ABSTRACTThe aim of this paper is to bring a phenomenological perspective to bear on a specific problem: how to understand the diminished sense of reality that is often reported by persons who have suffered severe and prolonged interpersonal trauma. For this purpose I turn to resources from two traditions. First, I present a phenomenological account of the intersubjective constitution of objective experience, which is then complemented by a developmental account of how the very small child comes to inhabit a world (...) of shared mind-independent things. On this basis, I aim to show how the sense of reality, as the clear and dependable sense of the difference in experience between inner life and external reality, is an interpersonal developmental achievement that goes hand in hand with the development of the sense of self. I will in particular draw on Husserlian phenomenology and Winnicott’s psychoanalytic perspective on developmental psychology. (shrink)

Humboldt Revisited offers a fresh perspective on the contemporary discourse surrounding reform of European universities. Arguing that contemporary reform derives its basis from pre-constructed truths about the so-called 'Humboldt-university,' this monograph traces the historical descent of these truths to the American reception of Humboldt's ideas from the mid-19th century up until the 1960s. Drawing from a rich selection of historical sources, this volume offers an alternative to conventional explanations of the forces behind the ongoing reform of European universities. It also (...) challenges the conventional historical narrative on the Humboldt University, providing new insight into the American reception of the German ideas. (shrink)

Certain health care services and goods, although legal and often generally accepted in a society, are by some considered morally problematic. Debates on conscientious objection in health care try to resolve whether and when physicians, nurses and pharmacists should be allowed to refuse to provide medical services and goods because of their ethical or religious beliefs. These debates have most often focused on issues such as how to balance the interests of patients and health care professionals, and the compatibility of (...) conscientious objection with professional obligations, but it is also possible to think about conscientious objection in terms of how to respond to moral disagreement and the requirements of liberal neutrality. (shrink)

Research on ethical, legal and social aspects of life sciences and new technologies has mainly been focused on impacts and consequences, while the emerging framework of Responsible Research and Innovation focuses rather on increased involvement and reflexivity in research processes to foster science and technology that better answers the needs of society. I argue that philosophy of science should be a central feature of RRI and demonstrate how the philosophy of science can contribute in this sense. I show how investigating (...) basic assumptions in research, here exemplified by reductive assumptions in causal modeling, can have important ethical and societal implications. (shrink)

Lynch et al. (Biol Philos 34:62, 2019) employ stability, specificity, and proportionality as criteria for evaluating microbiome causal explanations. Although these causal characteristics signify relevant differences between causal roles, I suggest that they should not be used as general criteria for strong or good causal explanations.

The method in human genetics of ascribing causal responsibility to genotype by the use of heritability estimates has been heavily criticized over the years. It has been argued that these estimates are rarely valid and do not serve the purpose of tracing genetic causes. Recent contributions strike back at this criticism. I present and discuss two opposing views on these matters represented by Richard Lewontin and Neven Sesardic, and I suggest that some of the disagreement is based on differing concepts (...) of genetic causation. I use the distinction of structuring and triggering causes to help clarifying the basis for the opposing views. (shrink)

Synthetic biology research is often described in terms of programming cells through the introduction of synthetic genes. Genetic material is seemingly attributed with a high level of causal responsibility. We discuss genetic causation in synthetic biology and distinguish three gene concepts differing in their assumptions of genetic control. We argue that synthetic biology generally employs a difference-making approach to establishing genetic causes, and that this approach does not commit to a specific notion of genetic program or genetic control. Still, we (...) suggest that a strong program concept of genetic material can be used as a successful heuristic in certain areas of synthetic biology. Its application requires control of causal context, and may stand in need of a modular decomposition of the target system. We relate different modularity concepts to the discussion of genetic causation and point to possible advantages of and important limitations to seeking modularity in synthetic biology systems. (shrink)

The unfairness of health inequalities depends on the more fundamental question of the relationship between justice in health and distributive justice more generally. In this article, I discuss some constraints on how health should be incorporated in a theory of justice and their implications for when health inequalities can be considered to be unfair. I argue against adopting separate distributive principles for health, and in favour of conceiving justice in health as interrelated with, and contingent on, justice in the distribution (...) of other important social goods and resources, in particular income. Accordingly, health inequalities are unfair when they are the result of an unfair distribution of resources. (shrink)

This paper investigates the process of moral agency development as a community-supported process. Based on a multimethod qualitative inquiry, including diaries, focus groups, and documentary analysis, we analyze the experiences of middle managers in two Norwegian hospitals during the first year of the COVID-19 pandemic. We find that moral agency is developed through a community-embedded value inquiry, emerging in three partially overlapping steps. The first step is marked by moral reflex, an intuitive, value-driven, pre-reflective response to a crisis situation. In (...) the second step, the managers involved the community in value calibration, a collective-ethical sensemaking. In the third step, they took active stances to translate values into actions, with an increased awareness of values and an ability to explain and justify their actions. We label the steps, respectively: value inquiry-in-action, value inquiry-on-action and reflective enactment of value. An analysis of the process reveals two aspects critical for moral agency development: it happens through confrontation with uncertainty, and it is relational, that is, embedded in a community. While uncertainty forces an intuitive moral response, dialogical reflection in the community develops value awareness and relationships of mutual care and support. (shrink)

I MAKE NO APOLOGIES for writing about this well-worn topic. For, although there has been an enormous amount written about the account Hume gives of the nature of moral evaluation, commentators are as far from agreement as ever. My own contribution to the controversy has, if anything, not only added to the variety of opinions but also has increased the general confusion. For this I must accept some responsibility. I have certainly laid myself open to some misinterpretation, and the view (...) I have so far expressed in print may also need some modification. I shall here attempt to clarify what precisely my view now is, and why I prefer it to some alternative views advanced by those who find my interpretation of this aspect of Hume's philosophy unacceptable. II. Since what I want to defend is in all important respects my earlier interpretation of the Treatise, 2 I shall for the most part, though not exclusively, be concerned with what Hume says in this, his early, but major, work. (shrink)

A grandfather clause is a provision whereby an old rule continues to apply to some existing situation while a new rule applies to all future cases. This paper focuses on the use of grandfather clauses in health technology appraisals (HTAs) issued by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. NICE provides evidence‐based guidance on healthcare technologies and public health interventions that influence resource allocation decisions in the National Health Service (NHS) and the broader public (...) sector in England and Wales. In this context, a grandfather clause is included when NICE does not recommend treatment with a given technology. The grandfather clause provides an exemption from the general recommendation for patients who have already started treatment with the technology in question, before the publication of the NICE guidance. In this paper we first lay out the contexts in which grandfather clauses occur in NICE guidance, and then consider ethical arguments against and in support of grandfather clauses and the continuation of treatment. We argue that NICE’s current practice of automatic inclusion of a grandfather clause is ethically problematic and unfair. While the inclusion of a grandfather clause may be appropriate and justified in specific cases, we argue that inclusion of such a clause should be considered as part and parcel of the decision making process on a case by case basis, rather than adopted as the default. (shrink)

This thesis is neither e page to page commentary nor en assessment of Hume's place in the history of Philosophy. It mainly consists in an attempt at justifying a certain approach to the Interpretation of his theory of value with special reference to morals.

How and why could some stories be construed as sacred in organizations, and what functions does the sacred have in organizational values work? Research has shown how values can be made formative of a range of organizational purposes and forms but has underscored their performative, situated, and agentic nature. We address that void by studying the sacred as a potentially salient yet under-researched realm of values work. Drawing on an ethnographic case study of a faith-based health care organization and the (...) ethical philosophy of Paul Ricoeur, we describe how the sacred is figured in two sets of tales that were lived and told with surprising intensity and consistency: the parable of the Good Samaritan and the tale of the legacy bestowed by the organization’s founder. We theorize how this figuring of the sacred in story and in action recasts values work from a centralized and unitary process to a two-way learning dialectic between the ongoing creative imitation of action and narrative. Values in the shape of stories of the sacred do not achieve their meaning as unchangeable cores or sanctioned beliefs. Rather, they come to life in a process of ongoing moral inquiry that co-evolves with moral agencies. In the latter regard, the sacred primarily becomes manifest in everyday work in the form of questioning and creative acts of care. People become moral agents when they feel and respond to the sacred in the call of the other. (shrink)

Antibiotic research and development has failed to produce innovative antibiotics in the past two decades, which is due to both scientific and economic factors. We reviewed national and international funding agencies and critically assessed current grant funding mechanisms. Finally, we propose four complementary grant-funding incentives aimed to help developers along the R&D pipeline. Equally important objective of these incentives is to address some of the known R&D risks and bottlenecks.

Reducing inequalities in health and the determinants of health is a widely acknowledged health policy goal, and methods for measuring inequalities and inequities in health are well developed. Yet, the evidence base is weak for how to achieve these goals. There is a lack of high-quality randomised controlled trials reporting impact on the distribution of health and non-health benefits and lack of methodological rigour in how to design, power, measure, analyse and interpret distributional impact in RCTs. Our overarching aim in (...) this paper is to contribute to the emerging effort to improve transparency and coherence in the theoretical and conceptual basis for RCTs on effective interventions to reduce health inequity. We endeavour to achieve this aim by pursuing two more specific objectives. First, we propose an overview of three broader health equity frameworks and clarify their implications for the measurement of health inequality in RCTs. Second, we seek to clarify the relationship between theory and translational challenges that researchers would need to attend to, in order to ensure that equity-relevant RCTs are coherently grounded in theory. (shrink)

Margaret Atwood’s The Handmaid’s Tale has predominantly been read as a critique of patriarchy, a feminist dystopia. This article amends the feminist analysis by applying a biocultural approach to the novel, taking as its point of departure three problems that have troubled the feminist reading: Offred’s perceived passivity, the novel’s subtly critical stance towards its feminist characters, and the open ending. By taking into account the environmental context-a fertility crisis-the biocultural reading is able to analyze char­acter in terms of survival (...) and reproductive strategies. Recognizing that the characters are negotiating male and female mating strategies under extreme conditions leads to a deeper comprehension of the way the contrasting philosophies of radical feminism and sociobi­ology inform sexual politics in the Republic of Gilead. (shrink)

This study aimed to identify the antibiotic-relevant lessons from the controlled drug regimen for narcotics. Whereas several elements of the United Nations Single Convention on Narcotic Drugs could be advantageous for antibiotics, we doubt that an international legally binding agreement for controlling antibiotic consumption would be any more effective than implementing stewardship measures through national AMR plans.

This article discusses what arguments best support universal health care (UHC), with a focus on Norman Daniels’ equality of opportunity account. This justification for UHC hinges on the assumption of a close relationship between health care and health. But in light of empirical research that suggests that health outcomes are shaped to a large extent by factors other than health care, such as income, education, housing, and working conditions, the question arises to what extent health care is really necessary to (...) protect and promote health, and thereby opportunity. The author argues that, although this challenge to the equality of opportunity rationale is legitimate, it is not sufficiently specified to allow us to adequately assess the extent to which universal health succeeds in protecting equality of opportunity. The article concludes by outlining a more promising strategy for developing a viable rationale for UHC. (shrink)

L'A. se propose d'expliquer l'idée que M. Blondel a développée sur la mortification de soi comme moyen de s'assimiler à Dieu. D'après sa doctrine, en effet, la philosophie elle-même discerne en l'homme un besoin de déification. Il en trouve la clé dans l'idée de mortification. L'A. souligne le jeu d'échange qui s'établit entre Dieu et l'homme sur la notion d'être : c'est de Dieu que l'homme a reçu le don de l'être, c'est à Dieu qu'il se doit de le rendre (...) librement pour être comblé d'un don supérieur qu'inexorablement la nature humaine recherche : l'être divin. Et pour obtenir ce don supérieur, il faut renoncer au don précédent. La mortification intervient à ce stade du renoncement. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume and Davidson on Pride Pall S. krdal In reading the Treatise one has to be alive to the fact that Hume gives certain crucial words new meanings. He does not always draw the reader's attention to this and sometimes explicitly claims to be using terms with their ordinarymeaningswhen heis clearlygiving the words special technical uses by expanding or contracting their usual meanings. "Passion," "love," "hatred," "pride," and "humility" (...) have special meanings in Hume's psychological scheme. He also sometimes uses important terms with more than one meaning, as in the case of "justice." The word "justice" both is the title of Book 3, Part 2 of the Treatise, which deals with a number ofartificial virtues, and alsorefers to the much narrower concept ofthe respectfor property. The following two questions should be borne in mind: "What did Hume have to say about what he calls justice, passion, love, etc.?" and "What did Hume have to say about what we refer to by the same terms?" Thus, Books 2 and 3 of the Treatise may be described as attempting to show how unbiased evaluations are possible, in spite ofthe fact that our passions are naturally biased and judgments of virtue and vice are passions. This clearly involves a discussion of how we can do justice to our own and other peoples' qualities ofmind or character. Hume, therefore, had something very important to say about what we call justice, but his contribution to issues involving what we call justice today is obscured by his terminology. In what follows I shall be claiming that Hume's account of pride throws light upon what we call pride although he clearly was not aiming to do so. Donald Davidson, in a footnote to "Hume's Cognitive Theory of Pride," points out that there is a close similarity between his reading ofHume on pride andmy own treatment ofprideinPassionand Value. Since the two accounts were arrived at completely independently, each ofus can see the other'sinterpretation as some confirmation ofhis own. The accounts are not identical, however, and without aiming at a comprehensive comparison, I shall attempt to decide whether one or two ofthe apparent differences between our accounts indicate substantial disagreement. I shall try not to confuse the following four questions: "What did Hume thinkconstitutes pride?""Whatlesson do I, and whatlesson does Davidson think one could learn from Hume's account?" and finally, "What constitutes pride?" Davidson and I agree that a lesson is to be Volume XV Number 2 387 PALL ARDAL learned from Hume's account, but disagree about the nature of this lesson because of a disagreement about the nature of pride. Both Davidson and I think that Hume's claim that pride is a simple impression is an embarrassment to him. It does not have any immediate appeal and also leads him to clearly misrepresent the relation between pride and its object. Pride has self as its object in the sense that it is a form of self-evaluation. Hume misrepresents this relation as a causal relation between pride and the thoughtofoneself. Whenever one is proud, one's thought is drawn to oneself, but according to Hume it couldhave been otherwise. Itjust so happens that the feeling ofpride makes one think of oneself, that when you are already proud your thought turns to yourself. Hume, it is true, does not always represent the relation between the object of pride and the passion itself as contingent. Much ofwhathe says suggests the more plausible view that pride is essentially a form of self-evaluation, but the lesson we can learn from Hume we can learn in spite ofhis atomism, so let us follow Davidson and disregard the atomism, while admitting its presence in Hume's account. Davidson points out that the pride Hume is talking about is pride for a reason. I follow Hume in talking about the cause ofpride, or what makes one proud, but the two accounts seem to me to be very similar on this issue. The two accounts are alsoin agreement thatHume should have said that the proud person must see the cause of pride as having value rather than as an independent source of pleasure, but we are... (shrink)

Dans cet article, je soutiens que les métaphores « missile » et « ciblage » dans la recherche sur les médicaments à base de nanoparticules jouent différents rôles. Je soutiens que le « missile » joue un rôle scientifique marginal et un rôle plus central dans la communication, tandis que le « ciblage» est devenu une métaphore organisatrice dans le domaine de la recherche. La raison, je le suggère, est que le ciblage est l’explanandum principal du domaine et que cette (...) métaphore continue d’être pertinente même lorsque la nanomédecine mûrit pour s’attaquer à des problèmes plus complexes. Enfin, je discute des suggestions récentes de nouvelles métaphores axées sur la complexité, et je suggère que le rôle significatif des modèles simplificateurs et le besoin réel de tels modèles peuvent expliquer pourquoi les métaphores de complexité n’ont pas retenu l’attention des chercheurs. (shrink)

Dans cet article, je soutiens que les métaphores « missile » et « ciblage » dans la recherche sur les médicaments à base de nanoparticules jouent différents rôles. Je soutiens que le « missile » joue un rôle scientifique marginal et un rôle plus central dans la communication, tandis que le « ciblage» est devenu une métaphore organisatrice dans le domaine de la recherche. La raison, je le suggère, est que le ciblage est l’explanandum principal du domaine et que cette (...) métaphore continue d’être pertinente même lorsque la nanomédecine mûrit pour s’attaquer à des problèmes plus complexes. Enfin, je discute des suggestions récentes de nouvelles métaphores axées sur la complexité, et je suggère que le rôle significatif des modèles simplificateurs et le besoin réel de tels modèles peuvent expliquer pourquoi les métaphores de complexité n’ont pas retenu l’attention des chercheurs. (shrink)

Dans cet article, je soutiens que les métaphores « missile » et « ciblage » dans la recherche sur les médicaments à base de nanoparticules jouent différents rôles. Je soutiens que le « missile » joue un rôle scientifique marginal et un rôle plus central dans la communication, tandis que le « ciblage» est devenu une métaphore organisatrice dans le domaine de la recherche. La raison, je le suggère, est que le ciblage est l’explanandum principal du domaine et que cette (...) métaphore continue d’être pertinente même lorsque la nanomédecine mûrit pour s’attaquer à des problèmes plus complexes. Enfin, je discute des suggestions récentes de nouvelles métaphores axées sur la complexité, et je suggère que le rôle significatif des modèles simplificateurs et le besoin réel de tels modèles peuvent expliquer pourquoi les métaphores de complexité n’ont pas retenu l’attention des chercheurs. (shrink)

No country has yet implemented a pilot to ensure access to or the innovation of new antibiotics for multi-drug infections. A team from national health agencies in Norway, with the support of the Innovative Medicine Initiative-funded project DRIVE-AB, designed a model suitable for the national context, including the selection of the antibiotics, the potential value, and the operational model.

In a Recent paper to The Joint Session of the AristotelianSociety and Mind Association Professor Neil MacCormick makes some interesting observations about the nature of promises and the source of the obligation to keep them. He rejects the view that an act can count as a promise only because a certain practice exists in a society. One may on the contrary well understand what promises are and know how to make them without there being any special convention making possible the (...) speech act of promising which amounts to no more than …“an utterance of the speaker's about his own future conduct which is essentially characterized by the speaker's intending his addressee to take it as being intended to induce the addressee to rely upon the speaker's taking the action in question.” One needs no special rule to explain why promise-breaking is wrong for …“the fact of the addressee's reliance on the promisor is sufficient ground for asserting that the promisor has an obligation to keep his word.” To bring home the point, MacCormick contrasts promising with divorcing by the simple utterance of 'I divorce thee, I divorce thee.' This is intelligible as an act of divorcing only by presupposing a convention that allows a divorce to be effected in this way. In performing the act by the appropriate formula the person is invoking the conventional rules that must obtain in the society if the act is to be successful. Searle, we are told, fails to see that promises are quite different in that they …“are explicable in terms of an intention to bring about a specific perlocutionary effect, and an intention that that intention be recognized” It is neither here nor there to point out, as Searle does, that ‘I predict’ and ‘I intend’ like ‘I promise’ tend to create expectations for the effect a promise is intended to achieve is reliance and not simply an expectation. (shrink)

In many biological experiments, due to gene-redundancy or distributed backup mechanisms, there are no visible effects on the functionality of the organism when a gene is knocked out or down. In such cases there is apparently no counterfactual dependence between the gene and the phenotype in question, although intuitively the gene is causally relevant. Due to relativity of causal relations to causal models, we suggest that such cases can be handled by changing the resolution of the causal model that represents (...) the system. By decreasing the resolution of our causal model, counterfactual dependencies can be established at a higher level of abstraction. By increasing the resolution, stepwise causal dependencies of the right kind can serve as a sufficient condition for causal relevance. Finally, we discuss how introducing a temporal dimension in causal models can account for causation in cases of non-modular systems dynamics. (shrink)

Journal Name: Cognitive Linguistics Issue: Ahead of print.

Political philosophers have become increasingly interested in questions of justice as applied to health. Much of this literature works from a distributive understanding of justice. In the recent debate, however, ‘relational’ egalitarians have proposed a different way of conceptualising equality, which focuses on the quality of social relations among citizens and/or how social institutions ‘treat’ citizens. This paper explores some implications of a relational approach to health, with particular focus on health care, health inequalities and health policy. While the relational (...) account can add interesting perspectives to current debates on justice and health, we also highlight some tensions and difficulties relational egalitarians might encounter and some discontinuities between the implications of a relational account and current discourse on health equity. (shrink)

A wide range of gene knockout experiments shows that functional stability is an important feature of biological systems. On this backdrop, we present an argument for higher‐level causation based on counterfactual dependence. Furthermore, we sketch a metaphysical picture providing resources to explain the metaphysical nature of functional stability, higher‐level causation, and the relevant notion of levels. Our account aims to clarify the role empirical results and philosophical assumptions should play in debates about reductionism and higher‐level causation. It thereby contributes to (...) the development of a philosophical foundation for systems biology. †To contact the authors, please write to: CSMN/IFIKK, University of Oslo, Box 1020 Blindern, N‐0315, Oslo, Norway; e‐mail: [email protected] , [email protected]. (shrink)