Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

There is currently a debate over whether cognitive architecture is classical or connectionist in nature. One finds the following three comparisons between classical architecture and connectionist architecture made in the pro-connectionist literature in this debate: (1) connectionist architecture is neurally plausible and classical architecture is not; (2) connectionist architecture is far better suited to model pattern recognition capacities than is classical architecture; and (3) connectionist architecture is far better suited to model the acquisition of pattern recognition capacities by learning than (...) is classical architecture. If true, (1)-(3) would yield a compelling case against the view that cognitive architecture is classical, and would offer some reason to think that cognitive architecture may be connectionist. We first present the case for (1)-(3) in the very words of connectionist enthusiasts. We then argue that the currently available evidence fails to support any of (1)-(3). (shrink)

Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful perspective on the (...) field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. (shrink)

Journal of the History of Biology provides a fifty-year long record for examining the evolution of the history of biology as a scholarly discipline. In this paper, we present a new dataset and preliminary quantitative analysis of the thematic content of JHB from the perspectives of geography, organisms, and thematic fields. The geographic diversity of authors whose work appears in JHB has increased steadily since 1968, but the geographic coverage of the content of JHB articles remains strongly lopsided toward the (...) United States, United Kingdom, and western Europe and has diversified much less dramatically over time. The taxonomic diversity of organisms discussed in JHB increased steadily between 1968 and the late 1990s but declined in later years, mirroring broader patterns of diversification previously reported in the biomedical research literature. Finally, we used a combination of topic modeling and nonlinear dimensionality reduction techniques to develop a model of multi-article fields within JHB. We found evidence for directional changes in the representation of fields on multiple scales. The diversity of JHB with regard to the representation of thematic fields has increased overall, with most of that diversification occurring in recent years. Drawing on the dataset generated in the course of this analysis, as well as web services in the emerging digital history and philosophy of science ecosystem, we have developed an interactive web platform for exploring the content of JHB, and we provide a brief overview of the platform in this article. As a whole, the data and analyses presented here provide a starting-place for further critical reflection on the evolution of the history of biology over the past half-century. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

The question of what political system best suites post colonial/independent African states remain alive and ever more pertinent particularly in the face of failed attempts at democratisation. Kwasi Wiredu notes that the adversarial nature of Western democratic practices along party political lines may not be well suited for African politics. Instead he suggests that the practice of consensual democracy as practised in the traditional Ashanti society may be more appropriate. Emmanuel Eze raises three objections against Wiredu’s account of consensual democracy. (...) This paper seeks to respond to Eze’s objections and argue that consensual democracy may have more appeal than Eze is prepared to concede. (shrink)

In vitro fertilization (IVF) involves making embryos outside of the human body, which has spurred debate about the status of the embryo, embryo research and donation. We explore couples’ perceptions about embryos and their thoughts and acceptability about various disposition decisions in Norway. Based on an ethnographic study including interviews and observations in an IVF clinic, we show that couples do not perceive their pre-implantation IVF embryos to be human lives; rather, they consider successful implantation the start of life. We (...) suggest that this response indicates a change in the perception of the human embryo or the fertilised egg fromincipient life—a viewpoint that was dominant in the discussions of embryo research in the 1980s and 1990s. We also show how this view of the pre-implantation embryo elucidates why donating embryos to research appears acceptable but donating to other infertile couples seems rather difficult. Before transfer to a woman’s uterus, the embryo exists in a liminality; it is not yet human life but a living cell with potential for both researchandpregnancy. When an embryo is implanted and pregnancy is confirmed, human life activates; the embryo becomes potential kin, influencing couples’ struggles with donating embryos to other couples. (shrink)

Volume 20, Issue 4, May 2020, Page 71-73.

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

In addition to facing the known competitors in the formal economy, entrepreneurs must also be concerned with rivalry emanating from the informal economy. The informal economy is characterized by actions outside the normal scope of commerce, such as unsanctioned payments and gift-giving, as means of influencing competition. Scholars and policy makers alike have an interest in mitigating the impacts of such informal activity in that it might present an obstacle for legitimate commerce. Received theory suggests that country institutions can enable (...) and constrain productive activity, and, in doing so, influence competitive obstacles in a country. Leveraging 13,670 responses from entrepreneurs distributed across 59 countries, we provide evidence that two particular types of enabling institutions, countries’ property rights regulations and cooperative actions, are useful for lowering the obstacles presented by informal activity. We also find evidence that two constraining institutions, economic and financial regulations lead to more obstacles presented by informal activity. We describe implications for entrepreneurs, policy makers, and future researchers stemming from these findings. (shrink)

This paper examines the standard conceptualizations of the notion of hallucination in light of various non-ordinary phenomenological patterns associated with altered states of consciousness induced by psychoactive agents. It is argued that in general, the conceptualizations encountered in the literature do not do justice to the richness and complexity that the psychological phenomenology actually exhibits. A close inspection of this phenomenology reveals some pertinent distinctions which are usually not made in the scientific literature. On the one hand, the discussion is (...) based on first-hand experiences and, on the other hand, it is grounded in empirical and theoretical cognitive investigations of the phenomenology of human consciousness. Theoretically, the discussion is grounded in an approach highlighting the centrality of experience, meaning and action in cognition. (shrink)

Much of the opinion scandalized by recent reports of kidneys being sold for transplant is significantly inconsistent. The sale of kidneys is not substantially different from practices espoused, and indeed endorsed, by many of those who condemn the former. Our moral concern, I suggest, needs to focus on the customer's actions rather than the seller's; and on the implications for larger questions of the considerations to which this gives rise.

Denne artikkelen tar utgangspunkt i et skille mellom samfunnsstrukturer som avgrenser legers skjønnsmessige utfoldelse på den ene siden, og profesjonens tilrettelegging for kultiveringen av erkjennelsesmessige ferdigheter på den annen. Ved å videreføre H. Grimen og A. Molanders anvendelse av S.E. Toulmins modell for praktisk resonnering i en klinisk kontekst redegjør jeg for legeskjønnets multidimensjonale, epistemiske struktur. Gjennomgangen viser hvordan skjønnsanvendelse i legerollen kan analyseres i henhold til en fagteknisk, en distributiv og en relasjonell dimensjon. Mot denne bakgrunnen diskuterer jeg så (...) spenninger som oppstår i skjæringspunktet mellom strukturering og kultivering av skjønnets ulike dimensjoner. Diskusjonen tydeliggjør at den medisinske profesjonen ikke kan betraktes som en selvtilstrekkelig premissleverandør når det gjelder å sikre adekvat kultivering av medlemmenes skjønnsutøvelse i en klinisk kontekst. Ved å synliggjøre og vektlegge de relevante profesjonseksterne bidragene i profesjonens pågående selvregulering kan befolkningens berettigete tillit til profesjonen styrkes ytterligere.Nøkkelord: strukturelt skjønn, epistemisk skjønn, profesjon, selvregulering, tillitEnglish summary: In Between Structures of Society and Profession: On Delimitation, Cultivation and Premises for Adequately Exercising Judgment in the Role as PhysicianThe point of departure of this article is a distinction between societal structures that delimit the discretion of the physician on the one hand and the profession's arrangements for the cultivation of the physician's judgment on the other. By developing H. Grimen and A. Molander's application of S.E. Toulmin's model for practical reasoning in a clinical context, the multi-dimensional epistemic structure of the physician's judgment in terms of technical, distributive, and relational judgment is accounted for. Against this backdrop, tensions emerging in the intersection between delimitation and cultivation of professional judgment in its various dimensions are discussed. The discussion clarifies that the medical profession is not a self-sufficient provider when it comes to ensuring an adequate cultivation of its members' judgment in a clinical context. It is argued that by emphasising and implementing the relevant external contributions to the profession's ongoing self-regulation, the public's justified trust in the medical profession can be strengthened. (shrink)

Screening of newborns for permanent congenital or early-onset hearing impairment has emerged as an essential component of neonatal care in developed countries, following favourable outcomes from early intervention in the critical period for optimal speech and language development. Progress towards a similar programme in developing countries, where most of the world’s children with hearing impairment reside, may be impeded by reservations about the available level of support services and the possible effect of the prevailing healthcare challenges. Ethical justification for the (...) systematic introduction of screening programmes for hearing in newborns based on the limitations in current primary prevention strategies, lack of credible alternative early-detection strategies and the incentives for capacity-building for the requisite support services is examined. (shrink)

Char et al. describe an interesting and useful approach in their paper, “Identifying ethical considerations for machine learning healthcare applications.” Their proposed framework, which see...

In its most basic form, Simple Reliabilism states that: a belief is justified iff it is formed as the result of a reliable belief-forming process. But so-called New Evil Demon cases have been given as counterexamples. A common response has been to complicate reliabilism from its simplest form to accommodate the basic reliabilist position, while at the same time granting the force of NED intuitions. But what if despite initial appearances, Simple Reliabilism, without qualification, is compatible with the NED intuition? (...) What we can call the Dispositionalist Response to the New Evil Demon problem is fascinating because it contends just that: Simple Reliabilism is fully compatible with the NED intuition. It is claimed that all we need to do to recognize their compatibility is appreciate that reliability is a dispositional property. In this paper I shall critically evaluate the Dispositionalist proposal. (shrink)

In The Realm of Reason (2004), Christopher Peacocke develops a “generalized rationalism” concerning, among other things, what it is for someone to be “entitled”, or justified, in forming a given belief. In the course of his discussion, Peacocke offers two arguments to the best explanation that aim to undermine scepticism and establish a justification for our belief in the reliability of sense perception, respectively. If sound, these ambitious arguments would answer some of the oldest and most vexing epistemological problems. In (...) this paper I will evaluate these arguments, concluding that they are inconclusive at best. Despite offering some interestingly original arguments, Peacocke gives us no reason to think that scepticism is false, and that perception is generally reliable. (shrink)

ABSTRACT In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision‐making competence and 2) the practice of surrogate decision‐making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because of ‘structural (...) arbitrariness’ in the whole process of how we assess decision‐making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision‐ making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision‐making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non‐competent others. (shrink)

Transformations in the biological, medical and legal processes of infertility, substantial modifications in family structure and the advancement of methods and techniques of reproductive technology will affect the next step in both legal and medical terms to address the regulation of bioethics and law in Kosovo. There is a need to establish perspectives in both ethical and professional terms, since the Republic of Kosovo is in the process of drafting a Civil Code. Many of these issues have been raised and (...) addressed during the review and evaluation of family law in the context of harmonisation and inclusion of this law in the Civil Code of the Republic of Kosovo. During the several meetings of official members with different interest groups regarding family law, the need has been raised to regulate family law to be included in the Civil Code for motherhood and fatherhood in the case of reproduction with biomedical assistance, as well as for the birth contract as a donation for another person (so-called surrogate motherhood). These bioethical and legal issues indicate the urgent need for legal harmonisation of a multidimensional platform specifically based on the principles of public health and universal human rights Conclusion. These bio-ethical and legal interferences indicate the urgent need for legal harmonization of a multidimensional platform specifically designed based on the principles of public health and universal human rights. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Learning to BreatheFive Fragments Against RacismB. Venkat Mani (bio)For Dr. JLW, for all Black academics and students1. Air HungerI know you, Derek Chauvin. You may think that we first met on May 25, 2020, in Minneapolis. I was called George Perry Floyd. For you, I was just another Black man, a potential criminal. For me, you were not a police officer, but the knee that stands for racism. You (...) kneeled on my windpipe for 9 minutes and 29 seconds. Those were neither my first nor my last memories.You may choose not to recognize me, as you always have. But I do. I recognize every bone, muscle, tendon, pointy curve of the cap, every contour of your strong, heavy, determined, calculating, conniving knee that presses on my windpipe with a false sense of racist superiority. 9 minutes and 29 seconds. As often as you can.We have a history. You have never missed the opportunity of kneeling on my windpipe. You hauled me into your slave ships from various African ports along the Atlantic, then you kneeled on my windpipe all over your cotton and tobacco plantations in the Americas. We met again on schooners from Indian shores journeying across the Indian and Pacific oceans. With slavery banned in the British empire, you turned me into an indentured laborer. You made me put my thumb imprint on a document you created, in a script I could not read, of a language I could not speak. Then you threw me thousands of miles away in Mauritius, Fiji, and numerous Caribbean islands, pressing on my windpipe on sugarcane plantations. My wife, children, sisters, mothers, aunts, brothers, uncles, nephews, nieces, grandparents, great grandparents, we all have lived through those fatal 9 minutes and 29 seconds: on water and land. Repeatedly. Consistently. Incessantly.You want specific dates? April 8, 1857, Barrackpore, Northern India. My name was Mangal Pandey, you called me a Sepoy. You hanged me for standing up against my subjugation by your British East India Company. Against your rule over my land and my people. With your many titles [End Page 41] and names: Major-General Sir Henry Havelock, Lieutenant-General Sir Colin Campbell, Brigadier-General Charles Windham, you rampaged through the streets of Delhi, Meerut, Lucknow, killing anyone in your way so I could be a jewel in Victoria's crown. January 29, 1863, Bear River, Idaho. I was one among the Shoshone of Bia Ogoi, you were Colonel Patrick Connor. You came to us on a frigid morning and killed us by the hundreds. November 15, 1884, the Congo Conference, Berlin. You were called Chancellor Otto von Bismarck and were acting at the behest of sharecropping interests of King Leopold the Second. Your name for me was a "savage." You set up a society to civilize me while you plundered my bounty. You started drawing lines through land, rivers, mountains, deserts. For you, it was the Scramble for Africa. For me, bloody murder. You knelt on my windpipe, smoking a pipe with tobacco my people had grown. April 13, 1919, Jallianwala Bagh, Amritsar. You were called Brigadier General Reginald Edward Harry Dyer. For you, I was just a troublemaking native disrupting the civilized business of the Empire. You surrounded our peaceful gathering in Amritsar and opened fire. Your Nobel Laureate Rudyard Kipling claimed that "you did your duty as you saw fit." By killing us in thousands until the bullets ran out. Rikki Tikki Tavi. May 31, 1921, Tulsa, Oklahoma. Inspired by Jim Crow, your knees came running to us in mobs to massacre us. October 19, 1926, Imperial Conference, London. Your name was Field Marshall the Right Honorable Jan Christian Smuts. For you, I was one among the many "colored" subjects from the Cape Colony. You spoke vehemently against mixing my people with your people. Eloquently, I was told, in favor of apartheid.You know very well, Chauvin, that our acquaintance neither begins in 1857 nor ends in 1926. I could take you on a grand tour of the world and give you all the dates when you appeared in different forms. Your self-induced conviction of racial supremacy over me remained the same... (shrink)

In the paper “Translational Neuroethics: A Vision for a More Integrated, Inclusive, and Impactful Field,” Wexler and Sullivan provide an insightful analysis of challenges within the field and how t...