Access to state-funded fertility treatments is age-restricted in many countries based on epidemiological evidence showing age-associated fertility decline and aimed at administering scarce resources. In this article, we consider whether age-related restrictions can be considered ageist and what this entails for a normative appraisal of access criteria. We use the UK as a case study due to the state-funded and centrally regulated nature of in vitro fertilization provision. We begin by reviewing concepts of ageism and age discrimination in (...) gerontological scholarship and contend that it is analytically useful to differentiate between them when considering age-restricted health services. We then argue that criteria to access IVF could be considered indirectly ageist so far as they rely on an age-related evidence base that manifests ageist categorizations of persons. Lastly, we examine whether there could be more normatively desirable alternatives to devise criteria to access fertility treatment, considering “lifestyle” as a potential candidate. We conclude, however, that lifestyle-based discrimination is problematic because, unlike age-based discrimination, it risks exacerbating existing socioeconomic and ethnic inequalities. (shrink)

Franz Kafka's "Before the Law" distills his longer works, like The Trial and The Castle, into a single theme: Access. In "Before the Law," the main character seeks entrance into the law. The doorkeeper apathetically refuses while instigating the man's need. Often, in Kafka's works, the main character seeks access to some part of his life, but is prohibited, sometimes in a material way and, at other times, in an epistemic way. This paper will explore this access (...) problem using Martin Heidegger's Being and Time. It will phenomenologically interrogate the concept of "access" within Kafka, using an early Heideggerian distinction between ready-to-hand and present-at-hand, the former marked by thoughtless availability (thereness) and the latter by a sustained and thoughtful suspension, the result of a break from the regular availability of life's tools (the lack of thereness), forcing Kafka's main characters to dwell in the negation of access. (shrink)

Professor Thomas Pogge, Professorial Fellow, Centre for Applied Philosophy, LPO Box 8260, Canberra. Tel.: +61 261255485; Email: tp6{at}columbia.edu ' + u + '@' + d + ' '//--> Abstract I would pay three million to go into space, says the banker to his attorney. — I wouldn't go if you paid me, the latter laughs, for me the French Riviera is quite exciting enough. Ah, I would pay a million for an extra year of life , the elderly tourist effusively (...) tells his lover. — We have never had even a hundred dollars , the Cambodian teenager replies, we are a large family. CiteULike Connotea Del.icio.us What's this? (shrink)

Jordi Fernandez has recently offered an interesting account of introspective justification according to which the very states that (subjectively) justify one's first-order belief that p justify one's second order belief that one believes that p. I provide two objections to Fernandez's account.

The standard model of theory of mind (ToM) development holds that children normally acquire a representational ToM by about age 4 at the latest. Perceptual Access Reasoning (PAR) theory presents a fundamental challenge to the standard model by arguing that representational ToM does not develop until about age 7. One set of predictions of PAR theory concerns children's errors on certain true belief (TB) tasks. Schidelko and Rakoczy subscribe to the standard model, and report a test of the PAR (...) account of TB errors versus their pragmatic account. The authors’ preregistered predictions were not confirmed, and their publicly available data show that, contrary to their claims, the findings actually support the PAR account. (shrink)

Access to fruits and vegetables by low-income residents living in selected urban and rural Minnesotan communities was investigated. Communities were selected based on higher than state average poverty rates, limited access to grocery stores, and urban influence codes (USDA ERS codes). Four communities, two urban and two rural, were selected. Data were gathered from focus group discussions (n = 41), responses to a consumer survey (n = 396 in urban neighborhoods and n = 400 in rural communities), and (...) an inventory of foodstuffs available at stores located in all the communities and at large grocery stores in neighborhoods adjacent to the urban communities. In the two urban neighborhoods, a significant number of foods (26% and 52%) were significantly more expensive than the Thrifty Food Plan’s (TFP) market basket price (MBP). Additionally, a significant number of foods in the two rural communities were more expensive (11% and 26%). In focus groups, participants identified major barriers to shopping in their community to be cost, quality of food, and food choice limitations. Results of the food inventory show that foods within the communities were costly, of fair or poor quality, and limited in number and type available, supporting complaints verbalized by focus group participants. Through focus groups and surveys, participants expressed concern that healthy food choices were not affordable within their communities and believed that people in their community suffered from food insecurity. The absence of quality, affordable food for low-income residents in these four Minnesota communities prevents or diminishes their ability to choose foods that help maintain a healthy lifestyle. (shrink)

The access problem for mathematics arises from the supposition that the referents of mathematical terms inhabit a realm separate from us. Quine’s approach in the philosophy of mathematics dissolves the access problem, though his solution sometimes goes unrecognized, even by those who rely on his framework. This paper highlights both Quine’s position and its neglect. I argue that Michael Resnik’s structuralist, for example, has no access problem for the so-called mathematical objects he posits, despite recent criticism, since (...) he relies on an indispensability argument. Still, Resnik’s structuralist does not provide an account of our access to traditional mathematical objects, and this may be seen as a problem. (shrink)

The objectives of this article are twofold. First, by denying the dualism inherent in attempts to load metaphysical significance on the inner/outer distinction, it defends the view that scientific investigation can approach consciousness in itself, and is not somehow restricted in scope to the outward manifestations of a private and hidden realm. Second, it provisionally endorses the central tenets of global workspace theory, and recommends them as a possible basis for the sort of scientific understanding of consciousness thus legitimised. However, (...) the article goes on to argue that global workspace theory alone does not constitute a fully worked-out objective account of the conscious subject. This requires additional attention to be paid to the issue of embodiment, and to the possibility of indexicality that arises when an instantiation of the global workspace architecture inhabits a spatially localised body. (shrink)

Dying before one’s time has been a prominent theme in classic literature and poetry. Catherine Linton’s youthful death in Wuthering Heights leaves behind a bereft Heathcliff and generations of mourning readers. The author herself, Emily Brontë, died young from tuberculosis. John Keats’ Ode on Melancholy captures the transitory beauty of 19th century human lives too often ravished by early death. Keats also died of tuberculosis, aged 25. “The bloom, whose petals nipped before they blew, died on the promise of the (...) fruit” is how Percy Bysshe Shelley expressed his grief over Keats’ death. Emily Dickinson wrote So Has a Daisy Vanished, being driven into depression by the early loss of loved ones from typhoid and tuberculosis. (shrink)

Access to justiceJustice access, a fundamental principle of the rule of law, is critical for operating a fair and unbiased legal system. It ensures that communities and individuals have the necessary means to seek legal redress, defend their rights, and participate in the judicial system. Nevertheless, numerous regions face obstacles in pursuing justice, including geographical barriers, inadequate legal resources, and exorbitant fees.

Public access to the commons is often restricted, thus leading to implicit regulations. This is relevant toward spatial systems, as an important geographical issue is access to various sites over space, and this paper presents varying degrees of accessibility in different places. There is a dialectic struggle to enhance access to the commons as a fundamental right of the public, with the need to balance tourism and recreational uses of coastal resources with conservation and preservation eff orts. (...) This paper will aid policy makers and those concerned with beach access in Connecticut better understand the nature and complexity of how citizens and officials within coastal municipalities have come to perceive, in a collective sense, their beaches/ municipal parks as common property resources to be utilized for recreational purposes while balancing environmental conservation efforts simultaneously. Various legal frameworks, as well as federal and state efforts in coastal zones in key states, in addition to historically recent court cases in Connecticut resulting in legal enhancements toward increasing public access to nonresidents of specific municipalities, have shaped who can and who cannot access the commons. (shrink)

Access to investigational medicines prior to approval is called “pre-approval access” (a.k.a. expanded use).

Health is higher on the international agenda than ever before, and improving the health of poor people is a central issue in development. Poor people suffer from far higher levels of ill health, mortality, and malnutrition than do those better off, and their inadequate health is one of the factors keeping them poor or for their being poor in the first place. Health is a crucially important economic asset, particularly for poor people. Their livelihoods depend on it. When poor people (...) become ill or injured, their entire household can become trapped in a downward spiral of lost income and high healthcare costs—a vicious circle of poverty and ill health. (shrink)

Sass (2013) proposes an innovative and compelling means for increasing blood donation by encouraging what he describes as the “prosocial” elements of this institution. My goals here are, first, to...

Medicines that are vital for the saving and preserving of life in conditions of public health emergency or endemic serious disease are known as essential medicines. In many developing world settings such medicines may be unavailable, or unaffordably expensive for the majority of those in need of them. Furthermore, for many serious diseases these essential medicines are protected by patents that permit the patent‐holder to operate a monopoly on their manufacture and supply, and to price these medicines well above marginal (...) cost. Recent international legal doctrine has placed great stress on the need to globalise intellectual property rights protections, and on the rights of intellectual property rights holders to have their property rights enforced. Although international intellectual property rights law does permit compulsory licensing of protected inventions in the interests of public health, the use of this right by sovereign states has proved highly controversial. In this paper I give an argument in support of states’ sovereign right to expropriate private intellectual property in conditions of public health emergency. This argument turns on a social contract argument for the legitimacy of states. The argument shows, further, that under some circumstances states are not merely permitted compulsory to license inventions, but are actually obliged to do so, on pain of failure of their legitimacy as sovereign states. The argument draws freely on a loose interpretation of Thomas Hobbes's arguments in his Leviathan, and on an analogy between his state of War and the situation of public health disasters. (shrink)

In Spring 2008 I went textbook-free. I linked all and only the readings for my Contemporary Analytic Philosophy course to the class website, along with powerpoints, handouts and external links to online resources.

: Urban bioethics seeks to broaden the traditional focus of bioethics to encompass questions about the interplay of individuals with family, group, community, and society. Urban bioethics will need to deal with cultural diversity, issues of equity, and the conflict between individual rights and the public good. Encouraging a multicultural ethical discernment, fostering an appreciation of the political, economic, sociological, and psychological issues that inform the question of urban moral choice, urban bioethics is essentially a multi-disciplinary, synthesizing enterprise. Several theoretical (...) models including social contract, rule utilitarian, communitarian, and feminist paradigms offer complementary conceptual frameworks. This paper is offered as a proposal, a road map for future study to place current bioethical analysis into a broader context. (shrink)

During a prostate exam, Mr. Watson, age 65, learns that his prostate appears to be abnormal. The family physician conducting the exam, Dr. Kleinman, informs Mr. Watson that he may have prostate cancer. Mr. Watson agrees to a variety of tests, including blood tests, bone scans, ultrasound scanning, and a biopsy. After learning about this possible diagnosis and these tests, Mr. Watson surfs the Web for information about prostate cancer and gathers data from many different sources, including the National Cancer (...) Society, the National Institutes of Health, Johns Hopkins University, the Mayo Clinic, and medicine sites. He also searches for information from medical journals using MEDLINE, visits several chat rooms on prostate cancer, and joins some e-mail lists. He arrives in Dr. Kleinman's office for a follow-up appointment with a stack of material and many questions. Dr. Kleinman is surprised, irritated, and offended. He recommends that Mr. Watson have a prostatectomy followed by radiation, but Mr. Watson does not want this operation. He would rather receive a form of radiation therapy recently approved by the FDA that he learned about through his own research. Dr. Kleinman admits that he does not know much about this new treatment, but he says that he would read up on it and consult an oncologist. (shrink)

Under the impact of cultural, economic and legislative forces the traditional role of the university health center is changing. The academic health center is rapidly evolving from a relatively undifferentiated general hospital, primarily responsible for the education of undergraduate students of medicine, into a center of clinical research, caring for very specialized mixes of patients, and having as its primary educational mission the training of subspecialists. The nature of the forces responsible for this change are analyzed, and some of its (...) possible consequences for the definition of quality health care, for the shape of medical practice and medical education, and for the allocation of resources for health care are explored. This exploration suggests that the functional separation of the medical school from the highly technical, clinical research center is inevitable. This in turn may exacerbate tensions within medicine between the physician as scientist and as healer, between curative and preventive practice and between personal and public health. Although the effects of this separation on medical education remain obscure, it has already occasioned the most comprehensive review of the medical curriculum since the time of Flexner. Out of this is likely to develop a more generalist view of the education of future physicians. (shrink)

If there is to be a natural theory of consciousness that would satisfy both philosophers and scientists, it must be based on naturalistic data and minimal clutter accumulated from semantic arguments. Carruthers offers a 'natural' theory of consciousness that is rather myopic. To explore the evolutionary basis of consciousness, a natural theory should include comparative psychological and neurological data that encompass nonlinguistic measures. Such an approach could provide a clearer picture of the adaptive function, mechanisms, and origins of consciousness.