The field of bioethics has evolved over the past half-century, incorporating new domains of inquiry that signal developments in health research, clinical practice, public health in its broadest sense and more recently sensitivity to the interdependence of global health and the environment. These extensions of the reach of bioethics are a welcome response to the growth of global health as a field of vital interest and activity. This paper provides a critical interpretive review of how the term “global health ethics” (...) has been used and defined in the literature to date to identify ethical issues that arise and need to be addressed when deliberating on and working to improve the discourse on ethical issues in health globally. Selected publications were analyzed by year of publication and geographical distribution, journal and field, level of engagement, and ethical framework. Of the literature selected, 151 articles were written by authors in high-income countries, as defined by the World Bank country classifications, 8 articles were written by authors in low- or middle-income countries, and 13 articles were collaborations between authors in HIC and LMIC. All of the articles selected except one from 1977 were published after 1998. Literature on global health ethics spiked considerably from the early 2000s, with the highest number in 2011. One hundred twenty-seven articles identified were published in academic journals, 1 document was an official training document, and 44 were chapters in published books. The dominant journals were the American Journal of Bioethics, Developing World Bioethics, and Bioethics. We coded the articles by level of engagement within the ethical domain at different levels: interpersonal, institutional, international, and structural. The ethical frameworks at use corresponded to four functional categories: those examining practical or narrowly applied ethical questions; those concerned with normative ethics; those examining an issue through a single philosophical tradition; and those comparing and contrasting insights from multiple ethical frameworks. This critical interpretive review is intended to delineate the current contours and revitalize the conversation around the future charge of global health ethics scholarship. (shrink)

Both the psychology of perception and the philosophy of perception seem to show a new face when the process is considered at its own level, distinct from that of sensation. Unfamiliar conceptions in physics, anatomy, physiology, psychology, and phenomenology are required to clarify the separation and make it plausible. But there have been so many dead ends in the effort to solve the theoretical problems of perception that radical proposals may now be acceptable. Scientists are often more conservative than philosophers (...) of science. I end, therefore, as I began, with a plea for help. (shrink)

Cognitivism in respect to the arts refers to a constellation of positions that share in common the idea that artworks often bear, in addition to aesthetic value, a significant kind of cognitive value. In this paper I concentrate on three things: (i) the challenge of understanding exactly what one must do if one wishes to defend a cognitivist view of the arts; (ii) common anti-cognitivist arguments; and (iii) promising recent attempts to defend cognitivism.

BackgroundArtificial intelligence has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: (...) What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective?MethodsEight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed.ResultsUpon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries.ConclusionsThe ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere. (shrink)

In this paper, we argue that time travel is problematic for the endurantist. For it appears to be possible, given time travel, to construct a wall out of a single time travelling brick. This commits the endurantist to one of the following: (a) the wall is composed of the time travelling brick many times over; (b) the wall does not in fact exist at all; (c) the wall is identical to the brick. We argue that each of these options is (...) unsatisfactory. (shrink)

The analogy between gustatory taste and critical or aesthetic taste plays a recurring role in the history of aesthetics. Our interest in this article is in a particular way in which gustatory judgments are frequently thought to be analogous to critical judgments. It appears obvious to many that to know how a particular object tastes we must have tasted it for ourselves; the proof of the pudding, we are all told, is in the eating. And it has seemed just as (...) obvious to many philosophers that aesthetic judgment requires first-person experience. In this article we argue that, despite its initial appeal, the claim that gustatory and critical judgments are analogous in this way is mistaken. The two sorts of judgments are, as a matter of fact, similar in their epistemology, but earlier theorists have got things entirely backward—neither gustatory judgment nor aesthetic judgment requires first-hand acquaintance with their objects. Our particular focus in this article is on arguing that first-person experience is not required to know how an item of food or drink tastes. In fact, there are a wide variety of ways in which we can acquire this knowledge. (shrink)

Kögel et al propose a multicriteria alternative to the standard early clinical selection method for xenotransplantation trials. As they note, existing recommendations for inclusion criteria indicate that only the most seriously ill—those lacking any viable alternative—should be considered for xenotransplantation. Rather than basing selection on, to put it indelicately, a Hail Mary in the face of certain death, Kögel et al recommend a selection system based on four ethical criteria: medical need, capacity to benefit, patient choice and compliance (the latter (...) being an exclusion criterion). Taken together, they paint a picture of an ethically ideal first-in-human xenotransplantation clinical trial participant: someone ‘in need of a heart replacement with a good capacity to benefit from a xenotransplantation who [has] a choice in terms of alternative potentially life-sustaining treatment options.’1 In other words, they argue that potential xenotransplantation organ recipients (they specify heart, but said criteria would apply to any vital organ recipient) should not be facing their imminent demise as this would inherently constrain that person’s freedom of choice, thus rendering them vulnerable. Instead, Kögel et al argue that trial participants should be selected from groups possessing genuine alternatives to xenotransplantation but opt to receive an animal organ. Now, their concern regarding the presence of coercion in the context of what is an experimental medical intervention is fully justified, as is their claim that those facing limited viable choices at the end of their lives are an inherently vulnerable population. Autonomy and consent are largely uncontroversial bedrocks on which most medical and research ethics theories are built. We are, all of us, familiar with the horrors from history—both distant and recent—where participant consent has taken …. (shrink)

It is often assumed that literary meaning is essentially linguistic in nature and that literary interpretation is therefore a purely linguistic affair. This essay identifies a variety of literary meaning that cannot be reduced to linguistic meaning. Meaning of this sort is generated not by a communicative act so much as through a creative one: the construction of a fictional world. The way in which a fictional world can bear meaning turns out to be strikingly unlike the way a sentence (...) can, and this, I argue, has important implications for the theory of interpretation. (shrink)

What is the relation between works of fiction and the acquisition of knowledge?

To commemorate 40 years since the founding of the Journal of Business Ethics, the editors in chief of the journal have invited the editors to provide commentaries on the future of business ethics. This essay comprises a selection of commentaries aimed at creating dialogue around the theme The Ethics and Politics of Academic Knowledge Production. Questions of who produces knowledge about what, and how that knowledge is produced, are inherent to editing and publishing academic journals. At the Journal of Business (...) Ethics, we understand the ethical responsibility of academic knowledge production as going far beyond conventions around the integrity of the research content and research processes. We are deeply aware that access to resources, knowledge of the rules of the game, and being able to set those rules, are systematically and unequally distributed. One could ask the question “for whom is knowledge now ethical’”? (See the Burrell commentary.) We have a responsibility to address these inequalities and open up our journal to lesser heard voices, ideas, and ways of being. Our six commentators pursue this through various aspects of the ethics and politics of academic knowledge production. Working with MacIntyre’s scheme of practices and institutions, Andrew West provides commentary on the internal good of business ethics learning and education. Inviting us to step out of the cave, Christopher Michaelson urges a clear-eyed, unblinking focus on the purposes and audiences of business ethics scholarship. As developmental editor, Scott Taylor uncovers some of the politics of peer review with the aim of nurturing of unconventional research. Mike Hyman presents his idiosyncratic view of marketing ethics. In the penultimate commentary, Julie Nelson attributes difficulties in the academic positioning of the Business Ethics field to the hegemony of a masculine-centric model of the firm. And finally, Gibson Burrell provides a powerful provocation to go undercover as researcher-investigators in a parallel ethics of the research process. (shrink)

Interventions are medically necessary when they are vital in achieving the goal of medicine. However, with varying perspectives comes varying views on what interventions are (un)necessary and, thus, what potential treatment options are available for those suffering from the myriad of conditions, pathologies and disorders afflicting humanity. Medical necessity's teleological nature is perhaps best illustrated in cases where there is debate over using contentious medical interventions as a last resort. For example, whether it is appropriate for those suffering from body (...) integrity dysphoria to receive healthy limb amputations. This paper explores how one's perception of medicine's goal underpins whether interventions are necessary or unnecessary, using the controversial topic of therapeutic amputation as an example. By contrasting ‘classical’ amputations with their more contentious counterparts, it highlights how the idea of medical necessity influences and restrains clinical decision-making. The paper starts by giving an account of body integrity dysphoria, focusing on the debate concerning elective amputation's justifiability. It then introduces Georges Canguilhem's vitalist theory of health, paying particular attention to his emphasis on adaptability. Then, this paper uses his theory as a lens through which to evaluate the appropriateness of therapeutic amputation as a medically necessary procedure. Ultimately, the paper highlights how the label of medical necessity is withheld from potential therapeutic interventions because they fail to conform to pre-established ideas of medicine's purpose and that by doing so, potential harm befalls those who are left with no effective treatments and must look for solutions in the non-clinical world. (shrink)

In her paper, Robinson asserts that if one is convinced by the arguments assigning personhood according to a threshold criterion, one should also be open to the potential for a secondary personhood threshold, satisfied when one is pregnant, which confers temporary enhanced moral status. Rather than grounding such a claim on a fetus’s possession, or lack thereof, of personhood, Robinson argues that the pregnant person’s status as a ‘unique being’ is enough to satisfy the requirements of such an additional personhood (...) classification. 1 She justifies her claim via three arguments: (1) that the pregnant person is, in fact, more than a singular individual; (2) that pregnant people play a critical role in the human race’s continuation and (3) that the significant harms and burdens to which pregnant people have been exposed to historically and contemporary requires counterbalancing with enhanced protections. Unfortunately, despite Robinson’s best efforts, she does not... (shrink)

The consideration of the problem of healthcare allocation as a special case of distributive justice is especially alluring when we only consider consequentialist theories. I articulate here an alternative Rawlsian non-consequentialist theory which prioritizes the fairness of healthcare allocation procedures rather than directly setting distributive parameters. The theory in question stems from Rawlsian commitments that, it is argued, have a better Rawlsian pedigree than those considered as such by Tännsjö. The alternative framework is worthy of consideration on its own merits, (...) but it also casts light on two related difficulties with Tännsjö’s approach: (i) the limits of his supposedly ecumenical methodology, which is revealed to be dialectically suspect and (ii) issues with the type of abstraction and idealization from actual judgements and preferences which the approach requires. (shrink)

Jonathan Beever and Nicolae Morar’s (2016) article “The Porosity of Autonomy: Social and Biological Constitution of the Patient in Biomedicine” and its accompanying commentaries in the American Journal of Bioethics—though insightful, innovative, and provocative—overlook key interlocutors necessary for any discussion of whether the mid-twentieth-century biomedical principle of autonomy should be revised or revoked. The conversation sparked by “The Porosity of Autonomy” will remain both incomplete and politically untenable so long as there is no meaningful engagement with persons/communities who appeal to (...) the principle of patient autonomy in order to articulate and challenge the conditions of their oppression. (shrink)

Models of moral responsibility rely on foundational views about moral agency. Many scholars believe that only humans can be moral agents, and therefore business needs to create models that foster greater receptivity to others through ethical dialog. This view leads to a difficulty if no specific person is the sole causal agent for an act, or if something comes about through aggregated action in a corporate setting. An alternate approach suggests that corporations are moral agents sufficiently like humans to be (...) treated as persons, which leads to questions of intentionality and the organizational structure required to support the claim. In this article, I make an intermediate claim combining Goodpaster and Matthews' (60:132–141, 1982 ) view that a corporation may have a moral culture which affects subjective choices, with those of Painter-Morland (17(3):515–534, 2007 ) who points out that we should move from a model that posits discrete persons acting on each other to one where morality comes about through shared experience between agents who participate in each other’s lives. I argue that the discussion has been trapped in traditional dichotomies, and is better served by language that more accurately represents the dynamic interplay between organization and individual. I underwrite this claim by looking at recent changes in British and American legal approaches to corporate responsibility. These provide greater incentives for owners and business leaders to encourage employees to discuss the reflexive nature of legal and moral responsibility in business, facilitate workers to voice their moral concerns, and create structures and processes that allow those concerns to be heard. (shrink)

Background In Canadian jurisdictions without specific legislation pertaining to research consent, the onus is placed on researchers to determine whether a child is capable of independently consenting to participate in a research study. Little, however, is known about how child health researchers are approaching consent and capacity assessment in practice. The aim of this study was to explore and describe researchers' current practices. Methods The study used a qualitative descriptive design consisting of 14 face-to-face interviews with child health researchers and (...) research assistants in Southern Ontario. Transcribed interviews were analysed for common themes. Results Procedures for assessing capacity varied considerably from the use of age cutoffs to in-depth engagement with each child. Three key issues emerged from the accounts: (1) requirements that consent be provided by a single person thwarted researchers' abilities to support family decision-making; (2) little practical distinction was made between assessing if a child was capable, versus determining if study information had been adequately explained by the researcher; and (3) participants' perceived that review boards' requirements may conflict with what they considered ethical consent practices. Conclusion The results suggest that researchers' consent and capacity knowledge and skills vary considerably. Perceived discrepancies between ethical practice and ethics boards' requirements suggest the need for dialogue, education and possibly ethics board reforms. Furthermore we propose, where appropriate, a ‘family decision-making’ model that allows parents and their children to consent together, thereby shifting the focus from separate assent and consent procedures to approaches that appropriately engage the child and family. (shrink)

Political realists claim that international relations are in a state of anarchy, and therefore every state is allowed to disregard its moral duties towards other states and their inhabitants. Realists argue that complying with moral duties is simply too risky for a state’s national security. Political moralists convincingly show that realists exaggerate both the extent of international anarchy and the risks it poses to states who act morally. Yet moralists do not go far enough, since they do not question realism’s (...) normative core: the claim that when national security is really at risk, states are allowed to disregard their moral duties. I contend that there is at least one moral duty that states should not disregard even if their inhabitants are at risk of death by military aggression: the duty to reduce extreme global poverty. The reason is that even granting that national security is about securing individuals’ right to life, global poverty relief is about that as well. (shrink)

What does it mean to say that a poem is expressive, even self-expressive? How can listeners be said to self-identify with the expressive content of a lyric? What is the relevant notion of ‘self’ here, and how does it help explain the communicative dimension of the lyric arts? Might the answer to these questions tell us something about the social and cognitive value of the lyric arts? This paper uses a discussion of Karen Simecek’s superb The Philosophy of Lyric Voice (...) to explore these issues. (shrink)

Neonatal suffering has been the focus of recent debates in pediatric bioethics and suffering theory. How can we access and conceptualize the suffering that can be attributed to newborns? How are we to discern the suffering of newborns who are non-neurotypical and may have short lives and severe neurocognitive disabilities, in addition to being entirely dependent on people or life-sustaining technologies? Phenomenology has provided valuable tools for analyzing the human experiences of suffering, but its application to neonatal suffering comes with (...) fundamental challenges. In this paper, I consider recent contributions for elucidating the phenomenon of neonatal suffering, especially those in the field of non-experiential theories of suffering. Based on this review, a recent phenomenological approach to suffering is examined. Explicitly directed toward narrative persons, that approach appears to be inherently limited in elucidating the phenomenon of neonatal pediatric suffering. A suggestion is offered for partially elaborating the theoretical foundations of a phenomenological theory of neonatal suffering. This suggestion points towards a program for a phenomenology of the existential feelings of newborns. (shrink)

This book is the first major study of the theme of misanthropy, its history, arguments both for and against it, and its significance for us today. Misanthropy is not strictly a philosophy. It is an inconsistent thought, and so has often been mocked. But from Timon of Athens to Motörhead it has had a very long life, vast historical purchase and is seemingly indomitable and unignorable. Human beings have always nursed a profound distrust of who and what they are. This (...) book does not seek to rationalize that distrust, but asks how far misanthropy might have a reason on its side, if a confused reason. There are obvious arguments against misanthropy. It is often born of a hatred of physical being. It can be historically explained. It particularly appears in undemocratic cultures. But what of the misanthropy of terminally defeated and disempowered peoples? Or born of progressivisms? Or the misanthropy that quarrels with specious or easy positivities (from Pelagius to Leibniz to the corporate cheer of contemporary `total capital`)? From the Greek Cynics to Roman satire, St Augustine to Jacobean drama, the misanthropy of the French Ancien Regime to Swift, Smollett and Johnson, Hobbes, Schopenhauer and Rousseau, from the Irish and American misanthropic traditions to modern women`s misanthropy, the book explores such questions. It ends with a debate about contemporary culture that ranges from the `dark radicalisms`, queer misanthropy, posthumanism and eco-misanthropy to Houellebecq, punk rock and gangsta rap. (shrink)

Mr. Brumbaugh gives several accounts in the course of his work of the main purpose of his study, and the emphasis falls now one way and now another. Readers may easily be misled by the opening sentence of the introduction, which suggests that Plato's mathematical illustrations are pointers to "diagrams which Plato had designed, and were intended to accompany and clarify his text." If that is what Mr. Brumbaugh intended, he has failed to make out his case. There is no (...) direct evidence that Plato designed diagrams; and there is some good inferential evidence to the contrary. It would be surprising, for example, if Plato's diagrams had survived that long, that Aristotle should have described the Divided Line in terms of an arithmetical progression and ignored Plato's express indication of proportion between the upper and lower segments. Mr. Brumbaugh himself faces this passage and admits that "no continuous tradition connects the figures of Hellenistic scholars with Plato's original design." But it really does not matter. If we design diagrams in the light of our knowledge of Plato's mathematical imagination, it is most certainly a help to the interpretation of the passages concerned. This, as a matter of fact, seems to be Mr. Brumbaugh's main reason for ascribing the diagrams to Plato, and while the conclusion does not follow, the premiss is correct; and the premiss, not the conclusion, is the main point at issue. (shrink)

RESUMEN Este artículo sostiene que la desobediencia coercitiva motivada por el cambio climático a veces es antidemocrática, pero no por eso es impermisible. El cambio climático representa un peligro tan grave para los derechos básicos de millones de personas en todo el mundo, que incluso el derecho básico a la democracia puede verse justificadamente desplazado como medio para disminuir el riesgo de una catástrofe climática. El articulo responde también a quienes afirman que la desobediencia coercitiva climática es siempre democrática porque (...) sirve para igualar la influencia informal sobre las decisiones públicas o protege las precondiciones de la democracia. Estos argumentos solo rescatan algunos actos de desobediencia climática coercitiva. Los demás son antidemocráticos, pero no por eso impermisibles. ABSTRACT This article argues that when coercive disobedience is motivated by climate change, it is sometimes permissible, even if it is undemocratic. Climate change poses such a serious danger to the basic rights of millions of people worldwide that even the basic right to democracy can be justifiably displaced as a means to reduce the risks posed by a climate catastrophe. The article also replies to the claim that coercive climate disobedience is always democratic because it equalizes informal influence over public decisions, or protects the preconditions of democracy; these arguments only rescue some acts of coercive climate disobedience. The rest are still undemocratic, but they are not for this reason impermissible. (shrink)