In an article in this journal, Christopher Cowley argues that we have ‘misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors’. We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors' personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation to assisted dying. We argue (...) that eligible patients could be guaranteed access to medical services that are subject to conscientious objections by: removing a right to conscientious objection; selecting candidates into relevant medical specialities or general practice who do not have objections; demonopolizing the provision of these services away from the medical profession. (shrink)

The smooth integration of the natural sciences with everyday lived experience is an important ambition of radical embodied cognitive science. In this paper we start from Koffka’s recommendation in his Principles of Gestalt Psychology that to realize this ambition psychology should be a “science of molar behaviour”. Molar behavior refers to the purposeful behaviour of the whole organism directed at an environment that is meaningfully structured for the animal. Koffka made a sharp distinction between the “behavioural environment” and the “geographical (...) environment”. We show how this distinction picks out the difference between the environment as perceived by an individual organism, and the shared publicly available environment. The ecological psychologist James Gibson was later critical of Koffka for inserting a private phenomenal reality in between animals and the shared environment. Gibson tried to make do with just the concept of affordances in his explanation of molar behaviour. We argue however that psychology as a science of molar behaviour will need to make appeal both to the concepts of shared publicly available affordances, and of the multiplicity of relevant affordances that invite an individual to act. A version of Koffka’s distinction between the two environments remains alive today in a distinction we have made between the field and landscape of affordances. Having distinguished the two environments, we go on to provide an account of how the two environments are related. Koffka suggested that the behavioural environment forms out of the causal interaction of the individual with a pre-existing, ready-made geographical environment. We argue that such an account of the relation between the two environments fails to do justice to the complex entanglement of the social with the material aspects of the geographical environment. To better account for this sociomaterial reality of the geographical environment, we propose a process-perspective on our distinction between the landscape and field of affordances. While the two environments can be conceptually distinguished, we argue they should also be viewed as standing in a relation of reciprocal and mutual dependence. (shrink)

To pursue the cultivation of a compassionate disposition is often perceived as an external demand, constraining one's individual freedom. Some might think of it as a necessary burden for the benefit of society, while others may exercise it only in the most convenient occasions. This most common view is gravely impoverished. Compassion is in fact a cognitive disposition with a certain historical life that actually frees us from our own perceptive constraints.

Public health policies often require individuals to make personal sacrifices for the sake of protecting other individuals or the community at large. Such requirements can be more or less demanding for individuals. This paper examines the implications of demandingness for public health ethics and policy. It focuses on three possible public health policies that pose requirements that are differently demanding: vaccination policies, policy to contain antimicrobial resistance, and quarantine and isolation policies. Assuming the validity of the ‘demandingness objection’ in ethics, (...) we argue that states should try to pose requirements that individuals would have an independent moral obligation to fulfil, and therefore that are not too demanding. In such cases, coercive measures are ethically justified, especially if the interventions also entail some benefits to the individuals; this is, for example, the case of vaccination policies. When public health policies need to require individuals to do something that is too demanding to constitute an independent moral obligation, states have an obligation to either provide incentives to give individuals non-moral reasons to fulfil a certain requirement – as in the case of policies that limit antibiotic prescriptions – or to compensate individuals for being forced to do something that is too demanding to constitute an independent moral obligation – as in the case of quarantine and isolation policies. (shrink)

According to the free energy principle all living systems aim to minimise free energy in their sensory exchanges with the environment. Processes of free energy minimisation are thus ubiquitous in the biological world. Indeed it has been argued that even plants engage in free energy minimisation. Not all living things however feel alive. How then did the feeling of being alive get started? In line with the arguments of the phenomenologists, I will claim that every feeling must be felt by (...) someone. It must have mineness built into it if it is to feel a particular way. The question I take up in this paper asks how mineness might have arisen out of processes of free energy minimisation, given that many systems that keep themselves alive lack mineness. The hypothesis I develop in this paper is that the life of an organism can be seen as an inferential process. Every living system embodies a probability distribution conditioned on a model of the sensory, physiological, and morphological states that are highly probably given the life it leads and the niche it inhabits. I argue for an ecological and enactive interpretation of free energy. I show how once the life of an organism reaches a certain level of complexity mineness emerges as an intrinsic part of the process of life itself. (shrink)

I argue that pregnant women have a duty to refrain from behaviours or to allow certain acts to be done to them for the sake of their foetus if the foetus has a reasonable chance of living and being in a harmed state if the woman does not refrain from those behaviours or allow those things to be done to her. There is a proviso: that her refraining from acting or allowing acts to be performed upon her does not significantly (...) harm her. This duty does not presuppose that the foetus is a person. It is grounded on principles of respect for the interests of sentient beings and prevention of harm to future individuals. I give an argument for a general duty of easy rescue. (shrink)

Anti-realism is plagued by Fitch’s paradox: the remarkable result that if one accepts that all truths are knowable, minimal assumptions about the nature of knowledge entail that every truth is known. Dorothy Edgington suggests to address this problem by understanding p is knowable to be a counterfactual claim, but her proposal must contend with a forceful objection by Timothy Williamson. I revisit Edgington’s basic idea and find that Williamson’s objection is obviated by a refined understanding of counterfactual knowability that is (...) grounded in possible courses of inquiry. I arrive at a precise definition of knowability that is not just a technical avoidance of paradox, but is metaphysically sound and does justice to the anti-realist idea. (shrink)

This impressive volume of essays that includes contributions from Herbert Dreyfus, Sean Kelly, Mike Wheeler, Dan Zahavi, and Shaun Gallagher reflects an emerging trend in cognitive science, and explores this new approach to cognitive science informed by Heidegger's thoughts on human existence.

Criminal behaviour is but one behavioural tendency for which a genetic influence has been suggested. Whilst this research certainly raises difficult ethical questions and is subject to scientific criticism, one recent research project suggests that for some families, criminal tendency might be predicted by genetics. In this paper, supposing this research is valid, we consider whether intervening in the criminal tendency of future children is ethically justifiable. We argue that, if avoidance of harm is a paramount consideration, such an intervention (...) is acceptable when genetic selection is employed instead of genetic enhancement. Moreover, other moral problems in avoiding having children with a tendency to criminal behaviour, such as the prospect of social discrimination, can also be overcome. (shrink)

The authors respond to a wide range of objections defending our argument that some forms of behaviour modification utilising advances in the cognitive sciences are desirable and need not necessarily undermine autonomy or freedom.

Here, a moral case is presented as to why sign languages such as Auslan should be made compulsory in general school curricula. Firstly, there are significant benefits that accrue to individuals from learning sign language. Secondly, sign language education is a matter of justice; the normalisation of sign language education and use would particularly benefit marginalised groups, such as those living with a communication disability. Finally, the integration of sign languages into the curricula would enable the flourishing of Deaf culture (...) and go some way to resolving the tensions that have arisen from the promotion of oralist education facilitated by technologies such as cochlear implants. There are important reasons to further pursue policy proposals regarding the prioritisation of sign language in school curricula. (shrink)

This is a clear and lucid account of Nietzsche's philosophy of art, combining exegesis, interpretation and criticism in a judicious balance. Julian Young argues that Nietzsche's thought about art can only be understood in the context of his wider philosophy. In particular, he discusses the dramatic changes in Nietzschean aesthetics against the background of the celebrated themes of the death of God, eternal recurrence, and the idea of the Übermensch. Young then divides Nietzsche's career and his philosophy of art (...) into four distinct phases, but suggests that these phases describe a circle. An attempt at world-affirmation is made in the central phases, but Nietzsche is predominantly influenced at the beginning and end of his career by a Schopenhauerian pessimism. At the beginning and end art is important because it 'redeems' us from life. (shrink)

We do not always benefit from the expansion of our choice sets. This is because some options change the context in which we must make decisions in ways that render us worse off than we would have been otherwise. One promising argument against paid living kidney donation holds that having the option of selling a ‘spare’ kidney would impact people facing financial pressures in precisely this way. I defend this argument from two related criticisms: first, that having the option to (...) sell one’s kidney would only be harmful if one is pressured or coerced to take this specific course of action; and second, that such forms of pressure are unlikely to feature in a legal market. (shrink)

The recent tragic and widely publicised death of Jesse Gelsinger in a gene therapy trial has many important lessons for those engaged in the ethical review of research. One of the most important lessons is that ethics committees can give too much weight to ensuring informed consent and not enough attention to minimising the harm associated with participation in research. The first responsibility of ethics committees should be to ensure that the expected harm associated with participation is reasonable. Jesse was (...) an 18-year-old man with a mild form of ornithine transcarbamylase (OTC) deficiency, a disorder of nitrogen metabolism. His form of the disease could be controlled by diet and drug treatment. On September 13 1999 a team of researchers lead by James Wilson at the University of Pennsylvania's Institute for Human Gene Therapy (IHGT) injected 3.8 X 1013 adenovirus vector particles containing a gene to correct the genetic defect. He was the eighteenth and final patient in the trial. The virus particles were injected directly into the liver. He received the largest number of virus particles in a gene therapy trial.1 Four days later he was dead from what was probably an immune reaction to the virus vector. This was the first death directly attributed to gene therapy. It resulted in worldwide publicity, an independent investigation, the Federal Drug Administration (FDA) suspending all trials at the IHGT, an FDA, and a senate subcommittee investigation. At a special public meeting at the National Institutes of Health (NIH) in December 1999, James Wilson, also the director of the IHGT, said they still did not understand fully what had gone wrong.2 Even though a massive dose had been used, only 1% of transferred genes reached the target cells. (None of the patients in the trial showed significant gene expression. Art …. (shrink)

Due to the economic and social effects of globalization democracy is currently in crisis in many states around the world. This book suggests that solving this crisis requires rethinking democratic education. It argues that educational public policy must cultivate democratic relationships not only within but also across and between states, and that such policy must empower citizens to exercise democratic control in domestic as well as in inter- and transnational politics. -/- Democratic Education in a Globalized World articulates and defends (...) democratic conceptions of global citizenship education and educational justice on the basis of a democratic understanding of global justice. It will be of interest to researchers across the fields of education, political theory, philosophy, development and postcolonial studies. (shrink)

The standard view in philosophy and psychology claims that mentalizing is necessary and sufficient for social understanding. Mentalizing (also known as “mindreading”) is the name given to the cognitive capacities humans employ in explaining and predicting their own and other’s actions. The standard view is rejected by philosophers working in the phenomenological tradition. They have argued that mentalizing is neither necessary nor sufficient for social understanding. They suggest instead that most of the time we understand each other through what Shaun (...) Gallagher has called “embodied practices.” My aim in this paper is to clarify and defend the claim that social understanding is grounded in embodied practice. (shrink)

This paper is a response to John Harris’ provocative ‘Justice and Equal Opportunities in Health Care’. The aim of this short response is to locate the difference between Harris and me within a broader debate about the nature of reasons for action. I argue that Harris is appealing to a desire‐based conception of normative reasons. I highlight some of the deficiencies of a desire‐based conception of reasons, and contrast it with a value‐based account.

El agnosticismo desarrollado por Huxley hacia mediados del siglo XIX constituye una teoría del conocimiento, que tiene como fundamentos la epistemología de la ilustración y la teoría darwinista de la evolución. Analizamos aquí la influencia de Hume, de Kant y de Darwin en la epistemología agnóstica; y señalamos las diferencias del agnosticismo con el positivismo, el materialismo y el supernaturalismo.

An innovative program recently initiated at the University of California, Los Angeles Medical Center allows people to donate a kidney in exchange for a voucher that a loved one can redeem for a kidney if and when needed. As a relatively new practice, the ethical implications of advanced kidney donation have not yet been widely discussed. This paper reflects on some of the bioethical issues at stake in this new donation program, as well as some broader philosophical issues related to (...) the meaning and moral salience of commodification. I first consider whether the literature on commercial markets in organs––a longstanding topic of bioethical debate––can meaningfully inform ethical analysis of kidney voucher programs. Specifically, I consider whether and to what extent common objections to the exchange of kidneys for cash also apply to the exchange of kidneys for “kidney vouchers.” Second, I argue that the contrast between the ethical issues raised by these two practices highlights the need to understand commodification as existing on a continuum, with different degrees of commodification giving rise to different ethical issues. Doing so can help sharpen our understanding of commodification as a moral concept, as well as its relevance to broader debates about the moral limits of markets. (shrink)

The aim of this paper is to introduce the instrumental variables technique to the discussion about causal inference in econometrics. I show that it may lead to causally incorrect conclusions unless some fairly strong causal background assumptions are made, assumptions which are usually left implicit by econometricians. These assumptions are very similar to, albeit not identical with, James Woodward's definition of an ‘intervention’. I discuss similarities and differences of the two points of view and argue that—understood as a practical method (...) of causal inference—the set presented here is superior. (shrink)

According to recent empirical research (Transparency International, 2013), nearly 15% of people worldwide admitted to having paid a bribe in an educational setting. Given the nature of corruption,...

This chapter contains sections titled: Possibility, Extent and Significance of Genetic Enhancement Should Human Genetic Enhancement Occur? Conclusion References.

In this article we discuss the validity of previous preferences and advance directives in cases of severe mental illness.

Although political pluralism can have an ethical justification, it does not need one. Political pluralism can be justified on the basis of an epistemological argument about what we can claim to know, one which has a normative conclusion about how strongly we ought to believe. This is important because for pluralism to command wide assent, it needs something other than an ethical justification, since many simply will not accept that justification. Thus understood, we can see that current threats to pluralism (...) come not just from authoritarian movements but from populism, which has already infected mainstream politics. (shrink)

The most obvious thing about the universe in which we find ourselves is its structure. Before the scientific revolution, the instinctive reaction of thinkers to the existence of perceived structure was to find a direct reason for that structure. This is reflected above all in the Pythagorean notion of the well-ordered cosmos: the cosmos has the structure it does because that is the best structure it could have. In fact, that is what the word cosmos really means—primarily order, but also (...) decoration, embellishment, or dress. Kepler and Galileo were no less entranced by the beauty of the world than was Pythagoras, and they formulated their ideas in the overall conceptual framework of the well-ordered cosmos. However, both studied the world so intently that they actually identified aspects of motion that fairly soon led to the complete overthrow of such a notion of cosmos. The laws of the new physics were found to determine not the actual structure of the universe, but the way in which structure changes from instant to instant. Ultimately, no explanation is provided for the currently observed structure; it is simply attributed to an initial structure that was never fashioned by the laws of nature but merely continually refashioned thereafter. The initial and boundary conditions for our universe lie outside the purview of science. But all of the structure we observe around us must ultimately be traced back to those mysterious initial and boundary conditions. (shrink)

(2001). Justice and Healthcare: The Right to a Decent Minimum, Not Equality of Opportunity. The American Journal of Bioethics: Vol. 1, No. 2, pp. 1a-3a.

The problem of individuality, physical and mental, is one which obviously has great interest for philosophy. The unity and continuity of the ordinary human consciousness—the “ ego,” the “personality—give us the concrete standard by which we ordinarily judge other systems which have tended towards individuation. A comparative and evolutionary study of biological data, however, will provide us with many facts which throw a new light on the problem. They are often puzzling, but must be taken into account.

Joint attention is recognised by many philosophers and psychologists as a fundamental cornerstone of our engagement with one another and the world around us. The most familiar paradigm of joint attention is joint perceptual—specifically visual—attention to an object in the present environment. However, some recent discussions have focused on a potentially different form of joint attention: namely, ‘joint reminiscing’ conversations in which two or more people discuss something in the past which they both remember. These exchanges are in some ways (...) comparable to joint perceptual attention to something present, and have been characterised by some as a form of joint attention to the past. In this paper, I will assess the prospects for characterising joint reminiscing as a genuine form of joint attention to the past, as understood on the model of joint perceptual attention to something present. My conclusions will be tentative, and my primary aim will be to explore how different commitments regarding the nature of both joint attention and episodic memory give rise to different possibilities for characterising joint reminiscing as a distinctive form of collective engagement with the past. I will suggest that joint reminiscing is unlike ordinary joint attention at least insofar as joint reminiscing trades on the participants’ mutual recognition of one another as having been present at an earlier experience. This is connected with joint reminiscing’s social function, and its role in facilitating the special kind of relationship conveyed by the idea of knowing a person. (shrink)

Our ordinary conception of time has it that there are temporal particulars: not only do people do things, but there are particular doings by people; not only are we born, but the birth of each one of us was a particular event, and each of us will have our own particular death. Temporal particulars in this sense are individuated, fundamentally, by their temporal locations or relations, rather than by their intrinsic or qualitative characteristics. In this respect they are unrepeatable, not (...) just de facto, but as a matter of their very nature. However, there is a tradition in philosophy that seriously downplays this aspect of our thinking about time. According to this tradition, the fundamental unit of temporal representation is _tensed truth_; the notion of an unrepeatable particular, individuated by its temporal location, is at best an abstraction from a complex of tensed truths. The aims of this paper are, first, to argue that the representation of temporal particulars is deeply implicated in our ordinary conception of the past as fixed and unalterable; and, secondly, to argue that the theorist of tensed truth is able to provide only a pale imitation of this aspect of our thinking. I will then reflect on the consequences of this for debates about the metaphysics of tense. (shrink)

It is suggested, following a proposal made recently by Smolin, that the most fundamental law of the universe takes this form: Among the set of all possible universes compatible with an irreducibly minimal set of structural constraints, the actually realized universe is the one which maximizes a mathematically well-defined number (the variety) that measures the structural variety of the universe (in the totality of its history). This gives expression to Leibniz's idea that the actual universe gives “the greatest variety possible, (...) but with the greatest possible order.” Two models are proposed in which the idea can be realized and its consequences tested; both are discrete in nature and satisfy highly nonlocal laws. In such a scheme a unique (finite) universe is called into being by the fundamental requirement of maximal variety (for given definition of the variety), which it is conjectured could have such a powerful ordering effect that space, time, the currently known laws of physics, and the observed structure of the universe could all appear as emergent consequences of the single underlying law. (shrink)

In ‘Moral Luck,’ Bernard Williams famously argued that “there is a particularly important species of regret, which I shall call ‘agent-regret,’ which a person can feel only towards his past actions.” Much subsequent commentary has focused on Williams’s claim that agent-regret is not necessarily restricted to voluntary actions, and questioned whether such an attitude could be rationally justified. This focus, however, obscures a more fundamental set of questions raised by Williams’s discussion: what is the role in our moral psychology of (...) evaluative attitudes that relate essentially to past exercises of our agency—occurrences which, by their very nature, cannot be repeated? On a standard conception, regret is directed principally towards actions that resulted from suboptimal deliberation. On this view, the main point of regret is to guide us away from similar poor decisions in the future. But Williams’s key insight in ‘Moral Luck,’ I argue, is that there is a mode of evaluation of one’s past actions and decisions that does not track considerations one could and should have been responsive to at the time, and is for this reason essentially retrospective. From this perspective, the full significance of regret cannot be captured in terms of a disposition to deliberate better in the future. Rather, the particular kind of painful of consciousness of the past embodied in regret amounts to a reflective, and essentially backward-looking, insight into the contingency and finitude of our own agency—that I am a particular person leading a particular life, and that the possibility of leading a different life is now gone forever. I end by making some speculative comments about the intractable question whether it is ultimately good or desirable to be disposed to regret one’s past mistakes. (shrink)

The attitudes of Australian practitioners working in clinical genetics and obstetrical ultrasound were surveyed on whether termination of pregnancy (TOP) should be available for conditions ranging from mild to severe fetal abnormality and for non-medical reasons.These were compared for terminations at 13 weeks and 24 weeks. It was found that some practitioners would not facilitate TOP at 24 weeks even for lethal or major abnormalities, fewer practitioners support TOP at 24 weeks compared with 13 weeks for any condition, and the (...) difference in attitudes to TOP between 13 weeks and 24 weeks is most marked for pregnancies which are normal or involve a mild disorder. It is argued that a fetal abnormality criterion for late TOP is inconsistently applied, discriminatory and eugenic. Four possible moral justifications for current practice are examined, each of which would require significant changes to current practice. I argue in favour of a maternal interests criterion for any TOP. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Autonomy, Well-Being, Disease, and DisabilityJulian Savulescu (bio)Keywordsautonomy, well-being, mental disorder, psychiatric disease, disability, welfare, body integrity identity disorderVarelius seeks to redefine what constitutes mental disorder or mental illness. (I use these terms interchangeably.) "According to this account, 'a person is mentally disordered when her psychological capacity for autonomy is diminished as compared with that of a typical member of our species of her age-group" (Varelius 2009). This is a (...) stimulating and important paper. Varelius describes fruitfully the relationship between mental illness and autonomy, specifically the ways in which mental disorder can undermine autonomy. This is valuable in understanding the impact of mental illness on the lives of people who suffer from it, which is a serious issue in practical ethics. But is it what constitutes mental disorder or illness? There are logical, conceptual reasons why we should not redefine mental illness in this way.Incomplete Account of Mental DisorderThere are a family of related concepts: disease, injury, disorder, illness, disability. There are old and entrenched disputes about how we should define these concepts. Varelius' paper is a contribution to the definition of mental disorder and illness.The primary classificatory category that defines medical practice is that of health and disease. Disease, broadly construed, involves the presence of pathology. Pathology can result from processes primarily or predominantly internal to the organism, such as genetic disease (although external factors affect their expression), or from processes primarily or predominantly external to the organism, such as injuries.The concepts of disorder and illness relate to the concept of disease. Disorder could be defined in terms of the functional effect of pathology. Illness could be defined in terms of the experiential impact of disease.1 How these terms are precisely defined and related need not concern us at the present. What matters is that the primary category is disease.Psychiatry has evolved in its use of terminology. What used to be called psychiatric diseases are now often called mental disorders. I now claim, for the purposes of illustration of the argument (though it does not require this claim), that the dominant category is disease. Indeed, what are called mental disorders appear in the International Classification of Diseases.Disease can be divided into the mental and physical. I believe that the mental will one day be [End Page 59] shown to be shown to be entirely a subset of the physical. That is, that brain pathology will be a cause, if not the only cause, of mental disease. But others may believe the sets of mental and physical disease are intersecting but not coextensive.What matters is that mental disease is a subcategory of the more general category of disease. It must have the same definitional features as "disease" plus some extra ones specific to the "mental," or mind. (The same points apply if you use "disorder" as the dominant category rather than "disease.")One problem for Varelius is this: how does this autonomy account of "mental disease" relate to an account of "physical disease," and "disease" in general? If mental disease is defined in terms of its impact on the psychological capacities necessary for autonomy, how is "disease" in general, or physical disease, to be defined? One obvious response is to define these related concepts in a similar way:Disease: "a person is diseased when her capacity for autonomy is diminished as compared to that of a typical member of our species of her age-group." Physical disease: "a person is physically disordered when her physical capacity for autonomy is diminished as compared to that of a typical member of our species of her age-group."This interpretation is suggested by the following passage from Varelius:As contrasted with the actual condition of being autonomous, as a capacity of an individual autonomy means that a person has the psychological and bodily abilities that being autonomous... requires.(2009)It would be radical to define disease in general in terms of capacity for autonomy. There is no doubt that disease affects our autonomy, and that is morally significant, but these seem clearly separable concepts. Varelius could respond that he is not defining mental disease but rather the mental component... (shrink)

“Whilst philosophical counsellors recognise that philosophy is a potentially practical and useful discipline, this isn’t how many of general public or counselling service providers perceive it. Philosophy has still got a lot of persuading to do about its practical relevance and efficacy.”.