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Despite protestations to the contrary, philosophers have always been renowned for espousing theories that do violence to common-sense opinion. In the last twenty years or so there has been a growing number of philosophers keen to follow in this tradition. According to these philosophers, if a story of pure fic-tion tells us that an individual exists, then there really is such an individual. According to these realists about fictional characters, ‘Scarlett O’Hara,’ ‘Char-lie Brown,’ ‘Batman,’ ‘Superman,’ ‘Tweedledum’ and ‘Tweedledee’ are not (...) denotationless terms, but names that really refer. What is truly surprising about this situation is that almost no one has inveighed against this unfortunate real-ist tendency. My aim here will be to challenge this new orthodoxy, and to defend an anti-realist position against the arguments proffered by the realist. (shrink)

Some medical services have long generated deep moral controversy within the medical profession as well as in broader society and have led to conscientious refusals by some physicians to provide those services to their patients. More recently, pharmacists in a number of states have refused on grounds of conscience to fill legal prescriptions for their customers. This paper assesses these controversies. First, I offer a brief account of the basis and limits of the claim to be free to act on (...) one’s conscience. Second, I sketch an account of the basis of the medical and pharmacy professions’ responsibilities and the process by which they are specified and change over time. Third, I then set out and defend what I call the “conventional compromise” as a reasonable accommodation to conflicts between these professions’ responsibilities and the moral integrity of their individual members. Finally, I take up and reject the complicity objection to the conventional compromise. Put together, this provides my answer to the question posed in the title of my paper: “Conscientious refusal by physicians and pharmacists: who is obligated to do what, and why?”. (shrink)

The Human Genome Project will produce information permitting increasing opportunities to prevent genetically transmitted harms, most of which will be compatible with a life worth living, through avoiding conception or terminating a pregnancy. Failure to prevent these harms when it is possible for parents to do so without substantial burdens or costs to themselves or others are what J call “wrongful handicaps”. Derek Parfit has developed a systematic difficulty for any such cases being wrongs — when the harm could be (...) prevented only by preventing the existence of the individual who would have a worthwhile life even with the handicap, then bringing him into existence with the handicap does not make him worse off and so does not wrong him. I argue that a non “person‐affecting” principle requiring the avoidance of suffering and limited opportunity correctly accounts for cases of wrongful handicaps without requiring that the individuals with the handicap have been made worse off and therefore wronged. It is an advantage, not a difficulty, of this account that it does not imply that the person with the handicap has been wronged or is a victim with a special moral complaint. (shrink)

This essay explains why creationism about fictional characters is an abject failure. Creationism about fictional characters is the view that fictional objects are created by the authors of the novels in which they first appear. This essay shows that, when the details of creationism are filled in, the hypothesis becomes far more puzzling than the linguistic data it is used to explain. No matter how the creationist identifies where, when and how fictional objects are created, the proposal conflicts with other (...) strong intuitions we have about fictional characters. (shrink)

There are a bewildering variety of ways the terms "realism" and "anti-realism" have been used in philosophy and furthermore the different uses of these terms are only loosely connected with one another. Rather than give a piecemeal map of this very diverse landscape, the authors focus on what they see as the core concept: realism about a particular domain is the view that there are facts or entities distinctive of that domain, and their existence and nature is in some important (...) sense objective and mind-independent. The authors carefully set out and explain the different realist and anti-realist positions and arguments that occur in five key domains: science, ethics, mathematics, modality and fictional objects. For each area the authors examine the various styles of argument in support of and against realism and anti-realism, show how these different positions and arguments arise in very different domains, evaluate their success within these fields, and draw general conclusions about these assorted strategies. Error theory, fictionalism, non-cognitivism, relativism and response-dependence are taken as the most important positions in opposition to the realist and these are explored in depth. Suitable for advanced level undergraduates, the book offers readers a clear introduction to a subject central to much contemporary work in metaphysics, epistemology and philosophy of language. (shrink)

Do any needs defensibly make claims on anyone? If so, which needs and whose needs can defensibly do this? What are the grounds for our responsibilities to meet others' needs, when we have such responsibilities? The distinguished contributors to this volume consider these questions as they evaluate the moral force of needs. They approach questions of obligation and moral importance from a variety of different theoretical perspectives, including contractarian, Kantian, Aristotelian, rights-based, egalitarian, liberal, and libertarian perspectives.

In this paper I argue that needs are tremendously salient in developing any plausible account of global justice. I begin by sketching a normative thought experiment that models ideal deliberating conditions. I argue that under such conditions we would choose principles of justice that ensure we are well positioned to be able to meet our needs. Indeed, as the experiment aims to show, any plausible account of distributive justice must make space for the special significance of our needs. I go (...) on to offer some empirical support for this view by looking at the important work of Frohlich and Oppenheimer. I then present an account of our basic needs that can meet a number of goals: for instance, it provides a robust theoretical account of basic needs which can enjoy widespread support, and it can also provide an adequate framework for designing policy about needs, and thus help us to discharge our global obligations. I then briefly discuss the relationship between basic needs and human rights, arguing why the basic needs standard is more fundamental than—and required by—the human rights approach. Finally, I tackle a few important sets of objections to my view, especially some objections concerning distributing our responsibilities for meeting needs. (shrink)

In spite of the wide variety of approaches to ethics training it is still debatable which approach has the highest potential to enhance professionals’ integrity. The current effort assesses a novel curriculum that focuses on metacognitive reasoning strategies researchers use when making sense of day-to-day professional practices that have ethical implications. The evaluated trainings effectiveness was assessed by examining five key sensemaking processes, such as framing, emotion regulation, forecasting, self-reflection, and information integration that experts and novices apply in ethical decision-making. (...) Mental models of trained and untrained graduate students, as well as faculty, working in the field of physical sciences were compared using a think-aloud protocol 6 months following the ethics training. Evaluation and comparison of the mental models of participants provided further validation evidence for sensemaking training. Specifically, it was found that trained students applied metacognitive reasoning strategies learned during training in their ethical decision-making that resulted in complex mental models focused on the objective assessment of the situation. Mental models of faculty and untrained students were externally-driven with a heavy focus on autobiographical processes. The study shows that sensemaking training has a potential to induce shifts in researchers’ mental models by making them more cognitively complex via the use of metacognitive reasoning strategies. Furthermore, field experts may benefit from sensemaking training to improve their ethical decision-making framework in highly complex, novel, and ambiguous situations. (shrink)

In a period of rapid internationalization of trade and increased labor mobility, is it relevant for nations to think about their moral obligations to others? Do national boundaries have fundamental moral significance, or do we have moral obligations to foreigners that are equal to our obligations to our compatriots? The latter position is known as cosmopolitanism, and this volume brings together a number of distinguished political philosophers and theorists to explore cosmopolitanism: what it consists in, and the positive case which (...) can be made for it. Their essays provide a comprehensive overview of both the current state of the debate and the alternative visions of cosmopolitanism with which we can move forward, and they will interest a wide range of readers in philosophy, political theory, and law. (shrink)

"This reviewer had to be restrained from stopping people in the street to urge them to read it: They would learn something of the way science is done,...

It is widely recognized that prioritizing health care resources by their relative cost-effectiveness can result in lower priority for the treatment of disabled persons than otherwise similar non-disabled persons. I distinguish six different ways in which this discrimination against the disabled can occur. I then spell out and evaluate the following moral objections to this discrimination, most of which capture an aspect of its unethical character: it implies that disabled persons' lives are of lesser value than those of non-disabled persons; (...) it constitutes “double jeopardy” or violates Frances Kamm's non-linkage principle; it conflicts with equality of opportunity; it conflicts with fairness, which requires ignoring (some/most) differential impacts of treatment; it wrongly gives lower priority to disabled persons for equally effective treatment; it conflicts with giving all persons an equal chance to reach their full potential; and, it is in conflict with giving priority to the worse off. (shrink)

I examine how reforming our international tax regime could be an important vehicle by which we can begin to realize global justice. For instance, eliminating tax havens, tax evasion, and transfer pricing schemes are all important to ensure accountability and to support democracies. I argue that the proposals concerning taxation reform are likely to be more effective in tackling global poverty than Thomas Pogge's global resources dividend because they target some of the central issues more effectively. I also discuss many (...) particular proposals for global taxes that have already been floated and implementation prospects and successes. (shrink)

In a number of influential articles published since 1972, Dorothy Grover has developed the prosentential theory of truth. Brought together and published with a new introduction, these essays are even more impressive as a group than they were as single contributions to philosophy and linguistics. Denying that truth has an explanatory role, the prosentential theory does not address traditional truth issues like belief, meaning, and justification. Instead, it focuses on the grammatical role of the truth predicate and asserts that (...) “it is true” is a prosentence, functioning much as a pronoun does. Grover defends the theory by indicating how it can handle notorious paradoxes like the Liar, as well as by analyzing some English truth-usages. The introduction to the volume surveys traditional theories of truth, including correspondence, pragmatic, and coherence theories. It discusses the essays to come and, finally, considers the implications of the prosentential theory for other theories. Despite the fact that the prosentential theory dismisses the “nature of truth” as a red herring, Grover shows that there are important aspects of traditional truth theories that prosentential theorists have the option of endorsing. (shrink)

Eleven original essays discuss a range of puzzling philosophical questions about fictional characters, and more generally about fictional objects. For example, they ask questions like the following: Do they really exist? What would fictional objects be like if they existed? Do they exist eternally? Are they created? Who by? When and how? Can they be destroyed? If so, how? Are they abstract or concrete? Are they actual? Are they complete objects? Are they possible objects? How many fictional objects are there? (...) What are their identity conditions? What kinds of attitudes can we have towards them? This volume will be a landmark in the philosophical debate about fictional objects, and will influence higher-level debates within metaphysics, the philosophy of mind, and the philosophy of language. (shrink)

Recent years have seen widespread calls to transform food systems to address complex demands such as feeding a growing global population while reducing environmental impacts. But what is a food system and how can we most effectively work to change it? “Food System” can be found describing more limited dietary regimens as well as sector-specific supply chains going back to the 1930s, but its use to describe very large, dynamic, coupled socio-ecological systems gained traction in academic and civil society publications (...) in the 1990s and this use of the term has increased dramatically in recent years. When the influential food system actors from non-governmental organizations, foundations, consultancies, and the UN that this research focuses on talk about food systems, they seem to be talking about the same thing. Yet the interpretive flexibility of the concept obfuscates that people may have very different framings that may be deeply incompatible. Drawing from interviews, participant observation, and document analysis, this paper examines what food systems thinking does in terms of setting the stage for how we enact the food system and efforts to intervene in it. It reveals that rather than leading to more expansive understanding, the unexamined use of the concept food system might actually serve to sharpen divides. (shrink)

I argue that the suppositional view of conditionals, which is quite popular for indicative conditionals, extends also to subjunctive or counterfactual conditionals. According to this view, conditional judgements should not be construed as factual, categorical judgements, but as judgements about the consequent under the supposition of the antecedent. The strongest evidence for the view comes from focusing on the fact that conditional judgements are often uncertain; and conditional uncertainty, which is a well-understood notion, does not function like uncertainty about matters (...) of fact. I argue that the evidence for this view is as strong for subjunctives as it is for indicatives. (shrink)

This chapter examines whether an individual’s being worse off than others should be a relevant consideration in the allocation of limited medical resources. It reviews arguments pressed by proponents of different theories of justice about whether being worse off than others makes special demands on health care resource prioritization. Even if there is good reason to restrict the concern for the worse off to those with worse health in the prioritization and allocation of health care resources, additional issues remain. One (...) is how to determine who has worse health, and whether the worse off are those with the worse overall health or those with the most serious medical condition now in need of treatment. Another issue is whether only individuals’ present health, or instead their lifetime health, including past and expected future health, is relevant. (shrink)

The Puzzle of Imaginative Failure asks why, when readers are invited to do so, they so often fall short of imagining worlds where the moral facts are different. This is puzzling because we have no difficulty imagining worlds where the descriptive facts are different. Much of the philosophical controversy revolves around the question of whether the reader's lack of imagination in such cases is a result of psychological barriers (an inability or a difficulty on the reader's part to imagine what (...) she is asked to imagine) or whether it is instead a result of wilful resistance (a desire not to imagine what she's asked to imagine). I argue for a different kind of solution. I maintain the primary reason for such systematic failures on the reader's part is due to an inability on the author's part to make clear that she is inviting the reader to engage in such imaginings. (shrink)

This contribution discusses three important issues that should be addressed by those concerned with global justice. Theorizing should be better informed by a range of important bodies of knowledge, such as scholarly, activist, policy, legal, and practitioner-based. There is also a need for more inclusive normative frameworks for allocating specific responsibilities to particular agents. I explain the need for both by discussing an especially important neglected topic, namely that of corruption, which so badly undermines prospects for global justice.

Is there enough progress in philosophy? It is notable that even within the discipline, opinions are divided. Optimists think there is more than enough progress in philosophy. Pessimists think we could and should do better. In this chapter I defend an optimistic answer to this question.

Fictionalism about fictional characters is a view according to which all claims ostensibly about fictional characters are in fact claims about the content of a story. Claims that appear to refer to or quantify over fictional objects contain an implicit prefix of the form “according to such-and-such story. In.

There are substantial data establishing that surrogates are often mistaken in predicting what treatments incompetent patients would have wanted and that supplements such as advance directives have not resulted in significant improvements. Rid and Wendler’s Patient Preference Predictor (PPP) proposal will attempt to gather data about what similar patients would prefer in a variety of treatment choices. It accepts the usual goal of patient autonomy and the Substituted Judgment principle for surrogate decisions. I provide reasons for questioning sole reliance on (...) autonomy when surrogates, not patients, are deciding and for giving some independent weight to patient well-being. Moreover, that family members, typical surrogates, will know best what the patient if incompetent would have wanted is not the only reason why they are chosen. The more pressing problem is that the PPP would fail to remove the more serious mistakes that empirical psychology over the last few decades has shown to infect such decision making. (shrink)

Rationing is the allocation of a good under conditions of scarcity, which necessarily implies that some who want and could be benefitted by that good will not receive it. One reflection of our ambivalence towards health care rationing is reflected in our resistance to having it distributed in a market like most other goods—most Americans reject ability to pay as the basis for distributing health care. They do not view health care as just another commodity to be distributed by markets. (...) Despite this widespread view, we are the only developed country without some form of universal health insurance, and so for the 46 million Americans without health insurance their access to health care often does depend on their ability to pay for it. Rationing largely remains a topic that the public, their elected leaders, and many health care professionals prefer to avoid. Ever-growing costs of health care will increasingly force the practice and issue of health care resource prioritization and rationing into the open for public, professional, and political attention. This paper explores some of the features of those practices and issues that make them especially ethically and politically difficult. Those issues will not be easily resolved, but avoiding them will not avoid the need or reality of rationing, it will only mean that it will go on covertly and unexamined. That will lead neither to better or more legitimate prioritization and rationing decisions. (shrink)

There is much current and growing interest in theorizing about global justice. Contemporary events in the world probably account for most of this, but if any philosophical text can be identified as igniting theorists' relatively newly found interest, it must be John Rawls's influential book, The Law of Peoples . There is a lively debate between critics and advocates of Rawls's approach, and much theorizing about global justice is framed in terms of that exchange. Because of its enormous influence in (...) shaping the terms of discussion, familiarity with this work is important for being able to participate in the current theoretical conversations about global justice. In this article I examine that debate and assess the state of play. I briefly outline the central themes of Law of Peoples in section 2 and criticism these ideas attracted in 3. In section 4 I cover some defenses of Rawls's account. In section 5, I assess the state of play and implications for debates about global justice. (shrink)

The intense and extensive debate over human embryonic stem cell research has focused primarily on the moral status of the human embryo. Some commentators assign full moral status of normal adult human beings to the embryo from the moment of its conception. At the other extreme are those who believe that a human embryo has no significant moral status at the time it is used and destroyed in stem cell research. And in between are many intermediate positions that assign an (...) embryo some degree of moral status between none and full. This controversy and the respective positions, like the abortion controversy, is by now well understood, despite the lack of progress in resolving it. I have argued briefly elsewhere that early embryos do not have significant moral status, but I do not want to reenter that debate here. Instead, I want to focus on an issue that has had relatively little explicit and separate attention, but is likely to loom larger in light of the Obama administration’s partial lifting of the Bush administration’s restriction on the embryos that can be used in stem cell research that receives federal funding. (shrink)

: Bioethics has focused principally on ethical issues arising in clinical medicine. When it has addressed justice or equity, it has focused on access to health care and on defending a general moral right to health care. This dual focus on establishing a right to health care and on health care rather than health has left bioethics largely silent on two issues of fundamental importance for a full account of justice and health. First, the focus on establishing a right to (...) health care has contributed to a failure to address difficult issues in developing ethical standards for equitably prioritizing limited resources in health care. Second, the focus on inequalities in access to health care has ignored the much greater impact of social determinants of health, in particular socioeconomic class and inequality, on health and health inequalities. Bioethics must broaden its agenda. (shrink)