RESUMOA climatologia está no centro de um dos debates mais polarizados da atualidade, apresentado como confronto entre os defensores da existência de um aquecimento global antropogênico e aqueles que rejeitam sua existência. A instituição chave para esse tema é o Painel Intergovernamental sobre Mudanças Climáticas, um corpo simultaneamente científico e político. O debate surge aí mesclado com a discussão política sobre as respostas adequadas ao aquecimento global. Mas, rechaçados nesse terreno, os negacionistas transpõem o debate para a mídia, onde mobilizam (...) a pseudociência para deslegitimar as conclusões das disciplinas científicas ligadas ao entendimento do clima. Temos, assim, uma produção consciente da ignorância em larga escala sobre o tema do aquecimento global, demandando o uso da agnotologia para desvendar o mecanismo de produção da ignorância. A climatologia revela-se, então, um campo exemplar para o estudo da inserção histórico-social do conhecimento científico e das tensões e trajetórias conflitivas no seu interior, dos dilemas éticos que coloca e das possibilidades universalistas do conhecimento científico na era da tecnociência. ABSTRACTClimatology is at the center of one of the most polarized debates of today. It is presented as a confrontation between supporters of the existence of anthropogenic global warming and those who deny its existence. The key institution for this theme is the Intergovernmental Panel on Climate Change, which is both a scientific and political body. In this context, the debate arises merged with the political discussion on appropriate responses to global warming. However, contested on this ground, the deniers transfer the debate to the media, mobilizing pseudo-science to delegitimize the conclusions of the scientific disciplines related to climate understanding. Therefore, we have a deliberate production of large-scale ignorance on this subject, which requires the use of agnotology to unravel it. Thus, climatology reveals itself an exemplary space to study the historical and social roots of scientific knowledge and the tensions and conflicting trajectories inside it, the ethical dilemmas posed and the universalist possibilities of scientific knowledge in the age of technoscience. (shrink)

This paper examines the use of case studies in ethics education. While not dismissing their value for specific purposes, the paper shows the limits of their use. While agreeing that case studies are narratives, although rather thin stories, the paper argues that the claim that case studies could represent reality is difficult to sustain. Instead, the paper suggests a way of using stories in ethics teaching that could be more real for students, while also giving them a way of thinking (...) about their own professional practices. The paper shows how the method can be used to develop a more critical and reflective practice for students in the health care professions. Some immediate problems with the method are discussed. (shrink)

Archaeologists have proposed that behavioral knowledge of a tool can be conceptualized as a “recipe”—a unit of cultural transmission that combines the preparation of raw materials, construction, and use of the tool, and contingency plans for repair and maintenance. This parallels theories in cognitive psychology that behavioral knowledge is hierarchically structured—sequences of actions are divided into higher level, partially independent subunits. Here we use an agent-based simulation model to explore the costs and benefits of hierarchical learning relative to holistic learning, (...) where entire behavioral sequences are learned in an all-or-nothing fashion, and diffusionist learning, where actions are completely independent. Hierarchical learning is favored under the reasonable assumptions that learning is associated with some degree of both error and cost, and that behavior can be grouped into subunits that repeat in one or more tool recipes. These general predictions can be tested in the archaeological and ethnographic record. Recent advances in evolutionary developmental biology have revealed a number of parallels between the hierarchically structured, recipe-like organization of behavioral knowledge that we examine here and the manner in which biological organisms develop. (shrink)

The annual cost of healthcare in the United States reached $2.5 trillion in 2009 (about 17.6% of GDP) with projections to 2019 of about $4.5 trillion (about 20% of likely GDP).

Can Rawlsian public reason sufficiently justify public policies that regulate or restrain controversial medical and technological interventions in bioethics (and the broader social world), such as abortion, physician aid-in-dying, CRISPER-cas9 gene editing of embryos, surrogate mothers, pre-implantation genetic diagnosis of eight-cell embryos, and so on? The first part of this essay briefly explicates the central concepts that define Rawlsian political liberalism. The latter half of this essay then demonstrates how a commitment to Rawlsian public reason can ameliorate (not completely resolve) (...) many of the policy disagreements related to bioethically controversial medical interventions today. The goal of public reason is to reduce the size of the disagreement by eliminating features of the disagreement that violate the norms of public reason. The norms of public reason are those norms that are politically necessary to preserve the liberal, pluralistic, democratic character of this society. What remains is reasonable disagreement to be addressed through normal democratic deliberative processes. Specific issues addressed from a public reason perspective include personal responsibility for excessive health costs, the utility of a metaphysical definition of death for organ transplantation, and the moral status of excess embryos generated through IVF and/or their use in medical research. (shrink)

Accelerated approval of aducanumab for mild Alzheimer's by the U.S. Food and Drug Administration on June 7, 2021, has generated substantial medical, scientific, and ethical controversy. That approval was contrary to the nearly unanimous judgment of the FDA's Advisory Committee that little reliable evidence existed of significant benefit, even though the drug did reduce β‐amyloid. Three major ethical problems were created by this approval: (1) Medicare resources would be unjustly squandered, given the drug's $56,000 annual price and the 3.1 million (...) older potential American patients needing the drug; (2) physicians will feel ethically compelled to provide the drug to desperate, insistent patients, given FDA approval and in spite of side effects of brain bleeds and brain swelling; (3) and false hopes are generated for patients. A needed corrective by the federal government would reduce reimbursement to the bare cost of producing the drug (plus only a modest profit) until a phase IV trial has been successfully completed. (shrink)

Abstract:Because the demand for intensive care unit (ICU) beds exceeds the supply in general, and because of the formidable costs of that level of care, clinicians face ethical issues when rationing this kind of care not only at the point of admission to the ICU, but also after the fact. Under what conditions—if any—may patients be denied admission to the ICU or removed after admission? One professional medical group has defended a rule of “first come, first served” in ICU admissions, (...) and this approach has numerous moral considerations in its favor. We show, however, that admission to the ICU is not in and of itself guaranteed; we also show that as a matter of principle, it can be morally permissible to remove certain patients from the ICU, contrary to the idea that because they were admitted first, they are entitled to stay indefinitely through the point of recovery, death, or voluntary withdrawal. What remains necessary to help guide these kinds of decisions is the articulation of clear standards for discontinuing intensive care, and the articulation of these standards in a way consistent with not only fiduciary and legal duties that attach to clinical care but also with democratic decision making processes. (shrink)

The phrase "personalized medicine" has a built-in positive spin. Simple genetic tests can sometimes predict whether a particular individual will have a positive response to a particular drug or, alternatively, suffer costly and debilitating side effects. But little attention has been given to some challenging issues of justice raised by personalized medicine. How should we determine who would have a just claim to access particular treatments, especially very expensive ones? How effective do those treatments need to be?If there were a (...) thick, bright line separating minimal responders from maximal responders, then we could allocate these treatments in a fair and cost-effective way. But there is no bright line. The .. (shrink)

I fundamentally agree with Childress et al. (2023) in the scenario they have constructed with Mr. J. None of the arguments they critically assess are ethically persuasive enough to justify removing...

This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must learn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democratic deliberation. Part I of this essay notes that rationing is a ubiquitous feature of our health care system at present, but it is mostly hidden (...) rationing, which is presumptively unjust. Part II argues that the need for health care rationing is inescapable. Although Oregon is flawed as a model of health rationing, it gives us worthy moral lessons for health reform at the national level, which I analyze and defend in Part III. The most significant of these lessons is the importance of rational democratic deliberation in articulating fair rationing protocols for a community. In Part IV I sketch the philosophic justification for this approach and respond to some important criticisms from Daniels. Keywords: cost containment, democratic deliberation, fairness, justice, rationing CiteULike Connotea Del.icio.us What's this? (shrink)

In this paper, I will defend an alternative account of disposition ascriptions influenced by considerations from possible worlds semantics for modals according to which disposition ascriptions express modals relations characterized by a particular restriction on accessible worlds. My focus will be on the "modal problem" for disposition ascriptions (precisely what kind of modality do these claims express?), and the approach I adopt reflects this starting point. Most analyses – like the Simple Conditional Analysis – have explained disposition ascriptions by suggesting (...) schematic truth-conditional equivalences with other modal claims in English. This only indirectly addresses the modal problem – for instance by first drawing a truth conditional equivalence between disposition ascriptions and counterfactuals and then explaining the modal relation expressed by counterfactuals. I will try to give a ‘direct’ answer to the modal question -- that is, to analyse disposition ascriptions in a general possible worlds framework in which we can compare the analysis to actual and possible analyses for other modals – in particular, counterfactuals. The framework I’ll use is a simple version of Angelika Kratzer’s relational analysis of modals. I'll focus on two problems that nicely connect the dispositional and the modal – (a) the challenge of purportedly ‘extrinsic dispositions,’ and (b) the problem of the "granularity" of possibilities we’re quantifying over (are they situation- or world-sized?). (shrink)

Health reform must include health care rationing, both for reasons of fairness and efficiency. Few politicians are willing to accept this claim, including the Clinton Administration. Brown and others have argued that enormous waste and inefficiency must be wrung out of our health care system before morally problematic cost constraining options, such as rationing, can be justifiably adopted. However, I argue that most of the policies and practices that would diminish waste and inefficiency include implicit (and therefore morally problematic) rationing. (...) Critics of rationing see as its most morally and psychologically troubling feature that an identified individual is denied potentially beneficial care. That psychic anguish may not be eliminable, and perhaps ought not be eliminated. But if rationing protocols are fairly adopted through a process of free and informed rational democratic deliberation to which all have access, the moral objections are largely overcome. Such a process is possible only if implicit rationing is recognized and rejected. Keywords: Justice, health care rationing, health reform, democratic decision-making CiteULike Connotea Del.icio.us What's this? (shrink)

This article explores Sylvia Wynter’s analysis of gender as a category differentially applied across the global color line and María Lugones’ account of the coloniality of gender. While Wynter’s and Lugones’s work offer consequential insights for queer, trans, and intersex studies and activism, they have deliberately engaged these particular discourses and histories of struggle in limited ways. Wynter analyzes the contradictions of Western feminists’ organizing against female genital cutting in Africa, but she does not link her conclusions to their ramifications (...) for activism against genital cutting on children deemed intersex. Lugones uses the existence of intersex people as a turning point in her critique of Aníbal Quijano when developing her concept of the coloniality of gender, but she does not go further to connect global intersex activism and decolonial feminist struggles. This article explores the work of Wynter and Lugones for their compatibility with trans and intersex studies and activism, and the places where their work can be furthered through insights from trans and intersex studies. It concludes that to move beyond the coloniality of gender requires trans and intersex liberation and that trans and intersex liberation must be understood in a broader decolonial feminist framework. (shrink)

Abstract:The American College of Physicians in its ethics manual endorsed the idea that physicians ought to improve their ability to provide care to their patients more parsimoniously. This elicited a critical backlash; critics essentially claimed that what was being endorsed was a renamed form of rationing. In a recent article, Tilburt and Cassel argued that parsimonious care and rationing are ethically distinct practices. In this essay I critically assess that claim. I argue that in practice there is considerable overlap between (...) what they term parsimonious care and what they define as rationing. The same is true of the Choosing Wisely campaign endorsed by the American Board of Internal Medicine. In both cases, if the goal is to control healthcare costs by reducing the use of marginally beneficial care that is not cost effective, then a public conversation about the justness of specific choices is essential. (shrink)

It's not only necessary, but possible, if the public can be educated.

Twenty-five years ago some young artists initiated V2, a contemporary interdisciplinary arts centre focusing on art and technology and its social, cultural relations. V2 focuses on the interference between media itself, and the social and cultural impact of (media) technology. In its projects V2 explores the relationship between the arts, science and technology by bringing together artists from different art disciplines, scientists and people from different practices thus initiating interdisciplinary working relations among them, this within concrete art projects. Research is (...) an important aspect of all activities within V2; it concerns presentation, hardware and software development, publications and artist in residencies and the education activities. V2 looks for the encounter between practice and theory within these projects. V2 operates within diverse (inter)national and local collaborations - some structural, some on a project basis. (shrink)

Recent years have seen a revival of interest in Michael Walzer's doctrine of ‘supreme emergency’. Simply put, the doctrine holds that, when a state confronts an opponent who threatens annihilation, it can be morally legitimate to violate one of the cardinal rules of the war convention – the principle of non-combatant immunity. Walzer cites the case of Britain's decision to bomb German cities in 1940 as a case in point. Although the theory of supreme emergency has been scrutinised, the historical (...) case that Walzer refers to has not been looked at in depth. This article seeks to remedy this problem by asking whether the principle actors involved in the decision to bomb German cities understood themselves to be in a supreme emergency. It argues that the British leadership never openly admitted that they were in fact targeting German civilians, and that the principle reason for this was a widespread belief that the British and American publics would not support such a campaign. As a result, throughout the war, the British government publicly maintained the fiction that the devastation of German cities was a collateral product of attacks on its industrial infrastructure. This, in turn, suggests that liberal societies – even those facing imminent destruction – do not tend to support a relaxing of the rules of non-combatant immunity, suggesting that the prohibition on deliberately killing non-combatants may be more embedded than has hitherto been thought. (shrink)

This book considers how 'affect', the experience of feeling or emotion, has developed as a critical concept within literary studies in different periods and through a range of approaches. Stretching from the classical to the contemporary, the first section of the book, 'Origins', considers the importance of particular areas of philosophy, theory, and criticism that have been important for conceptualizing affect and its relation to literature. Includes ancient Greek and Roman philosophy, eighteenth-century aesthetics, Marxist theory, psychoanalysis, queer theory, and postcolonial (...) theory. The chapters of the second section, 'Developments', correspond to those of the previous section and build on their insights through readings of particular texts. The final 'Applications' section is focused on contemporary and future lines of enquiry, and revolves around a particular set of concerns: media and communications, capitalism, and an environment of affective relations that extend to ecology, social crisis, and war. (shrink)

Typically, students are assessed on elements of their performance, and it is assumed that the sum of marks for these elements will be just as impressive as the students' whole performances. Examiners might expect more for a particular grade if they only see parts of the students' work separately. Two experiments were carried out comparing examiners' judgements of the grade-worthiness of candidates' A-level examination work at question paper level and at subject level. The results of both studies suggested that examiners (...) may have compensated to some extent for the different aspects of the subject tested in different question papers when they made holistic judgements, but did not make this compensation when they made question paper judgements. Tunnel vision effects are likely to be greater in the AS/A2 examinations than those found here, because the examinations will be broken into smaller parts. (shrink)

This paper contrasts the personal experiences of a man with learning disabilities and autism with staff in two different settings: a long-stay institution for people with learning disabilities, and the community. These experiences highlight some of the potential personal, professional and ethical conflicts facing staff working in learning disability services.

Galasso calls for “the actualization of the public health potential of precision medicine….as the best realistic contribution to health equity” (Galasso 2024, 83). Unfortunately, this is wishful th...

Theodor W. Adorno's late critical theory is often regarded as quietist and resignated. This article seeks to question this verdict through an analysis of both the diagnosis of time made by the author as of the relationship between theory and praxis outlined in Frankfurtian thinker's late works. It is suggested that instead of resigned, Adorno's critical theory is engaged either in processes of resistance to the latent barbarism, whether in specific improvements that could be achieved within the existing order. This (...) engagement, however, does not mean a mitigation of the thesis that the possibility of emancipation would be blocked. (shrink)

Park and Davies (2024) address the question of whether vaccine status can be an ethically legitimate criterion for the allocation of scarce medical resources, such as access to an ICU bed and venti...

Those who criticize the theory of thought-styles do admit their existence, but would rather see them as an obstacle to an “objective” perception, a kind of malum necessarium to be eliminated. Through an analysis of the example of serology it is, however, possible to demonstrate that the specific sociological structure of the community of serologists and the history of this discipline are intrinsically connected with a particular serological thought-style, and that the very content of scientific knowledge in this discipline stems (...) from its thought-style. It is impossible even to imagine a styleless scientific knowledge. (shrink)

The Dobbs decision has precipitated renewed medical, political, and professional interest in the issue of abortion. Because this decision handed responsibility for regulation of abortion back to the states, and because the states are enacting or have enacted policies that tend to be very permissive or very restrictive, the result has been legal and professional confusion for physicians and their patients. Medical education cannot resolve either the legal or ethical issues regarding abortion. However, medical education must prepare future physicians for (...) caring for patients seeking abortion-related services. Physicians must be prepared to interact appropriately (sensitively and with integrity) with patients or colleagues whose views on abortion differ significantly from their own. This essay describes our educational effort to achieve that objective. The motto that governed this exercise was “No Easy Answers.”. (shrink)

Este texto pretende apresentar reflexões acerca do pensamento em constelação proposto por Adorno para problematizar as práticas formativas colocadas em movimento nos contextos educativos. Para tanto, nos utilizamos da pesquisa bibliográfica para pensar criticamente sobre a formação dos sujeitos nos contextos educativos. Inspirados no pensamento adorniano nos reportamos ao conceito de constelação e, posteriormente, às categorias de emancipação e autorreflexão. As problematizações construídas nesse trabalho podem contribuir para o desvelamento da multiplicidade de questões que envolvem a complexidade do campo educativo (...) e dos sujeitos que ali se constituem. Indicam a necessidade de compreender que um conceito se entrelaça com outros conceitos, que ultrapassa a linearidade e a busca de um ponto de chegada. Nessa direção, é imprescindível redimensionar os processos de formação docente, ampliando as perspectivas de formação e promovendo experiências de autorreflexão da própria razão. Palavras chaves: Constelação. Emancipação. Autorreflexão. (shrink)

In this paper, I argue for the following points. First, all of us have a presumptive moral obligation to be organ donors if we are in the relevant medical circumstances at the time of death. Second, family members should not have the right to interfere with the fulfillment of that obligation. Third, the ethical basis for that obligation is reciprocity. If we want a sufficient number of organs available for transplantation, then all must be willing donors. Fourth, that likelihood is (...) diminished if individuals are entirely free to refuse to be organ donors but still would demand to be organ recipients. Fifth, although individuals would be ethically obligated to be organ donors, we still need to permit them to refuse to be organ donors. Sixth, to encourage individuals to stay within the organ donation system, we should have as a just and ethically justified policy denying individuals an organ transplant in the relevant medical circumstances if they have chosen to exit the organ donation system. Individuals would not be permitted to be organ recipients if they were unwilling to be organ donors. This is what it means to be part of what Rawls in Political liberalism (15-22) would refer to as a “fair system of social cooperation.” We refer to this as the “reciprocity requirement.”. (shrink)

We investigate a certain system of intuitionistic set theory from three points of view: an elementary set theory with bounded separation, a topos with distinguished inclusions, and a category of classes with a system of small maps. The three presentations are shown to be equivalent in a strong sense.

The paper questions the extent to which MacIntyre’s current ethical and political outlook should be traced to a project begun in After Virtue. It is argued that, instead, a critical break comes in 1985 with his adoption of a ‘Thomistic Aristotelian’ standpoint. After Virtue’s ‘positive thesis’, by contrast, is a distinct position in MacIntyre’s intellectual journey, and the standpoint of After Virtue embodies substantial commitments not only in conflict with, but antithetical to, MacIntyre’s later worldview-mostly clearly illustrated in the contrasting (...) positions on moral conflict and tragedy. (shrink)

The United States has dealt with issues on immigration for over a century. The largest wave of immigration before the late 20th century began in the 1870s and peaked in 1910. In the past few decades, the United States has dealt overwhelmingly with the issue of undocumented immigrants. This challenge has led to different approaches to immigration reform and to help regulate the influx of immigrants across its borders. Generally, however, there have been two major sets of voices indicative of (...) the opinion of the American populace. One group has called for tighter immigration rules to prevent the easy entry of undocumented immigrants who have been branded as criminals. The other group has taken a moral and ethical stance to permit the entry of immigrants and to formulate a process for their legal residency. These two opposing views have triggered an ongoing discussion on undocumented immigrants. (shrink)

I review Shlomi Segall's book 'Why Inequality Matters'. I argue that it conclusively establishes that alongside egalitarians, prioritarians and sufficientarians must sometimes regard a prospect as better (in at least one respect) when it is not better (in terms of well-being) for anyone. Sufficientarians and prioritarians must therefore relinquish a treasured anti-egalitarian argument. It also makes a powerful case that among these three views, egalitarians are in the best position to explain such departures from what is in each person’s prudential (...) interest. For egalitarians can point to the natural idea that it is unfair when, due to pure chance, some fare much better than others. By contrast, it remains unclear what value, if any, sufficientarians or prioritarians can appeal to in order to justify their departures from what best promotes people’s well-being. (shrink)

The sociological dimension of science is studied using the discovery of the Wasserman reaction and its accidental application as a test for syphilis as a basis, ...

This book presents an analysis of the institutional development of selected social science and humanities disciplines in Argentina, France, Germany, Hungary, Italy, the Netherlands, Sweden and the United Kingdom. Where most narratives of a scholarly past are presented as a succession of ‘ideas,’ research results and theories, this collection highlights the structural shifts in the systems of higher education, as well as institutions of research and innovation within which these disciplines have developed. This institutional perspective will facilitate systematic comparisons between (...) developments in various disciplines and countries. Across eight country studies the book reveals remarkably different dynamics of disciplinary growth between countries, as well as important interdisciplinary differences within countries. In addition, instances of institutional contractions and downturns and veritable breaks of continuity under authoritarian political regimes can be observed, which are almost totally absent from narratives of individual disciplinary histories. This important work will provide a valuable resource to scholars of disciplinary history, the history of ideas, the sociology of education and of scientific knowledge. (shrink)

You know what someone else is thinking and feeling by observing them. But how do you know what you are thinking and feeling? This is the problem of self-knowledge: Alex Byrne tries to solve it. The idea is that you know this not by taking a special kind of look at your own mind, but by an inference from a premise about your environment.