Background Artificial intelligence (AI) has revolutionized various healthcare domains, where AI algorithms sometimes even outperform human specialists. However, the field of clinical ethics has remained largely untouched by AI advances. This study explores the attitudes of anesthesiologists and internists towards the use of AI-driven preference prediction tools to support ethical decision-making for incapacitated patients. Methods A questionnaire was developed and pretested among medical students. The questionnaire was distributed to 200 German anesthesiologists and 200 German internists, thereby focusing on physicians who (...) often encounter patients lacking decision-making capacity. The questionnaire covered attitudes toward AI-driven preference prediction, availability and utilization of Clinical Ethics Support Services (CESS), and experiences with ethically challenging situations. Descriptive statistics and bivariate analysis was performed. Qualitative responses were analyzed using content analysis in a mixed inductive-deductive approach. Results Participants were predominantly male (69.3%), with ages ranging from 27 to 77. Most worked in nonacademic hospitals (82%). Physicians generally showed hesitance toward AI-driven preference prediction, citing concerns about the loss of individuality and humanity, lack of explicability in AI results, and doubts about AI’s ability to encompass the ethical deliberation process. In contrast, physicians had a more positive opinion of CESS. Availability of CESS varied, with 81.8% of participants reporting access. Among those without access, 91.8% expressed a desire for CESS. Physicians' reluctance toward AI-driven preference prediction aligns with concerns about transparency, individuality, and human-machine interaction. While AI could enhance the accuracy of predictions and reduce surrogate burden, concerns about potential biases, de-humanisation, and lack of explicability persist. Conclusions German physicians frequently encountering incapacitated patients exhibit hesitance toward AI-driven preference prediction but hold a higher esteem for CESS. Addressing concerns about individuality, explicability, and human-machine roles may facilitate the acceptance of AI in clinical ethics. Further research into patient and surrogate perspectives is needed to ensure AI aligns with patient preferences and values in complex medical decisions. (shrink)

A comprehensive understanding of the ethics of the COVID-19 pandemic priorities must be sensitive to the influence of social inequality. We distinguish between ex-ante and ex-post relevance of social inequality for COVID-19 disadvantage. Ex-ante relevance refers to the distribution of risks of exposure. Ex-post relevance refers to the effect of inequality on how patients respond to infection. In the case of COVID-19, both ex-ante and ex-post effects suggest a distribution which is sensitive to the prevalence social inequality. On this basis, (...) we provide a generic fairness argument for the claim that welfare states ought to favour a healthcare priority scheme that gives particular weight to protecting the socially disadvantaged. (shrink)

This article advances a tentative theory of skill in relation to eSports. This conjectural theory of skill rests on hypothesizes informed by assumptions from watching 100+ hours of eSport events on Twitch, YouTube, and AfreecaTV and is supported by discussions, reflections and evaluations with eSport players. The case material of this article includes the games Clash Royale (CR), StarCraft 2 (SC2), Counter-Strike: Global Offensive (CS:GO), and online battle arenas (mobas) such as League of Legends (LOL) and Defense of the Ancient (...) 2 (DOTA2). This inferred theory of skill is conjoined and composed of seven strands, which provide a framework for explaining how to understand skill in eSport. These seven strands are presented under the headings: (1) knowledge about game objects, (2) insights into game systems, (3) understanding metagaming, (4), yomi: ‘reading’ the opponent, (5) ability to execute, (6) emotional discipline, and finally (7) team coherency (depending upon whether the skill is associated with a one-versus-one or team-versus-team game). In conclusion, the proposed theory of skill will expose its explanatory power and reach by providing an example of how it can both be implemented to create profiles of players’ skill, and how these profiles in turn can serve as guides to help players improve their skill levels in eSport. (shrink)

This book represents a considerable revision and expansion of Public Choice II. Six new chapters have been added, and several chapters from the previous edition have been extensively revised. The discussion of empirical work in public choice has been greatly expanded. As in the previous editions, all of the major topics of public choice are covered. These include: why the state exists, voting rules, federalism, the theory of clubs, two-party and multiparty electoral systems, rent seeking, bureaucracy, interest groups, dictatorship, the (...) size of government, voter participation, and political business cycles. Normative issues in public choice are also examined including a normative analysis of the simple majority rule, Bergson–Samuelson social welfare functions, the Arrow and Sen impossibility theorems, Rawls's social contract theory and the constitutional political economy of Buchanan and Tullock. (shrink)

Telic sufficientarianism is the view that it is better, other things equal, if people are lifted above some sufficiency threshold of special moral importance. In a recent contribution, Shlomi Segall has raised the following objection to this position: The telic ideal of sufficiency can neither be grounded on any personal value, nor any impersonal value. Consequently, sufficientarianism is groundless. This article contains a rejoinder to this critique. Its main claim is that the value of autonomy holds strong potential for grounding (...) sufficiency. It argues, firstly, that autonomy carries both personal value for its recipient as well as impersonal value, and that both of these values are suitable for grounding sufficiency. It thus follows that we should reject both and. Secondly, although autonomy is presumably the strongest candidate for grounding sufficiency, the article provides some counterargument to Segall's rejection of the other candidates — the impersonal value of virtue; the personal value for the allocator; and the personal value for others. If the arguments are sound, they show that we need not worry about sufficientarianism being groundless. (shrink)

In recent works, Shlomi Segall suggests and defends a luck egalitarian approach to justice in health. Concurring with G. A. Cohen’s mature position he defends the idea that people should be compensated for “brute luck”, i.e. the outcome of actions that it would be unreasonable to expect them to avoid. In his defense of the luck egalitarian approach he seeks to rebut the criticism raised by Norman Daniels that luck egalitarianism is in some way too narrow and in another too (...) wide to uphold justice in health and health care distribution. He points out that a pluralistic outline of luck egalitarianism taking into account the moral requirement of meeting everyone’s basic needs can avoid this line of criticism. In this article I argue against the application of such pluralistic luck egalitarianism in matters of health distribution. First of all, Segall has not shown that luck egalitarianism handles well health distributions above a threshold of basic needs. Secondly, his way of avoiding Elizabeth Anderson’s abandonment objection is theoretically problematic. Finally, I argue that luck egalitarianism in general fails to acknowledge the moral foundation of health and health care as a basic human entitlement. Thus I conclude that luck egalitarianism fails to take health needs seriously and that it cannot therefore uphold justice in health. (shrink)

It is generally accepted that morally justified healthcare rationing must be non-discriminatory and cost-effective. However, given conventional concepts of cost-effectiveness, resources spent on disabled people are spent less cost-effectively, ceteris paribus, than resources spent on non-disabled people. Thus, it is reasonable to assume that standard cost-effectiveness discriminates against the disabled. Call this thedisability discrimination problem.Part of the disability discrimination involved in cost-effectiveness stems from the way in which health-related quality of life is accounted for and measured. This paper offers and (...) defends a patient-sensitive account of health-related quality of life, which can effectively make cost-effectiveness less discriminatory against the disabled and thus more morally justified. (shrink)

It is a common socio-moral practice to appeal to reasons as a guiding force for one’s actions. However, it is an intriguing possibility that this practice is based on fiction: reasons cannot or do not motivate the majority of actions—especially moral ones. Rather, pre-reflective evaluative processes are likely responsible for moral actions. Such a view faces two major challenges: i.) pre-reflective judgements are commonly thought of as inflexible in nature, and thus they cannot be the cause of the varied judgements (...) people rely on in everyday life, and ii.) if reflective reason-based judgements do not play a strong causative role in judgement, why do people rely on the articulation of reasons in their moral practices? We argue that the pre-reflective judgements motivating moral actions are embodied in nature. The experience of the rightness of an action that drives a person to act depends on the sensorimotor interactions that have cultivated an agent’s perspective on the world. These interactions are embedded in relational contexts, relative to which judgements are individuated. Because of this relational embeddedness they are more flexible than they are commonly thought to be, enabling us to explain the variety of human behavior by appealing to them. The Anglo-European practice of appealing to reason as if they were propositional belief-statements motivating actions can be accounted for as nothing more than an idiosyncratic way of constructing narratives to clarify and express the relational context of intentional actions. (shrink)

Introduction -- Towards a critical theory of society -- The public sphere -- Communicative action and reason -- Discourse ethics -- Deliberative democracy -- The new political constellation.

Setting out to defend luck egalitarianism in matters of justice in health, Shlomi Segall outlines a pluralistic version of the luck egalitarian framework allowing egalitarian justice to be traded-off against other moral requirements. The suggested pluralism enables luck egalitarian justice to coexist with a concern for meeting everyone’s basic needs thereby avoiding Elizabeth Anderson’s ‘abandonment objection’. In this article, however, we present three objections to Segall’s luck egalitarian justice in health. Firstly, the account is vulnerable to the common objection that (...) luck egalitarianism becomes too expansive, and that Segall’s defence against this is inadequate. Secondly, Segall’s pluralist attempt to balance luck egalitarian justice and other moral requirements ends up compromising its own ideal of justice. Due to the fact that resource scarcity is the reality of health and health care distribution, this problem would often arise in actual health policy. Finally, the account has a way of intensifying blameworthy behaviour which seems contrary to luck egalitarian principles. Based on these three objections, we conclude that Segall’s luck egalitarian account of justice in health must either be rejected or qualified further. (shrink)

The capability approach, originated by Amartya Sen is among the most comprehensive and influential accounts of justice that applies to issues of health and health care. However, although health is always presumed as an important capability in Sen’s works, he never manages to fully explain why health is distinctively valuable. This paper provides an explanation. It does this by firstly laying out the general capability-based argument for health justice. It then discusses two recent attempts to justify why health is distinctively (...) valuable from within a capability framework – these are Sridhar Venkatapuram’s conception of health as the central human meta-capability and, respectively, Norman Daniels’ embrace of the capability metric in his use of Rawls’ principle of fair equality of opportunity. The paper argues that none of these accounts succeed in providing a plausible justification of the value of health. Finally, the paper suggests an alternative more complex justification, closely tied to different but central element of the capability view, that captures the core intuitions of both Venkatapuram and Daniels’ accounts but without being vulnerable to the objections raised against each of them. This, the paper concludes, provides a promising ground on which the capability view on health justice should be founded. (shrink)

On the sesquicentennial of T. R. Malthus’s second and much enlarged edition of An Essay on the Principle of Population (1803), the retired doctor and public health official George F. McCleary publi...

A key question in the art debate in the eighteenth and nineteenth centuries was whether color should be used for sculpture. Recent archaeological research had shown that the sculpture in ancient Greece was polychrome, but skepticism about applying paint to one’s own work was widespread among modern sculptors. Some scholars explain this reluctance as a consequence of racial prejudice: the Greek athlete was an image of white Europeans. This article will try to show that a re-reading of Johann Gottfried Herder’s (...) book on sculpture can give us a different and more probable explanation. Herder shared Roger de Piles’s view that the essence of sculpture was form, while color was most characteristic of painting. What set Herder apart from his predecessor, however, was his attempt to give the theory a scientific rationale. He found this in contemporary accounts of visually impaired persons’ relationship to the sensory world and not least in empiricist philosophy’s distinction between primary and secondary sensory properties. (shrink)

The taste for classical art that induced museums in the West to acquire masterpieces from ancient Greece and Rome for their collections was stimulated largely by the writings of Johann Joachim Winckelmann. In the past decade, a number of articles have claimed that Winckelmann’s glorification of marble statues representing the white, male body promotes notions of white supremacy. The present article challenges this view by examining theories prevalent in the eighteenth century that affected Winckelmann’s views on race. Through an examination (...) of different types of classicism, the article also seeks to demonstrate that Winckelmann’s aesthetics were opposed to the eclectic use of ancient models typical of the fascist regimes of the twentieth century. (shrink)

Recently, Kenneth Westphal has presented a highly interesting and innovative reading of Kant's critical philosophy.2 This reading continues a tradition of Kantscholarship of which, e.g., Paul Guyer's work is representative, and in which the antiidealistic potential of Kant's critical philosophy is pitted against its idealistic selfunderstanding. Much of the work in this tradition leaves matters at observing the tensions this introduces in Kant's work. But Westphal's proposed interpretation goes farther. Its attractiveness derives for the most part from the promise that (...) it permits an internal critique of Kant's transcendental idealism (TI), that is, a critique that is based on the very resources of Kantian transcendental philosophy.3 In contrast to these resources, which currently seem to go through a sort of revival in an enormous array of fields, TI is notorious for dismaying even sympathetic interpreters. How attractive and needed such an internal critique of TI would be becomes all the more patent when we place such a promise in the context of some of the contemporary discussions about TI after Allison's famous defense of it. Before directly engaging with Westphal's interpretation, I would therefore like to quickly sketch on what background it acquires its force (I). After characterizing the main features of Westphal's view (II), and supporting it in more detail by an account of Kant's theory of cognitive significance (III), I then want to review the extent of its success to present Kant as issuing an anti-skeptical argument (IV.1), or semantic views that are incompatible with TI (IV.2), or a 'proof of not merely empirical realism' (IV.3). I agree that purely idealist readings of Kant are mistaken. Westphal's... (shrink)

This article draws on ethnographic field data collected during an investigation of the informed consent process and AIDS clinical trials. It describes the involvement of care providers (physicians, nurse practitioners, physician assistants) during the enlistment, or recruitment, phase of the informed consent process. It shows that sometimes care providers are involved in the receipt, evaluation and distribution of information on clinical trials through their interactions with research professionals and patients. It suggests that the involvement of care providers has the potential (...) to influence the informed consent process. Some of the ethical and practice considerations of this are discussed. (shrink)

Prioritarianism pertains to the generic idea that it matters more to benefit people, the worse off they are, and while prioritarianism is not uncontroversial, it is considered a generally plausible and widely shared distributive principle often applied to healthcare prioritisation. In this paper, I identify social justice prioritarianism, severity prioritarianism and age-weighted prioritarianism as three different interpretations of the general prioritarian idea and discuss them in light of the effect of pandemic consequences on healthcare priority setting. On this analysis, the (...) paper arrives at the following three conclusions: that we have strong prioritarian reasons for special concern about the vulnerable and socially disadvantaged in reference to pandemic effects, that severity of illness is an important factor in identifying the worse off in priority setting but that this must not over-ride the special priority to the socially disadvantaged and that the maximisation rationale of the age-weighted view runs against the core prioritarian idea, and the age-weighted prioritarianism is thus unfitting as a prioritarian response to the COVID-19 case. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 63.2 (2002) 303-321 [Access article in PDF] "The Peak on Which Abraham Stands": The Pregnant Moment of Søren Kierkegaard's Fear and Trembling Lasse Horne Kjaeldgaard When Søren Kierkegaard in the 1840s began his one-man crusade against the predominant philosophy of his time and place—the right Hegelianism that was en vogue among his contemporaries in Copenhagen—he chose his weapons with great circumspection. The (...) indirect form of communication, which he later advocated in more direct terms in his "Point of View," 1 was not only a maieutic means that helped the reader conceive of the latent and strictly private messages of the texts; it was also a strategy for Kierkegaard's undercover assaults on the Hegelian turn of the Geistesleben around him. By interweaving many of the Hegelian platitudes and self-confident pronouncements that circulated in the intellectual life of the day into the pseudonymous writings, Kierkegaard contested them with parody rather than argumentation. This is the local background against which these texts are structured and to which they are addressed in multiple and very subtle ways. That also goes for that of the pseudonymous writings which has become the best known but which may also be regarded as the most private and most secretive of them all, Fear and Trembling, published pseudonymously in 1843.Secrecy, silence, and unspeakable messages are abundantly thematized in Fear and Trembling, as one could expect from the name of the narrator, Johannes de Silentio. Silentio is a prominent member of the choir of pseudonymous figures Kierkegaard invented to communicate indirectly with his audience and in [End Page 303] the name of which he published his most celebrated works. The silence that Silentio speaks of is that of Abraham of the Old Testament, who was commanded by God to sacrifice his only son on Mount Moriah. Although Genesis 22 includes fragments of the dialogue between Abraham and Isaac on their way to the mountain, Silentio insists that Abraham remained silent on the essential issue: the command he acts upon. The unmediated message Abraham had received from God could not be conveyed, and he was therefore barred from communication and bereft of his community as he journeyed to the Mountain. Yet Silentio's discourse upon this silence in Fear and Trembling has given impetus to innumerable pages of commentary. The questions and answers he poses in his reflections upon Abraham's ordeal have called for critical attention and controversy since the time of its publication. His obsession with the biblical narrative certainly seems to have been passed on to many readers of Fear and Trembling, which, a recent commentator has remarked, "continues to haunt us like no other of [Kierkegaard's] writings." 2 So far, it would seem, then, that Kierkegaard was right when he predicted, in an undated journal entry, that "Fear and Trembling will be enough to immortalise my name." It has indeed been "read and translated into foreign languages," as he foresaw it would. 3Even so, what has passed unnoticed in its long history of reception is the significance of the titles that the manuscript text bore before it came to be called Fear and Trembling. On the title page the definitive appellation is placed together with two alternatives with less suggestion of pathos: "Movements and Postures" (Bevægelser og Stillinger) and "Between-each-other" (Mellemhver-andre). 4 Not much can be discerned from these unpeculiar phrases in isolation. However, tracing their history and significance through Kierkegaard's writings and beyond, will make it clear that Fear and Trembling was also dispatched to the narrow Hegelian community in Copenhagen for the purpose of questioning their literary and visual aesthetics and philosophy of history. Into the guerrilla warfare against them Fear and Trembling introduces a weapon of such sophistication that it has remained undetected so far: the power of the "pregnant moment." My aim here will be to demonstrate the way in which Fear and Trembling appropriates a principle of selection intended for the... (shrink)

The concepts of adaptation and fitness have such an appeal that they have been used in other scientific domains, including the social sciences. One particular aspect of this theory transfer concerns the so-called fitness landscape models. At first sight, fitness landscapes visualize how an agent, of any kind, relates to its environment, how its position is conditional because of the mutual interaction with other agents, and the potential routes towards improved fitness. The allure of fitness landscapes is first and foremost (...) that it represents a complex story about adaptation and fitness in one coherent image. Different accounts of fitness landscapes in different domains in the social sciences suggest that the properties and functions of fitness landscapes are attributed rather freely. These differences are testimony of the model’s versatility. At the same time, one will notice that the different approaches can also create ambiguity about the exact meaning and role of fitness landscapes in the social sciences. This article presents an extensive literature survey of the diverging interpretations and uses of fitness landscapes in the social sciences and discusses the implications in terms of how these models inform scientific inquiry. (shrink)

This paper discusses limitarianism in light of three popular objections to the redistribution of extreme wealth: (i) that such redistribution legitimizes envy, which is a morally objectionable attitude; (ii) that it disincentivizes the wealthy to invest and work, leading to a diminished social product, and, thereby, making everyone worse-off; and (iii) that it undercuts the pursuit and achievement of human excellence by depriving successful people of resources through which they may otherwise excel. We argue that these objections fail to undermine (...) limitarianism. An elaborated defence against them, rather, reveals how the Standard Defence of limitarianism may be expanded and strengthened by relying explicitly on the importance of preventing a society of envy, avoiding harm to non-rich citizens, and ensuring that humans are given the opportunities to excel in ways that go beyond those that allow for the amassment of wealth. (shrink)

A survey of Euclid's Elements, this text provides an understanding of the classical Greek conception of mathematics and its similarities to modern views as well as its differences. It focuses on philosophical, foundational, and logical questions — rather than strictly historical and mathematical issues — and features several helpful appendixes.

In this paper, I ask what is wrong with sufficiency. I formulate a generic sufficiency principle in relation to which I discuss possible problems for sufficientarianism. I argue against the arbitrariness–concern, that sufficiency theory need only to identify a possible space for determining a plausible threshold, and I argue against the high–low threshold dilemma concern, that multiple-threshold views can solve this dilemma. I then distinguish between currency-pluralist and currency-monist multiple-threshold views and test them against two different versions of the widely (...) shared ‘ignorance of inequality objection’ to sufficientarianism—a benefit-driven and a burden-driven version. I argue that currency-pluralist sufficiency views are better capable of responding to the former than currency-monist views. However, I show that no existing sufficiency view can provide a plausible response to the burden-driven version. Hence, I conclude that the problem of unequal distribution of burdens above the thresholds represents an overlooked threat to the sufficiency view, in any version. (shrink)

In this book, Andy Mueller examines the ways in which epistemic and practical rationality are intertwined. In the first part, he presents an overview of the contemporary debates about epistemic norms for practical reasoning, and defends the thesis that epistemic rationality can make one practically irrational. Mueller proposes a contextualist account of epistemic norms for practical reasoning and introduces novel epistemic norms pertaining to ends and hope. In the second part Mueller considers current approaches to pragmatic encroachment in epistemology, ultimately (...) arguing in favor of a new principle-based argument for pragmatic encroachment. While the book defends tenets of the knowledge-first programme, one of its main conclusions is thoroughly pragmatist: in an important sense, the practical has primacy over the epistemic. (shrink)

This article identifies value‐satiability sufficientarianism as a distinctive version of the sufficiency view, which has been ignored in the literature on distributive justice. This is unfortunate because value‐satiability sufficientarianism is much better equipped than alternative sufficiency views to cope with the standard objections against sufficiency. Most often, sufficientarianism refers to satiability as a feature of moral principles and reasons. But value‐satiability sufficientarianism also invokes satiability in the space of value‐theory, as it determines the sufficiency threshold at the point where justice‐relevant (...) values have been completely fulfilled. The article gives examples of how this view is widely apparent in the literature, and it provides some reasons in its favour. It then presents the two standard objections against sufficientarianism – the threshold objection and the indifference objection – and argues that these critiques do not apply to value‐satiability sufficientarianism. The general argument of the article therefore proves sufficientarianism more difficult to refute than is commonly credited. (shrink)

This paper explores the role individual responsibility plays in contemporary political theory. It argues that the standard luck egalitarian view—the view according to which distributive justice is ensured by holding people accountable for their exercise of responsibility in the distribution of benefits and burdens—obscures the more fundamental value of being responsible. The paper, then, introduces an account of ‘self-creative responsibility’ as an alternative to the standard view and shows how central elements on which this account is founded has been prominently (...) defended in the history of Western political thought but are comparatively neglected in contemporary political theory. Relying on this account, the paper argues that society should hold persons responsible when, and only when, doing so enables them to lead responsible lives, and only on the condition that doing so does not infringe other persons’ equivalently valuable ability to lead responsible lives. The account of self-creative responsibility, the paper concludes, plausibly captures the intuitive attraction of holding responsible while respecting the value of being responsible. (shrink)

Since his contribution to the field of personal identity in 1738 Hume’s theory has been debated thoroughly. Throughout the years there have been multiple critiques of Hume’s theory, but despite the fact that all of these generally appear unsatisfactory, Hume’s theory of personal identity is far from being a popular one in the field. I believe the blame partly falls on Hume himself. Hume’s appendix to Treaties is most often read as expressing a deep concern regarding his own theory, and (...) this concern, I believe, is to blame for his theory never gaining the respect it deserves. After all, why should we listen to Hume if he himself found his theory lacking? It is, however, a mistake to judge Hume’s theory of personal identity, based on the appendix to Treaties. The appendix is far too ambiguity for any real conclusion and it offers nothing that cannot be found in the original chapter on personal identity from Treaties. (shrink)

Many methods are used in research on complexity. One of these is qualitative comparative analysis. Although many authors allude to the relationships between complexity and QCA, these links are rarely made explicit. We propose that one way of doing so is by using critical realism as a meta-framework. This article discusses the viability of this approach by examining the extent to which QCA is a complexity-informed method. This question is answered in three steps. First, we discuss the nature of complexity (...) and its epistemological implications. Second, we focus on Bhaskar’s perspective on critical realism and show how it can be used as a framework for understanding social complexity. Third, we examine the ontological and epistemological assumptions underlying QCA and synthesize these with our critical realist approach to complexity. We argue that complex reality is non-decomposable, contingent, non-compressible and time-asymmetric. We conclude that, although QCA is inevitably reductive and partial, its core premises are built upon the notions of contingency and time-asymmetry. Therefore, it is not only a powerful method for doing complexity-informed research, but is also a complexity-informed method by itself. (shrink)