As algorithms pervade numerous facets of daily life, they are incorporated into systems for increasingly diverse purposes. These systems’ results are often interpreted differently by the designers who created them than by the lay persons who interact with them. This paper offers a proposal for human-centered algorithm design, which incorporates human and social interpretations into the design process for algorithmically based systems. It articulates three specific strategies for doing so: theoretical, participatory, and speculative. Drawing on the author’s work designing and (...) deploying multiple related systems, the paper provides a detailed example of using a theoretical approach. It also discusses findings pertinent to participatory and speculative design approaches. The paper addresses both strengths and challenges for each strategy in helping to center the process of designing algorithmically based systems around humans. (shrink)

How do ethics show up in the everyday behaviors and conversations of researchers in a scientific laboratory? How does the microcosmic culture of the laboratory shape researchers’ understandings of scientific ethics? We, an interdisciplinary team representing anthropology, computer science, and rhetorical studies, investigated these questions in two university STEM labs. Similar to previous work mapping out the epistemic cultures, we sought to understand the ethical cultures of these research groups. We observed their lab meetings for several months and conducted interviews (...) with members of the research laboratories. Ultimately, we recognized two distinct ethical cultures within the two laboratories: one focused on the relationship between science and social justice, and the other focused on clean data and accuracy as an ethical issue. These two distinct ethical cultures were discernable through ethnography, close reading of laboratory members’ language, as well as broad-scale topic modeling. Our project complements previous studies of ethics in science that have focused on codes of ethics or student curricula as ways in which scientists develop an understanding of scientific ethics. Our project demonstrates that everyday interactions between the members of scientific research labs additionally shape, at a decidedly local level, how scientists understand and ultimately approach ethical decision-making in the scientific research process. (shrink)

This paper reports on the results of a survey of faculty members at California State University, Northridge in Los Angeles, California regarding their understanding of and familiarity with the concept of fake news. With very few studies published on the attitudes of teaching faculty at universities, this study is a unique approach to the issues facing educators, knowledge creators, and information specialists. The paper examines the origins of the term “fake news”, the factors contributing to its current prevalence, and proposes (...) a new definition. It also reports upon the attitudes that teaching faculty hold, and how they define fake news within their specific disciplines. Though nearly all surveyed faculty felt fake news was an important topic that impacted them professionally, the researchers also find that faculty across all disciplines and ranks, ages, and gender, hold widely differing conceptions of fake news. This lack of consensus may have future implications for students in particular and higher education in general and are worth exploring further. (shrink)

Although Brouwer is well known for his Intuitionistic philosophy of mathematics, a constructivist philosophy which calls for restricted use of certain logical principles, there is much less awareness of the well-developed metaphysical basis which underlies those restrictions. In the first half of this paper I outline a basic interpretation of Brouwer's metaphysics, and then in the second half consider the compatibility of that metaphysics with Dummett's argument for a principled non-metaphysical approach to intuitionism. I conclude that once the variously misleading (...) accretions of the central concepts - metaphysics and logic - are set aside, Dummett and Brouwer's accounts can be seen to be at the very least compatible, if not complementar. (shrink)

Although Brouwer is well known for his Intuitionistic philosophy of mathematics, a constructivist philosophy which calls for restricted use of certain logical principles, there is much less awareness of the well-developed metaphysical basis which underlies those restrictions. In the first half of this paper I outline a basic interpretation of Brouwer's metaphysics, and then in the second half consider the compatibility of that metaphysics with Dummett's argument for a principled non-metaphysical approach to intuitionism. I conclude that once the variously misleading (...) accretions of the central concepts - metaphysics and logic - are set aside, Dummett and Brouwer's accounts can be seen to be at the very least compatible, if not complementar. (shrink)

Gene therapy approaches have great promise in the treatment of neurodegenerative disorders and malignant brain tumors. Neuwelt et al. review available viral-mediated gene therapy methods and their blood-brain-barrier (BBB) disruption delivery technique, briefly mentioning nonviral mediated gene therapy methods. This commentary discussed the BBB disruption delivery technique, viral and nonviral mediated gene therapy approaches to Parkinson's disease, and the potential use of antisense oligo to suppress malignant brain tumors.

Reduced Environmental Stimulation Therapy (REST) alters the balance of sensory input to the nervous system by systematically attenuating sensory signals from visual, auditory, thermal, tactile, vestibular, and proprioceptive channels. Previous research from our group has shown that REST via floatation acutely reduces anxiety and blood pressure while simultaneously heightening interoceptive awareness in clinically anxious populations. Anorexia nervosa (AN) is an eating disorder characterized by elevated anxiety, distorted body representation, and abnormal interoception, raising the question of whether REST might positively impact (...) these symptoms. However, this approach has never been studied in eating disorders and it is unknown whether exposure to REST might worsen AN symptoms. To examine these possibilities we conducted an open-label study to investigate the safety and tolerability of REST in AN. We also explored the impact of REST on affective symptoms, body image disturbance, and interoception. Twenty-one partially weight-restored AN outpatients completed a protocol involving four sequential sessions of REST: reclining in a zero-gravity chair, floating in an open pool, and two sessions of floating in an enclosed pool. All sessions were 90 minutes, approximately one week apart. We measured orthostatic blood pressure before and immediately after each session (primary outcome), in addition to collecting blood pressure readings every 10 minutes during the session using a wireless waterproof system as a secondary outcome measure. Each participant's affective state, awareness of interoceptive sensations, and body image was assessed before and after every session (exploratory outcomes). There was no evidence of orthostatic hypotension following floating, and no adverse events (primary outcome). Secondary analyses revealed that REST induced statistically significant reductions in blood pressure, anxiety and negative affect, heightened awareness of cardiorespiratory but not gastrointestinal sensations, and reduced body image dissatisfaction. The findings from this initial trial suggest that individuals with AN can safely tolerate the physical effects of REST via floatation. Future randomized controlled trials will need to investigate whether these initial observations of improved anxiety, interoception, and body image disturbance can be effectively extended to acutely ill AN populations. (shrink)

Quine has proposed an alternative criterion for identifying observation sentences which has not yet received serious evaluation. We investigate this new criterion, showing how it differs from more traditional criteria and measuring it against the major objections to traditional criteria. Our judgment is that it meets Suppe's and Achinstein's objections and one version of the theory-ladenness objection offered by Hanson, Feyerabend, and Kuhn. We suggest how it might also provide an answer to the more serious version of the theory-ladenness objection. (...) To determine whether it meets this final objection, though, requires actual analysis of scientific cases, which has not yet been performed. (shrink)

This book aims to show why a proper ontology of persons has paramount importance for our understanding of the nature of consciousness and its relation to the phenomenon of unconsciousness and artificial intelligence. Contemporary discussions on consciousness often focus on seeking solutions for a wide range of issues that revolve around questions related to what sort of role the brain plays in the existence of consciousness. These questions raise multi-layered and diverse metaphysical (especially, ontological), personal, medical, moral, and legal issues. (...) In navigating through such a complex web of issues, it has been said that the central problems philosophers and scientists face are establishing the nature and origin of consciousness. For example, is consciousness nothing but a brain process? If not, how is it related to brain activities? Can consciousness exist without depending on the brain and its activities? What are the neural correlates of consciousness, unconsciousness, and persons? Can we make an advance on the science of consciousness by investigating what happens to the brain during general anesthesia? Is there a relation between consciousness and unconsciousness? What is the bearer of consciousness and unconsciousness? Can consciousness exist without being someone’s consciousness? Is consciousness reproducible in computers or digital machines? If consciousness is not in all things, then what conditions must be satisfied for its emergence? Is it ethical to take someone’s vital organs without any prior consent from a person in an irreversible comatose state? The beginning and end of life issues also bring up their own complicated ethical conundrums involving consciousness. (shrink)

We present a one per cent measurement of the cosmic distance scale from the detections of the baryon acoustic oscillations in the clustering of galaxies from the Baryon Oscillation Spectroscopic Survey, which is part of the Sloan Digital Sky Survey III. Our results come from the Data Release 11 sample, containing nearly one million galaxies and covering approximately 8500 square degrees and the redshift range 0.2 < z < 0.7. We also compare these results with those from the publicly released (...) DR9 and DR10 samples. Assuming a concordance Λ cold dark matter cosmological model, the DR11 sample covers a volume of 13 Gpc3 and is the largest region of the Universe ever surveyed at this density. We measure the correlation function and power spectrum, including density-field reconstruction of the BAO feature. The acoustic features are detected at a significance of over 7σ in both the correlation function and power spectrum. Fitting for the position of the acoustic features measures the distance relative to the sound horizon at the drag epoch, rd, which has a value of rd,fid = 149.28 Mpc in our fiducial cosmology. We find DV = at z = 0.32 and DV = at z = 0.57. At 1.0 per cent, this latter measure is the most precise distance constraint ever obtained from a galaxy survey. Separating the clustering along and transverse to the line of sight yields measurements at z = 0.57 of DA = and H =. Our measurements of the distance scale are in good agreement with previous BAO measurements and with the predictions from cosmic microwave background data for a spatially flat CDM model with a cosmological constant. © 2014 The Author Published by Oxford University Press on behalf of the Royal Astronomical Society. (shrink)

This comment is offered in response to Hansen's "A Multidimensional Scale for Measuring Business Ethics: A Purification and Refinement". Five issues arising from Hansen's purification and refinement efforts are addressed. These include the issues of parsimony, predictive validity, collinearity, reliability, and what we see as a confusion between normative and positive theory.

This comment is offered in response to Hansen's A Multidimensional Scale for Measuring Business Ethics: A Purification and Refinement. Five issues arising from Hansen's purification and refinement efforts are addressed. These include the issues of parsimony, predictive validity, collinearity, reliability, and what we see as a confusion between normative and positive theory.

A framework is designed to aid the marketing decision maker in choosing between deontological and utilitarian reasoning when attempting to solve ethical problems. the framework uses miller's theory of living systems to develop a hierarchy of exchanges as a basis for analysis. then the historical appeal of deontology and utilitarianism are analyzed with respect to the hierarchy.

This article uses Arndt's depiction of marketing epistemology to suggest a possible explanation for the lack of emphasis on marketing ethics within the marketing literature. While a growing number of writers are turning their attention to the area, marketing's heavy reliance on logical empiricism has contributed to a disinclination in the development of this area. Only through recent and numerous revelations of misconduct has the discipline of marketing responded to its ethical dimensions.

In much the same way that genomic technologies are changing the complexion of biomedical research, the issues they generate are changing the agenda of IRBs and research ethics. Many of the biggest challenges facing traditional research ethics today — privacy and confidentiality of research subjects; ownership, control, and sharing of research data; return of results and incidental findings; the relevance of group interests and harms; the scope of informed consent; and the relative importance of the therapeutic misconception — have become (...) important policy issues over the last 20 years because of the ways they have been magnified by genomic research efforts. Research that examines the ethical, legal, and social implications of human genomics research has become a burgeoning international field of scholarship over the last 20 years, thanks in part to its support first by the genome research funding bodies in the U.S. and then by national science agencies in other countries. (shrink)

© 2017. The American Astronomical Society. All rights reserved.We present new observations of the low-mass companion to HD 984 taken with the Gemini Planet Imager as a part of the GPI Exoplanet Survey campaign. Images of HD 984 B were obtained in the J and H bands. Combined with archival epochs from 2012 and 2014, we fit the first orbit to the companion to find an 18 au orbit with a 68% confidence interval between 14 and 28 au, an eccentricity (...) of 0.18 with a 68% confidence interval between 0.05 and 0.47, and an inclination of 119°with a 68% confidence interval between 114°and 125°. To address the considerable spectral covariance in both spectra, we present a method of splitting the spectra into low and high frequencies to analyze the spectral structure at different spatial frequencies with the proper spectral noise correlation. Using the split spectra, we compare them to known spectral types using field brown dwarf and low-mass star spectra and find a best-fit match of a field gravity M6.5 ±1.5 spectral type with a corresponding temperature of K. Photometry of the companion yields a luminosity of log=2.88 ± 0.07 dex with DUSTY models. Mass estimates, again from DUSTY models, find an age-dependent mass of 34 ±1 to 95 ±4 M Jup. These results are consistent with previous measurements of the object. (shrink)

The essays in this special issue focus on connecting the relevant aspects of Lowe’s metaphysics to issues in philosophical theology. In this regard, the essays focus on Trinity, divine causal agency, atonement, embodied existence, physicalism vs. dualism, natural science, and theological claims.

This book updates and adds to the classic Social Movements of the Sixties and Seventies, showing how social movement theory has grown and changed.

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

There is an increasing interest in the possibility of using nudges to promote people's health. Following the advances in developmental biology and epigenetics, it is clear that one's health is not always the result of one's own choices. In the period surrounding pregnancy, maternal choice behaviour has a significant influence on perinatal morbidity and mortality as well as the development of chronic diseases later in life. One's health is thus a matter of one's own as well as one's maternal choices. (...) Therefore, self-regarding and other-regarding nudges should be considered as viable strategies to promote health. In this article, we introduce the concept of other-regarding nudges. We use the harm principle and the principle of beneficence to justify these other-regarding nudges. We conclude by stressing the importance of a fair assessment of expectations towards the nudgee, when determining whether a nudge is aimed at preventing harm or promoting a good. (shrink)

This paper investigates the implicative conditional, a connective intended to describe the logical behavior of an empirically defined class of natural language conditionals, also named implicative conditionals, which excludes concessive and some other conditionals. The implicative conditional strengthens the strict conditional with the possibility of the antecedent and of the contradictory of the consequent. $${p\Rightarrow q}$$ p ⇒ q is thus defined as $${\lnot } \Diamond {(p \wedge \lnot q) \wedge } \Diamond {p \wedge } \Diamond {\lnot q}$$ ¬ ◊ (...) ( p ∧ ¬ q ) ∧ ◊ p ∧ ◊ ¬ q. We explore the logical properties of this conditional in a reflexive normal Kripke semantics, provide an axiomatic system and prove it to be sound and complete for our semantics. The implicative conditional validates transitivity and contraposition, which we take to be integral parts of reasoning and communication. But it only validates restricted versions of strengthening the antecedent, right weakening, simplification, and rational monotonicity. Apparent counterexamples to some of these properties are explained as due to contextual factors. Finally, the implicative conditional avoids the paradoxes of material and strict implication, and validates some connexive principles such as Aristotle’s theses and weak Boethius’ thesis, as well as some highly entrenched principles of conditionals, such as conjunction of consequents, disjunction of antecedents, modus ponens, cautious monotonicity and cut. (shrink)

In Beyond Physicalism, an interdisciplinary group of physical scientists, behavioral and social scientists, and humanists from the Esalen Institute’s Center for Theory and Research argue that physicalism must be replaced by an expanded scientific naturalism that accommodates something spiritual at the heart of nature.

Consider the following three claims. (i) There are no truths of the form ‘p and ~p’. (ii) No one holds a belief of the form ‘p and ~p’. (iii) No one holds any pairs of beliefs of the form {p, ~p}. Irad Kimhi has recently argued, in effect, that each of these claims holds and holds with metaphysical necessity. Furthermore, he maintains that they are ultimately not distinct claims at all, but the same claim formulated in different ways. I find (...) his argument suggestive, if not entirely transparent. I do think there is at least an important kernel of truth even in (iii), and that (i) ultimately explains what’s right about the other two. Consciousness of an impossibility makes belief in the obtaining of the corresponding state of affairs an impossibility. Interestingly, an appreciation of this fact brings into view a novel conception of inference, according to which it consists in the consciousness of necessity. This essay outlines and defends this position. A central element of the defense is that it reveals how reasoners satisfy what Paul Boghossian calls the Taking Condition and do so without engendering regress. (shrink)

We argue that honesty in assertion requires non-empirical knowledge that what one asserts is what one believes. Our argument proceeds from the thought that to assert honestly, one must follow and not merely conform to the norm ‘Assert that p only if you believe that p’. Furthermore, careful consideration of cases shows that the sort of doxastic self-knowledge required for following this norm cannot be acquired on the basis of observation, inference, or any other form of detection of one’s own (...) doxastic states. It is, as we put it, transparent rather than empirical self-knowledge. (shrink)

Testing the other. It is nowadays a commonplace of academic discourse on social sciences, especially when it comes to such disciplines as anthropology and semiotics, to oppose the old (and old-fashioned) methods of the “structuralists” to post-modern and post-structural epistemological attitudes. Structuralism, it is said, was based on the idea that it is possible to apprehend the meaning of cultural productions from an exterior and therefore objective standpoint, just by making explicit their immanent principles of organization. Today, on the contrary, (...) a totally distinct approach of cultural productions would stem from the consciousness of a strict interdependence, or even of an identity in nature between subject and object at all levels of the process of knowledge, at least in the area of the humanities. However, such a crude opposition proves insufficient when one observes the effective practices of current research. The example here analysed is the account given by the American anthropologist Paul Rabinow of his first mission abroad: Reflections on Fieldwork in Morocco. The analysis, based on the use of a semiotic modelling of interaction, consists in exploring the variety of positions respectively adopted by the anthropologist and his informants according to circumstances and contexts. Four regimes are in principle distinguishable: programmation, based on regularity and predictability of the actors’ behaviour, manipulation, based on some kind of contractualization of their relationships, adjustment, based upon reciprocal sensitivity and various strategies permitting to both partners of the interaction to test one another, and a regime of consent to the unexpected or the unforeseeable. The main result of the analysis resides in the possibility of showing that at each of these styles of pragmatic interaction corresponds a specific regime at the cognitive level as well. This leads tostressing the complexity, if not heterogeneity, of the strategies of knowledge involved at various stages of anthropological research, from the collection ofdata to the cooperative production of new forms of understanding. Taking the risk of generalization, one might also consider the interactional device, which ishere tested through the reading of P. Rabinow’s report as a metatheoretical model describing the various epistemological stances at work and at stake in thepractices of research in social sciences at large. (shrink)

Deontic Logic goes back to Ernst Mally’s 1926 work, Grundgesetze des Sollens: Elemente der Logik des Willens [Mally. E.: 1926, Grundgesetze des Sollens: Elemente der Logik des Willens, Leuschner & Lubensky, Graz], where he presented axioms for the notion ‘p ought to be the case’. Some difficulties were found in Mally’s axioms, and the field has much developed. Logic of Knowledge goes back to Hintikka’s work Knowledge and Belief [Hintikka, J.: 1962, Knowledge and Belief: An Introduction to the Logic of (...) the Two Notions, Cornell University Press] in which he proposed formal logics of knowledge and belief. This field has also developed quite a great deal and is now the subject of the TARK conferences. However, there has been relatively little work combining the two notions of knowledge (belief) with the notion of obligation. (See, however, [Lomuscio, A. and Sergot, M.: 2003, Studia Logica 75 63–92; Moore, R. C.: 1990, In J. F. Allen, J. Hendler and A. Tate (eds.), Readings in Planning, Morgan Kaufmann Publishers, San Mateo, CA]) In this paper we point out that an agent’s obligations are often dependent on what the agent knows, and indeed one cannot reasonably be expected to respond to a problem if one is not aware of its existence. For instance, a doctor cannot be expected to treat a patient unless she is aware of the fact that he is sick, and this creates a secondary obligation on the patient or someone else to inform the doctor of his situation. In other words, many obligations are situation dependent, and only apply in the presence of the relevant information. Thus a case for combining Deontic Logic with the Logic of Knowledge is clear. We introduce the notion of knowledge based obligation and offer an S5, history based Kripke semantics to express this notion, as this semantics enables us to represent how information is transmitted among agents and how knowledge changes over time as a result of communications. We consider both the case of an absolute obligation (although dependent on information) as well as the (defeasible) notion of an obligation which may be over-ridden by more relevant information. For instance a physician who is about to inject a patient with drug d may find out that the patient is allergic to d and that she should use d′ instead. Dealing with the second kind of case requires a resort to non-monotonic reasoning and the notion of justified belief which is stronger than plain belief, but weaker than absolute knowledge in that it can be over-ridden. This notion of justified belief also creates a derived notion of default obligation where an agent has, as far as the agent knows, an obligation to do some action a. A dramatic application of this notion is our analysis of the Kitty Genovese case where, in 1964, a young woman was stabbed to death while 38 neighbours watched from their windows but did nothing. The reason was not indifference, but none of the neighbours had even a default obligation to act, even though, as a group, they did have an obligation to take some action to protect Kitty. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS I. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[i] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[ii] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. II. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[iii] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[iv] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[v] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[vi] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[vii] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[viii] In democratic societies, one must take into consideration community morals and values.[ix] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[x] III. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[xi] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[xii] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[xiii] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[xiv] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. IV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[xv] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[xvi] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[xvii] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[xviii] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[xix] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[xx] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[xxi] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. VI. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[xxii] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[xxiii] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[xxiv] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. VII. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [i] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [ii] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [iii] Moss, p. 1295-1298. [iv] Moss, p. 1296. [v] Moss, p. 1295-1298. [vi] Moss, p. 1295-1298. [vii] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [viii] Cohen, p. 1299-1301. [ix] Moss, p. 1297. [x] Cohen, p. 1300. [xi] Cappelen, p. 478-480. [xii] Cappalen, p. 478-480. [xiii] Cappelen, p.479. [xiv] Cappelen, p. 479. [xv] Cappelen, p. 479 [xvi] Cohen, p. 1301. [xvii] Cappelen, p. 478. [xviii] Cohen, p. 1299-1301. [xix] Cohen, p. 1301. [xx] Cappelen, p. 476-480. [xxi] Cappelen, p. 476-480. [xxii] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [xxiii] Kawachi, p. 18-33. [xxiv] Kawachi, p. 18-33. (shrink)

Most agree that believing a proposition normally or ideally results in believing that one believes it, at least if one considers the question of whether one believes it. I defend a much stronger thesis. It is impossible to believe without knowledge of one's belief. I argue, roughly, as follows. Believing that p entails that one is able to honestly assert that p. But anyone who is able to honestly assert that p is also able to just say – i.e., authoritatively, (...) yet not on the basis of evidence – that she believes that p. And anyone who is able to just say that she believes that p is able to act in light of the fact that she holds that belief. This ability to act, in turn, constitutes knowledge of the psychological fact. However, without a broader theory of belief to help us make sense of this result, this conclusion will be hard to accept. Why should being in a particular mental state by itself necessitate an awareness of being in that state? I sketch a theory that helps to answer this question: believing is a matter of viewing a proposition as what one ought to believe. I show how this theory explains the thesis that to believe is to know that you believe. (shrink)

Philosophers of information, according to Luciano Floridi (The philosophy of information. Oxford University Press, Oxford, 2010, p 32), study how information should be “adequately created, processed, managed, and used.” A small number of epistemologists have employed the concept of information as a cornerstone of their theoretical framework. How this concept can be used to make sense of seemingly intractable epistemological problems, however, has not been widely explored. This paper examines Fred Dretske’s information-based epistemology, in particular his response to radical epistemological (...) skepticism. We discuss the relationship between information, evidence and knowledge in relation to the problem of skepticism and the options available to an information-based epistemology for dealing with it. (shrink)

In recent decades, a view of identity I call Sortalism has gained popularity. According to this view, if a is identical to b, then there is some sortal S such that a is the same S as b. Sortalism has typically been discussed with respect to the identity of objects. I argue that the motivations for Sortalism about object-identity apply equally well to event-identity. But Sortalism about event-identity poses a serious threat to the view that mental events are token identical (...) to physical events: A particular mental event m is identical with a particular physical event p only if there is a sortal S such that m and p are both Ss. If there is no such sortal, the doctrine of token-identity is not true. I argue here that we have no good reason for thinking that there is any such sortal. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

Philosophers tend to be pretty impressed by human self-knowledge. Descartes (1641/1984) thought our knowledge of our own stream of experience was the secure and indubitable foundation upon which to build our knowledge of the rest of the world. Hume – who was capable of being skeptical about almost anything – said that the only existences we can be certain of are our own sensory and imagistic experiences (1739/1978, p. 212). Perhaps the most prominent writer on self-knowledge in contemporary philosophy is (...) Sydney Shoemaker. The central aim of much of his work has been to show that certain sorts of error are impossible (1963, 1988, 1994). David Chalmers has likewise attempted to show that, for a suitably constrained class of beliefs about one’s own consciousness, error is impossible (2003, sec. 4.1). Even philosophers most of the community thinks of as pessimistic about self-knowledge of consciousness seem to me, really, to be fairly optimistic. Paul Churchland, famous for his disdain of ordinary people’s knowledge about the mind, compares the accuracy of introspection to the accuracy of sense perception – pretty good, presumably, about medium-sized, nearby matters (1985, 1988). Dan Dennett, often cited as a pessimist about introspective report, actually says that we can come close to infallibility when charitably interpreted (2002). The above references concern knowledge of the stream of conscious experience, but philosophers have also tended to be impressed with our self-knowledge of our attitudes, such as our beliefs and desires. Consider this: Although I can be wrong about its being sunny outside, I can’t in the same way be wrong, it seems, about the fact that I think it’s sunny outside. Some.. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Is Literature Self-Referential?Eric MillerIIs literary language necessarily self-referential? And does this put paradox at the heart of literature? For at least two decades now, affirmative answers to both questions have been articles of faith among critics in the structuralist and poststructuralist mainstream. Literature’s ineluctable paradoxicality attracts us so because a paradox suggests that there are limits to human rationality, and thus strikes a blow for literature and against (...) science. Paradox ensures literature its own special realm, safe from the culturally imperialistic inroads of science’s orderly, rational-empirical constructions. Literature thus gets to be seen as “bigger” than reason, because only literature can live with paradox, and thus only literature reveals those “deeper” truths of contradiction-ridden human existence, whereas science can never penetrate beyond rational manipulations of phenomenal surfaces. Indeed, for anyone who holds all human existence to be fundamentally paradoxical, this special capacity makes literature the only genuine, demystified species of human knowledge. In the war between C. P. Snow’s Two Cultures, a war humanists are now losing badly, we like to regard paradox as our ultimate weapon.Belief in the paradoxicality of literature may also be found among the New Critics, 1 and in fact goes back at least to the Romantics, 2 but they did not derive this belief from a necessary self-referentiality of literary language. This newer way of deriving paradox appears to offer several competitive advantages. Self-reference seems to be the ultimate version of “art for art’s sake”: if all literary language is necessarily self-referential, then literature must be something totally self-contained, and is thus legitimized solely in and through itself. In addition, deriving [End Page 475] literature’s paradoxicality from self-reference seems to ground it in the same conceptual realm as mathematical logic, and thus tempts us to claim for literature a “rigor” normally conceded only to logic, mathematics, and theoretical physics. Self-referentiality would thus seem both to protect literature’s autonomy and to raise its cultural status into the company of mathematics and science.But it is a trap. For behind this new strategy lurks a capitulation to the underlying conceptual scheme of natural science, and literature thus comes to be conceived, in effect, as a science. Self-reference is, after all, still a kind of reference; paradox is still a kind of truth-relational construction;—and truth-relations built around reference constitute the correspondence theory of truth. From such a foundational commitment to reference and correspondence-truth, flows the rest of the scientific worldview: the dualism of referring expression and referent, word and object, sentence and fact, theory and data, language and world, culture and nature. The presentation of literature as a quasi-negation of this ontology changes nothing. The dualism of reference still functions as literature’s conceptual starting point, as its arche. We only appear to be defining a peculiar and radically distinct sphere for literature when we insist on its self-referentiality, on the (recursive) identity, for it, of referring expression and referent. For, this is still to treat the conceptual distinction between the two as foundational, and literature thereby tacitly assimilates science’s fundamental categorial division: the referential language-world duality of correspondence truth. Indeed, literature thus comes to live even more completely in the margins of science: it will have no essence of its own; it will differ at most in being a photo-negative image of science’s positiv(istic) project. In Snow’s war, self-reference is a Trojan horse.With self-reference as the essence of literature, we are thus staking our reputations on literature’s being a special field of formalizable “knowledge about...,” rather than, say, a quality or kind or realm of possible experience—which is to adopt science’s understanding of what is important. Matters are only made worse by that other attempt to define literary studies as a negation of the theory-data dualism of natural science: the poststructuralist denial of the distinction between criticism and literature. For the institutional need professional critics have to be seen as a discipline with a method and a subject, as a form of “knowledge about,” hardly disappears with... (shrink)

Testing the other. It is nowadays a commonplace of academic discourse on social sciences, especially when it comes to such disciplines as anthropology and semiotics, to oppose the old (and old-fashioned) methods of the “structuralists” to post-modern and post-structural epistemological attitudes. Structuralism, it is said, was based on the idea that it is possible to apprehend the meaning of cultural productions from an exterior and therefore objective standpoint, just by making explicit their immanent principles of organization. Today, on the contrary, (...) a totally distinct approach of cultural productions would stem from the consciousness of a strict interdependence, or even of an identity in nature between subject and object at all levels of the process of knowledge, at least in the area of the humanities. However, such a crude opposition proves insufficient when one observes the effective practices of current research. The example here analysed is the account given by the American anthropologist Paul Rabinow of his first mission abroad: Reflections on Fieldwork in Morocco. The analysis, based on the use of a semiotic modelling of interaction, consists in exploring the variety of positions respectively adopted by the anthropologist and his informants according to circumstances and contexts. Four regimes are in principle distinguishable: programmation, based on regularity and predictability of the actors’ behaviour, manipulation, based on some kind of contractualization of their relationships, adjustment, based upon reciprocal sensitivity and various strategies permitting to both partners of the interaction to test one another, and a regime of consent to the unexpected or the unforeseeable. The main result of the analysis resides in the possibility of showing that at each of these styles of pragmatic interaction corresponds a specific regime at the cognitive level as well. This leads tostressing the complexity, if not heterogeneity, of the strategies of knowledge involved at various stages of anthropological research, from the collection ofdata to the cooperative production of new forms of understanding. Taking the risk of generalization, one might also consider the interactional device, which ishere tested through the reading of P. Rabinow’s report as a metatheoretical model describing the various epistemological stances at work and at stake in thepractices of research in social sciences at large. (shrink)

A critique of LaPorte's views on chemical kinds, like jade and ruby, is presented. More positively, a new slant is provided on the question of whether elements are natural kinds. This is carried out by appeal to the dual nature of elements, a topic that has been debated in the philosophy of chemistry but not in the natural kinds literature. It is claimed that the abstract notion of elements, as opposed to their being simple substances, is relevant to the Kripke–Putnam (...) approach to natural kinds and to some criticisms that have been raised against it, although I do not support the K–P account. The proposed view avoids the traditional microstructuralist approach to natural kinds. The article also addresses the question of whether natural kinds concern metaphysical or epistemological considerations. Recent attempts by chemists to modify the periodic table are brought to bear on the question of classification and consequently on whether the identification of elements is interest dependent. (shrink)

F. P. Ramsey was a remarkably creative and subtle philosopher who in the briefest of academic careers made significant contributions to logic, philosophy of mathematics, philosophy of language and decision theory. His few published papers reveal him to be a figure or comparable importance to Russell, Carnap and Wittgenstein in the history of analytical philosophy. This book was the first critical study of Ramsey's work, offering a thorough exposition and interpretation of his ideas, setting the ideas in their historical context, (...) and assessing their significance for contemporary research. The study is intended to complement the reissue of Ramsey's papers edited by Professor Hugh Mellor. (shrink)

Extensive research has demonstrated that rs1360780, a common single nucleotide polymorphism within the FKBP5 gene, interacts with early-life stress in predicting psychopathology. Previous results suggest that carriers of the TT genotype of rs1360780 who were exposed to child abuse show differences in structure and functional activation of emotion-processing brain areas belonging to the salience network. Extending these findings on intermediate phenotypes of psychopathology, we examined if the interaction between rs1360780 and child abuse predicts resting-state functional connectivity (rsFC) between the amygdala (...) and other areas of the salience network. We analyzed data of young European adults from the general population (N = 774; mean age = 18.76 years) who took part in the IMAGEN study. In the absence of main effects of genotype and abuse, a significant interaction effect was observed for rsFC between the right centromedial amygdala and right posterior insula (p <.025, FWE-corrected), which was driven by stronger rsFC in TT allele carriers with a history of abuse. Our results suggest that the TT genotype of rs1360780 may render individuals with a history of abuse more vulnerable to functional changes in communication between brain areas processing emotions and bodily sensations, which could underlie or increase the risk for psychopathology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 25.1 (2001) 14-30 [Access article in PDF] Mallarmé Contra Wagner Eric Gans I In early 1885, Edouard Dujardin wrote to Stéphane Mallarmé for a contribution to his newly founded Revue wagnérienne. Mallarmé, admitting that he had never seen--and perhaps never heard--anything of Wagner, replied to Dujardin in July that he was working on a "half article, half prose poem," and that "never has anything seemed (...) to me more difficult." 1 A month later, the Revue published a text, more prose poem than article, entitled "Richard Wagner, rêverie d'un poète français." 2Wagner was an increasingly obligatory reference for the French avant-garde after his death in 1883. But as far back as 1862, the 20-year-old Mallarmé, no doubt influenced by Baudelaire's enthusiastic groundbreaking article "Richard Wagner et Tannhäuser à Paris" of the year before, had included Wagner along with Mozart and Beethoven in a group of three creators of the "mystery" of music, in a brief article entitled "Artistic Heresies: Art for Everyone." Characteristically enough, what fascinated the young Mallarmé was not music itself so much as the "signes sévères, chastes, inconnus" ("severe, chaste, unknown signs") (OC, p. 257) with which it was written, which give music the advantage over poetry--written in the universally understood alphabet--of being inaccessible to the uninitiated. This characteristic emphasis on writing over sound reappears in the "Hommage" sonnet for Wagner published in Dujardin's journal in January 1886, where Wagner's music is described as "mal tu par l'encre même en sanglots sibyllins" ("badly silenced by the ink itself in Sibylline sobs") (OC, p. 71). As we shall see, however, the relation between music and poetry suggested in "Art for Everyone" had by then been reversed. [End Page 14]Unlike most of his circle, Mallarmé was no Wagnerite; his "Rêverie," like his sonnet, expresses reluctant praise and reflects a certain professional jealousy. The theater had long been Mallarmé's chief preoccupation, as it had been for so many nineteenth-century writers who would be forced to make their reputation in other genres. The unfinished poem "Hérodiade," which occupied him throughout his life, took the form of a drama, and an early version of the "Après-midi d'un faune" had actually been presented to a theater director. References to music in Mallarmé's writings increase in number and specificity after 1885, and it is not unreasonable to assume that for him the prime representative of "music" in this period was Wagner. However much Mallarmé's own theater had become internalized and idealized, Wagner's theatrical success, as well as his near-deification by friends and disciples like Dujardin or Villiers de l'Isle-Adam, could not leave the poet indifferent. II What I would like to explore, however, is something more fundamental than the personal equation. Mallarmé's rivalry with Wagner over the theatrical center of culture is the rivalry of two arts and their respective means. What makes Mallarmé's critique of Wagner of particular interest is the exemplary rigor of the former's artistic intentions. Mallarmé's poems are a series of attempts to produce literary form with a minimum of figural content. Each poem has been submitted, so to speak, to Ockham's razor. The ultimate aim of this labor may be described as the discovery of the originary scene of poetry itself, the minimal sine qua non of representation, and therefore of humanity. 3 On the contrary, Wagner did not shrink from saturating the figural imagination in the pursuit of his totalizing aims. The confrontation reveals that musical maximalism in the service of national myth becomes a threat to what we may call, from Mallarmé's minimalist perspective, the anthropological mission of true art.Mallarmé held no particular brief for the theater of words; his tastes in performance went rather to the ballet, or to the mime-show, the subject of one of his most aesthetically interesting reflections. 4 Mallarmé anticipated 20th-century dramaturgy in seeing the theater not as a place for ratiocination and... (shrink)