BackgroundNusinersen is one of an increasing number of new, expensive orphan drugs to receive authorization. These drugs strain public healthcare budgets and challenge principles for resource allocation. Nusinersen was introduced in the Norwegian public healthcare system in 2018. A national expert group consisting of physicians was formed to oversee the introduction and continuation of treatment in light of specific start and stop criteria.MethodsWe have studied experiences within the expert group with a special emphasis on their application of the start and (...) stop criteria, rationing of treatment, and experienced moral dilemmas. A research interview with six members of the national expert group was performed, then analysed with manifest content analysis. The analysis was supplemented with publically available sources on priority setting and the process leading up to the introduction of nusinersen and the establishment of the expert group.ResultsSixty-six patients have received treatment within the first 25 months since the national expert group’s establishment. Treatment has not been discontinued for any patient. No patients under 18 years of age have been denied treatment, as those who were referred at this age were all deemed to fulfill the start criteria. The expert group has, however, increased geographical treatment equity and facilitated important cooperation at the national level. Furthermore, it has enhanced open and critical discussions of both medical issues and new ethical dilemmas.ConclusionAlthough facilitating equal access to treatment for SMA patients, the national expert group has not discontinued treatment for any patient. It is suggested that in order for clinicians to be able to ration care for individual patients, they require both adequate support and sufficient formal authority. Start and stop criteria need to be re-evaluated as more knowledge and experience are gained regarding the treatment. (shrink)

In a recent JME article, Joona Räsänen makes the case for allowing legal age change. We identify three problems with his argument and, on that basis, propose an improved version thereof. Unfortunately, even the improved argument is vulnerable to the objection that chronological age is a better proxy for justice in health than both legal and what we shall call official age.

Heloise Robinson argues that pregnant women have a higher moral status than non-pregnant persons and that, for this reason, pregnant women ought to be treated ‘noticeably’ better than non-pregnant persons.1 In this commentary, we present two challenges to Robinson’s argument. First, the compounding disadvantage objection: treating involuntarily, non-pregnant women worse than voluntarily pregnant women unjustly compounds their disadvantage. Second, the identity objection: treating non-pregnant people worse than pregnant people amounts to pro tanto wrongful discrimination based on a fundamental aspect of (...) people’s identity. We conclude that either pregnant persons do not have a higher moral status than non-pregnant persons, or they do, but higher moral status so grounded does not justify better treatment. According to the standard view of moral status: (1) most human beings are persons; (2) persons have a higher moral status than non-persons; and (3) persons have an equal moral status. Many believe: (1) is true because most human beings have a sufficiently high level of personhood-generating psychological capacities; (2) is true because moral status is tied to personhood; and (3) is true because variations in the level of personhood-generating psychological capacities do not matter to an individual’s moral status once that individual’s level surpasses the threshold required for personhood.2 (3) is significant …. (shrink)

The correspondence theory of truth is a precise and innovative account of how the truth of a proposition depends upon that proposition's connection to a piece of reality. Joshua Rasmussen refines and defends the correspondence theory of truth, proposing new accounts of facts, propositions, and the correspondence between them. With these theories in hand, he then offers original solutions to the toughest objections facing correspondence theorists. Addressing the Problem of Funny Facts, Liar Paradoxes, and traditional epistemological questions concerning how (...) our minds can access reality, he challenges recent objections, and defends what has traditionally been the most popular theory of truth. Written with clarity, precision, and sensitivity to a range of philosophical backgrounds, his book will appeal to advanced students and scholars seeking a deeper understanding of the relationship between truth and reality. (shrink)

We argue that there exists a necessary causally potent being. We then argue that that being is God.

Universalism vs. Communitarianism focuses on the question, raised by recent work in normative philosophy, of whether ethical norms are best derived and justified on the basis of universal or communitarian standards. It is unique in representing both Continental and American points of view and both the older and a younger generation of scholars. The essays introduce the key issues involved in universalism vs. communitarianism and take up ethics in historical perspective, practical reason and ethical responsibility, justification, application and history, and (...) communitarian alternatives. Based on a special issue of the Journal Philosophy and Social Criticism, the book includes two additional essays by Chantal Mouffe and by Hubert and Stuart Dreyfus. David Rasmussen is Professor of Philosophy at Boston College and editor of Philosophy and Social Criticism. Contents: introduction, David, Rasmussen. Universalisms: Procedural, Contextualist, and Prudential, Alessandro Ferrara. Beyond Liberalism and Communitarianism: Toward a Critical Theory of Social Justice, Gerald Doppelt. The Liberal/Communitarian Controversy and Communicative Ethics, Kenneth Baynes. Discourse Ethics and Civil Society, Jean Cohen. Equality, Political Order and Ethics: Hobbes and the Systematics of Democratic Rationality, Rolf Zimmermann. Atomism and Ethical Life: On Hegel's Critique of the French Revolution, Axel Honneth. The Gadamer-Habermas Debate Revisited: The Question of Ethics, Michael Kelly. What Is and What Is Not Practical Reason? Agnes Heller. Adorno, Heidegger, and Postmodernity, Hauke Brunkhorst. Impartial Application of Moral and Legal Norms: A Contribution to Discourse Ethics, Klaus Günther. An Ethics, Politics, and History, Jürgen Habermas in an interview conducted by Jean-Marc Ferry. Rawls: Political Philosophy without Politics, Chantal Mouffe. What Is Morality: A Phenomenological Account of the Development of Ethical Expertise, Hubert L Dreyfus, Stuart E. Dreyfus. Universalism and Communitarianism: A Bibliography, Michael Zilles. (shrink)

The paper argues that Paul Ricoeur's The Philosophy of the Will retained a certain fidelity to phenomenology's early emphasis on subjectivity. When Ricoeur turned to the philosophy of language, he found a way to retain a certain emphasis on subjectivity and individuality that would make his work distinctive among other approaches to the philosophy of language. Hence, the title, Preserving the Eidetic Moment, intends to characterize Ricoeur's distinctive contribution to philosophy. The paper goes on to show how Ricoeur's approach can (...) contribute to Critical Theory, particularly in relationship to its theory of interlocution. (shrink)

_The Handbook of Critical Theory_ brings together for the first time a detailed examination of the state of critical theory today. The fifteen essays provide analyses of the various orientations which critical theory has taken both historically and systematically in recent years, expositions of the new perspectives which have begun to shape the field, and reflections upon the direction of critical theory.

We investigate the value of persons. Our primary goal is to chart a path from equal and extreme value to infinite value. We advance two arguments. Each argument offers a reason to think that equal and extreme value are best accounted for if we are infinitely valuable. We then raise some difficult but fruitful questions about the possible grounds or sources of our infinite value, if we indeed have such value.

If biotechnology can be used to "upgrade" humans physically and mentally, should it be done? And if so, to what extent? How will biotechnology affect societal cohesion, and can the development be controlled? Or is this a Pandora's box that should remain closed? These are just a few of the many questions that arise as a result of the increasing ability of technology to change biology and, eventually, transform human living conditions. This development has created a new horizon of a (...) posthuman future that will influence contemporary life and politics in a number of ways. The book gathers researchers within the fields of biotechnology, medicine, ethics, politics, and aesthetics. Among the contributors are Francis Fukuyama, Julian Savulescu, Maxwell Mehlman, Lone Frank and Chris Hables Gray. (shrink)

Journal of Political Philosophy, EarlyView.

The community has legislatively conferred on external auditors a special but lucrative responsibility to provide fair and independent opinions about management''s preparation of company financial statements. In return, auditors are obliged by professional standards to act with integrity, independently and in the public interest. This study examined 174 auditors'' predisposition to provide just and fair judgements, using Kohlberg''s theory of developmental moral reasoning, one of the most widely accepted theories in justice psychology. Respondents came from five international audit firms in (...) Copenhagen. Results indicated that auditors with pre-conventional or low level of just reasoning or comprised 64 respondents, the largest group in the sample. The pre-conventional level suggests that people will act in their own self-interest and do the right only to avoid punishment. Pre-conventional auditors have the ability to "do deals", advantageous for business. When faced with an ethical crisis, however, auditors as this level will tend to focus on their own needs at the expense of others. The post-conventional or mid level of just reasoning comprised 59 auditors, second largest group in the sample. This level indicates that these auditors have the predisposition to act fairly on principal, particularly when faced with an ethical crisis. The conventional level or mid-just reasoning consisted of 51 auditors. People with a conventional level of just reasoning believe in law and order, the maintenance of the status quo, however they tend not to be critical of laws, nor authority even if those laws and authority are unjust or evil. (shrink)

This paper argues that Foucault’s genealogy of racism deserves appreciation due to the highly original concept of racism as biopolitical government. Modern racism, according to Foucault, is not merely an irrational prejudice, a form of socio-political discrimination, or an ideological motive in a political doctrine; rather, it is a form of government that is designed to manage a population. The paper seeks to advance this argument by reconstructing Foucault’s unfinished project of a genealogy of racism. Initially, the paper situates the (...) genealogy of racism within the context of Foucault’s work. It belongs to a period of transition between the mature and the late part of Foucault’s work, more specifically a period of transition from discipline to governmentality. The paper proceeds by reading closely key passages from the 1976 lectures at Collège de France in which Foucault proposes to rethink racism as a form of biopolitical government. While Foucault’s genealogy of racism remains an incomplete project, lacking for example any substantial treatment of European colonialism, the paper proposes to expand the Foucauldian analysis by linking it to the pan-German discourse between 1890 and 1914. Finally, the paper reflects on some of the implications of the Foucauldian analysis, in particular attempts to understand and counter contemporary forms of racism. Foucault’s genealogy of racism, in short, shows us the constructedness of our racialized world and challenges us to develop new and more effective strategies to change it. (shrink)

In National Responsibility and Global Justice, David Miller defends the view that a member of a nation can be collectively responsible for an outcome despite the fact that: (i) she did not control it; (ii) she actively opposed those of her nation’s policies that produced the outcome; and (iii) actively opposing the relevant policy was costly for her. I argue that Miller’s arguments in favor of this strong externalist view about responsibility and control are insufficient. Specifically, I show that Miller’s (...) two models of synchronic collective responsibility*the like-minded group model and the cooperative practice model*ground neither synchronic nor diachronic national responsibility, nor apply in the case of nations generally speaking. Keywords: collective responsibility; David Miller; nations; historical responsibility; national responsibility (Published: 19 May 2009) Citation: Ethics & Global Politics, Vol. 2, No. 2, 2009, pp. 109-130. DOI: 10.3402/egp.v2i2.1935. (shrink)

This article focus on paradigms, methods and ethics of action research in the Scandinavian countries. The specific features of the action research paradigm are identified. a historical overview follows of some main action research projects in Norway, Sweden and Denmark. The tendency towards upscale action research projects from organisational or small community projects to large-scale, regional based network approaches are also outlined and discussed. Finally, a synthesised approach of the classical, socio-technical action research approach and the large-scale network and holistic (...) approaches is suggested as a promising approach for the future. (shrink)

This book provides a perceptive analysis of the "narrative turn" that led Paul Ricoeur to his magisterial work Time and Narrative. Ricoeur has for many years explored the intersections of diverse strands of European philosophy, but it is his recent work that has attracted the most discussion and engendered the most debate in Europe and America. The Narrative Path explores the roots and meaning of that work. Two of the book's five essays reach back to Ricoeur's earlier work to clarify (...) his themes: Richard Kearney concentrates on the role of imagination in hermeneuties, and Maria Villela Petit explores the development of Ricoeur's concept of history from History and Truth to Time and Narrative. Two essays analyze the significance of Ricoeur's reflections on metaphoric and narrative language: Serge Mellinger looks at the relationship between time and poetry from the point of view of Ricoeur's discussions of the connection between time and narrative, and T. Peter Kemp extends Ricoeur's analysis to argue that narration is indispensable to ethics. The book concludes with a reflection by Ricoeur himself on the linguistic, practical, and ethical dimensions of human beings, and with a bibliography of Ricoeur's work in English. T. Peter Kemp teaches in the Department of Philosophy at the University of Copenhagen. The Narrative Pathis based on a special issue of the journal Philosophy and Social Criticism, edited by David Rasmussen, who is Professor of Philosophy at Boston College. (shrink)

It is impermissible to violate a constraint, even if by doing so a greater number of violations of the very same constraint were to be prevented. Most find this puzzling. But what makes the impermissibility of such minimizing violations puzzling? This article discusses some recent answers to this question. The article's first aim is to make clear in what way these answers differ. The second aim is to evaluate the answers, along with Kamm's and Nagel's proposed solutions of what they (...) see as the puzzle of constraints. The main thesis of the article is this: because defenders of constraints are not committed to any conception of valuable states of affairs, constraints do not conflict with maximizing rationality; but neither can they be accounted for in terms of impersonal values. (shrink)

In this essay I consider the normative implications of the notion of reasonability for the construction of an idea of public reason that is cosmopolitan in scope. First, I consider the argument for the distinction between reason and reasonability in the work of Sibley and Rawls. Second, I evaluate the normative implications of reasonability through a consideration of Korsgaard's recent work. Third, I argue for a notion of reasonability that moves us beyond a Kantian concept of autonomy through a consideration (...) of the relationship between reasonability and judgment vis-à-vis Arendt's work on Kant's Third Critique. Finally, I argue for a cosmopolitan appropriation of the notion of reasonability based on Kant's notion of the aesthetic idea. The latter argument relaxes the bonds of public reason, moving us beyond the domain of ethnocentricism. (shrink)

Scenarios are flexible means to integrate disparate ideas, thoughts and feelings into holistic images, providing the context and meaning of possible futures. The application of narrative scenarios in engineering, development of socio-technical systems or communities provides an important link between general ideas and specification of technical system requirements. They focus on how people use systems through context-related storytelling rather than abstract descriptions of requirements. The quality of scenarios depends on relevant assumptions and authentic scenario stories. In this article, we will (...) explore how the narrative approach may enrich the scenario ‘skeleton’ with ‘flesh and blood’, that is, living, detailed and consistent storytelling. In addition, criteria are suggested for evaluation of the quality of scenario storytelling. (shrink)

Over the last twenty years, many political philosophers have rejected the idea that justice is fundamentally about distribution. Rather, justice is about social relations, and the so-called distributive paradigm should be replaced by a new relational paradigm. Kasper Lippert-Rasmussen seeks to describe, refine, and assess these thoughts and to propose a comprehensive form of egalitarianism which includes central elements from both relational and distributive paradigms. He shows why many of the challenges that luck egalitarianism faces reappear, once we try (...) to specify relational egalitarianism more fully. His discussion advances understanding of the nature of the relational ideal, and introduces new conceptual tools for understanding it and for exploring the important question of why it is desirable in the first place to relate as equals. Even severe critics of the distributive understanding of justice will find that this book casts important new light on the ideal to which they subscribe. (shrink)

The ‘buck-passing’ account equates the value of an object with the existence of reasons to favour it. As we argued in an earlier paper, this analysis faces the ‘wrong kind of reasons’ problem: there may be reasons for pro-attitudes towards worthless objects, in particular if it is the pro-attitudes, rather than their objects, that are valuable. Jonas Olson has recently suggested how to resolve this difficulty: a reason to favour an object is of the right kind only if its formulation (...) does not involve any reference to the attitudes for which it provides a reason. We argue that despite its merits, Olson's solution is unsatisfactory. We go on to suggest that the buck-passing account might be acceptable even if the problem in question turns out to be insoluble. (shrink)

Against arguments that suggest that Rawls’s notion of reasonability is ‘obscure’ and ‘unclear’ I argue in this essay that the idea of reasonability in the later Rawls can be defended in three ways. First, it can be shown that reasonability is fundamental to the architectonic of the later work. Reasonability, and the subordination of reason to reasonability, is fundamental to the later (post-1980) writings. Second, it can be shown that reasonability is not necessarily a vague term as many have claimed. (...) Third, it can be shown that reasonability is fundamental to what Rawls calls the three major new ideas of Political Liberalism: overlapping consensus; the reconception of the priority of the right over the good; and the idea of public reason. (shrink)

This book addresses these three issues: What is discrimination?; What makes it wrong?; What should be done about wrongful discrimination? It argues: that there are different concepts of discrimination; that discrimination is not always morally wrong and that when it is, it is so primarily because of its harmful effects.

Kasper Lippert-Rasmussen tackles all the major questions concerning luck egalitarianism, providing deep, penetrating and original discussion of recent academic discourses on distributive justice as well as responses to some of the main objections in the literature. It offers a new answer to the “Why equality?” and “Equality of what?” questions, and provides a robust luck egalitarian response to the recent criticisms of luck egalitarianism by social relations egalitarians. This systematic, theoretical introduction illustrates the broader picture of distributive justice and (...) enables the reader to understand the core intuitions underlying, or conflicting with, luck egalitarianism. (shrink)

Recent Work on Intrinsic Value brings together for the first time many of the most important and influential writings on the topic of intrinsic value to have appeared in the last half-century. During this period, inquiry into the nature of intrinsic value has intensified to such an extent that at the moment it is one of the hottest topics in the field of theoretical ethics. The contributions to this volume have been selected in such a way that all of the (...) fundamental questions concerning the nature of intrinsic value are treated in depth and from a variety of viewpoints. These questions include how to understand the concept of intrinsic value, what sorts of things can have intrinsic value, and how to compute intrinsic value. The editors have added an introduction that ties these questions together and places the contributions in context, and they have also provided an extensive bibliography. The result is a comprehensive, balanced, and detailed picture of current thinking about intrinsic value, one that provides an indispensable backdrop against which future writings on the topic may be assessed. (shrink)

An influential anti-democratic argument says: ‘(1) Answers to political questions are truth-apt. (2) A small elite only—the epistocrats—knows these truths. (3) If answers to political questions are truth-apt, then those with this knowledge about these matters should rule. (4) Thus, epistocrats should rule.’ Many democrats have responded by denying (1), arguing that, say, answers to political questions are a matter of sheer personal preference. Others have rejected (2), contending that knowledge of the true answers to political questions is evenly distributed. (...) David Estlund finds neither of these replies conclusive. Instead, he attacks (3) arguing that there can be no agreement between qualified people as to who the epistocrats are and that people are not subject to being ruled by experts, whose status as such they can reasonably dispute. Critically, I argue that this argument does not block all forms of epistocratic argument and that Estlund fails to consider the full range of plausible epistocratic views. More constructively, I offer a modest argument for why greater expertise does not necessarily warrant greater political authority. Presumably, the set of feasible options might differ, depending on what procedure is used, and a sub-optimal choice by nonepistocrats from a better set might be superior to the optimal choice by epistocrats from a worse set. In such cases, the mere fact of greater expertise does not warrant political authority, i.e., (3) is false. (shrink)

This book provides an up to date, high-level exchange on God in a uniquely productive style. Readers witness a contemporary version of a classic debate, as two professional philosophers seek to learn from each other while making their cases for their distinct positions. In their dialogue, Joshua Rasmussen and Felipe Leon examine classical and cutting-edge arguments for and against a theistic explanation of general features of reality. The book also provides original lines of thought based on the authors’ own (...) contributions to the field, and offers a productive and innovative inquiry into on one of the biggest questions people ask: what is the ultimate explanation of things? (shrink)

Relational egalitarianism says that moral equals should relate as equals. We explore how moral unequals should relate.

The all-affected principle is a widely accepted solution to the problem of constituting the demos. Despite its popularity, a basic question in relation to the principle has not received much attention: why does the fact that an individual is affected by a certain decision ground a right to inclusion in democratic decision-making about that matter? An answer to this question must include a reason that explains why an affected individual should be included because she is affected. We identify three such (...) reasons in the literature – to wit, interest protection, self-government and welfare – and show why they all fail. We then propose two alternative reasons, equal relations and fairness, and show why they are also deficient. Surprisingly, the all-affected principle then appears groundless, which supports withholding belief in the all-affected principle or(/and) investing future research in identifying the thus-far unidentified reason why being affected grounds a claim to inclusion. (shrink)

The contributors to the volume are: Richard Arneson, Linda Barclay, Thomas Christiano, Nils Holtug, Susan Hurley, Kasper Lippert-Rasmussen, Dennis McKerlie, ...

Philosophers analyzing standing to blame have argued that in view of a blamer’s own fault she can lack standing to blame another for an act even if the act is blameworthy and that standingless, hypocritical blame is pro tanto morally wrongful. The bearing of these conclusions on standing to praise is yet to receive the attention it deserves. I defend two claims. The first is the conditional claim that if and are true, so are and. The latter are: a praiser (...) can lack the standing to praise herself for an act even if that act is praiseworthy and standingless, hypocritical praise is pro tanto morally wrongful. So I am suggesting that facts about standing to blame reflect more general facts about standing to hold responsible. The second is the claim that and are true. (shrink)

In this book Kasper Lippert-Rasmussen address the complexities of his question "Is affirmative action morally justifiable?" by analyzing the prevailing contemporary arguments both for and against affirmative action. The book applies current political philosophy to demonstrate that arguments on both sides justify different conclusions given different specific cases, though it ultimately does argue in favor of affirmative action based on the relative strength and significance of the anti-discrimination- and equality of opportunity-based positions.

We develop a new puzzle concerning a material being's relationship to the smallest parts of the material world. In particular, we investigate how a being could be responsible for anything if its be...

It is commonly believed that blamees can dismiss hypocritical blame on the ground that the hypocrite has no standing to blame their target. Many believe that the feature of hypocritical blame that undermines standing to blame is that it involves an implicit denial of the moral equality of persons. After all, the hypocrite treats herself better than her blamee for no good reason. In the light of the complement to hypocrites and a comparison of hypocritical and non-hypocritical blamers subscribing to (...) hierarchical moral norms, I show why we must reject the moral equality account of the hypocrite’s lack of standing to blame. (shrink)

The most blatant forms of discrimination are morally outrageous and very obviously so; but the nature and boundaries of discrimination are more controversial, and it is not clear whether all forms of discrimination are morally bad; nor is it clear why objectionable cases of discrimination are bad. In this paper I address these issues. First, I offer a taxonomy of discrimination. I then argue that discrimination is bad, when it is, because it harms people. Finally, I criticize a rival, disrespect-based (...) account according to which discrimination is bad regardless of whether it causes harm. (shrink)

Many have thought that there is a problem with causal commerce between immaterial souls and material bodies. In Physicalism or Something Near Enough, Jaegwon Kim attempts to spell out that problem. Rather than merely posing a question or raising a mystery for defenders of substance dualism to answer or address, he offers a compelling argument for the conclusion that immaterial souls cannot causally interact with material bodies. We offer a reconstruction of that argument that hinges on two premises: Kim’s Dictum (...) and the Nowhere Man principle. Kim’s Dictum says that causation requires a spatial relation. Nowhere Man says that souls can’t be in space. By our lights, both premises can be called into question. We’ll begin our evaluation of the argument by pointing out some consequences of Kim’s Dictum. For some, these will be costs. We will then present two defeaters for Kim’s Dictum and a critical analysis of Kim’s case for Nowhere Man. The upshot is that Kim’s argument against substance dualism fails. (shrink)

Construed as a theory of justice, relational egalitarianism says that justice requires that people relate as equals. Construed as a theory of what makes democracy valuable, it says that democracy is a necessary, or constituent, part of the value of relating as equals. Typically, relational egalitarians want their theory to provide both an account of what justice requires and an account of what makes democracy valuable. We argue that relational egalitarians with this dual ambition face the justice-democracy dilemma: Understanding social (...) relations in such a way that renders relational egalitarianism plausible as an answer to what makes democracy valuable comes at the price of understanding social relations in a way that makes it less plausible as a theory of justice, and vice versa. We also argue that there is no easy way out of the dilemma and that relational egalitarians, who want relational equality to provide both accounts mentioned, may simply have to set their ambitions lower on behalf of relational equality. (shrink)