It is widely held that, in his pre-Critical works, Kant endorsed a necessitation account of laws of nature, where laws are grounded in essences or causal powers. Against this, I argue that the early Kant endorsed the priority of laws in explaining and unifying the natural world, as well as their irreducible role in in grounding natural necessity. Laws are a key constituent of Kant’s explanatory naturalism, rather than undermining it. By laying out neglected distinctions Kant draws among types (...) of natural law, grounding relations, and ontological levels, I show that his early works present a coherent and sophisticated laws-first account of the natural order. (shrink)

'Everyone knows what attention is’ according to William James. Much work on attention in psychology and neuroscience cites this famous phrase only to quickly dismiss it. But James is right about this: ‘attention’ was not introduced into psychology and neuroscience as a theoretical concept. I argue that we should therefore study attention with broadly the same methodology that David Marr has applied to the study of perception. By focusing more on Marr's Computational Level of analysis, we arrive at a unified (...) answer to the question of what attention is, what role it plays in the mind, and why organisms like us have that capacity. I propose a methodology for studying attention at Marr's Computational Level that optimizes in a three-dimensional space: it should capture core aspects of our first-person experience of attention, be explanatorily powerful in psychology and neuroscience, and fertile in an interdisciplinary context. I show how this methodology leads to what I call the priority structure account of attention. Attention is what organizes current information to make it more useful for the organism. We can identify it by four features. Attention, in this way, helps a cognitive system to integrate its informational state with its current motivational state. I describe how this account improves on alternatives and shows why attention is a useful concept in many disciplines and for connecting them. -/- This article is categorized under: Philosophy > Psychological Capacities Psychology > Attention Philosophy > Foundations of Cognitive Science. (shrink)

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

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)

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)

The combination of panpsychism and priority monism leads to priority cosmopsychism, the view that the consciousness of individual sentient creatures is derivative of an underlying cosmic consciousness. It has been suggested that contemporary priority cosmopsychism parallels central ideas in the Advaita Vedānta tradition. The paper offers a critical evaluation of this claim. It argues that the Advaitic account of consciousness cannot be characterized as an instance of priority cosmopsychism, points out the differences between the two views, (...) and suggests an alternative positioning of the Advaitic canon within the contemporary debate on monism and panpsychism. (shrink)

In recent work, the interrelated questions of whether there is a fundamental level to reality, whether ontological dependence must have an ultimate ground, and whether the monist thesis should be endorsed that the whole universe is ontologically prior to its parts have been explored with renewed interest. Jonathan Schaffer has provided arguments in favour of 'priority monism' in a series of articles (2003, 2004, 2007a, 2007b, forthcoming). In this paper, these arguments are analysed, and it is claimed that they (...) are not compelling: in particular, the possibility that there is no ultimate level of basic entities that compose everything else is on a par with the possibility of infinite 'upward' complexity. The idea that we must, at any rate, postulate an ontologically fundamental level for methodological reasons ( Cameron 2008 ) is also discussed and found unconvincing: all things considered, there may be good reasons for endorsing 'metaphysical infinitism'. In any event, a higher degree of caution in formulating metaphysical claims than found in the extant literature appears advisable. (shrink)

Philosophical orthodoxy has it that intentional action consists in one’s intention appropriately causing a motion of one’s body, placing the latter as (conceptually and/or metaphysically) prior to the former. Here I argue that this standard schema should be reversed: acting intentionally is at least conceptually prior to intending. The argument is modelled on a Williamsonian argument for the priority of knowledge developed by Jenifer Nagel. She argues that children acquire the concept KNOWS before they acquire BELIEVES, building on this (...) alleged developmental priority of knowledge to establish its conceptual priority. I start by taking a closer look at Nagel’s argument, canvassing extant objections to do both with the empirical adequacy of her claims and their philosophical implications. Doing so allows me in the second part of the paper to draw lessons that inform the construction of a revamped parallel argument for the priority of ACTS INTENTIONALLY. (shrink)

Priority monism is the view that the cosmos is the only independent concrete object. The paper argues that, pace its proponents, Priority monism is in conflict with the dependence of any whole on any of its parts: if the cosmos does not depend on its parts, neither does any smaller composite.

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.

Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws (...) of first-come, first-served allocation; (iv) the relevance of post-episode survival; (v) the difference between age and other factors that affect life-expectancy; and (vi) the need to avoid quality-of-life judgments. In the second part, we lay out some positions on which reasonable people can and do differ. These include (i) conflicts between maximizing benefits and priority to the worst off; (ii) role-based priority; and (iii) whether patients’ existing lifesaving resources should be subject to redistribution. (shrink)

In this article, I address concerns that the ontological priority claims definitive of ontic structural realism are as they stand unclear, and I do so by placing these claims on a more rigorous formal footing than they typically have been hitherto. I first of all argue that Kit Fine’s analysis of ontological dependence furnishes us with an ontological priority relation that is particularly apt for structuralism. With that in place, and with reference to two case studies prominent within (...) the structuralist literature, I consider whether any of structuralism’s distinctive priority claims may be regarded as warranted. The discussion as a whole has largely negative implications for the radical structuralism of French and Ladyman (including their ‘eliminativist’ interpretation of it), largely positive implications for the moderate structuralism primarily advocated by Esfeld and Lam, and some broad lessons for contemporary fundamentalist metaphysics as a whole. 1 Introduction2 The Right Priority Relation for Structuralism: Supervenience or Dependence?3 Introducing Ontological Dependence4 Fine’s System5 The Priority of Structure 1: Entangled Quantum Particles6 The Priority of Structure 2: The Group-Theoretic Conception of Elementary Particles7 Concluding Remarks. (shrink)

Epistemic burdens – the nature and extent of our ignorance (that and how) with respect to various courses of action – serve to determine our incentive structures. Courses of action that seem to bear impossibly heavy epistemic burdens are typically not counted as options in an actor’s menu, while courses of action that seem to bear comparatively heavy epistemic burdens are systematically discounted in an actor’s menu relative to options that appear less epistemically burdensome. That ignorance serves to determine what (...) counts as an option means that epistemic considerations are logically prior to moral, prudential, and economic considerations: in order to have moral, prudential, or economic obligations, one must have options, and epistemic burdens serve to determine our options. One cannot have obligations without doing some epistemic work. We defend this claim on introspective grounds. We also consider how epistemic burdens distort surrogate decision-making. The unique epistemology of surrogate cases makes the priority of the epistemic readily apparent. We then argue that anyone who accepts a principle similar to ought implies can is committed to the logical priority of the epistemic. We also consider and reject several possible counterarguments. -/- . (shrink)

Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity (...) criteria in Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. (shrink)

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)

Prioritized bases, i.e., weakly ordered sets of sentences, have been used for specifying an agent’s ‘basic’ or ‘explicit’ beliefs, or alternatively for compactly encoding an agent’s belief state without the claim that the elements of a base are in any sense basic. This paper focuses on the second interpretation and shows how a shifting of priorities in prioritized bases can be used for a simple, constructive and intuitive way of representing a large variety of methods for the change of belief (...) states—methods that have usually been characterized semantically by a system-of-spheres modeling. Among the methods represented are ‘radical’, ‘conservative’ and ‘moderate’ revision, ‘revision by comparison’ in its raising and lowering variants, as well as various constructions for belief expansion and contraction. Importantly, none of these methods makes any use of numbers. (shrink)

Priority monism is roughly the view that the universe is the only fundamental object, that is, a concrete object that does not depend on any other concrete object. Schaffer, the main advocate of PM, claims that PM is compatible with dependence having two different directions: from parts to wholes for subcosmic wholes, and from whole to parts for the cosmic whole. Recently it has been argued that this position is untenable. Given plausible assumptions about dependence, PM entails that dependence (...) has only one direction, it always goes from wholes to parts. One such plausible assumption is a principle of Isolation. I argue that, given all extant accounts of dependence on the market, PM entails No Isolation. The argument depends upon a particular feature of the dependence relation, namely, necessitation and its direction. In the light of this, I contend that the argument is important, insofar as it suggests that we should distinguish dependence from other cognate notions, e.g. grounding. Once this distinction is made, I suggest we should also distinguish between two different notions of fundamentality that might turn out to be not-coextensive. (shrink)

One‐third of all human deaths are due to poverty‐related causes, to malnutrition and to diseases that can be prevented or cured cheaply. Yet our politicians, academics, and mass media show little concern for how such poverty might be reduced. They are more interested in possible military interventions to stop human rights violations in developing countries, even though such interventions – at best – produce smaller benefits at greater cost. This Western priority may be rooted in self‐interest. But it engenders, (...) and is sustained by, a deeply flawed moral presentation of global economic cooperation. The new global economic order we impose aggravates global inequality and reproduces severe poverty on a massive scale. On any plausible understanding of our moral values, the prevention of such poverty is our foremost responsibility. (shrink)

Prioritarianism is the view that we ought to give priority to benefiting those who are worse off. Sufficientism, on the other hand, is the view that we ought to give priority to benefiting those who are not sufficiently well off. This paper concerns the relative merits of these two views; in particular, it examines an argument advanced by Roger Crisp to the effect that sufficientism is the superior of the two. My aim is to show that Crisp's argument (...) is unsound. While I concede his objections against the particular prioritarian views that he considers, I propose a different version of prioritarianism that is invulnerable to those objections. (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)

Schaffer (2010) argues that the internal relatedness of all things, no matter how it is conceived, entails priority monism. He claims that a sufficiently pervasive internal relation among objects implies the priority of the whole, understood as a concrete object. This paper shows that at least in the case of an internal relatedness of all things conceived in terms of physical intentionality - one way to understand dispositions - priority monism not only doesn't follow but also is (...) precluded. We conclude that the internal relatedness of all things is compatible with several different ontologies (including varieties of pluralism) but entails nothing concerning dependence between concrete objects. (shrink)

This paper aims to illuminate some issues in the equality, priority, or what debate. I characterize egalitarianism and prioritarianism, respond to the view that we should care about sufficiency or compassion rather than equality or priority, discuss the levelling down objection, and illustrate the significance of the distinction between prioritarianism and egalitarianism, establishing that the former is no substitute for the latter. In addition, I respond to Bertil Tungodden's views regarding the Slogan, the levelling down objection, the Pareto (...) Principle, leximin, the principle of personal good, strict moderate egalitarianism, the Hammond Equity Condition, the intersection approach, and non-aggregative reasoning. (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)

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)

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)

Argument that priority monism is best understood as being a contingent thesis.

A contemporary form of panpsychism says that phenomenality is prevalent because all physical ultimates instantiate phenomenal or protophenomenal properties. According to priority cosmopsychism, an alternative to panpsychism that we propose in this chapter, phenomenality is prevalent because the whole cosmos instantiates phenomenal or protophenomenal properties. It says, moreover, that the consciousness of the cosmos is ontologically prior to the consciousness of ordinary individuals like us. Since priority cosmopsychism is a highly speculative view our aim in this chapter remains (...) modest and limited. Instead of providing a full defense of priority cosmopsychism, we try to show only the theoretical advantage of the view over panpsychism. Tis, however, by no means entails that we develop the view in logical space merely for its own sake. We offer instead a blueprint for a new alternative to panpsychism and explain how such a view avoids some of the most persistent problems for panpsychism while maintaining several of its strengths. (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal access may (...) compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

In The Priority of the Person, world-class philosopher David Walsh advances the argument set forth in his highly original philosophic meditation Politics of the Person as the Politics of Being (2015), that "person" is the central category of modern political thought and philosophy. This book is divided into three main parts. Beginning with the political discovery of the inexhaustibility of persons, it then explores the philosophic differentiation of the idea of the "person," and finally traces its historical emergence through (...) art, science, and faith. Walsh argues that, although the roots of the idea of "person" are found in the Greek concept of the mind and in the Christian conception of the soul, this notion is ultimately a distinctly modern achievement, because it is only the modern turn toward interiority that illuminated the unique nature of persons as each being a world unto him or herself. As Walsh shows, it is precisely this feature of persons that makes it possible for us to know and communicate with others, for we can only give and receive one another as persons. In this way alone can we became friends and, in friendship, build community. In showing how the person is modernity's central preoccupation, and in demonstrating how it is only as persons that we can truly give ourselves to others and thus develop real community, David Walsh's The Priority of the Person makes an important contribution to current discussions in both political theory and philosophy. It will also appeal to students and scholars of theology and literature, and any groups interested in the person and personalism. (shrink)

Consider the kinds of macroscopic concrete objects that common sense and the sciences allege to exist: tables, raindrops, tectonic plates, galaxies, and the rest. Are there any such things? Opinions differ. Ontological liberals say they do; ontological radicals say they don't. Liberalism seems favored by its plausible acquiescence to the dictates of common sense abetted by science; radicalism by its ontological parsimony. Priority theorists claim we can have the virtues of both views. They hold that tables, raindrops, etc., exist, (...) but they aren't fundamental. The ontological liberal's ontology provides the correct inventory of existent individuals. The ontological radical's more restricted ontology provides the correct inventory of fundamental individuals. The priority theorist claims that the derivative individuals are "no addition in being" to the fundamental ones, so we can have our cake and eat it too. It would be nice if priority theorists were right. In this paper I argue, with regret, that they are not. One upshot is that the sort of explanations which underwrite the priority theorist's distinction between fundamental and derivative individuals do not mitigate our ontological commitments. Another is that we still have to choose between the charms of liberalism and radicalism. (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)

In this paper, I consider the basis for Kant's praise of Wolff's general logic as "the best we have." I argue that Wolff's logic was highly esteemed by Kant on account of its novel analysis of the three operations of the mind (tres operationes mentis), in the course of which Wolff formulates an argument for the priority of the understanding's activity of judging.

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 article distinguishes between a telic and a deontic version of Derek Parfit's influential Priority View. Employing the distinction, it shows that the existence of variations in how intrapersonal and interpersonal conflicts should be resolved fails to provide a compelling case in favour of relational egalitarianism and against all pure versions of the Priority View. In addition, the article argues that those variations are better understood as providing counterevidence to certain distribution-sensitive versions of consequentialism.

Suppose that you must make choices that may influence the well-being and the identities of the people who will exist, though not the number of people who will exist. How ought you to choose? This paper answers this question. It argues that the currency of distributive ethics in such cases is a combination of an individual’s final well-being and her expected well-being conditional on her existence. It also argues that this currency should be distributed in an egalitarian, rather than a (...) prioritarian, manner. (shrink)

Recently theorists have demonstrated a growing interest in the ethical aspects of resource allocation in international non-governmental humanitarian, development and human rights organizations (INGOs). This article provides an analysis of Thomas Pogge's proposal for how international human rights organizations ought to choose which projects to fund. Pogge's allocation principle states that an INGO should govern its decision making about candidate projects by such rules and procedures as are expected to maximize its long-run cost-effectiveness, defined as the expected aggregate moral value (...) of the projects it undertakes divided by the expected aggregate cost of these projects? I critique Pogge's argument on two fronts: (1) I demonstrate that his view is problematic on his own terms, even if we accept the cost-effectiveness framework he employs. (2) I take issue with his overall approach because it generates results which can undermine the integrity of INGOs. Further, his approach mis-characterizes the nature of INGOs, and this mistake is at the root of his problematic view of INGO priority-setting. Ultimately, I argue for a conception of INGOs in which they are understood as ?organizations of principle?, in the sense that they are independent moral agents and so should be permitted a fairly wide sphere of autonomy within reasonable moral constraints. (shrink)

The (dis)information age represses questioning and distorts what we take to be genuine questioning. Most studies construe questions as “epistemic imperatives,” and critics reject it as exploitative. In its defense, this chapter isolates the significance of indeterminacy in questioning. It develops a hermeneutic of questioning to show its priority in receiving meanings, and exposes that shared questioning makes the questioners too indeterminate to claim one is exploiting the other. It also develops a phenomenology of questioning to identify what it (...) is people share when they share questions and reach an understanding through them. On the acting or noetic side, it is like the dehiscence of our bodies, where its openness consists in its both feeling and being felt. Questioning is dehiscent in that it opens understanding to enfold new meaning. On the content or noematic side, questioning expresses subject matters in the state of indeterminacy, where a topic is suspended in a network of predicative possibilities. Through questioning, we gain empowerment to determine things for ourselves, to take responsibility for our own answers. (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)

Michael Otsuka, Alex Voorhoeve and Marc Fleurbaey have challenged the priority view in favour of a theory based on competing claims. The present paper shows how their argument can be used to recast the priority view. All desert claims in distributive justice are comparative. The stronger a party’s claims to a given benefit, the greater is the value of her receiving it. Ceteris paribus, the worse-off have stronger claims on welfare, and benefits to them matter more. This can (...) account for intuitions that at first appear egalitarian, as the analysis of an example of Larry Temkin’s shows. The priority view, properly understood, is desert-adjusted utilitarianism under the assumption that no other claims pertain. (shrink)

Truthmaker monism is the view that the one and only truthmaker is the world. Despite its unpopularity, this view has recently received an admirable defence by Schaffer :307–324, 2010b). Its main defect, I argue, is that it omits partial truthmakers. If we omit partial truthmakers, we lose the intimate connection between a truth and its truthmaker. I further argue that the notion of a minimal truthmaker should be the key notion that plays the role of constraining ontology and that truthmaker (...) monism is not necessary for an appropriate solution to the problem of finding truthmakers for negative truths. I conclude that we should reject truthmaker monism once and for all. (shrink)

The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA’s provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA (...) is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the health care system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry. (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)

The growing gap between demands and resources is putting immense pressure on all government spending in Sweden. The gap is especially apparent in care and services for elderly people in light of the rapid aging of the population. The article considers the decisions and priorities concerning resource allocation in the welfare sector in general and in elderly care in particular. The aim is to describe the political and administrative setting and to provide a conceptual structure that outlines the nature of (...) the problem. Various levels of decision making are identified and discussed in the context of political accountability. Current transitions in elderly care are described with respect to service provision, marketisation, coverage rates, and eligibility standards. Basic principles of distribution are highlighted in order to clarify some central concepts of efficiency and justice, and a number of strategies for actual prioritising are identified. The article concludes with an endorsement of more conscious decisions in resource allocation. Existing knowledge and information concerning the effects of various strategies must be utilised, and the values and assumptions used for setting priorities must be made explicit. (shrink)

I introduce and argue for a Priority Principle, according to which we exemplify certain of our mental properties in the primary or non-derivative sense. I then apply this principle to several debates in the metaphysics and philosophy of mind.

As synthetic biology develops into a promising science and engineering field, we need to have clear ideas and priorities regarding its safety, security, ethical and public dialogue implications. Based on an extensive literature search, interviews with scientists, social scientists, a 4 week long public e-forum, and consultation with several stakeholders from science, industry and civil society organisations, we compiled a list of priority topics regarding societal issues of synthetic biology for the years ahead. The points presented here are intended (...) to encourage all stakeholders to engage in the prioritisation of these issues and to participate in a continuous dialogue, with the ultimate goal of providing a basis for a multi-stakeholder governance in synthetic biology. Here we show possible ways to solve the challenges to synthetic biology in the field of safety, security, ethics and the science-public interface. (shrink)