Book reviewed in this article: Protecting The Vulnerable: A Reanalysis of Our Social Responsibilities. By Robert E. Goodin. Chicago: University of Chicago Press.

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

This essay explores the role of informal logicand its application in the context of currentdebates regarding evidence-based medicine. This aim is achieved through a discussion ofthe goals and objectives of evidence-basedmedicine and a review of the criticisms raisedagainst evidence-based medicine. Thecontributions to informal logic by StephenToulmin and Douglas Walton are explicated andtheir relevance for evidence-based medicine isdiscussed in relation to a common clinicalscenario: hypertension management. This essayconcludes with a discussion on the relationshipbetween clinical reasoning, rationality, andevidence. It is argued that (...) informal logic hasthe virtue of bringing explicitness to the roleof evidence in clinical reasoning, and bringssensitivity to understanding the role ofdialogical context in the need for evidence inclinical decision making. (shrink)

This distinction has sometimes been read as purely epistemic, resting not on things, but on our knowledge of them: there is one world, not two, though it may be apprehended in two ways. But this view is patently at odds with the text. Knowledge and opinion are δυνάμεις, "faculties," to be distinguished and defined by their objects, no less than by the state of mind they produce, and Plato clearly states that the fallibility and unclearness of opinion is rooted in (...) the relative unreality of opinables. (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)

In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a model (...) to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

The thesis of this article is that there has never been any ground for the controversy between the doctrine of free will and determinism, that it is based upon a misapprehension, that the two assertions are entirely consistent, that one of them strictly implies the other, that they have been opposed only because of our natural want of the analytical imagination. In so saying I do not tamper with the meaning of either phrase. That would be unpardonable. I mean free (...) will in the natural and usual sense, in the fullest, the most absolute sense in which for the purposes of the personal and moral life the term is ever employed. I mean it as implying responsibility, merit and demerit, guilt and desert. I mean it as implying, after an act has been performed, that one " could have done otherwise " than one did. I mean it as conveying these things also, not in any subtly modified sense but in exactly the sense in which we conceive them in life and in law and in ethics. These two doctrines have been opposed because we have not realised that free will can be analysed without being destroyed, and that determinism is merely a feature of the analysis of it. And if we are tempted to take refuge in the thought of an "ultimate ", an "innermost" liberty that eludes the analysis, then we have implied a deterministic basis and constitution for this liberty as well. For such a basis and constitution lie in the idea of liberty. -/- The thesis is not, like that of Green or Bradley, that the contending opinions are reconciled if we adopt a certain metaphysic of the ego, as that it is timeless, and identifies itself with a desire by a " timeless act". This is to say that the two are irreconcilable, as they are popularly supposed to be, except by a theory that delivers us from the conflict by taking us out of time. Our view on the contrary is that from the natural and temporal point of view itself there never was any need of a reconciliation but only of a comprehension of the meaning of terms. (The metaphysical nature of the self and its identity through time is a problem for all who confront memory, anticipation, etc.; it has no peculiar difficulties arising from the present problem.) -/- I am not maintaining that determinism is true; only that it is true insofar as we have free will. That we are free in willing is, broadly speaking, a fact of experience. That broad fact is more assured than any philosophical analysis. It is therefore surer than the deterministic analysis of it, entirely adequate as that in the end appears to be. But it is not here affirmed that there are no small exceptions, no slight undetermined swervings, no ingredient of absolute chance. All that is here said is that such absence of determination, if and so far as it exists, is no gain to freedom, but sheer loss of it; no advantage to the moral life, but blank subtraction from it. -- When I speak below of "the indeterminist" I mean the libertarian indeterminist, that is, him who believes in free will and holds that it involves indetermination. (shrink)

Francis Fukuyama, in his Our Posthuman Future, and Gregory Stock, in his Redesigning Humans, present competing versions of the biomedical future of human beings, and debate the merits of more or less stringent regimes of regulation for biomedical innovation. In this article, these positions are shown to depend on a shared discourse of market liberalism, which limits both the range of ends for such innovation discussed by the authors, and the scope of their policy analyses and proposals. A proper evaluation (...) of the human significance and policy imperatives for biomedical innovation needs to be both more utopian in its imagination, and more sophisticated in its political economy. In essence, the Fukuyama/Stock debate tells us more about current US political ideology than it does about the morality of human genetic and biopsychological engineering. (shrink)

This study represents an improvement in the ethics scales inventory published in a 1988 Journal of Business Ethics article. The article presents the distillation and validation process whereby the original 33 item inventory was reduced to eight items. These eight items comprise the following ethical dimensions: a moral equity dimension, a relativism dimension, and a contractualism dimension. The multidimensional ethics scale demonstrates significant predictive ability.

There are a variety of puzzling features about this argument. One of them—questions of validity apart—is its apparent redundancy. Parmenides’ initial division provided him with an infinite plurality of parts. He might therefore have given an existence proof of infinitely many numbers, conceived as pluralities of units, by means of this division. Instead, he introduces a new principle of division for the purpose. Again, he derives the conclusion that Unity has infinitely many parts from the infinity of number; but he (...) has already shown that Unity is infinitely divisible into parts consisting of being and unity. In short, the new principle of division introduced for number seems unnecessary, and Parmenides has twice shown that Unity has infinitely many parts. (shrink)

I am idebted to members of the Wellington Logic Seminar for useful discussions of work of which this essay forms part, in particular to M. J. Cresswell for comments in the earlier stages of the investigation and to R. I. Goldblatt who suggested the definition ofB infD supu and made numerous other suggestions.

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

Kai Nielson (Secession: The Case of Quebec), as did Allen Buchanan in Secession, discusses secession on an analogy with no-fault divorce. Both these writers fail to distinguish between what it is to be a person and what it is to be a people, where peoples are the items that secede. The issue of what constitutes a people is thus crucial to the theory of secession (for similar reasons to those that made it crucial to seventeenth century debate about the right (...) of resistance to the monarch). It is also the case that what makes a group of persons a people is often the fact that they are a particular racial group that has suffered unfair discrimination from the prevailing government or that they came to live where they do live by virtue of incidents that affect the justice of their relations with that government. Issues of justice thus enter the matter of the people's identity in a way that rules out the justifiability of unilateral no-fault secession. (shrink)

In this study, the drawbacks of using some religious concepts produced in the tradition of Western thought directly in their studies on Islamic belief will be discussed. The claim in question will be put forward within the framework of the concepts of deism, atheism and especially theism. Especially by reviewing the philosophy of religion studies made in Turkey, the fact that the three concepts mentioned are directly transferred to the philosophy of religion studies carried out in the Islamic world will (...) be revealed as a problem and this situation will be defined as the reduction of Islamic belief to some other concepts. The aim to be achieved by emphasizing such a problem is to ensure that the principles of Islamic belief are understood in their own meaning without reducing them to other meanings. Because every concept produced within the tradition of Western thought is directly related to its own intellectual and practical past. For this reason, when a solution or criticism that is formed in a different sense or dependent on a certain practical past is brought to Islamic thought, the philosophical and practical past of those concepts will also be carried. However, every belief should be evaluated by considering its own meaning and history. Evaluating this problem through concepts that Islam directly rejects, such as deism and atheism, is more understandable than the concept of theism. However, when it comes to the concept of theism, the subject becomes quite complex. Because in almost all sources, Islam is defined as a theistic religion and this is considered as a necessary pre-acceptance for the Islamic belief. However, theism is the understanding of God in modern Western thought, in which Descartes rationalism and Newtonian mechanics are accepted as the dominant element. Such an understanding of God, built within the epistemic boundaries of the thinking subject, is incompatible with the Islamic conception of God. (shrink)

Corporate social responsibility is a recognised and common part of business activity. Some of the regularly cited motives behind CSR are employee morale, recruitment and retention, with employees acknowledged as a key organisational stakeholder. Despite the significance of employees in relation to CSR, relatively few studies have examined their engagement with CSR and the impediments relevant to this engagement. This exploratory case study-based research addresses this paucity of attention, drawing on one to one interviews and observation in a large UK (...) energy company. A diversity of engagement was found, ranging from employees who exhibited detachment from the CSR activities within the company, to those who were fully engaged with the CSR activities, and to others who were content with their own personal, but not organisational, engagement with CSR. A number of organisational context impediments, including poor communication, a perceived weak and low visibility of CSR culture, and lack of strategic alignment of CSR to business and personal objectives, served to explain this diversity of employee engagement. Social exchange theory is applied to help explore the volition that individual employees have towards their engagement with CSR activities, and to consider the implications of an implicit social, rather than explicit economic, contract between an organisation and its employees in their engagement with CSR. (shrink)

Geoffrey Lloyd engages in a wide-ranging exploration of what we can learn from the study of ancient civilisations that is relevant to fundamental problems, both intellectual and moral, that we still face today. How far is it possible to arrive at an understanding of alien systems of belief? Is it possible to talk meaningfully of 'science' and of its various constituent disciplines, 'astronomy', 'geography', 'anatomy', and so on, in the ancient world? Are logic and its laws universal? Is there one (...) ontology - a single world - to which all attempts at understanding must be considered to be directed? When we encounter apparently very different views of reality, how far can that be put down to a difference in conceptions of what needs explaining, or of what counts as an explanation, or to different preferred modes of reasoning or styles of inquiry? Do the notions of truth and belief represent reliable cross-cultural universals? In another area, what can ancient history teach us about today's social and political problems? Are the discourses of human nature and of human rights universally applicable? What political institutions do we need to help secure equity and justice within nation states and between them? Lloyd sets out to answer all these questions, and to convince us that the science and culture of ancient Greece and China provide precious resources to advance modern debates. (shrink)

Those of us who were made to study Pride and Prejudice at school know that Darcy represents pride and Elizabeth represents prejudice. Those of us who have actually read the book know that the situation is a good deal more complicated than that. The motivation for a significant part of the action is Elizabeth's pride, a point that is made quite clearly and is recognized by Elizabeth herself in what sounds like a thoroughly rehearsed speech: ‘How despicably have I acted!’ (...) she cried.—‘I, who have prided myself on my discernment!—I, who have valued myself on my abilities! who have disdained the generous candour of my sister, and gratified my vanity, in useless or blameable distrust.—How humiliating is this discovery!—Yet, how just a humiliation!—Had I been in love, I could not have been more wretchedly blind. But vanity, not love, has been my folly.—Pleased with the preference of one, and offended by the neglect of the other, on the very beginning of our acquaintance, I have courted prepossession and ignorance, and driven reason away, where either were concerned. Till this moment, I never knew myself’. (shrink)

We formulate a restricted version of the Tukey-Teichmüller Theorem that we denote by (rTT). We then prove that (rTT) and (BPI) are equivalent in ZF and that (rTT) applies rather naturally to several equivalent forms of (BPI): Alexander Subbase Theorem, Stone Representation Theorem, Model Existence and Compactness Theorems for propositional and first-order logic. We also give two variations of (rTT) that we denote by (rTT)+ and (rTT)++; each is equivalent to (rTT) in ZF. The variation (rTT)++ applies rather naturally to (...) various Selection Lemmas due to Cowen, Engeler, and Rado. (shrink)

We give a tensor formulation of synchronization transformations within special relativity in order to bridge the gap between some philosophical discussions (e.g., by Grünbaum and Winnie) and the analyses given by physicists (e.g., Møller). As an application, we discuss a physical interpretation of the duality between covariant and contravariant indices in the tensor formulation.

The overall aim of this article is to discuss the organization of limit setting in healthcare in terms of legitimacy. We argue there is a strong ethical demand that such processes should be arranged to provide adversely affected people well-justified reasons to confer legitimacy to the processes despite favouring a different decision-making outcome. Two increasingly popular approaches, Accountability for Reasonableness (A4R) and Multi-Criteria Decision Analysis (MCDA), can both be applied to support legitimate decision-making processes. However, the role played by ‘fair-minded (...) people’ in the A4R framework can be shown to undermine an adequate conceptualization of legitimacy according to the ethical demand. We discuss and specify conditions enabling A4R to meet this ethical demand when being implemented in a real-world setting without having to renounce the aim of striving for ‘reasonableness’ and impartiality. The methodological approach MCDA describes how to arrange for transparent resource allocation. This approach does not encompass any normative guidance on how to shape limit settings in terms of ‘reasonableness’; it basically promotes ‘rational’ decisions. We discuss how this practical methodology can be integrated with the theoretical A4R framework to meet the ethical demand while at the same time promoting politically required impartiality of healthcare limit setting. (shrink)