This article introduces the Special Issue on ‘Interpretivism and the English School of International Relations’. It distinguishes between what we term the interpretivist and structuralist wings of...

Webber argues for a new interpretation of Sartrean existentialism. On this reading, Sartre is arguing that each person’s character consists in the projects they choose to pursue and that we are all already aware of this but prefer not to face it. Careful consideration of his existentialist writings shows this to be the unifying theme of his theories of consciousness, freedom, the self, bad faith, personal relationships, existential psychoanalysis, and the possibility of authenticity. Developing this account affords many insights into (...) various aspects of his philosophy, not least concerning the origins, structure, and effects of bad faith and the resulting ethic of authenticity. This discussion makes clear the contributions that Sartre’s work can make to current debates over the objectivity of ethics and the psychology of agency, character, and selfhood. Written in an accessible style and illustrated with reference to Sartre’s fiction, this book should appeal to general readers and students as well as to specialists. (shrink)

This article analyses the evolution of the English school’s approach to international relations from the work of the early British Committee in the late 1950s and early 1960s to its revival in the...

Interest in NFIB v. Sebelius has been extraordinarily high, from as soon as the legislation was passed, through lower court rulings, the Supreme Court’s grant of certiorari, and the decision itself, both for its substantive holdings and the purported behind-the-scene dynamics. Legal blogs exploded with analysis, bioethicists opined on our collective responsibilities, and philosophers tackled concepts like ‘coercion’ and the activity/inactivity distinction. This volume aims to bring together scholars from disparate fields to analyze various features of the decision. It comprises (...) over twenty essays from a range of academic disciplines, namely law, philosophy, and political science. Essays are divided into five units: context and history, analyzing the opinions, individual liberty, Medicaid, and future implications. (shrink)

The recovery of ancient skepticism in the sixteenth century had broad consequences in various intellectual domains, including fictional discourse. In the following centuries several authors echoed skeptical philosophical discourse and made literary use of skepticism. Jonathan Swift (1667-1745) is inserted in the hall of the modern writers who echoed and assimilated the skeptical tradition. Satires as A Tale of a Tub (1704), The Battle of Books (1704) and Gulliver's Travels (1726) are framed with marks of skepticism. Thus, my (...) purpose is to present a study on the incorporation of skeptical aspects and arguments in Swift's fictional and satirical discourse. I will try to show that Swift assimilates and uses artifices of skeptical discourse, and therefore, given his relation and knowledge of this tradition, has a place in the history of skeptical thinking. (shrink)

Character plays a central role in our everyday understanding and evaluation of ourselves and one another. It informs the expectations that ground our plans and projects, our moral responses to other people's behaviour and to opportunities we ourselves face, and our political decisions concerning formal education, criminal punishment, and other aspects of social organisation. These philosophical essays clarify this idea of character, analyse its relation with the findings of experimental psychology, and draw out the implications of this for education and (...) for criminal punishment. They emphasise that character is inherently dynamic, challenging the tendency among personality psychologists and virtue ethicists alike to focus on static snapshots of traits, and they emphasise the close integration of character with the individual's social context. The volume is intended to demonstrate the deep conceptual affinity of moral philosophy and social psychology and the consequent potential for each to benefit from the other. (shrink)

Clinical Ethics, Ahead of Print. This paper is a response to a recent BMJ Blog: ‘The duty to treat: where do the limits lie?’ Members of the Surrey Heartlands Integrated Care Service Clinical Ethics Group reflected on arguments in the Blog in relation to resuscitation during the COVID-19 pandemic.Clinicians have had to contend with ever-changing and conflicting guidance from the Resuscitation Council UK and Public Health England regarding personal protective equipment requirements in resuscitation situations. St John Ambulance had different guidance (...) for first responders.The situation regarding resuscitation led the CEG to consider ethical aspects of health care professionals’ responses to the need for resuscitation during COVID-19. Members agreed that professionals should, ideally, have the level of PPE required for an aerosol generating procedure. However, there was no consensus regarding professionals’ duty to care when this is not available. On the one hand, it was agreed that the casualty/patient’s interests regarding resuscitation should be prioritised due to professionals’ contract with the public and professional privilege. On the other hand, risk thresholds were considered relevant to individual decision-making and professionals’ duty to care. All agreed that decision-making should not be influenced by rewards or reprimands. It was agreed also that decisions to resuscitate should not be considered as moral heroism or supererogatory - regardless of PPE availability - but rather as ‘minimally decent’. We agreed that it may be acceptable for professionals, with good reasons, to opt out of resuscitation attempts and these should be reflected on and discussed before the event. (shrink)

Volume 19, Issue 5, May 2019, Page 70-72.

This paper responds to the commentaries from Stacy Carter and Alan Cribb. We pick up on two main themes in our response. First, we reflect on how the process of setting standards for empirical bioethics research entails drawing boundaries around what research counts as empirical bioethics research, and we discuss whether the standards agreed in the consensus process draw these boundaries correctly. Second, we expand on the discussion in the original paper of the role and significance of the concept of (...) ‘integrating’ empirical methods and ethical argument as a standard for research practice within empirical bioethics. (shrink)

"Central Themes in Early Modern Philosophy is a selection of some of the best work being done in early modern philosophy by Anglo-American philosophers today.... The essays in this collection are historically informed and philosophically challenging. The book is a fitting tribute to Jonathan Bennett." -- Daniel Garber, University of Chicago.

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

The new millennium is still very young, so it is too early to declare National Federation of Independent Business v. Sebelius1 the health law “case of the century,” but that title would not be hyperbolic. Never before have we seen a case of such monumental importance for how health care is financed and delivered in the United States. At the Supreme Court, no decision has been more closely watched and more anxiously awaited since Bush v. Gore in 2000. In the (...) balance was the fate of President Obama's signature piece of domestic legislation, one that affects nearly every aspect of the largest segment of our economy, and so is perhaps the most important piece of social legislation since the New Deal. To no one's surprise, the decision was announced at the very end of the Court's term and was split five to four.What was very surprising, however, was the Court's embrace of the tax power defense of the individual mandate. And what was outright shocking was a seven‐to‐two majority in favor of finding the Medicaid expansion unconstitutional unless states are allowed to opt out of the expansion.The case holds great significance not only for the fate of the Patient Protection and Affordable Care Act—and, thus, for the nation's health care public policy—but also for constitutional doctrine that applies much more broadly than in the health care arena. (shrink)

In Perfection and Disharmony in the Thought of Jean-Jacques Rousseau, Jonathan Marks offers an interpretation of the philosopher's thought and its place in the contemporary debate between liberals and communitarians. Against prevailing views, he argues that Rousseau's thought revolves around the natural perfection of a naturally disharmonious being. At the foundation of Rousseau's thought he finds a natural teleology that takes account of and seeks to harmonize conflicting ends. The Rousseau who emerges from this interpretation is a radical critic (...) of liberalism who is nonetheless more cautious about protecting individual freedom than his milder communitarian successors. Marks elaborates on the challenge that Rousseau poses to liberals and communitarians alike by setting up a dialogue between him and Charles Taylor, one of the most distinguished ethical and political theorists at work today. (shrink)

This book offers a novel critique of public-private partnerships in public health. The author argues these relationships create webs of influence that undermine the integrity of public health agencies, and imperil public health. He makes a compelling case that the paradigm interaction between governments and corporations should be at arm's length: separation, not collaboration.

We tend to think of conflict as bad and compromise as good. But how should we view conflict that exposes potential threats to the environment and health? And what about a compromise between litigants that may adversely affect the interests of third parties or undermine public health? There can be few places in the country where this issue has become more pressing than in my home state, Pennsylvania. The hydraulic fracturing of natural gas in the Marcellus Shale has transformed lives (...) and landscapes here, mainly in rural communities with low‐income populations. The Hallowich family is a case in point. (shrink)

Selecting, applying and reporting on investment screens for socially responsible investing (SRI) presents challenges for companies, investors and fund managers. This article seeks to clarify the nature of these challenges in developing an understanding of the foundations of ethical investment screens. At a conceptual level this work argues that there is a common element to the ethical foundations of SRI, even with very different apparent motivations and investment restrictions. Establishing this commonality assists in explaining the information asymmetry problem inherent in (...) SRI. A market-facilitated solution illustrates how these insights might foster the development of socially responsible investment. (shrink)

Let M be a structure for a language L on a set M of urelements. HYP(M) is the least admissible set above M. In § 1 we show that pp(HYP(M)) [ = the collection of pure sets in HYP(M] is determined in a simple way by the ordinal α = ⚬(HYP(M)) and the $\mathscr{L}_{\propto\omega}$ theory of M up to quantifier rank α. In § 2 we consider the question of which pure countable admissible sets are of the form pp(HYP(M)) for (...) some M and show that all sets L α (α admissible) are of this form. Other positive and negative results on this question are obtained. (shrink)

This book explores the making of health care rationing decisions through the analysis of three alternative decision makers: patients paying out of pocket; officials setting limits on treatments and coverage; and physicians at the bedside. Hall develops this analysis along three dimensions: political economics, ethics, and law. The economic dimension addresses the practical feasibility of each method. The ethical dimension discusses the moral aspects of these methods, while the legal dimension traces the most recent developments in jurisprudence and health (...) law. (shrink)

The importance of preserving trust in physicians and in medical institutions has received widespread attention in recent years. Primarily, this is due to the threats to trust posed by managed care, but there is a general and growing recognition that trust deserves more attention than it traditionally has received in all aspects of medical ethics, law, and public policy. Trust has both intrinsic and instrumental value. Trust is intrinsically important because it is a core characteristic that affects the emotional and (...) interpersonal aspects of the physician/patient relationship. As an instrumental value, trust is widely believed to be essential for effective therapeutic encounters. It has been hypothesized or shown to affect a host of important behaviors and attitudes relating to care, including seeking care, disclosing private information, complying with treatment, and being satisfied with care. Moreover, trust may be a mediator of measurable clinical outcomes and a key factor in the mind–body interactions that underlie placebo/nocebo effects and the effectiveness of alternative medicine. It is no surprise, then, that preserving, justifying, and enhancing trust is the fundamental goal of much of medical ethics, and is a prominent objective in healthcare law and public policy. Discussions of trust and related concepts were commonplace in professionally based medical ethics prior to the 1970s. a 1 2. (shrink)

This article reviews the primary avenues of judicial challenge to the ACA, focusing on those that have reached, or have the potential to reach, the Supreme Court. The review demonstrates how deep-seated public policy opposition can be expressed through litigation.

On September 8, 2015, the Department of Health and Human Services issued a Notice of Proposed Rule Making to revise the Federal Policy for the Protection of Human Subjects, widely known as the “Common Rule.” The NPRM proposes several changes to the current system, including a dramatic shift in the approach to secondary research using biospecimens and data. Under the current rules, it is relatively easy to use biospecimens and data for secondary research. This approach systematically facilitates secondary research with (...) biospecimens and data, maximizing the capacity for substantial public benefit. However, it has been criticized as insufficiently protective of the privacy and autonomy interests of biospecimen and data sources. Thus, the NPRM proposes a more restrictive regime, although more so for biospecimens than data. Both the status quo and the NPRM's proposal are critically flawed. (shrink)

My invitation to respond to Lepora and Goodin may be the result of my work on complicity—in particular, the participation of health professionals in torture and aggressive interrogation in the so-called ‘war on terror’.1,2 However, instead of responding to the précis, I intend to address the section of the authors' book dealing with compromise and to explore the implications of their approach for some pressing public health issues.3,4 In their chapter entitled ‘Compromise as a Template’, Lepora and Goodin contend that (...) ‘[i]t is only when the intra-personal conflict forces an agent to choose among items of principled concern … to her that a compromise is genuinely involved’ (p. 19). The authors are right to emphasise the ethical significance of setting aside, forsaking or violating one's principles to reach an agreement. There may be serious implications for the integrity of an individual or an institution that makes such a compromise. But we should ensure that the intrapersonal focus does not lead to the neglect of other important ethical dimensions. A compromise may be problematic because of its impact on others who are affected by, but are not …. (shrink)

These are not the words of a harsh critic of the Food and Drug Administration. They were penned by the agency’s deputy commissioner for food. That this is an insider’s view makes it all the more troubling. Recent studies suggest that roughly half the products on supermarket shelves proclaim their purported health benefits.2 But a trip to the supermarket suggests that this is a conservative estimate. The FDA is not powerless to regulate these claims, but it operates in a regulatory (...) framework that is the product of piecemeal reform and compromise, not intelligent design. And its limited staff resources and budget further constrain what it can do. The food industry is required to seek prior .. (shrink)

The decision to initiate invasive, first-in-human trials involving Parkinson’s disease presents a vexing ethical challenge. Such studies present significant surgical risks, and high degrees of uncertainty about intervention risks and biological effects. We argue that maintaining a favorable riskbenefit balance in such circumstances requires a higher than usual degree of confidence that protocols will lead to significant direct and/or social benefits. One critical way of promoting such confidence is through the application of stringent evidentiary standards for preclinical studies. We close (...) with a series of recommendations for strengthening the internal and external validity of preclinical studies, reducing their tendency toward optimism and publication biases, and improving the knowledge base used to design and evaluate preclinical studies. (shrink)

Nell Toussaint is not well. In recent years, she has been diagnosed with uterine fibroids, uncontrolled hypertension, nephrotic syndrome, poorly controlled diabetes, hyperlipidemia, and a pulmonary embolism. She also suffers from decreased mobility, shortness of breath, and‐perhaps not surprisingly, given her other ailments‐anxiety. Toussaint is an indigent undocumented immigrant living in Canada who has been trying to secure medical coverage in the federal courts. In the process, she has sacrificed the medical confidentiality that most of us ordinarily enjoy. Toussaint first (...) came to Canada from Grenada as a visitor in 1999 and remained after the term of her visa expired. At first, she earned enough to sustain a living, but in 2006, her health began to deteriorate, and she was no longer able to work. Although she has received some medical care since then, it has been sporadic, on an emergency basis, and at great expense. When Toussaint applied for medical health coverage under Canada's Interim Medical Health Program, which covers the cost of emergency medical care for legally admitted indigents, her application was rejected. She challenged the decision in federal court on the grounds that her right to life and security of the person under the Canadian Charter had been violated and that the denial of coverage was discriminatory. (shrink)

Many models of evolution are implicitly causal processes. Features such as causal feedback between evolutionary variables and evolutionary processes acting at multiple levels, though, mean that conventional causal models miss important phenomena. We develop here a general theoretical framework for analyzing evolutionary processes drawing on recent approaches to causal modeling developed in the machine-learning literature, which have extended Pearls do-calculus to incorporate cyclic causal interactions and multilevel causation. We also develop information-theoretic notions necessary to analyze causal information dynamics in our (...) framework, introducing a causal generalization of the Partial Information Decomposition framework. We show how our causal framework helps to clarify conceptual issues in the contexts of complex trait analysis and cancer genetics, including assigning variation in an observed trait to genetic, epigenetic and environmental sources in the presence of epigenetic and environmental feedback processes, and variation in fitness to mutation processes in cancer using a multilevel causal model respectively, as well as relating causally-induced to observed variation in these variables via information theoretic bounds. In the process, we introduce a general class of multilevel causal evolutionary processes which connect evolutionary processes at multiple levels via coarse-graining relationships. Further, we show how a range of fitness models can be formulated in our framework, as well as a causal analog of Prices equation, clarifying the relationships between realized/probabilistic fitness and direct/indirect selection. Finally, we consider the potential relevance of our framework to foundational issues in biology and evolution, including supervenience, multilevel selection and individuality. Particularly, we argue that our class of multilevel causal evolutionary processes, in conjunction with a minimum description length principle, provides a conceptual framework in which identification of multiple levels of selection may be reduced to a model selection problem. (shrink)

“Unconscionable.” “Outrageous.” “Indefensible.” These are just some of the tamer descriptions for the billing practices of most hospitals, and also many physicians, that have recently come to the public's attention. Earlier this year, Time magazine published an extraordinary 24,000‐word exposé—the longest article it has ever published—detailing how even charitable hospitals routinely price‐gouge their patients.1 With characteristic flare for telling details, journalist Steven Brill documented ten‐fold markups of charges over costs at some prominent hospitals for common services like X rays and (...) lab tests, and one‐hundred‐fold mark‐ups on mundane supplies such as gauze pads and generic aspirin. Just as the buzz from Brill's article was abating, the Centers for Medicare & Medicaid Services released a comprehensive data set in May that galvanized local and national media across the country. This news tsunami caught hospital managers flat‐footed and tongue‐tied. Typical responses conceded that hospitals’ pricing practices are based neither on actual cost structures nor rational marketplace dynamics. Instead, hospitals attempted to deflect blame by noting that hardly anyone actually pays list prices, and they characterized their indefensible pricing as a symptom of a broken system that is beyond them to fix. There are two glaring faults in these standard defenses. (shrink)

Both the USA and Europe limit access to care by undocumented immigrants. In the debate over what level of access to confer to IMs, there are various public policy rationales operating either explicitly, or below the surface, ranging from minimalist humanitarianism to full cosmopolitan equality, with several intermediate positions between these two poles. This article informs the international debate by providing a conceptual mapping of these underlying policy rationales. Each position is based on different lines of reasoning or bodies of (...) evidence, and each leads to somewhat different conclusions about the extent to which IMs should have access to different types of health care. It is unlikely that broad consensus will be achieved in this ongoing debate. However, by articulating the ethical, legal, pragmatic and conceptual reasons to support or oppose various positions, we hope to help determine where in the landscape of reasoned argument various positions lie, and how each position might be best supported or refuted. In particular, we see in this debate an illustration of Michael Walzer’s classic analysis of competing spheres of justice. Various positions depend to a considerable extent on whether their advocates approach this issue from the health policy sphere rather than the sphere of immigration policy, or whether they attempt to blend the two spheres. (shrink)

This article responds to Charlotta Friedner Parrat’s critique of our argument that the English School of international relations should embrace a more thoroughgoing interpretivism. We address four of Friedner Parrat’s objections to our argument: that our distinction between structuralism and interpretivism is too stark; that our understanding of the relationship between agency and structure is problematic; that our approach would confine the English School to the study of intellectual history; and that the English School should eschew explanation. We argue that (...) if the School is to use structuralism, it must be clearer about how it understands structures and their relationships to agents. We argue too that interpretivism not only offers a better account of situated agency, but also that it provides the English School with one way to move beyond the description and classification of institutions in international society towards better explanations of international relations. (shrink)

As politicians revisit the merits of health insurance reform and courts deliberate its constitutionality, government regulators are busily working on the wonky details of implementation. The Affordable Care Act leaves vast swaths of regulation for various agencies to prescribe, most notably the Department of Health and Human Services. Infamously (or perhaps apocryphally, since I'm certainly not going to bother counting), the statute contains more than a thousand commands to the effect of, "the Secretary shall decide." This massive delegation of authority (...) is unavoidable in any attempt to comprehensively reform, yet preserve, our Byzantine health insurance system.Throughout this regulatory nativity, the government .. (shrink)

A paradigmatic experience of agency is the felt effort associated with the act of making a difficult choice. The challenge of accounting for this experience within a compatibilist framework has been called ‘the agency problem of compatibilism’ (Vierkant, 2022, The Tinkering Mind: Agency, Cognition and the Extended Mind, Oxford University Press, 116). In this paper, I will propose an evolutionarily plausible, actional account of deciding which explains the phenomenology. In summary: The act of making a difficult choice is triggered by (...) a metacognitive decision to intentionally stop deliberating, despite ongoing uncertainty. This decision is the output of a metacognitive cost–benefit computation, which weighs the value of uncertainty reduction against the costs of ongoing deliberation. Strikingly, contemporary theories of effort suggest that this cost–benefit computation is also the source of the feeling of mental effort, which tracks the costs of that decision. If this account is correct, the agency problem of compatibilism has been solved. The act of making a difficult choice and the associated paradigmatic experience of agency, felt effort, both follow from the metacognitive evaluation. Implications are explored. (shrink)

Health insurance mandates have been a component of many recent health care reform proposals. Because a federal requirement that individuals transfer money to a private party is unprecedented, a number of legal issues must be examined. This paper analyzes whether Congress can legislate a health insurance mandate and the potential legal challenges that might arise, given such a mandate. The analysis of legal challenges to health insurance mandates applies to federal individual mandates, but can also apply to a federal mandate (...) requiring employers to purchase health insurance for their employees. There are no constitutional barriers for Congress to legislate a health insurance mandate as long as the mandate is properly designed and executed, as discussed below. This paper also considers the likelihood of any change in the current judicial approach to these legal questions. (shrink)