flesh out potential implications for pandemic priority-setting, and healthcare in general, using a case study of COVID-19 priority-setting. We also explore whether this would conflict with utilitarianism. We conclude that an Epicurean pandemic priority-setting approach would be different but, surprisingly, not radically different from many of the actual priority-setting decisions we saw under the COVID-19 pandemic. (shrink)

Call the claim, common to many in the Christian intellectual tradition, that Christ, in virtue of his created human intellect, had certain, infallible, exhaustive foreknowledge the Foreknowledge Thesis. Now consider what I will call the Conditional: if the Foreknowledge Thesis is true, then Christ's created human will was not free. In so far as many, perhaps all, of the people who affirm the Foreknowledge Thesis also wish to affirm the freedom of Christ's human will, the truth of the Conditional would (...) be most unwelcome to them. I consider an argument in support of the Conditional; I argue that it is not successful. (shrink)

This chapter explores the relationship between knowing-how and skill, as well other success-in-action notions like dispositions and abilities. I offer a new view of knowledge-how which combines elements of both intellectualism and Ryleanism. According to this view, knowing how to perform an action is both a kind of knowing-that (in accord with intellectualism) and a complex multi-track dispositional state (in accord with Ryle’s view of knowing-how). I argue that this new view—what I call practical attitude intellectualism—offers an attractive set of (...) solutions to various puzzles concerning the connections between knowing-how and abilities and skills to perform intentional actions. (shrink)

The priority of liberty has always played a central role in John Rawls's political theory. This chapter reviews Rawls's three arguments for the priority of liberty in Theory and argues that two of them do indeed fail (either in whole or in part) because of two types of error. It presents a partial reconstruction of the hierarchy argument, and demonstrates that our highest‐order interest in the development and exercise of rationality follows naturally from the Kantian commitment to autonomy (...) that Rawls expresses in Theory. The chapter discusses an apparent problem with the scope of the hierarchy argument: it does not offer a particularly compelling defense of the priority of the basic political liberties, including the rights to vote and hold public office. The chapter also discusses the implications of the priority of liberty for the American practice of civil libertarianism. (shrink)

In this article, we aim to map out the complexities which characterise debates about the ethics of vaccine distribution, particularly those surrounding the distribution of the COVID-19 vaccine. In doing so, we distinguish three general principles which might be used to distribute goods and two ambiguities in how one might wish to spell them out. We then argue that we can understand actual debates around the COVID-19 vaccine – including those over prioritising vaccinating the most vulnerable – as reflecting disagreements (...) over these principles. Finally, we shift our attention away from traditional discussions of distributive justice, highlighting the importance of concerns about risk imposition, special duties, and social roles in explaining debates over the COVID-19 vaccine. We conclude that the normative complexity this article highlights deepens the need for decision-making bodies to be sensitive to public input. (shrink)

'Everyone knows what attention is’ according to William James. Much work on attention in psychology and neuroscience cites this famous phrase only to quickly dismiss it. But James is right about this: ‘attention’ was not introduced into psychology and neuroscience as a theoretical concept. I argue that we should therefore study attention with broadly the same methodology that David Marr has applied to the study of perception. By focusing more on Marr's Computational Level of analysis, we arrive at a unified (...) answer to the question of what attention is, what role it plays in the mind, and why organisms like us have that capacity. I propose a methodology for studying attention at Marr's Computational Level that optimizes in a three-dimensional space: it should capture core aspects of our first-person experience of attention, be explanatorily powerful in psychology and neuroscience, and fertile in an interdisciplinary context. I show how this methodology leads to what I call the priority structure account of attention. Attention is what organizes current information to make it more useful for the organism. We can identify it by four features. Attention, in this way, helps a cognitive system to integrate its informational state with its current motivational state. I describe how this account improves on alternatives and shows why attention is a useful concept in many disciplines and for connecting them. -/- This article is categorized under: Philosophy > Psychological Capacities Psychology > Attention Philosophy > Foundations of Cognitive Science. (shrink)

Published accounts of specific priority-setting projects in healthcare are relatively few. This article chronicles the collaborative efforts of a professional practice lead and a bioethicist to strengthen the priority-setting process for a specific home care service. The project included two features not often reported in other priority-setting projects: the entire “frontline team” was involved for the project’s duration, and a group of parents was canvassed for their views. Informed by both Daniels’s “accountability for reasonableness” approach and challenges (...) levied against it, the article explains the evolution of an assessment procedure, eligibility and priority criteria, and guiding substantive principles and concludes with the “lessons learned” by the project leads. (shrink)

The Social Value Judgments consultation document reveals NICE’s failure to understand its role in healthcare prioritisationThe National Institute for Health and Clinical Excellence has published a draft guideline, Social Value Judgments: Guidelines for the Institute and its Advisory Bodies , which outlines the ethical framework that will guide its decision making in the future.1 NICE guidance has a profound effect upon the delivery of health care within the National Health Service so it is crucial that an overarching guideline such as (...) this is suited to the task that it needs to perform. In this paper we argue that NICE has misunderstood the way in which its advice fits into prioritisation decisions. This misunderstanding is amplified by its views about the ethical principles that should apply to prioritisation and, in particular, its failure to appreciate the role of fair processes in prioritisation.The national and international standing of NICE means that the definitive version of Social Value Judgments: Guidelines for the Institute and its Advisory Bodies is likely to have influence beyond the institute itself. There is much to welcome about the document, not least the acknowledgement that there are important ethical dimensions to NICE’s decision making. Indeed, the significance of the document lies in the fact that NICE is attempting to create an explicit ethical framework for funding decisions.There is, however, much that is of concern. Although John Harris has made some important points about the NICE position on age and sex,2 there are other important problems that need to be discussed. First, there appears to be confusion over the nature of the funding decisions taken by NICE and, as a result, the role of its guideline. It is of vital importance that professionals and public alike understand the precise nature of …. (shrink)

The study examined the question of who should make decisions for a National Health Scheme about the allocation of health resources when the health states of beneficiaries could change because of adaptation. Eight semi-structured small group discussions were conducted. Following focus group theory, interviews commenced with general questions followed by transition questions and ended with a ‘focus’ or ‘key’ question. Participants were presented with several scenarios in which patients adapted to their health states. They were then asked their views about (...) the appropriate role of the public, patients and health professionals in making social judgements of quality of life. After discussion and debate, all groups were asked the key question: ‘In light of adaptation, who should evaluate quality of life for the purpose of setting priorities in the allocation of health care?’ In all groups participants presented strong arguments for and against decision making by patients, the public and health professionals. However, most groups thought a representative body which included a range of perspectives should make the relevant judgements. This is at odds with the recommendations in most national pharmaceutical guidelines. The main conclusion of the paper is that health economists and other researchers should explore the possibility of adopting a deliberative, consensus-based approach to evaluating health-related quality of life when such judgements are to be used to inform priority setting in a public system. (shrink)

If funding allocation is an indicator of a field’s priorities, then the priorities of the field of bioethics are misaligned because they perpetuate injustice. Social justice mandates priority for the factors that drive systematic disadvantage, which tend not to be the areas supported by funding within academic bioethics. Current funding priorities violate social justice by overemphasizing technologies that aim to enhance the human condition without addressing underlying structural inequalities grounded in racism, and by deemphasizing areas of inquiry most frequently (...) pursued by Scholars of Color. This lack of attention to upstream determinants of health in bioethics research perpetuates a gap in the resources needed to understand the experiences of communities disproportionately experiencing poor health, which is itself a form of epistemic injustice. Both social and epistemic injustices are apparent in the impact of these funding priorities on people of color, both in the public and in the bioethics community. (shrink)

This paper attempts to show how certain approaches in Values Based Practice duplicate key moves in liberal political theory.

According to the priority view, or prioritarianism, it matters more to benefit people the worse off they are. But how exactly should the priority view be defined? This article argues for a highly general characterization which essentially involves risk, but makes no use of evaluative measurements or the expected utility axioms. A representation theorem is provided, and when further assumptions are added, common accounts of the priority view are recovered. A defense of the key idea behind the (...) priority view, the priority principle, is provided. But it is argued that the priority view fails on both ethical and conceptual grounds. (shrink)

In a series of articles, Thomas Dunfee defended the view that managers are permitted and at times, required, to utilize corporate resources to alleviate human misery even if this is at the expense of shareholder interests. In this article, I summarize Dunfee's defense of this view, raise some questions about his account and propose ways in which to answer these questions. The aim of this article is to highlight one of Dunfee's contributions to the debate about corporate governance and corporate (...) responsibility. (shrink)

성격적 탁월함의 본성(physis)을 설명하기 위해 아리스토텔레스가 도입하는 중용은 두 가지 차원에서 언급된다. 하나는 행위자의 품성 상태(hexis)의 차원에서, 다른 하나는 그 행위자가 구체적 상황에서 행하고 표출하는 개별적 행위와 감정의 차원에서 제시되는 것이다. 우리는 전자를 ‘반응으로서 중용’, 후자를 ‘상태로서 중용’으로 구분할 수 있다. 그런데, 아리스토텔레스가 성격적 탁월함을 설명하기 위해 도입한 중용 개념은 본질적으로 어떤 차원의 중용일까? 일단의 연구자들은 탁월한 사람이 중용적인 이유는 그의 개별적 행위와 감정의 중용적 속성에 기인한다고 전제하면서, 아리스토텔레스가 궁극적으로 의미하는 중용은 ‘반응으로서의 중용’이라고 주장한다. 이러한 입장을 우리는 ‘반응우선성 논지’로 부를 (...) 수 있다. 이 글에서 우리는 ‘반응우선성 논지’가 많은 학자들에 의해 주목받고 있기는 하지만, 간과할 수 없는 중요한 오류를 다수 내포하고 있음을 밝히고, 이에 재고의 필요성을 제기할 것이다. (shrink)

Thomas Pogge argues that John Rawls’s priority of liberty rule is not constraining enough: it permits morally unacceptable restrictions of basic liberties. Because of this, Pogge claims that Rawls fails in his two central ambitions: to construct a moral conception that (1) opposes utilitarianism and (2) matches his judgments in reflective equilibrium. Pogge attributes this error to Rawls’s “purely recipient-oriented theorizing”—assessing a society’s basic structure based on how its citizens fare. I argue that Rawls’s theory does not allow restrictions (...) of liberty that are offensive to moral considerations. I then explain how my arguments against Pogge show that Rawls’s idea of reflective equilibrium is crucial for assessing a society’s basic structure and how it follows from this that Rawls’s theorizing is not purely recipient-oriented. (shrink)

In this essay, we notice that the priority of persons, the unbridgeable political gap between persons and mere things, corresponds to a special sort of moral and legal treatment for persons, namely, as irreplaceable individuals. Normative language that conflates the category of person with fungible kinds of being can thus appear to justify destroying and replacing human beings, just as we do with things. Lethal consequences may result, for example, from a common but improper extension of the word “value” (...) to persons. Theattitude and act called “respect” brings forth much more adequately than “value” the distinctively individual priority of persons, allowing our common humanity to be a reason for each person’s separate significance. Unless we focus on the respect-worthiness of humanlife rather than on its value, we will not be able to argue coherently against those who think its destruction permissible. (shrink)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content (...) analysis. The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

As synthetic biology develops into a promising science and engineering field, we need to have clear ideas and priorities regarding its safety, security, ethical and public dialogue implications. Based on an extensive literature search, interviews with scientists, social scientists, a 4 week long public e-forum, and consultation with several stakeholders from science, industry and civil society organisations, we compiled a list of priority topics regarding societal issues of synthetic biology for the years ahead. The points presented here are intended (...) to encourage all stakeholders to engage in the prioritisation of these issues and to participate in a continuous dialogue, with the ultimate goal of providing a basis for a multi-stakeholder governance in synthetic biology. Here we show possible ways to solve the challenges to synthetic biology in the field of safety, security, ethics and the science-public interface. (shrink)