Metabolic Bariatric Surgery (MBS) has gained significant popularity over the past decade. Legally and ethically, physicians should obtain the patient’s voluntary and informed consent before proceeding with the surgery. However, the decision to undergo MBS is often influenced by external factors, prompting questions about their impact on the patient’s ability to choose voluntarily. In addressing this issue, the study focuses on two key questions: first, which factors influence MBS candidates during the decision-making process, and second, whether these influences undermine the (...) candidates' ability to make decisions voluntarily, according to theories of autonomy. The study employed a qualitative methodology, conducting 21 in-depth semi-structured interviews with adults who had undergone bariatric surgery. The conclusions were drawn from an inductive analysis of the interview data conducted using a grounded theory approach, and by applying theories of autonomy to the empirical findings. Our study indicates that interviewees were exposed to different external influences, which had diverse effects on the interviewees' decision to undergo MBS. Category 1 influences included intentional attempts to induce people, through arguments and reason, to accept the attitudes advocated by the persuader in support of the surgery. Applying theoretical accounts of autonomy to these influences suggests that they did not compromise the interviewees’ autonomy. Category 2 influences included threats made by a physician or a family member. These influences were found to undermine autonomy. Category 3 influences included emotional manipulation, informational manipulation, and the construction of medical and social norms. Manipulations and norms were experienced differently by different interviewees, and their impact on autonomy varies depending on the theoretical framework applied. Acknowledging that the influences exerted on MBS candidates may undermine their ability to make autonomous decisions regarding surgery, we suggest reformulating the duties that apply to medical practitioners with respect to informed consent to MBS. Medical practitioners who discuss the option of MBS with candidates should be aware of the various factors that influence this choice, and actively promote the candidates’ ability to make autonomous decisions. (shrink)

The Self-Intimation thesis has it that whatever justificatory status a proposition has, i.e., whether or not we are justified in believing it, we are justified in believing that it has that status. The Infallibility thesis has it that whatever justificatory status we are justified in believing that a proposition has, the proposition in fact has that status. Jointly, Self-Intimation and Infallibility imply that the justificatory status of a proposition closely aligns with the justification we have about that justificatory status. Self-Intimation (...) has two noteworthy implications. First, assuming that we never have sufficient justification for a proposition and for its negation, we can derive Infallibility from Self-Intimation. Interestingly, there seems to be no equivalently simple way to derive Self-Intimation from Infallibility. This asymmetry provides reason for thinking that bottom-level justification rather than top-level justification drives the explanation for why the levels of justification align. Second, Self-Intimation suggests a counterintuitive treatment of information concerning what justificatory status a proposition has. It follows from Self-Intimation that we always have justification for the truth about whether a proposition is justified for us, and therefore, that higher-order evidence could change what we should believe on this matter only by misleading us. This permits forming beliefs about whether a proposition is justified for us without regard to higher-order evidence, and thus reveals a reason for thinking that top-level justification is evidentially inert. (shrink)

Both left libertarians, who support the redistribution of income and wealth through taxation, and right libertarians, who oppose redistributive taxation, share an important view: that, looming catastrophes aside, the state must never redistribute any part of our body or our person without our consent. Cécile Fabre rejects that view. For her, just as the undeservedly poor have a just claim to money from their fellow citizens in order to lead a minimally flourishing life, the undeservedly ‘medically poor’ have a just (...) claim to help from fellow citizens in order to lead such a life. Such obligatory help may in principle involve even the supply of body parts for transplantation. The state ought to exact such resources from the medically rich whenever doing so would secure the prospect of a minimally flourishing life to the medically poor without denying that prospect to anyone else. Fabre criticizes Ronald Dworkin's belief in ‘a prophylactic line that comes close to making the body inviolate, that is, making body parts not parts of social resources at all’. For her, ‘Duties to help. . . do not stop at material resources: they involve the body. . . in invasive ways’. (shrink)

We examine whether the "evidence of evidence is evidence" principle is true. We distinguish several different versions of the principle and evaluate recent attacks on some of those versions. We argue that, whatever the merits of those attacks, they leave the more important rendition of the principle untouched. That version is, however, also subject to new kinds of counterexamples. We end by suggesting how to formulate a better version of the principle that takes into account those new counterexamples.

Can we talk about "the people" as an agent with its own morally important integrity? How should we understand ownership of public property by "the people"? Nili develops philosophical answers to both of these questions, arguing that we should see the core project of a liberal legal system – realizing equal rights - as an identity-grounding project of the sovereign people, and thus as essential to the people's integrity. He also suggests that there are proprietary claims that are intertwined (...) in the sovereign people's moral power to create property rights through the legal system. The practical value of these ideas is illustrated through a variety of real-world policy problems, ranging from the domestic and international dimensions of corruption and abuse of power, through transitional justice issues, to the ethnic and religious divides that threaten liberal democracy. This book will appeal to political theorists as well as readers in public policy, area studies, law, and across the social sciences. (shrink)

Increasingly, bioethicists defend informed consent as a safeguard for trust in caretakers and medical institutions. This paper discusses an ‘ideal type’ of that move. What I call the trust-promotion argument for informed consent states:1. Social trust, especially trust in caretakers and medical institutions, is necessary so that, for example, people seek medical advice, comply with it, and participate in medical research.2. Therefore, it is usually wrong to jeopardise that trust.3. Coercion, deception, manipulation and other violations of standard informed consent requirements (...) seriously jeopardise that trust.4. Thus, standard informed consent requirements are justified.This article describes the initial promise of this argument, then identifies challenges to it. As I show, the value of trust fails to account for some commonsense intuitions about informed consent. We should revise the argument, commonsense morality, or both. (shrink)

Political theory lacks a compelling account of public property. Addressing this gap, I present a “deep public ownership” model, according to which the body politic ultimately owns all the resources within its jurisdiction. I argue that this model is compatible with liberal intuitions regarding private property. I then contend that the model expands the scope of government’s duty to uphold the equality of all citizens, by challenging private property constraints on antidiscriminatory government policies. I anticipate the worry that the model (...) supports excessive government intrusion into private affairs. I close by discussing abuse of public property by elected leaders. (shrink)

This article argues that, in its standard formulation, luck-egalitarianism is false. In particular, I show that disadvantages that result from perfectly free choice can constitute egalitarian injustice. I also propose a modified formulation of luck-egalitarianism that would withstand my criticism. One merit of the modification is that it helps us to reconcile widespread intuitions about distributive justice with equally widespread intuitions about punitive justice.

Detecting that two images are different is faster for highly dissimilar images than for highly similar images. Paradoxically, we showed that the reverse occurs when people are asked to describe how two images differ—that is, to state a difference between two images. Following structure-mapping theory, we propose that this disassociation arises from the multistage nature of the comparison process. Detecting that two images are different can be done in the initial (local-matching) stage, but only for pairs with low overlap; thus, (...) “different” responses are faster for low-similarity than for high-similarity pairs. In contrast, identifying a specific difference generally requires a full structural alignment of the two images, and this alignment process is faster for high-similarity pairs. We described four experiments that demonstrate this dissociation and show that the results can be simulated using the Structure-Mapping Engine. These results pose a significant challenge for nonstructural accounts of similarity comparison and suggest that structural alignment processes play a significant role in visual comparison. (shrink)

The divergence point analysis procedure is aimed at obtaining an estimate of the onset of the influence of an experimental variable on response latencies (e.g., fixation duration, reaction time). The procedure involves generating survival curves for two conditions, and using a bootstrapping technique to estimate the timing of the earliest discernible divergence between curves. In the present paper, several key extensions for this procedure were proposed and evaluated by conducting simulations and by reanalyzing data from previous studies. Our findings indicate (...) that the modified versions of the procedure performed substantially better than the original procedure under conditions of low experimental power. Furthermore, unlike the original procedure, the modified procedures provided divergence point estimates for individual participants and permitted testing the significance of the difference between estimates across conditions. The advantages of the modified procedures are illustrated, the theoretical and methodological implications are discussed, and promising future directions are outlined. (shrink)

We discuss the evolution of the distributive double noun (quivis) in biblical Hebrew. This construction developed from an asyndeton in Classical Biblical Hebrew (e.g., איש איש) into a syndeton in Late Biblical Hebrew (e.g., איש ואיש), a process that makes it an important diachronic marker in classifying and analyzing these two varieties of the language.

The Global Burden of Disease Study is one of the largest-scale research collaborations in global health, producing critical data for researchers, policy-makers, and health workers about more than 350 diseases, injuries, and risk factors. Such an undertaking is, of course, extremely complex from an empirical perspective. But it also raises complex ethical and philosophical questions. In this volume, a group of leading philosophers, economists, epidemiologists, and policy scholars identify and discuss these philosophical questions. Better appreciating the philosophical dimensions of a (...) study like the GBD can make possible a more sophisticated interpretation of its results, and it can improve epidemiological studies in the future, so that they are better suited to produce results that help us to improve global health. (shrink)

The paper explores the role played by concepts of temporality in shaping the self's identity and its moral responsibility. This theme is examined in both Kant and Benjamin, two theorists who view the modern self as an essentially historical being. For Kant, teleological and uniform time shoulders the heightening of the self's universal attributes and the constant expansion of a moral community. The desired end is the establishment of an integrated and homogeneous human space, a cosmopolitan stage wherein history is (...) finally redeemed. This progressive notion of time is seen as dangerous by Benjamin, since it generates forgetfulness and inner impoverishment of the self. Instead, Benjamin advances a fragmented conception of time, one allowing conversation between distant moments and grounding identity in concrete images. While the poetic recovery of memory leads to the distinct and exclusive, Benjamin follows Kant in demanding universal moral responsibility of the self. However, Benjamin's strategy, so to speak, is the integration of our temporal - not spatial - experience. Key Words: Benjamin • history • Kant • nation-state • space • time. (shrink)

For Max Weber, modernity is characterized by a tragic conflict among value spheres, each claiming to possess the ‘true meaning’ of human life. In particular, Weber argues that while the political sphere is dominated by the unifying, exclusionary, power-driven, and war-prone nation state, the ethical sphere is characterized by the universalization of individually based, deontological norms. For Weber, I argue, the modern separation between the ethical and political spheres originates in ancient Judaism. His work on Judaism, mostly neglected by political (...) theorists, describes the emergence of politics as an autonomous, naturalistic sphere with the establishment of kingship. Biblical prophets, simultaneously, were the inventors of an idealistic, mulish, universal ethics Weber termed the ‘ethics of ultimate ends’. Thus, against the Greek model harmonizing ethics and politics, Judaism invented an antagonistic model of the two. This Jewish imagination lay dormant for almost two millennia but returned to the stage in secularized modernity. (shrink)

ABSTRACTThis paper explores specific forms that neoliberal discourse and culture in academia today take in the field of Israeli Middle Eastern and Islamic studies. The article applies various textual and contextual interrogation strategies to the language, narratives and the unsaid in interviews with leading scholars in the field, in order to construe what Fredric Jameson calls the ‘political unconscious,’ particularly that arising from the use of market as a conceptual metaphor. Contextualising this field of discourse within neoliberal academia, I deconstruct (...) the work ‘demand’ and ‘interest’ do, and highlight the dialectical dynamics of experts’ dependence on audience. I argue that, in this field, the economic discourse shelters Zionist logics, presuppositions and praxis, such as recruitment logics and fundraising practices that effectively address Jewish and Zionist students and donors. (shrink)

Several contributions in this book tell of doctors' increasing emigration from developing countries where they are in critical shortage, especially from the underserved rural and public sectors of countries in sub-Saharan Africa (SSA) and South Asia. They point out the severe harm from that migration to some of the world's poorest and sickest populations who have no other doctors to turn to, and gain little from their emigration. Since significant harm to the badly off is bad, decline in that migration (...) is usually a good development. But how to strive to achieve it? (shrink)

John Roemer’s pragmatic proposal for luck-egalitarian planners normalizes risky choices for individuals’ social “types,” such that risk takers from types where the same risky behaviors are prevalent retain their just entitlements to societal redress, and ones from types where they are rare encounter just penalties. This chapter shows, however, that risky behaviors that are prevalent in one’s type do not always intuitively retain rights to redress, and that ones that are rare in one’s type do not always intuitively deserve a (...) penalty. The chapter puts forth a pragmatic proposal that may complement and partly replace Roemer’s. (shrink)

Patients’ medical conditions can result from their own avoidable risk taking. Some lung diseases result from avoidable smoking and some traffic accidents result from victims’ reckless driving. Although in many nonmedical areas we hold people responsible for taking risks they could avoid, it is normally harsh and inappropriate to deny patients care because they risked needing it. Why? A popular account is that protecting everyone’s "decent minimum," their basic needs, matters more than the benefits of holding people accountable. This account (...) is deficient. Protecting the decent minimum is not always served by offering noncompliant patients either nonbasic or basic care. Nor is protecting that minimum always served by unconditional medical care better than by nonmedical interventions. To interpret the decent minimum in democratic terms is a futile response to these challenges. Ideas for new accounts are suggested. (shrink)

When discussing whether or not our elected governments should intervene to end genocide, war crimes, ethnic cleansing, and crimes against humanity in other countries, the humanitarian intervention debate has largely been assuming that liberal democracies bear no responsibility for the injustice at hand: someone else is committing shameful acts; we are merely considering whether or not we have a positive duty to do something about it. Here I argue that there are important instances in which this dominant third party perspective (...) (TPP) is empirically false and normatively misguided. Much before our positive ?responsibility to protect? potential victims from mass atrocities, we violate our negative duty not to harm these victims. Employing work by Thomas Pogge and Leif Wenar, I argue that this harm currently comes about as our elected governments either buy, or allow our corporations to buy, the world's most precious resources from brutal dictators and warlords, who dominate some of the states that are at the heart of intervention discussions. In these cases, democracies' most immediate duty is not intervention but rather humanitarian disintervention: boycotting severely oppressive regimes, and in particular stopping to recognizing these regimes ? whether dictators or civil warriors ? as possessing legitimate authority to sell their peoples' resources. I begin with a brief survey of the intervention literature, followed by the foundations for the disintervention alternative. I then elaborate the conceptual and practical advantages of disintervention, concluding with thoughts on the reasons for TPP's lasting dominance. (shrink)

Philosophizing the indefensible asks what distinctive contributions political philosophers might make when reflecting on blatant moral failures in public policy - the kinds of failures that philosophers usually dismiss as theoretically un-interesting, even if practically important. This book argues that political philosophers can and should craft "strategic" arguments for public policy reforms, showing how morally urgent reforms can be grounded, for the sake of discussion, even in problematic premises associated with their opponents. The book starts by developing the general contours (...) of this approach - defending its general moral value in a democratic society, and examining how far one might go in strategically deploying dubious or even repugnant premises in debating public affairs. The book then applies strategic theorizing to a set of diverse policy issues. These range from the abortion debate and financial regulation in the United States, through controversies surrounding the participation of Arab parties in Israel's political process, to global issues, such as commercial ties with oil-rich dictatorships, and the bearing of such ties on global climate change. (shrink)

Whenever knowledge of the possible interpretation or conceptualization of some- thing helps in perceiving that thing, we say the processing is conceptually driven. That is, the process starts with conceptualization of what might be present and then looks for confirming evidence, biasing the processing mechanisms to give the expected result... Conceptually driven processing and data-driven processing almost always occur together, with each direction of processing contributing something to the total analysis. (Lindsay and Norman 1977, p. 13).

This paper discusses the stem variance of the root ḥ­b­q in the Bible, suggesting that its inconsistent conjugation does not reflect the original Biblical Hebrew, but rather results from an anachronistic pronunciation created by the Masoretes. The paper reviews the research of Masoretic anachronisms and the methodologies developed to identify them, applying these to the case of the root ḥ­b­q. It concludes that ḥ­b­q belongs to a specific type of Masoretic anachronism, in which original Qal forms were misvocalized by the (...) Masoretes as Piel under the influence of Mishnaic Hebrew. After presenting biblical and extra-biblical evidence to support this conclusion, the paper briefly discusses some of its main implications for the diachronic study of ancient Hebrew: the "late spelling paradox," the scope of the phenomenon of substituting Piel for Qal, and the relation between Masoretic anachronisms and the scholarly debate about the linguistic reliability of the Masoretic text. (shrink)

Civilian casualties contribute to the perpetuation of intergroup conflicts through increased radicalization and hostilities, but little is known on the psychological processes that affect responses to outgroup civilian casualties. The goal of the present research was to explore two factors expected to lead group members to act more cautiously, thereby reducing civilian casualties: perceived accountability and forecast group-based moral emotions. In two studies, Jewish–Israeli civilians (Study 1) and soldiers (Study 2) were asked to forecast their group-based moral emotions in case (...) of Palestinian (i.e., outgroup) civilian casualties, then exposed to accountability manipulations. Participants who expected to feel low levels of shame and were primed with accountability made more cautious decisions than those in the control condition. Participants who expected to feel high levels of shame were unaffected by accountability primes. Theoretical and practical implications regarding forecast moral emotions and accountability as an intervention in intergroup conflicts are discussed. (shrink)

The article argues that youth’s exposure to thin-idealizing content posted by their adored celebrities on interactive and highly engaging social networking sites poses potential challenges for these young people. Celebrity SNS presence responds to youth’s desire for social connectedness, public approval, and fame, which are highlighted at the time of their identity search and establishment. SNS content likely interacts with teens’ unique developmental characteristics, personal background, and interests to propel processes such as identification and social comparison with famous personae leading (...) to negative body image perceptions. The article suggests that even ostensibly “innocent” SNS content that presents thin-idealizing images and messages about the body may place pressures on youth and encourage a preoocupation with and risky behaviors associated with body image even unintentionally. The article further recognizes that netusers, readers, and social networking sites all share in the responsibility to minimize the risks posed to youth in this context. (shrink)

The article begins by reconstructing the just distribution of the social bases of self-respect, a principle of justice that is covert in Rawls’s writing. I argue that, for Rawls, justice mandates that each social basis for self-respect be equalized. Curiously, for Rawls, that principle ranks higher than Rawls’s two more famous principles of justice - equal liberty and the difference principle. I then recall Rawls’s well-known confusion between self-respect and another form of self-appraisal, namely, confidence in one’s determinate plans and (...) capacities. Correcting that confusion forces Rawls to accept objectionable and illiberal politics. Surprisingly, a consistent Rawls must endorse absolute economic equality, deny liberty any priority whatsoever, or sponsor still other illiberal political views - evidence of a flaw in the ethical basis of Rawls’s politics. (shrink)

Advances in artificial intelligence (AI) raise important questions about whether people view moral evaluations by AI systems similarly to human-generated moral evaluations. We conducted a modified Moral Turing Test (m-MTT), inspired by Allen et al. (Exp Theor Artif Intell 352:24–28, 2004) proposal, by asking people to distinguish real human moral evaluations from those made by a popular advanced AI language model: GPT-4. A representative sample of 299 U.S. adults first rated the quality of moral evaluations when blinded to their source. (...) Remarkably, they rated the AI’s moral reasoning as superior in quality to humans’ along almost all dimensions, including virtuousness, intelligence, and trustworthiness, consistent with passing what Allen and colleagues call the comparative MTT. Next, when tasked with identifying the source of each evaluation (human or computer), people performed significantly above chance levels. Although the AI did not pass this test, this was not because of its inferior moral reasoning but, potentially, its perceived superiority, among other possible explanations. The emergence of language models capable of producing moral responses perceived as superior in quality to humans’ raises concerns that people may uncritically accept potentially harmful moral guidance from AI. This possibility highlights the need for safeguards around generative language models in matters of morality. (shrink)

Law, Economics, and Morality examines the possibility of combining economic methodology and deontological morality through explicit and direct incorporation of moral constraints into economic models. Economic analysis of law is a powerful analytical methodology. However, as a purely consequentialist approach, which determines the desirability of acts and rules solely by assessing the goodness of their outcomes, standard cost-benefit analysis is normatively objectionable. Moderate deontology prioritizes such values as autonomy, basic liberties, truth-telling, and promise-keeping over the promotion of good outcomes. It (...) holds that there are constraints on promoting the good. Such constraints may be overridden only if enough good is at stake. While moderate deontology conforms to prevailing moral intuitions and legal doctrines, it is arguably lacking in methodological rigor and precision. Eyal Zamir and Barak Medina argue that the normative flaws of economic analysis can be rectified without relinquishing its methodological advantages and that moral constraints can be formalized so as to make their analysis more rigorous. They discuss various substantive and methodological choices involved in modeling deontological constraints. Zamir and Medina propose to determine the permissibility of any act or rule infringing a deontological constraint by means of mathematical threshold functions. Law, Economics, and Morality presents the general structure of threshold functions, analyzes their elements and addresses possible objections to this proposal. It then illustrates the implementation of constrained CBA in several legal fields, including contract law, freedom of speech, antidiscrimination law, the fight against terrorism, and legal paternalism. (shrink)

In _Differentiating the Pearl from the Fish-Eye_, Eyal Aviv offers an account of Ouyang Jingwu, a revolutionary Buddhist thinker and educator. The book surveys the life and career of Ouyang and his influence on modern Chinese intellectual history.

We revisit the analogy suggested by Madelung between a non-relativistic time-dependent quantum particle, to a fluid system which is pseudo-barotropic, irrotational and inviscid. We first discuss the hydrodynamical properties of the Madelung description in general, and extract a pressure like term from the Bohm potential. We show that the existence of a pressure gradient force in the fluid description, does not violate Ehrenfest’s theorem since its expectation value is zero. We also point out that incompressibility of the fluid implies conservation (...) of density along a fluid parcel trajectory and in 1D this immediately results in the non-spreading property of wave packets, as the sum of Bohm potential and an exterior potential must be either constant or linear in space. Next we relate to the hydrodynamic description a thermodynamic counterpart, taking the classical behavior of an adiabatic barotopric flow as a reference. We show that while the Bohm potential is not a positive definite quantity, as is expected from internal energy, its expectation value is proportional to the Fisher information whose integrand is positive definite. Moreover, this integrand is exactly equal to half of the square of the imaginary part of the momentum, as the integrand of the kinetic energy is equal to half of the square of the real part of the momentum. This suggests a relation between the Fisher information and the thermodynamic like internal energy of the Madelung fluid. Furthermore, it provides a physical linkage between the inverse of the Fisher information and the measure of disorder in quantum systems—in spontaneous adiabatic gas expansion the amount of disorder increases while the internal energy decreases. (shrink)

This book provides a novel account of integrity and its relevance to both individual and collective conduct, and analyses a wide range of practical policy problems.

This preregistered experiment examined two proximate drivers of retributive punishment attitudes: the motivation to make the perpetrator suffer, and understand the wrongfulness of his offense. In a sample of 514 US adults, we presented criminal case summaries that varied the level of suffering (absent vs. present) and understanding (absent vs. present) experienced by the perpetrator and measured punishment judgments and attitudes. Our results demonstrate, as predicted, that participants were more satisfied by the sentence and less punitive when they believed that (...) the perpetrator had suffered from the punishment or that he understood the wrongfulness of his actions. This pattern held across crimes of varying seriousness (theft vs. aggravated robbery) and across two narrative perspectives (participant as victim vs. participant as third party). However, joint evidence of suffering and understanding did not strengthen this effect, contrary to predictions. We discuss the implications of these findings for leading philosophical theories of punishment. (shrink)

The question of how we apply knowledge from biomedical science to medical and public health practice has been the subject of heated debates about generalizability and related concepts, such as applicability and inductive inference. In this essay, I interpret the term from the perspective of two causal models: determinism and indeterminism. I suggest that theories of generalizability can be formulated on the basis of both models and take the form of testable but unverifiable hypotheses, an attribute that is common to (...) all scientific theories. Nonetheless, there is one noteworthy difference between the two models: determinism allows one to rationalize a decision to treat a certain kind of patient but only indirectly a decision to treat any particular patient, whereas indeterminism accommodates both types of decisions. (shrink)

We suggest a common ground for alternative proposals In different domains of cognitive science which have previously seemed to have little in common. The underlying common theme is associated with a redefinition of the basic unit of analysis in each domain of thought. Our framework suggests a definition of unity which is based not on inherent properties of the elements constituting the unit, but rather on dynamic patterns of correlation across the elements. We introduce a set of features that characterize (...) the new dynamic units, and distinguish them from traditional units of analysis. A conceptual connection is made with the identification of elementary units in modern physics theories, as well as with concepts and structures in the study of complex dynamical systems and connectionism. The paper analyses the evolution of the concept of unit in different domains of thought in cognitive science, and examines the proposed framework of “dynamic unity” with regard to various theoretical problems within each domain. The particular cognitive science issues discussed in the paper include: (1) the binding problem in the brain; (2) the mental unit of conceptual organization; (3) defining ‘wordhood’ in linguistics; and (4) identifying the unit of cognition in the natural environment. (shrink)

Next SectionAccess to medicines, vaccination and care in resource-poor settings is threatened by the emigration of physicians and other health workers. In entire regions of the developing world, low physician density exacerbates child and maternal mortality and hinders treatment of HIV/AIDS. This article invites philosophers to help identify ethical and effective responses to medical brain drain. It reviews existing proposals and their limitations. It makes a case that, in resource-poor countries, ’locally relevant medical training’—teaching primarily locally endemic diseases and practice (...) in scarcity conditions, training in rural communities and admitting rural students preferentially—could help improve retention. Locally relevant training would arguably diminish medical brain drain in five ways. It would (i) make graduates less attractive for Western employers, (ii) align graduates’ expectations with actual practice, diminishing ‘burn-out’, (iii) enhance the professional prestige of local practice, (iv) hold rotations in, and recruit applicants from, rural areas, which is known to improve retention there, and (v) create local career development options that attract practitioners to stay. Such educational reform may raise worries about poor-quality care, breach of the freedom of education and occupation, breach of the freedom of movement, unequal distribution of opportunities among students, hypocrisy and resistance from influential actors. We address these worries. (shrink)

Is it ever rational to suspend judgment about whether a particular doxastic attitude of ours is rational? An agent who suspends about whether her attitude is rational has serious doubts that it is. These doubts place a special burden on the agent, namely, to justify maintaining her chosen attitude over others. A dilemma arises. Providing justification for maintaining the chosen attitude would commit the agent to considering the attitude rational—contrary to her suspension on the matter. Alternatively, in the absence of (...) such justification, the attitude would be arbitrary by the agent's own lights, and therefore irrational from the agent's own perspective. So, suspending about whether an attitude of ours is rational does not cohere with considering it rationally preferable to other attitudes, and leads to a more familiar form of epistemic akrasia otherwise. (shrink)