Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for metastatic (...) cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve “rough justice” and “supple solidarity.” The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity. (shrink)

In part I of this paper, I argue that #MeToo testimony increases epistemic value for the survivor qua hearer when experiences like hers are represented by others; for society at large when false but dominant narratives about sexual violence and sexual harassment against women are challenged and replaced with true stories; and for the survivor qua teller when her true story is believed. In part II, I argue that the epistemic significance of #MeToo testimony compels us to consider the tremendous (...) and often unappreciated costs to the individual tellers, and the increased credibility they are owed in virtue thereof. (shrink)

I agree with Jecker et al that “the headline-grabbing nature of existential risk (X-risk) diverts attention away from immediate artificial intelligence (AI) threats…”1 Focusing on very long-term speculative risks associated with AI is both ethically distracting and ethically dangerous, especially in a healthcare context. More specifically, AI in healthcare is generating healthcare justice challenges that are real, imminent and pervasive. These are challenges generated by AI that deserve immediate ethical attention, more than any X-risk issues in the distant future. Almost (...) 50 years ago, John Knowles edited a volume titled Doing Better and Feeling Worse: Health in the United States. We are ‘doing better’ because numerous advances in medical technologies are saving more lives and improving the quality of our lives. But we are ‘feeling worse’ because the additional costs are unsustainable, are threatening funding for other social goods and are increasing injustices regarding the allocation of those resources. This is precisely the situation we are faced with regarding AI in medicine today. Exploding healthcare costs have generated increasing pressure to control those costs, often with unjust consequences. AI is touted as a critical mechanism for controlling healthcare costs, often with little thought given to justice-relevant consequences. Consider, for example, …. (shrink)

Accelerated approval of aducanumab for mild Alzheimer's by the U.S. Food and Drug Administration on June 7, 2021, has generated substantial medical, scientific, and ethical controversy. That approval was contrary to the nearly unanimous judgment of the FDA's Advisory Committee that little reliable evidence existed of significant benefit, even though the drug did reduce β‐amyloid. Three major ethical problems were created by this approval: (1) Medicare resources would be unjustly squandered, given the drug's $56,000 annual price and the 3.1 million (...) older potential American patients needing the drug; (2) physicians will feel ethically compelled to provide the drug to desperate, insistent patients, given FDA approval and in spite of side effects of brain bleeds and brain swelling; (3) and false hopes are generated for patients. A needed corrective by the federal government would reduce reimbursement to the bare cost of producing the drug (plus only a modest profit) until a phase IV trial has been successfully completed. (shrink)

Helen Longino argues that the way to ensure scientific knowledge is objective is to have a diversity of scientific investigators. This is the best example of recent feminist arguments which hold that the real value of diversity is epistemic, and not political, but it only partly succeeds. In the end, Longino's objectivity amounts to intersubjective agreement about contextually based standards, and while her account gives us a good reason for wanting diversity in our scientific communities, this reason turns out to (...) be political. (shrink)

De Bie et al. (2023) call attention at the conclusion of their essay to the “novel questions” generated by complete ectogenesis. The question I explore is how complete ectogenesis from conception t...

John Rawls has held up as a model of public reason the U.S. Supreme Court. I argue that the Dobbs Court is justifiably criticized for failing to respect public reason. First, the entire opinion is governed by an originalist ideological logic almost entirely incongruent with public reason in a liberal, pluralistic, democratic society. Second, Alito’s emphasis on “ordered liberty” seems completely at odds with the “disordered liberty” regarding abortion already evident among the states. Third, describing the embryo/fetus from conception until (...) birth as an “unborn human being” begs the question of the legal status of the embryo/fetus, as if an obiter dictum settled the matter. Fourth, Alito accuses the Roe court of failing to exercise judicial restraint, although Alito argued to overturn Roe in its entirety. In brief, the Dobbs opinion is an illiberal, disingenuous, ideological swamp that swallows up public reason and the reproductive rights of women. (shrink)

Foundation models such as GPT-4 are fine-tuned to avoid unsafe or otherwise problematic behavior, such as helping to commit crimes or producing racist text. One approach to fine-tuning, called reinforcement learning from human feedback, learns from humans' expressed preferences over multiple outputs. Another approach is constitutional AI, in which the input from humans is a list of high-level principles. But how do we deal with potentially diverging input from humans? How can we aggregate the input into consistent data about "collective" (...) preferences or otherwise use it to make collective choices about model behavior? In this paper, we argue that the field of social choice is well positioned to address these questions, and we discuss ways forward for this agenda, drawing on discussions in a recent workshop on Social Choice for AI Ethics and Safety held in Berkeley, CA, USA in December 2023. (shrink)

The Oxford University Studies in the Enlightenment series, previously known as SVEC (Studies on Voltaire and the Eighteenth Century), has published over 500 peer-reviewed scholarly volumes since 1955 as part of the Voltaire Foundation at the University of Oxford. International in focus, Oxford University Studies in the Enlightenment volumes cover wide-ranging aspects of the eighteenth century and the Enlightenment, from gender studies to political theory, and from economics to visual arts and music, and are published in English or French.

In summary, the usual elements of a typical health care ethics consultation note might reasonably accommodate the needs and expectations of relevant parties, and would therefore include: 1. identification of the relevant ethical issues, questions, or dilemmas; 2. reference to any relevant facts--medical, nursing, social, psychological, spiritual, legal, political, etc.; 3. a prioritized list of recommendations to improve coordinated care; 4. a clear and concise articulation of relevant arguments, wtih specific reference to the list of recommendations as well as to (...) the institution's overall ethos; 5. a contextual statement, identifying the perceived degree of consensus or support for the recommendations and conclusions, as well as any inherent agendas. (shrink)

At the turn of the last century, paleontologists wagered that they could find the missing link between lobe-finned fish and early terrestrial vertebrates. Given how these evolutionary relatives are distributed in the fossil record, Daeschler et al. predicted that some transitional form awaited discovery in late Devonian outcrops of the Canadian Arctic. It was there that they won their bet: the team soon found Tiktaalik roseae, a “fishopod” with a mix of aquatic and terrestrial traits. Tiktaalik’s discovery now stands as (...) paleontologists’ textbook case of scientific reasoning done right. (shrink)

Community of inquiry is most often seen as a dialogical procedure for the cooperative development of reasonable approaches to knowledge and meaning. This reflects a deep commitment to normatively based reasoning that is pervasive in a wide range of approaches to critical thinking and argument, where the underlying theory of reasoning is logic driven, whether formal or informal. The commitment to normative reasoning is deeply historical reflecting the fundamental distinction between reason and emotion. Despite the deep roots of the distinction (...) and its canonization in current educational thought, contemporary cognitive neuroscience presents a fundamental challenge to the viability of the distinction and thus to any effort that sees education for reasonable judgment to be based on the remediation of cognition in isolation from its roots in the emotions. Cognitive neuroscience looks at the deep connections between emotion and memory, information retrieval, and resistance to refutation. This conforms with earlier studies in experimental psychology, which showed resistance to changing beliefs in the face of evidence, including evidence based on personal experience. This paper will look at the recent research including speculations from neurological modeling that shows the depth of connection between, emotions, memory and reasoning. It will draw implications for dialogic thinking within a community of inquiry including systematic self-reflection as an essential aspect of critical thinking. (shrink)

Few will, I think, doubt that the Trio from the Minuetto movement of Mozart's G Minor Symphony seems simple, direct, and lucid—even guileless. Its melodies are based upon common figures such as triads and conjunct diatonic motion. No hemiola pattern, often encountered in triple meter, disturbs metric regularity. With the exception of a subtle ambiguity..., rhythmic structure is in no way anomalous. There are no irregular or surprising chord progressions; indeed, secondary dominants and chromatic alterations occur very frequently. The instrumentation (...) is quite conventional, and no unusual registers are employed. In this essay, Leonard B. Meyer, Benjamin Franklin Professor of music and humanities at the University of Pennsylvania, further explores and details the significance of theories advanced in his book, Explaining Music: Essays and Explorations. His previous contribution to Critical Inquiry, "Concerning the Sciences, the Arts - AND the Humanities," appeared in our first issue. (shrink)

Presented as a Vorlesung in the German philosophical tradition, this book presents the most detailed account of Nelson's method of argument analysis, celebrated by many luminaries such as Karl Popper. It was written in 1921 in opposition to the relativistic, subjectivistic and nihilistic tendencies of Nelson's time. The book contains an exposition of a method that is a further development of Kant's transcendental dialectics, followed by an application to the critical analysis of arguments by many famous thinkers, including Bentham, Mill, (...) Poincaré, Leibniz, Hegel, Einstein, Bergson, Rickert, Simmel, Brentano, Stammler, Jellinek, Dingler, and Meinong. The book presents a general theory of philosophical argumentation as seen from the viewpoint of the typical fallacies committed by anybody arguing philosophically, whether professional philosophers or philosophical laypeople. Although the nature of philosophy and philosophical argumentation is one of the most recurrent objects of reflection for philosophers, this book represents the first attempt at a general theory of philosophical fallacy. According to Nelson, it is in the shape of false dilemmas that errors in reasoning always emerge, and false dilemmas are always the result of the same mechanism--the unwitting replacement of one concept for another. (shrink)

In this paper, I argue for the following points. First, all of us have a presumptive moral obligation to be organ donors if we are in the relevant medical circumstances at the time of death. Second, family members should not have the right to interfere with the fulfillment of that obligation. Third, the ethical basis for that obligation is reciprocity. If we want a sufficient number of organs available for transplantation, then all must be willing donors. Fourth, that likelihood is (...) diminished if individuals are entirely free to refuse to be organ donors but still would demand to be organ recipients. Fifth, although individuals would be ethically obligated to be organ donors, we still need to permit them to refuse to be organ donors. Sixth, to encourage individuals to stay within the organ donation system, we should have as a just and ethically justified policy denying individuals an organ transplant in the relevant medical circumstances if they have chosen to exit the organ donation system. Individuals would not be permitted to be organ recipients if they were unwilling to be organ donors. This is what it means to be part of what Rawls in Political liberalism (15-22) would refer to as a “fair system of social cooperation.” We refer to this as the “reciprocity requirement.”. (shrink)