Phenomenal conservatism is a popular theory of epistemic justification. Despite its popularity and the fact that some think that phenomenal conservatism can provide a complete account of justification, it faces several challenges. Among these challenges are the need to provide accounts of defeaters and inferential justification. Fortunately, there is hope for phenomenal conservatism. Explanationism, the view on which justification is a matter of explanatory considerations, can help phenomenal conservatism with both of these challenges. The resulting view is one that respects (...) the internalist character of phenomenal conservatism and its motivating intuitions while providing an intuitive and elegant account of both inferential justification and the justificatory impact of defeaters. (shrink)

Critics of medical aid in dying (MAID) often argue that it is impermissible because background social conditions are insufficiently good for some persons who would utilize it. I provide a critical evaluation of this view. I suggest that receiving MAID is a sort of “hard choice,” in that death is prima facie bad for the individual and only promotes that person’s interests in special circumstances. Those raising this objection to MAID are, I argue, concerned primarily about the effects of injustice (...) on hard choices. I show, however, that MAID and other hard choices are not always invalidated by injustice and that what matters is whether the injustice can be remediated given certain constraints. Injustice invalidates a hard choice when it can, reasonably, be remedied in a way that makes a person’s life go better. I consider the implications of this view for law and policy regarding MAID. (shrink)

Concerns over aid effectiveness have led to calls for greater accountability in international development aid. This article examines the state of accountability within and between international development agencies: aid NGOs, international financial institutions, and government aid ministries.

Shavelson and colleagues (2023) describe how medical aid-in-dying laws in the United States prohibit assistance in administering aid-in-dying medication. This prohibition distinguishes aid in dying...

Background Medical aid in dying (MAiD) was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues. Methods A retrospective chart review of all MAiD requests between December 2015 and (...) June 2017 at two Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests. Results Of 80 patients requesting MAiD, 54% (43) received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults (32%) came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 (prolongation of life remains a priority) at the time of the MAiD request and 19% were receiving life-prolonging interventions. Interpretation We highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend. (shrink)

Volume 19, Issue 10, October 2019, Page 61-63.

Why would we prohibit people with disabilities from receiving the assistance needed to achieve similar goals as people without disabilities? On its face, this would seem to be a discriminatory appr...

In his classic article, Famine, Affluence, and Morality, pp. 229–243), Peter Singer claimed that affluent people in the developed world are morally obligated to transfer large amounts of resources to poor people in the developing world. For present purposes I will not call Singers argument into question. While people can reasonably disagree about exactly how demanding morality is with respect to duties to the desperate, there is little question in my mind that it is much more demanding than common sense (...) morality or our everyday behavior suggests. Even someone who disagrees with this might still find some interest in seeing what a demanding morality would imply for well-off residents of the rich countries of the world. I proceed in the following way. First, I survey humanitarian aid, development assistance, and intervention to protect human rights as ways of discharging duties to the desperate. I claim that we should be more cautious about such policies than is often thought. I go on to suggest two principles that should guide our actions, based on an appreciation of our roles, relationships, and the social and political context in which we find ourselves. (shrink)

In this paper, I address the question of whether it is ever permissible to grant a request for physician-aid-in-dying (PAD) from an individual suffering from treatment-resistant depression. I assume for the sake of argument that PAD is sometimes permissible. There are three requirements for PAD: suffering, prognosis, and competence. First, an individual must be suffering from an illness or injury which is sufficient to cause serious, ongoing hardship. Second, one must have exhausted effective treatment options, and one’s prospects for recovery (...) must be poor. Third, the individual must be judged competent to request PAD. I argue that many cases of treatment-resistant depression meet the first two requirements. Thus, the key question concerns the third. I consider four features of depression that might compromise a person’s decision-making capacity. Ultimately, I conclude that PAD requests from depressed patients can be permissibly granted in some circumstances. (shrink)

Life, on a day to day basis, is a sequence of emotional states: hope, disappointment, irritation, anger, affection, envy, pride, embarrassment, joy, sadness and many more. We know intuitively that these states express deep things about our character and our view of the world. But what are emotions and why are they so important to us? In one of the most extensive investigations of the emotions ever published, Robert Roberts develops a novel conception of what emotions are and then applies (...) it to a large range of types of emotion and related phenomena. In so doing he lays the foundations for a deeper understanding of our evaluative judgments, our actions, our personal relationships and our fundamental well-being. Aimed principally at philosophers and psychologists, this book will certainly be accessible to readers in other disciplines such as religion and anthropology. (shrink)

In recent decades, many jurisdictions have moved toward legalizing euthanasia and assisted suicide—together with a growing recognition of the moral right to a medically assisted death. Herewe draw on a comprehensive quantitative review of existing laws on assisted dying, experimental survey evidence, and four decades of time-series data to explore the relationship between these legislative transitions and changing moral attitudes. Our analysis reveals that existing laws on medical aid in dying impose a common set of eligibility restrictions, based on the (...) patient’s age, decision-making capacity, prognosis and the nature of their illness. These eligibility restrictions shape public moral approval of physician-assisted death, equally in countries where euthanasia is legal (i.e., Spain) and illegal (i.e., the United Kingdom). Additionally, records of public attitudes toward euthanasia across numerous countries over a forty-year period uncovered anticipatory growth in moral approval leading up to legalization, but no accelerated growth thereafter. Collectively, our findings suggest that legal frameworks for medical aid in dying crystallize patterns of moral intuition. (shrink)

One criticism of medical aid in dying (MAID) is the expressivist objection: MAID is morally wrong because it expresses judgments about disabilities or persons with disabilities, that are offensive, disrespectful, or discriminatory. The expressivist objection can be made at the level of individual patients, medical providers, or the state. The expressivist objection originated with selective abortion, and responses to it in that context typically claim either that selective abortion does not express specific judgments about disabilities, or that any judgments expressed (...) are not offensive. This response is inadequate: MAID often does express negative judgments about disabilities, which could reasonably be seen as offensive. But, does this offensiveness make MAID wrong? Drawing on Joel Feinberg’s account of offense, I argue that it is unlikely that the offensiveness of the judgments expressed by individuals who seek MAID or through the state’s legalization of MAID is enough to make it morally impermissible. (shrink)

Decision making in health care contexts is often deeply challenging for the patients, their close ones, and those who care for them. All of them have and perceive different forms of responsibilitie...

This contribution discusses the development of the Data Ethics Decision Aid (DEDA), a framework for reviewing government data projects that considers their social impact, the embedded values and the government’s responsibilities in times of data-driven public management. Drawing from distinct qualitative research approaches, the DEDA framework was developed in an iterative process (2016–2018) and has since then been applied by various Dutch municipalities, the Association of Dutch Municipalities, and the Ministry of General Affairs (NL). We present the DEDA framework as (...) an effective process to moderate case-deliberation and advance the development of responsible data practices. In addition, by thoroughly documenting the deliberation process, the DEDA framework establishes accountability. First, this paper sheds light on the necessity for data ethical case deliberation. Second, it describes the prototypes, the final design of the framework, and its evaluation. After a comparison with other frameworks, and a discussion of the findings, the paper concludes by arguing that the DEDA framework is a useful process for ethical evaluation of data projects for public management and an effective tool for creating awareness of ethical issues in data practices. (shrink)

Human development is a matter of complex interactions between nutritional regimes, genes, educational regimes and other diverse developmental resources. I argue that there is no ethically salient difference between the contributions made to development by genes and the contributions made by these other resources. Since we think nutrition and schooling should be included in the calculus of distributive justice, we should include at least some genes in this calculus too. What is more, under the right circumstances genetic engineering may become (...) a useful tool for the distribution of developmental resources. This said, attention to the parity of genetic and environmental causation can also help to articulate the legitimate suspicions many groups have of genetic engineering. (shrink)

Background: In Quebec, medical aid in dying (MAiD) is legal under certain conditions. Access is currently restricted to patients who are able to consent at the time of the act, which excludes most people with dementia at an advanced stage. However, recent legislative and political developments have opened the door to an extension of the legislation that could give them access to MAiD. Our study aimed to explore the attitudes of people with early-stage dementia toward MAiD should it become accessible (...) to them. Methods: We used a qualitative descriptive design consisting of eight face-to-face semi-structured interviews with persons living with early-stage Alzheimer’s disease, followed by a thematic analysis of the contents of the interviews. Results and Interpretations: Analysis revealed three main themes: 1) favourable to MAiD; 2) avoiding advanced dementia; and 3) disposition to request MAiD. Most participants anticipated dementia to be a painful experience. The main reasons for supporting MAiD were to avoid cognitive loss, dependence on others for their basic needs, and suffering for both themselves and their loved ones. Every participant said that they would ask for MAiD at some point should it become available to incompetent patients and most wished that it would be legal to access it through a request written before losing capacity. Conclusion: The reasons for which persons with Alzheimer’s disease want MAiD are related to the particular trajectory of the disease. Any policy to extend MAiD to incompetent patients should take their perspective into account. (shrink)

abstract Most moral philosophers accept that we have obligations to provide at least some aid and assistance to distant strangers in dire need. Philosophers who extend rights and obligations to nonhuman animals, however, have been less than explicit about whether we have any positive duties to free‐roaming or ‘wild’ animals. I argue our obligations to free‐roaming nonhuman animals in dire need are essentially no different to those we have to severely cognitively impaired distant strangers. I address three objections to the (...) view that we have positive duties to free‐roaming nonhuman animals, and respond to the predation objection to animal rights. (shrink)

In _Discrimination Against the Dying_, Philip Reed argues, among other things, that ‘right to die laws (euthanasia and assisted suicide) also exhibit terminalism when they restrict eligibility to the terminally ill’. 1 Additionally, he suggests ‘the availability of the option of assisted death only for the terminally ill negatively influences the terminally ill who wish to live by causing them to doubt their choice’. 1 I argue that on scrutiny, neither of these two points hold. First, we routinely limit a (...) course of treatment to only those for whom we believe the treatment might provide a benefit. Typically, we do not think hastening death provides benefit when an individual is not experiencing a terminal illness. Thus, I conclude, either all treatments are discriminatory, or medical aid in dying is not. Second, I argue that permitting individuals to refuse or remove life sustaining care may very well cause... (shrink)

Volume 19, Issue 10, October 2019, Page 68-70.

Aim: Explore nurses’ values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses’ values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional review board (#191046). (...) Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: “Honoring Patient Autonomy without Judgment,” “Honoring with Limitations,” “Not until...,” and “Adamantly against.” Some felt it was a duty to honor the patients’ wishes, set aside own beliefs, and respect patients’ choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse’s role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses’ values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed. (shrink)

The following technique has proven effective in helping beginning logic students locate the sections of a three-circled Venn Diagram in which they are to represent a categorical sentence. Very often theses students are unable to identify the parts of the diagram they are to shade or bar.

Considering solidarity and mutual aid at the intersection of political philosophy and biology, made more urgent by the COVID-19 crisis, this book is grounded in the work of Catherine Malabou and takes her theories in creative new directions.

After a review of terminology, I identify—in addition to Margaret Battin’s list of five primary arguments for and against aid-in-dying—the argument from functional equivalence as another primary argument. I introduce a novel way to approach this argument based on Bernard Lonergan’s generalized empirical method. Then I proceed on the basis of GEM to distinguish palliative sedation, palliative sedation to unconsciousness when prognosis is less than two weeks, and foregoing life-sustaining treatment from aid-in-dying. I conclude that aid-in-dying must be justified on (...) its own merits and not on the basis of these well-established palliative care practices; and that societies must decide, in weighing the merits of aid-in-dying, whether or not to make the judgment that no life is better than life-like-this part of their operative value structure. (shrink)

Although Canada recently expanded access to medical assistance in dying, intolerably suffering Canadians with dementia still face seven obstacles to qualify for MAID. Advance directives for VSED are an important, yet under-appreciated, alternative.

In recent years philosophers have begun to reflect more deeply on the significance of disagreement between equally rational and well-informed peers. Many, including Richard Feldman, have argued that disagreement between such peers requires that both suspend judgement. Applying this to the religious domain and given widespread religious disagreement, Feldman’s view results in religious scepticism. This chapter questions Feldman’s view by first explaining more fully the equal weight view about disagreement, and secondly arguing that there are cases of disagreement where equal (...) weight would result in agreement. In such cases, the belief structure and the precise location of the disagreement within it explains why agreement is rationally mandated by equal weight. Thirdly, the chapter argues that religious disagreements could be examples of such cases. Equal weight could end up rationally requiring agreement that God exists (or not, depending on the details of the disagreement). (shrink)

Humanitarian aid professionals frequently encounter situations in which one is conscious of the morally appropriate action but cannot take it because of institutional obstacles. Dilemmas like this are likely to result in a specific kind of stress reaction at the individual level, labeled as moral stress. In our study, 16 individuals working with international humanitarian aid and rescue operations participated in semistructured interviews, analyzed in accordance with a grounded theory approach. A theoretical model of ethical decision making from a moral (...) stress perspective was developed. The practical implications of the study are discussed. (shrink)

Volume 19, Issue 10, October 2019, Page 8-9.

Open peer commentary on the article “On Climate Change Research, the Crisis of Science and Second-order Science” by Philipp Aufenvenne, Heike Egner & Kirsten von Elverfeldt. Upshot: On an epistemological level, Aufenvenne, Egner and von Elverfeldt argue convincingly for an increasing role for second-order science in climate research. However, the authors partially underestimate the already increasing role of reflexive critique in climate discourse, and they do not yet fully take into account the radical changes in our conception of climate change (...) through the deployment of a second-order approach. (shrink)

Three states—Oregon, Washington, and Vermont—have used straightforwardly democratic means to legalize the practice formerly known as “physician‐assisted suicide” but now termed “aid‐in‐dying.” In two states—Montana and New Mexico—aid‐in‐dying has been declared legal neither by directly democratic action by citizens nor by representatively democratic action by the legislature but by court rulings in cases brought by aid‐in‐dying activists. The court case in New Mexico (Morris v. New Mexico, 2014) is undoubtedly of greater significance to the rest of the states. The Morris (...) opinion is as interesting for what it declined to hold as for what it held. (shrink)

In their insightful article, Brent Kious and Margaret Battin (2019) correctly identify an inconsistency between an involuntary psychiatric commitment for suicide prevention and physician aid in dying (PAD). They declare that it may be possible to resolve the problem by articulating “objective standards for evaluating the severity of others’ suffering,” but ultimately they admit that this task is beyond the scope of their article since the solution depends on “a deep and difficult” question about comparing the worseness of two possible (...) scenarios: letting someone die (who could have been helped) with not letting someone die (whose suffering could only be alleviated by death). In our commentary, we argue that creating such standards is more difficult than the authors assume because of the many types of deep uncertainties we have to deal with: (1) diagnostic, (2) motivational, and (3) existential. (shrink)

In this paper we introduce a system AID of bounded arithmetic. The main feature of AID is to allow a form of inductive definitions, which was extracted from Buss’ propositional consistency proof of Frege systems F in Buss 3–29). We show that AID proves the soundness of F, and conversely any Σ 0 b -theorem in AID yields boolean sentences of which F has polysize proofs. Further we define Σ 1 b -faithful interpretations between AID+Σ 0 b -CA and a (...) quantified theory QALV of an equational system ALV in Clote 57–106). Hence ALV also proves the soundness of F. (shrink)

Courts and commentators are notoriously puzzled about the mens rea standards for complicity. Accomplices intend to aid, but what attitude need they have towards the crimes that they aid? This paper both criticizes extant accounts of the mens rea of complicity and offers a new account. The paper argues that an intention can commit one to an event’s occurrence without committing one to promoting the event, or making it more likely to take place. Under the proposed account of the mens (...) rea of complicity, an accomplice must have an intention that commits him to the crime’s occurrence, but need not commit him to making it more likely that the crime occurs. The paper traces the implications of this view both for several difficult complicity cases, and for ongoing debates among philosophers of action about the necessary and sufficient conditions of joint agency. (shrink)

When central authority fails in socially crucial tasks, mutual aid, solidarity, and grassroots organization frequently arise as people take up slack on the basis of informal networks and civil society organizations. We can learn something important about the possibility of horizontal organization by studying such experiments. In this paper we focus on the rationality, care, and effectiveness of grassroots measures to respond to the pandemic and show how they illustrate core elements of anarchist thought. We do not argue for the (...) correctness of any version of anarchist politics, nor claim that the bulk of this grassroots work was done with anarchist ideas explicitly in mind. Nonetheless, the current pandemic, like many social crises before it, serves as a sort experiment in political implementation. -/- Two things have been striking in the US response to the COVID-19 pandemic: the chaos, incompetence, irrationality, and often cruel misguidedness of the centralized government response; and the rationality, care, and effectiveness of grassroots measures in many parts of the country. In this paper we focus on the latter—especially the case of Washington, DC—to illustrate core features of anarchist politics. We do not argue for the correctness of any version of anarchist politics here, but merely illustrate guiding ideas that have been a part of anarchist theory and practice for well over a century. We also do not claim that the bulk of this grassroots work was done with anarchist ideas in mind, or explicitly out of a commitment to anarchist politics. Some was, and some arises out of related ideological commitments, but most simply functions out of no more than a desire to support one another. -/- The current pandemic, like many social crises before it, rather than providing a stand-alone argument or functioning as an implementation of any political theory, serves as a sort of laboratory experiment. When central authority fails in socially crucial tasks, mutual aid, solidarity, and grassroots organization frequently arise as people take up slack on the basis of informal networks and civil society organizations. We can learn something important about the possibility of horizontal organization by studying such experiments, including how it arises through spontaneous action. If political thought is best illustrated through its implementation in practice, the functioning of grassroots individuals and organizations in a time of crisis is one way to understand the political mechanisms core to anarchist thought. (shrink)

Although their use has been proposed for several decades as a fundamental part of mental health recovery, in recent years there has been an increasing push to integrate mutual aid groups (MAGs) into health services. While this integration could strengthen them, it risks transforming MAGs from alternatives to mere complements to psychiatric services. This article argues that the integration of mutual aid into formal health systems must be approached with caution, ensuring that such inclusion does not neutralize their transformative potential, (...) but rather reorients care systems toward ontological pluralism, justice and epistemic dignity. To answer this question, a dialogue is proposed between theory and several programs where MAGs were the central strategy. Transversalizing care implies recognizing that different forms of healing arise from distinct worlds, logics, and ways of experiencing suffering. Without this shift, MAGs risk being neutralized, depoliticized, and absorbed by recovery systems that do not always respond to diverse forms of psychosocial suffering. The question is not how peer support can be integrated into existing mental health systems, but how these same systems can support the radical ontological shift that MAGs demand. Mechanisms are proposed to integrate these strategies into a broader care system, preserving their autonomy and managing risks of co-optation. (shrink)

The traditional military-territorial model of the nation state defines international duties in terms of protecting citizens' property from foreign threats. In this 1992 book about the principles of the US agricultural policy and foreign aid, Professor Thompson replaces this model with the notion of the trading state that sees its role in terms of the establishment of international institutions that stabilize and facilitate cultural and intellectual, as well as commercial, exchanges between nations. The argument focuses on protectionist challenges to foreign (...) aid and development assistance programs, and engages with the views of a variety of economists, commodity organizations, and philosophers on world hunger and development. What emerges is a new interpretation of social contract theory that can determine goals for international trade and development policy. (shrink)

This paper theorizes that the effect of human rights violations on US economic aid is conditioned by the salience of US national security concerns. National security concerns will be more salient in situations where recipients contribute to maintaining US security and in temporal eras when the USA is perceived as being under increased external threat. As the relational and temporal salience of national security increases, any negative effect of human rights violations on US economic aid should decrease. I test this (...) hypothesis by examining US economic aid allocations to states from 1977 to 2005. The results show that the salience of national security concerns present in the US-recipient relationship does condition the relationship between human rights violations and US economic aid. There are also significant differences between different temporal eras of US foreign aid allocation. Future work should address how conflicts between interests and values in US foreign policy are negotiated. (shrink)