We analyze a frequent but undertheorized form of structural injustice, one that arises due to the difficulty of reaching numerically equitable representation of underrepresented subgroups within a larger group. This form of structural injustice is significant because it could occur even if it were possible to completely eliminate bias and overt discrimination from hiring and recruitment practices. The conceptual toolkit we develop can be used to analyze such situations and propose remedies. Specifically, based on a simple mathematical model, we offer a new argument in favour of quotas, explore implications for policy-making, and consider the wider philosophical significance of the problem. We show that in order to reach more equitable representations, quota-based recruitment may often be practically unavoidable. Assuming that members of groups in statistical minority are more likely to quit due to their marginalization, their proportions can stabilize at a low level, preventing a shift towards more equal representation and conserving the minority status of the subgroup. We show that this argument has important implications for addressing, preventing, and remediating the structural injustice of unfair representation.

Parents of a child with chronic kidney disease (CKD) must safely perform advanced care and treatment while at the same time allowing the child some freedom and maintaining everyday parenting and family tasks. Drawing on interviews with primary caregivers of children with CKD in Portugal, we examine the context of raising a child with CKD and how the parents practise their parenthood. The study takes inspiration from parenting studies and child studies and explores how good parenthood is constructed. Based on thematic analysis, three core themes emerged: protecting the child, involving the child in their treatment, and transferring responsibility. The transformation of life-limiting circumstances into a life that worked well for both parents and their child represents what we call ‘readiness parenting’. Assessing risks, supporting the child’s autonomy, and relating to social norms required constant vigilance and readjustments as well as negotiations about parental responsibility.

Caring for a child with chronic kidney disease (CKD) requires parents to reorganise mundane routines and develop advanced technical skills. Parents’ strategies used to meet these challenges need greater understanding. This article takes inspiration from phenomenology of practice and material culture studies to analyse interviews with parents in Portugal. It shows that, although home-based care leads to worsened social inequities, parents use the available financial and human resources to manage the situation and create normality. While they experience becoming confined and close relationships are strained, the mundane practices and social relations of care bring hope and meaning to the family.  

Is it possible to communicate ethics across cultural borders? Not according to representativesof “the incommensurability thesis”, who claim that values and norms are culturally bounded.This article argues against this thesis. A first problem is that cultures and traditions are seenas comprehensive, delimited, and exclusive. Normally, however, a culture develops from andis in dialogue with other cultures. Further, the inner diversity of cultures and traditions opensthe possibility of communication and shared understandings across cultural borders. Finally, theteaching and discussion of cross-cultural ethics provide practical evidence of the possibility ofdialogue and mutual understanding.

In 2020, the world faced a new pandemic. The corona infection hit an unprepared world, and there were no medicines and no vaccines against it. Research to develop vaccines started immediately and in a remarkably short time several vaccines became available. However, despite initiatives for global equitable access to COVID-19 vaccines, vaccines have so far become accessible only to a minor part of the world population. In this article, I discuss the global distribution of COVID-19 vaccines from an ethical point of view. I reflect on what ethical principles should guide the global distribution of vaccines and what global justice and international solidarity imply for vaccine distribution and I analyse the reasons for states to prioritize their own citizens. My focus is on ethical reasons for and against ‘vaccine nationalism’ and ‘vaccine cosmopolitanism.’ My point of departure is the appeal for international solidarity from several world leaders, arguing that ‘Where you live should not determine whether you live’. I discuss the COVAX initiative to enable a global vaccination and the proposal from India and South Africa to the World Trade Organization to temporarily waive patent rights for vaccines. In the final section, I argue for global vaccine sufficientarianism, which is a modified version of vaccine cosmopolitanism. 

Preexposure prophylaxis for HIV is a drug that reduces the risk for an HIV-negative person to acquire HIV if taken prior to sex. It has been suggested that it is important for resource allocation decisions that there are alternatives (such as abstinence, masturbation, etc.) for individuals potentially benefitted by this prophylaxis. In this paper we explore this idea from an ethical perspective in relation to three notions often discussed in priority setting ethics, namely responsibility, outcomes, and severity of disease. While the relevance of alternatives may be explained in terms by responsibility-sensitive priority setting, such a view comes with several challenges. We then discuss two other ways in which this intuition could be better explained: (a) in terms of total outcome of health, and (b) in terms of severity of the condition.

It is uncontroversial to claim that the extent to which health care interventions benefit patients is a relevant consideration for health care priority setting. However, when effects accrue to the individual patient, effects of a more indirect kind may accrue to other individuals as well, such as the patients children, friends, or partner. If, and if so how, such relational effects should be considered relevant in priority setting is contentious. In this paper, we illustrate this question by using disease-modifying drugs for Alzheimers disease as a case in point. The ethical analysis begins by sketching the so-called prima facie case for ascribing moral weight to relational effects and then moves on to consider a number of objections to it. We argue that, whereas one set of objections may be dismissed, there is another set of arguments that poses more serious challenges for including relational effects in priority setting.

How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems unreasonable that public values would straightforwardly decide the ethical question of how resources should be distributed. On the other hand, in a democratic society, it seems equally unreasonable that they would be considered irrelevant for this question. In this paper we draw on the notion of reflective equilibrium and discuss the relevance and roles that empirical studies may plausibly have for justification in priority setting ethics. We develop a framework for analysing how different kinds of empirical results may have different kinds of implications for justification.

Thomas Hobbes first law of nature states that 'each rational man shall and ought to endeavor peace'. Simultaneously, Hobbes first law of nature is perhaps the antithesis of his conception of man in nature (homo naturalis), where man is simply defined as an animal residing in an amoral and arbitrary environment in which every notion of "right and wrong" are connected to the individual's capacity for self-maximizing rationality. In turn, the social creature - zoon politikon - is the contradiction of Hobbes' homo naturalis: he is the impersonated restraint of the impulses and passions that leads him away from a life of an unending state of war into a moral and social community. Hobbes' social and moral creature is the result of a transition involving the creation of a social contract between an arbiter and the masses, binding them together in a shared fate: the excommunication of war and fear into the installment of peace and security. This essay addresses the transition of Hobbes conception of homo naturalis to his implicit understanding of zoon politikon; the transition from the amoral to the moral man. What implications does such a transition have for the egoistic-rational creature? What political and moral obligations are to be found between man and man, and between man and state? Finally, what is rational for the social creature to demand of the state? 

Fair priority setting is based on morally sound criteria. Still, there will be cases when these criteria, our primary considerations, are tied and therefore do not help us in choosing one allocation over another. It is sometimes suggested that such cases can be handled by tiebreakers. In this paper, we discuss two versions of tiebreakers suggested in the literature. One version is to preserve fairness or impartiality by holding a lottery. The other version is to allow secondary considerations, considerations that are not part of our primary priority setting criteria, to be decisive. We argue that the argument for preserving impartiality by holding a lottery is sound, while the argument for using tiebreakers as secondary considerations is not. Finally, we argue that the instances where a tiebreaker seems necessary are precisely the situations where we have strong reasons for preferring a lottery. We conclude that factors that we consider valuable should all be included among the primary considerations, while ties should be settled by lotteries.

Preface to the Special Issue on Free Will and Epistemology written by Robert Lockie

BACKGROUND: Breast cancer survivors' (BCS) attitudes toward eMental Health (eMH) are largely unknown, and adoption predictors and their interrelationships remain unclear. This study aimed to explore BCS' attitudes toward eMH and investigate associated variables.

METHODS: A cross-sectional study involving 336 Portuguese BCS was conducted. Attitudes toward eMH, depression and anxiety symptoms, health-related quality of life, and sociodemographic, clinical, and internet-related variables were assessed using validated questionnaires. Spearman-ranked correlations, χ², and multiple regression analyses were computed to explore associations between attitudes and collected variables.

RESULTS: BCS held a neutral stance toward eMH. In models adjusted for age and education, positive attitudes were statistically significantly associated with increased depressive symptoms and worse emotional, cognitive, and body image functioning. Social network use, online health information and mental healthcare seeking, higher self-reported knowledge of eMH, and previous use of remote healthcare were positively associated with better attitudes toward eMH.

CONCLUSIONS: eMH programs targeting BCS seem to be a promising strategy for providing supportive psychosocial care to BCS. However, increasing awareness about eMH efficacy and security may be necessary to improve its acceptance and use among BCS. Additional research is necessary to understand how BCS' unmet care needs, and specifically their psychological distress severity, may impact BCS' acceptance and use of eMH.

Background: Despite the potential of digital mental health to provide cost-effective mental health care, its adoption in clinical settings is limited, and little is known about the perspectives and practices of mental health professionals regarding its implementation or the factors influencing these perspectives and practices. Objective: This study aims to characterize in depth the perspectives and practices of mental health professionals regarding the implementation of digital mental health and explore the factors affecting such perspectives and practices. Methods: A qualitative study using in-depth semistructured interviews with Portuguese mental health professionals (N=13)-psychologists and psychiatrists-was conducted. The transcribed interviews were thematically analyzed. Results: Mental health professionals deemed important or engaged in the following practices during the implementation of digital mental health: indication evaluation, therapeutic contract negotiation, digital psychological assessment, technology setup and management, and intervention delivery and follow-up. Low-threshold accessibility and professionals perceived duty to provide support to their clients facilitated the implementation of digital mental health. Conversely, the lack of structured intervention frameworks; the unavailability of usable, validated, and affordable technology; and the absence of structured training programs inhibited digital mental health implementation by mental health professionals. Conclusions: The publication of practice frameworks, development of evidence-based technology, and delivery of structured training seem key to expediting implementation and encouraging the sustained adoption of digital mental health by mental health professionals.

Purpose

The purpose of this paper is to pinpoint and analyse ethical issues raised by the dual role of artificial intelligence (AI) in relation to climate change, that is, AI as a contributor to climate change and AI as a contributor to fighting climate change.

Design/methodology/approach

This paper consists of three main parts. The first part provides a short background on AI and climate change respectively, followed by a presentation of empirical findings on the contribution of AI to climate change. The second part presents proposals by various AI researchers and commentators on how AI companies may contribute to fighting climate change by reducing greenhouse gas emissions from training and use of AI and by providing AI assistance to various mitigation and adaptation measures. The final part investigates ethical issues raised by some of the options presented in the second part.

Findings

AI applications may lead to substantial emissions but may also play an important role in mitigation and adaptation. Given this dual role of AI, ethical considerations by AI companies and governments are of vital importance.

Practical implications

This paper pinpoints practical ethical issues that AI companies and governments should take into account.

Social implications

Given the potential impact of AI on society, it is vital that AI companies and governments take seriously the ethical issues raised by the dual role of AI in relation to climate change.

Originality/value

AI has been the subject of substantial ethical investigation, and even more so has climate change. However, the relationship between AI and climate change has received only limited attention from an ethical perspective. This paper provides such considerations.

In the initial phase of the COVID-19 pandemic, Sweden’s response stood out as an exception. For example, Sweden did not introduce any lockdowns, while many other countries did. In this paper I take the Swedish Corona Commission’s critique of the initial Swedish response as a point of departure for a general analysis of precaution in relation to pandemics. The Commission points out that in contrast to many other countries Sweden did not follow ‘the precautionary principle’. Based on this critique, the Commission proposes that the precautionary principle should be included among Sweden’s guiding principles for crisis management. However, as the debate on this principle during the last 30 years indicates, the principle is loaded with problems. I discuss one of these problems, namely its lack of clarity. I argue, however, that this problem is not unsurmountable. A principle is lacking clarity precisely by being a principle and not a rule with a well-defined meaning. As a principle it indicates a direction but does not prescribe a specific action. However, to be action-guiding its content needs to be specified by rational deliberation. With this in mind, I propose a framework for specification of the precautionary principle as applied to pandemics. The framework focuses on the principle’s four key elements: threat, uncertainty, action and responsibility. I also suggest certain general ethical restrictions on specification.

Syftet med denna studie är att undersöka gymnasieelevers attityder till användningen av ChatGPT i skolan utifrån följande frågeställningar:

- Hur stor andel av de tillfrågade gymnasieeleverna känner till ChatGPT och hur vanligt är det att de använder chattboten i skolarbeten?

- Hur använder eleverna ChatGPT i skolarbetet?

- Vilka är elevernas attityder till användningen av ChatGPT i skolan?

- Vilken inställning har gymnasieelever till användning av ChatGPT i uppgifter som bedöms?

Data har samlats in genom en så kallad "mixed-method-design" bestående av en online-enkät och semistrukturerade intervjuer. Som grund för analysarbetet har ett fenomenologiskt perspektiv tillämpats. Resultatet visar på stora olikheter vad beträffar elevers kunskaper om och användning av ChatGPT. Några elever var väl bekanta med teknologin och använde den ofta, medan andra elever hade ytterst liten kännedom om den. Överlag var majoriteten av eleverna positiva till användning av ChatGPT i undervisningen, så länge som det sker på ett sätt som är förenligt med lärande och rättvis bedömning. Däremot menade flera elever att ChatGPT inte bör användas för att skriva hela texter eller i ämnen som svenska där språket bedöms. Det framkom även att elever hade skilda uppfattningar om vad fusk innebär och huruvida det är acceptabelt att ägna sig åt fusk. Under samtalen framkom en distinktion mellan fusk och orättvisa och några elever menade att ChatGPT kan främja likvärdighet och motverka orättvisa.

In this paper I will argue that some of the contradictions in the Problem of the Many occur since we're dealing with two different types of concepts of a cloud, one that is 'common-sense', and one that is 'scientific'. I will borrow from Noam Chomsky’s distinction between common-sense concepts, which are understood intuitively and are usually human-centric, and scientific concepts, which are carefully constructed and aspire to be objective. The common-sense concept of a cloud has certain properties (such as having a sharp boundary) which contradict some found in the scientific concept (such as having a vague boundary), and this is the source of some contradictions found within the Problem of the Many. I will propose that in the future we should approach the problem with this in mind, and not treat it as if we're dealing with only one concept of a cloud, but instead, several.

Current studies indicate that robotic-assisted surgery is not inferior to laparoscopic or open surgery regarding oncologic or functional outcomes. An exception may be uterine cervix cancer, where the survival after minimal invasive surgery might not be as good as after open surgery. There is less bleeding and need for blood transfusion after robotic-assisted surgery, and postoperative complications are similar to open or laparoscopic surgery. Robotic-assisted surgery offers ergonomic advantages compared to laparoscopic surgery. The effect of the surgical learning curve is not sufficiently studied. Presently robotic-assisted surgery is not cost-effective due to high costs of investments. The operation is more time consuming than laparoscopic or open surgery with risks of delaying and cancellation of other operations.

Slutsatser

Vid psykisk och muskuloskeletal sjukdom

• Unimodala insatser, multimodala insatser och insatser som involverar arbetsplatskontakt eller koordinering mot arbetsplats har möjligen positiv effekt på återgång i arbete på kort sikt (upp till 12 månader) för personer sjukskrivna på grund av psykisk eller muskuloskeletal sjukdom (låg tillförlitlighet)³. Det går inte att bedöma effektens storlek.

• Det går inte att bedöma effekten på återgång i arbete av insatser som riktar sig till vårdgivare².

• Det går inte att bedöma effekten på återgång i arbete på längre sikt för någon typ av insats.

• Effekterna på hälsa och funktion går inte att bedöma för någon typ av insats, varken på kort eller lång sikt⁴.

^2. Med vårdgivare avses den organisation som bedriver hälso- och sjukvård på en övergripande nivå, inte den enskilda läkaren. De insatser som studerats som riktas till vårdgivare kan förutom till vårdgivaren dock även vara riktade till behandlande personal.

^3. För noggrannare beskrivning av vilka populationer som slutsatsen gäller, se Tabell 1.

^4. Slutsatserna gäller för insatser som syftar till att underlätta återgång i arbete.

Vid bröstcancer

• Det går inte att bedöma insatsernas effekt på återgång i arbete eller hälsa och funktion för personer sjukskrivna på grund av bröstcancer⁵.

^5. Slutsatserna gäller för insatser som syftar till att underlätta återgång i arbete och inkluderar inte medicinska insatser som har kurativt syfte.

Kommentar

Majoriteten av de inkluderade studierna uppvisar inga statistiskt säkerställda effekter, men resultat från flera studier talar för att vissa insatser kan ha effekter som är betydelsefulla för patienter och samhälle. Det går inte att dra slutsatser om specifika insatser eller om vilka komponenter i insatserna som fungerar. Framtida forskning kan bidra med kunskap genom att replikera studier som uppvisat positiva resultat.

Det är önskvärt att forskning om insatser som syftar till att främja återgång i arbete i möjligaste mån använder standardiserade mät- och analysmetoder och att forskare utvärderar ett begränsat antal prioriterade utfallsmått på ett vis som gör att dessa kan inkluderas i metaanalyser.

De studier som ligger till grund för slutsatserna i denna rapport är i huvudsak genomförda i Nederländerna, Norge, Sverige och Danmark. Projektgruppen bedömer att resultatens överförbarhet till svenska förhållanden är god. Samtidigt kan arbetsmarknad, sjukförsäkringslagstiftning och hälso- och sjukvårdens organisation och arbetssätt ha betydelse för hur insatser genomförs och vilka effekter de har, och dessa faktorer kan dessutom förändras över tid.

Ett krav för att en studie skulle inkluderas var att den undersökte insatsens effekt på återgång i arbete. I vissa fall har författarna även undersökt insatsens effekter på hälsa och funktion. Slutsatsen från denna rapport är att det inte går att bedöma insatsernas effekt på hälsa och funktion. Detta ska dock inte tolkas som att det är säkerställt att insatserna saknar effekt på dessa utfall, utan att det skulle behövas ytterligare, välgjorda studier för att kunna bedöma effekten. De sammanvägda resultaten ger inget stöd för att metoderna har negativa effekter, vare sig på återgång i arbete eller hälsa och funktion.

Det är svårt att dra slutsatser om kostnadseffektivitet för de olika insatskategorierna som definierats i projektet. Hälsoekonomiska studier har bara identifierats för ett mindre antal av de specifika insatser som omfattas av utvärderingen, och det är oklart om dessa insatser är representativa för kategorierna som helhet. En hälsoekonomisk analys som genomförts i projektet visar att det räcker med en förhållandevis liten effekt på arbetsåtergång för att en insats ska bli kostnadsbesparande i ett samhällsekonomiskt perspektiv.

I statistik över långtidssjukskrivning finns ofta könsskillnader. I de inkluderade studierna rapporterades endast undantagsvis separata resultat för kvinnor och män. De inkluderade studierna har inte redovisat effekter utifrån olika yrken eller arbetsmiljöer.

Det identifierades inga studier som undersökt insatser till personer sjukskrivna på grund av bipolär sjukdom eller till följd av postinfektiöst tillstånd, inklusive postcovid.

Den etiska analysen visar att insatser i vården vid långtidssjukskrivning berör etiska värden som jämlikhet, rättvisa, autonomi och integritet samt kan påverka tredje part vilket ställer höga krav på hur insatser planeras och genomförs i praktiken.

Är det möjligt för ett kollektiv att misslyckas med att leva upp till någon moralisk norm trots att ingen av dess medlemmar gör det? Sådana här situationer presenterar något av en paradox: något fel eller moraliskt klandervärt verkar hända trots att alla individuella aktörer gjort sitt bästa. För att lösa paradoxen verkar det rimligt att säga att det är kollektivet som agerar. Det kollektiva handlandet kan ses antingen som en produkt av det sammanlagda agerandet, eller av det kollektiva agerandet av gruppen. Jag visar hur ingendera tolkning erbjuder någon möjlig lösning på paradoxen.

This paper argues that emotions can play an epistemic role as justifiers of evaluative beliefs. It also presents the heuristics theory of emotion as an empirically informed explanation of how emotions can play such a role and why they in practice usefully complement non-affective evaluative judgments. As such, the heuristics theory represents a form of moderate rationalism: it acknowledges that emotions can be epistemically valuable, even privileged in some sense, but denies that they would be uniquely privileged. I argue that judgments and emotional responses pick out different but correlated kinds of evaluative properties and therefore emotional responses and non-affective evaluative judgments play mutually complementary rather than mutually exclusive roles. It follows that emotional responses can be legitimately drawn upon to support evaluative beliefs, but they lack supreme epistemic authority.

Bernard Williams (1929–2003) was one of the great philosophical figures of the second half of the twentieth century. This collection, devoted to Williams’s ethical thought, is divided into two sections. The chapters in the first section deal with Williams’s attempts to explore theoretical options beyond the confines of what he called “the morality system.” These chapters show how, through a critical confrontation with this system, Williams found new ways to think about moral obligation, morally relevant emotions such as shame, the relevance of the history of philosophy, and also how these new ways of thinking are linked to Williams’s novel metaethical ideas concerning the possibility and limits of moral knowledge. In the book’s second section, readers will find chapters related to Williams’s discussions of freedom and responsibility, the role of luck in our moral lives, and agents’ practical reasons. Williams’s concerns about the morality system still loom large here. For example, Williams was skeptical about the prospects of putting our responsibility practices, and the conception of free will with which they are associated, on a firm footing. But as more than one author shows, Williams’s skepticism is largely confined to conceptions of free will and responsibility that are conditioned by the morality system’s uneasiness with luck. Williams has a more vindicatory story to tell about the prospects for freedom and responsibility once these concepts have been untethered from the assumptions of this system.

Die Debatte um Gedankenexperimente, die seit den späten 1980ern und frühen 1990er Jahren Fahrt aufgenommen hat, war lange Zeit vornehmlich auf Fragen der Erkenntnis- und Wissenschaftstheorie beschränkt. Der nachstehende Aufsatz reiht sich demgegenüber in die Liste neuerer Arbeiten ein, die auf die Rolle von gedankenexperimentellen Techniken in anderen Bereichen wie etwa der Literatur hinweisen. Obwohl ich im ersten Teil meines Artikels wiederum von der Physik ausgehe, um einige grundlegende Funktionsweisen von Gedankenexperimenten zu illustrieren, geht es mir in weiterer Folge um den Nachweis, dass Literatur von sehr ähnlichen Funktionsweisen Gebrauch macht, um einen epistemischen Mehrwert zu erzielen. Als konkretes literarisches Beispiel dient mirKapitel 100 des Mann ohne Eigenschaften, in dem sich Musil—so meine These—in bester gedankenexperimenteller Manier mit Fragen der Mathematik und Metamathematik beschäftigt.

Edmund Husserl devoted considerable effort to the devel-opment of a phenomenological theory of rationality, as, forinstance, part four ofIdeas 1attests. After providing somenecessary background, I will spell out the details of Huss-erl's account. Yet, as I will also argue, Husserl's official doc-trine is untenable due to several ambiguities and internaltensions. Hence, my primary aim in this paper is to offer amodified phenomenological theory of rationality that avoidsthe problems of Husserl's original account.

To say that we—and with “we” I mean humanity as a whole—have big challenges ahead of us would be a massive understatement. The earth’s climate crossed several crucial tipping points this year. Our lives are still overshadowed by a pandemic whose societal repercussions we do not even begin to fathom. And we are at the brink of a new era in which our biggest evolutionary advantage so far—our intellect—will be outrivaled massively by machines. I take it for granted that the only realistic chance to deal with these challenges is science and the technology we build on the basis of scientifc insight. Of course, I am not saying that science alone will be able to save the day. But just like it took a scientifcally engineered vaccine to turn things around with COVID-19, we will need more than thoughts and prayers to preserve a su¡ciently stable biosphere for our children and grandchildren...

The aim of this chapter is to give an idea of how the Husserlian mind had at least an indirect impact on contemporary physics by influencing the thinking of Hermann Weyl, one of the most prolific mathematicians and theoretical physicists of the twentieth century. I will take a closer look at Husserl’s notorious annihilation of the world thought experiment in order to elucidate Hermann Weyl’s remark that the coordinate system ought to be understood as the necessary residuum of the annihilation of the ego. By doing so, I will not only show how Weyl made creative use of central components of Husserl’s phenomenological methodology to better understand the nature of mathematical representation in physics. Ultimately, the upshot of this chapter is that on Weyl’s view, the perspectivity, and subject-relativity of every symbolic-mathematical representation of reality is not just an artifact of interpretation, it is indeed mandated by physics itself.