In recent work, Louis deRosset (Philosophical Studies 149:73–97, 2010) has argued that priority theorists, who hold that truths about macroscopic objects can be metaphysically explained without reference to such things, cannot meet an independently motivated constraint upon good explanation. By clarifying the nature of the priority theorist’s project, I argue that deRosset’s argument fails to establish its conclusion.

Michail Peramatzis presents a new interpretation of Aristotle's view of the priority relations between fundamental and derivative parts of reality, following ...

Many moral theories are committed to the idea that some kinds of moral considerations should be respected, whatever the cost to ‘lesser’ types of considerations. A person's life, for instance, should not be sacrificed for the trivial pleasures of others, no matter how many would benefit. However, according to the decision-theoretic critique of lexical priority theories, accepting lexical priorities inevitably leads us to make unacceptable decisions in risky situations. It seems that to operate in a risky world, we must (...) reject lexical priorities altogether. This paper argues that lexical priority theories can, in fact, offer satisfactory guidance in risky situations. It does so by equipping lexical priority theories with overlooked resources from decision theory. (shrink)

Derek Parfit has argued that (Teleological) Egalitarianism is objectionable by breaking a person-affecting claim to the effect that an outcome cannot be better in any respect - such as that of equality - if it is better for nobody. So, he presents the Priorty View, i.e., the policy of giving priority to benefiting the worse-off, which avoids this objection. But it is here argued, first, that there is another person-affecting claim that this view violates. Secondly, Egalitarianism can be construed (...) as person-affecting in a weaker sense. Thirdly, it is possible to construct a Relational version of the Priority View which incorporates the Egalitarian value of just equality in this sense. Two reasons are given for why this Relational View and Egalitarianism are superior to the Parfitian Absolute Priority View. However, no attempt is made to abjudicate between the first two views, the main point being that they both accept the value of just equality in the same sense. (shrink)

This chapter explores the relationship between knowing-how and skill, as well other success-in-action notions like dispositions and abilities. I offer a new view of knowledge-how which combines elements of both intellectualism and Ryleanism. According to this view, knowing how to perform an action is both a kind of knowing-that (in accord with intellectualism) and a complex multi-track dispositional state (in accord with Ryle’s view of knowing-how). I argue that this new view—what I call practical attitude intellectualism—offers an attractive set of (...) solutions to various puzzles concerning the connections between knowing-how and abilities and skills to perform intentional actions. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order (...) to ensure that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

John Rawls’s thesis that a certain package of basic liberties should be given lexical priority is of great interest for legal and political philosophy, but it has received relatively little defense from Rawls or his supporters. In this paper, I examine three arguments for the thesis: the first is based on the two ‘moral powers’; the second, on the social bases of self-respect; and the third, on a Kantian notion of autonomy. I argue none of these accounts successfully establishes (...) 1) the distinct claim of lexical priority, 2) for the complete package of basic liberties, on the basis of reasons that are appropriately public. In turn, I propose an alternative argument, in support of those two claims, based on the social or ‘relational’ conception of equality. (shrink)

In this article, we aim to map out the complexities which characterise debates about the ethics of vaccine distribution, particularly those surrounding the distribution of the COVID-19 vaccine. In doing so, we distinguish three general principles which might be used to distribute goods and two ambiguities in how one might wish to spell them out. We then argue that we can understand actual debates around the COVID-19 vaccine – including those over prioritising vaccinating the most vulnerable – as reflecting disagreements (...) over these principles. Finally, we shift our attention away from traditional discussions of distributive justice, highlighting the importance of concerns about risk imposition, special duties, and social roles in explaining debates over the COVID-19 vaccine. We conclude that the normative complexity this article highlights deepens the need for decision-making bodies to be sensitive to public input. (shrink)

Market crises amplify fear, disrupting rational decision-making of stock investment. This study examines the relationship between investors’ information priorities—such as intuition, company performance, technical analysis, and other factors—and their fear responses (freeze, flight, and hiding) during market crashes. Using the Bayesian Mindsponge Framework (BMF) to analyze data from 1,526 investors in China and Vietnam, the findings reveal complex dynamics. We found positive associations between investors’ prioritization of social influence and intuition for investment decision-making with being freeze (i.e., not knowing what (...) to do with the owned stock), between prioritization of professionals’ evaluation and intuition with fleeing (i.e. giving up stock investment permanently), and between prioritization of professionals’ evaluation and social influence with hiding (i.e., stopping investing in stock for a while). In contrast, prioritization of companies’ performance metrics (e.g., net profit, debt, etc.) was negatively associated with being freeze, fleeing, and hiding. Meanwhile, prioritization of professionals’ evaluation, technical analysis, and liquidity was negatively associated with being freeze, fleeing, and hiding, respectively. The study highlights the importance of disseminating transparent, accurate information through government and media channels, along with implementing financial education programs, to promote rational investment decisions and reduce fear-driven behaviors. (shrink)

I address an intuition commonly endorsed by metaphysicians, that there must be a fundamental layer of reality, i.e., that chains of ontological dependence must terminate: there cannot be turtles all the way down. I discuss applications of this intuition with reference to Bradley’s regress, composition, realism about the mental and the cosmological argument. I discuss some arguments for the intui- tion, but argue that they are unconvincing. I conclude by making some suggestions for how the intuition should be argued for, (...) and discussing the ramifications of giving the justification I think best. (shrink)

The number of positions identified with structural realism in philosophical debates about scientific knowledge has grown significantly in the past decade, particularly with respect to the metaphysical or ‘ontic’ approach (OSR). In recent years, several advocates of OSR have proposed a novel understanding of it in order to side-step a serious challenge faced by its original formulation, eliminative OSR. I examine the conceptual basis of the new, noneliminative view, and conclude that it too faces a serious challenge, resulting in a (...) dilemma for ontic structuralists regarding the ontological status of objects and properties, and the relative “ontological priority” of these entities with respect to the relations in which they stand. (shrink)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content (...) analysis. The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

The development of some COVID-19 vaccines by private companies like Moderna and Sanofi-GSK has been substantially funded by various governments. While the Sanofi CEO has previously suggested that countries that fund this development ought to be given some priority, this suggestion has not been taken seriously in the literature. Considerations of nationalism, sustainability, need, and equitability have been more extensively discussed with respect to whether and how much a country is entitled to advance purchase orders of the vaccine under (...) conditions of absolute scarcity. Yet, little attention has been paid to whether prior investment into developing a vaccine entitles a country to some priority with respect to these orders. Moreover, while not a majority view, some survey results show that a significant minority of the populace does endorse some view like this. This article argues that the minority have a point: recognizing funder countries some priority is justified by the weak Lockean claim (WLC). According to the WLC, the fact that someone has contributed to the development of something gives them some entitlement to the resultant product. This article will defend the WLC, and address objections to the argument, including those pertaining to questions of historical injustice and medical need. This argument does not imply an unconstrained entitlement. Rather, contribution to development is one morally relevant factor that must be tempered by and weighed against potentially more substantial claims to priority based on need, equity, and other considerations. (shrink)

This paper highlights a feature common to many ethical guidelines—namely, the idea that the interests of the individual shall always prevail over the interests of science and society. The paper presents how some major ethical guidelines treat the balancing of research interests against those of research subjects and spells out the difficulties in interpreting the principle of the primacy of the individual in a way that can be action-guiding. It suggests various alternative interpretations of the primacy of the individual and (...) argues that they do not hold. Finally, the implications of this analysis for ethical guidelines are discussed. (shrink)

Volume 48, Issue 3, November 2019, Page 471-488.

I will defend two claims. First, Schaffer's priority monism is in tension with many research programs in quantum gravity. Second, priority monism can be modified into a view more amenable to this physics. The first claim is grounded in the fact that promising approaches to quantum gravity such as loop quantum gravity or string theory deny the fundamental reality of spacetime. Since fundamental spacetime plays an important role in Schaffer's priority monism by being identified with the fundamental (...) structure, namely the cosmos, the disappearance of spacetime in these views might undermine classical priority monism. My second claim is that priority monism can avoid this issue with two moves: first, in dropping one of its core assumptions, namely that the fundamental structure is spatio-temporal, second, by identifying the connection between the non-spatio-temporal structure and the derivative spatio-temporal structure with mereological composition. (shrink)

ABSTRACT In this paper I respond to Fricker’s paradigm-based account of forgiveness, which aims to integrate two seemingly different versions of responses to wrongdoing—conditional forgiveness (what Fricker calls ‘Moral Justice Forgiveness’) and unconditional forgiveness (what Fricker calls ‘Gifted Forgiveness’)—into one explanatory order, as well as, she argues, showing the second to be derivative and parasitic on the basic functioning of the first, and more contingent. My aim is to endorse and draw on Fricker’s paradigm-based strategy and the way it enables (...) us to present a unified account, to endorse her view that both gifted and conditional forgiveness are versions of one loosely unified phenomenon, but to argue for the reverse account of the order of conceptual priority. I will argue that gifted forgiveness is the paradigm, and that once we understand what it is and its role we can see why and how forgiveness also makes sense as something offered in response to a wrongdoer’s remorse, but that this latter form of forgiveness retains an aspect of being something essentially gifted. (shrink)

This article explores the nature of corporate social responsibility (CSR) and corporate reputation using qualitative research approach. Specifically, the relationship between CSR and corporate reputation is examined from the viewpoint of value theory. This paper brings up for discussion the various value priorities lying in the background of CSR actions. The aim is to form categories of value priorities around CSR and reputation, based on qualitative research approach. The main concepts in this paper – CSR, reputation and value – are (...) also defined. This paper further discusses the theory of value structure and content, which identifies certain principal values among different cultures. The data consist of eight interviews with employees of a newspaper company. The results suggest that value priorities play an influential role in CSR actions, influencing to the essence of certain reputation stories in the corporate context. (shrink)

This paper motivates and develops a new theory of time: priority presentism. Priority presentism is the view according to which (i) only present entities exist fundamentally and (ii) past and future entities exist, but they are grounded in the present. The articulation of priority presentism is an exercise in applied grounding: it draws on concepts from the recent literature on ontological dependence and applies those concepts in a new way, to the philosophy of time. The result, as (...) I will argue, is an attractive position that can do much of the same work in satisfying our intuitions about time as presentism, but without the ontological cost. (shrink)

Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: Ethical approval (...) granted by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

Some theories of practical reasons incorporate a lexical priority structure, according to which some practical reasons have infinitely greater weight than others. This includes absolute deontological theories and axiological theories that take some goods to be categorically superior to others. These theories face problems involving cases in which there is a non-extreme probability that a given reason applies. In view of such cases, lexical-priority theories are in danger of becoming irrelevant to decision-making, becoming absurdly demanding, or generating paradoxical (...) cases in which each of a pair of actions is permissible yet the pair is impermissible. (shrink)

The priority of liberty has always played a central role in John Rawls's political theory. This chapter reviews Rawls's three arguments for the priority of liberty in Theory and argues that two of them do indeed fail (either in whole or in part) because of two types of error. It presents a partial reconstruction of the hierarchy argument, and demonstrates that our highest‐order interest in the development and exercise of rationality follows naturally from the Kantian commitment to autonomy (...) that Rawls expresses in Theory. The chapter discusses an apparent problem with the scope of the hierarchy argument: it does not offer a particularly compelling defense of the priority of the basic political liberties, including the rights to vote and hold public office. The chapter also discusses the implications of the priority of liberty for the American practice of civil libertarianism. (shrink)

In section III of Pryor 2006a, I argued against the view that the mere fact that a thought- type is hyper-reliable directly gives one justification to believe a thought of that type. A close alternative says that our merely appreciating that the thought-type is hyper-reliable directly gives us that justification.

There is a growing movement to increase access to palliative care by declaring it a human right. Calls for such a right—in the form of articles in the healthcare literature and pleas to the United Nations and World Health Organization—rarely define crucial concepts involved in such a declaration, in particular ‘palliative care’ and ‘human right’. This paper explores how such concepts might be more fully developed, the difficulties in using a human rights approach to promote palliative care, and the relevance (...) of such an enterprise to public health ethics. (shrink)

A central aim of the contemporary reductive scientistic project is the task, inherited from the French Enlightenment, of producing a machine model of man. Cognitive science is the attempt at that most difficult part of this project, namely, to do for mind what Newton had already allegedly done for corporeal nature. Kant has recently been claimed as a precursor of this French project. The most detailed picture of a cognitive-scientistic Kant is defended by Kitcher. Contra Strawson, she claims that in (...) his transcendental psychology Kant is “offering hypotheses about the mechanisms that carry out [cognitive] tasks.”. (shrink)

This paper offers a novel solution to the long-standing puzzle of why the Canon of Pure Reason maintains, in contradiction to Kant’s position elsewhere in the first Critique, both that practical freedom can be proved through experience, and that the question of our transcendental freedom is properly bracketed as irrelevant in practical matters. The Canon is an a priori investigation of our most fundamental practical capacity. It is argued that Kant intends its starting point to be explanatorily independent of transcendental (...) logic and the ontic more generally, an independence that would be compromised if transcendental freedom were included in that starting point, even in a mode of supposition. In a different sense, however, practical reason precisely is dependent on the ontic: it can be realized only in beings. This species of dependence is used to explain the puzzling claim that practical freedom can be experienced. (shrink)

Testimonial injustice occurs when bias against the credibility of certain social identities results in discounting of their contributions to deliberations. In this analysis, we describe testimonial injustice against women and how it figures in macroallocation procedure. We show how it harms women as deliberators, undermines the objective of inclusivity in macroallocation and affects the justice of resource distributions. We suggest that remedial action is warranted in order to limit the effects of testimonial injustice in this context, especially on marginalised and (...) disadvantaged groups, and propose three areas for action, whose implementation might feasibly be achieved by those immediately involved in macroallocation. (shrink)

The purpose of this paper is to consider the role that values play in priority setting through the use of EBP. It is important to be clear about the role of values at all levels of the decision making process. At one level, society as a whole has to make decisions about the kind of health provision that it wants. As is generally accepted, these priority setting questions cannot be answered by medical science alone but involve important judgements (...) of value. However, as I hope to show values come into priority setting questions at another level, one not often explicitly recognised in much of the literature: that of the very definition of the effectiveness of treatments. This has important consequences for patient care. If we do not recognise that the effectiveness of a treatment involve subjective elements — a patient's own assessment of the value of the treatment — then this could lead to the belief that we can purchase one treatment that is the most effective for all patients. This might result in a detrimental reduction in the range of options that a patient is given with some patients not receiving the treatment that is most effective for them. (shrink)

Germany has just started a public debate on priority-setting, rationing and cost-effectiveness due to the cost explosion within the German health care system. To date, the costs for German health care run at 11,6 % of its Gross Domestic Product (GDP, 278,3 billion €) that represents a significant increase from the 5,9 % levels present in 1970. In response, the German Parliament has enacted several major and minor legal reforms over the last three decades for the sake of cost (...) containment and maintaining stability of the health care system. The Statutory Health Insurance—SHI (Gesetzliche Krankenversicherung—GKV) is based on the fundamental principle of solidarity and provides an ethical and legal framework for implementing equity, comprehensiveness and setting the principles and rules for financing and providing health care services and benefits. Within the SHI system, several major actors can be identified: the Federal Ministry of Health, the 16 state ministries of health, the Federal Joint Committee (G-BA), the physicians (with their associations) and the hospitals (with their organizations) on the provider side, and the sickness funds with their associations on the purchasers’ side. This article reviews the structure and complexities of the German health care system with its major players and participants. The focus will be put on relevant ethical, legal and economic aspects for prioritization, rationalization, rationing and cost-effectiveness of medical benefits and services. In conclusion, this article pleads for open discussion on the challenging subject of priority-setting instead of accepting the implicit and non-transparent rationing of medical services that currently occurs at many different levels within the health care system, as it stands today. (shrink)

How can we argue, from neural facts, that representational states exhibit some specific representational structure? This paper approaches the question through a case study on the priority map-mechanism that underlies our capacity to orient visual attention. Computational models from cognitive neuroscience describe this mechanism as operating over neural topographic structures. These neural structures exhibit the functional profile of topographic representational structure. I argue that this fact warrants attributing topographic structure to the priority map mechanism’s representational states.

I discuss Peramatzis's (2011) argument that the form of a natural substance is essentially enmattered and so contains a material component.

성격적 탁월함의 본성(physis)을 설명하기 위해 아리스토텔레스가 도입하는 중용은 두 가지 차원에서 언급된다. 하나는 행위자의 품성 상태(hexis)의 차원에서, 다른 하나는 그 행위자가 구체적 상황에서 행하고 표출하는 개별적 행위와 감정의 차원에서 제시되는 것이다. 우리는 전자를 ‘반응으로서 중용’, 후자를 ‘상태로서 중용’으로 구분할 수 있다. 그런데, 아리스토텔레스가 성격적 탁월함을 설명하기 위해 도입한 중용 개념은 본질적으로 어떤 차원의 중용일까? 일단의 연구자들은 탁월한 사람이 중용적인 이유는 그의 개별적 행위와 감정의 중용적 속성에 기인한다고 전제하면서, 아리스토텔레스가 궁극적으로 의미하는 중용은 ‘반응으로서의 중용’이라고 주장한다. 이러한 입장을 우리는 ‘반응우선성 논지’로 부를 (...) 수 있다. 이 글에서 우리는 ‘반응우선성 논지’가 많은 학자들에 의해 주목받고 있기는 하지만, 간과할 수 없는 중요한 오류를 다수 내포하고 있음을 밝히고, 이에 재고의 필요성을 제기할 것이다. (shrink)

Priority setting (also known as resource allocation or rationing) occurs at every level of every health system and is one of the most significant health care policy questions of the 21st century. Because it is so prevalent and context specific, improving priority setting in a health system entails improving it in the institutions that constitute the system. But, how should this be done? Normative approaches are necessary because they help identify key values that clarify policy choices, but insufficient (...) because different approaches lead to different conclusions and there is no consensus about which ones are correct, and they are too abstract to be directly used in actual decision making. Empirical approaches are necessary because they help to identify what is being done and what can be done, but are insufficient because they cannot identify what should be done. Moreover, to be really helpful, an improvement strategy must utilize rigorous research methods that are able to analyze and capture experience so that past problems are corrected and lessons can be shared with others. Therefore, a constructive, practical and accessible improvement strategy must be research-based and combine both normative and empirical methods. In this paper we propose a research-based improvement strategy that involves combining three linked methods: case study research to describe priority setting; interdisciplinary research to evaluate the description using an ethical framework; and action research to improve priority setting. This describe-evaluate-improve strategy is a generalizable method that can be used in different health care institutions to improve priority setting in that context. (shrink)

In recent years there has been a good deal of discussion of equality’s place in the best account of distribution or distributive justice. One central question has been whether egalitarianism should give way to a principle requiring us to give priority to the worse off. In this article, I shall begin by arguing that the grounding of equality is indeed insecure and that the priority principle appears to have certain advantages over egalitarianism. But I shall then claim that (...) the priority principle itself is ungrounded and that the priority principle should itself give way to a sufficiency principle based — indirectly, via the notion of an impartial spectator — on compassion for those who are badly off. (shrink)

According to the priority view, or prioritarianism, it matters more to benefit people the worse off they are. But how exactly should the priority view be defined? This article argues for a highly general characterization which essentially involves risk, but makes no use of evaluative measurements or the expected utility axioms. A representation theorem is provided, and when further assumptions are added, common accounts of the priority view are recovered. A defense of the key idea behind the (...) priority view, the priority principle, is provided. But it is argued that the priority view fails on both ethical and conceptual grounds. (shrink)

All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities. We review explicit priority setting efforts in Norway, Sweden, Israel, the Netherlands, Denmark, New Zealand, the United Kingdom and (...) the state of Oregon in the US. The approaches used can be divided into those centered on outlining principles versus those that define practices. In order to establish the main lessons from their experiences we consider the process each country used, criteria to judge the success of these efforts, which approaches seem to have met these criteria, and using their successes and failures as a guide, how to proceed in setting priorities. We demonstrate that there is little evidence that establishment of a values framework for priority setting has had any effect on health policy, nor is there evidence that priority setting exercises have led to the envisaged ideal of an open and participatory public involvement in decision making. (shrink)