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The comorbidity of chronic pain and opioid addiction is a serious problem that has been growing with the practice of prescribing opioids for chronic pain. Neuroimaging research has shown that chronic pain and opioid dependence both affect brain structure and function, but this is the first study to evaluate the neurophysiological alterations in patients with comorbid chronic pain and addiction. Eighteen participants with chronic low back pain and opioid addiction were compared with eighteen age- and sex-matched healthy individuals in a (...) pain-induction fMRI task. Unified structural equation modeling (SEM) with Lagrange multiplier (LM) testing yielded a network model of pain processing for patient and control groups based on 19 a priori defined regions. Tests of differences between groups on specific regression parameters were determined on a path-by-path basis using z-tests corrected for the number of comparisons. Patients with the chronic pain and addiction comorbidity had increased connection strengths; many of these connections were interhemispheric and spanned regions involved in sensory, affective, and cognitive processes. The affected regions included those that are commonly altered in chronic pain or addiction alone, indicating that this comorbidity manifests with neurological symptoms of both disorders. Understanding the neural mechanisms involved in the comorbidity is crucial to finding a comprehensive treatment, rather than treating the symptoms individually. (shrink)

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The multiple emergencies of global heating require bioethicists to embrace the dormant, comprehensive bioethics legacy of Van RensselaerPotter, moving beyond the current narrower focus of the field on medicine and health care. We recommend readings that expand the core literature of bioethics to address key environmental issues. These are Jessica Pierce and Andrew Jameton's The Ethics of Environmentally Responsible Health Care; Dale Jamieson's Reason in a Dark Time; and David Wallace‐Well's The Uninhabitable Earth. Because efforts to mitigate climate (...) disasters are likely to be only partially successful, we also recommend the teachings of late Roman Stoicism and core texts of Buddhism, which provide ethical wisdom likely to be needed in the multiple crises of the Anthropocene. (shrink)

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Many philosophers have discussed problems of additive aggregation across lives. In this article, I suggest that anti-additive aggregationist principles sometimes apply within lives, as well as between lives, and hence that we should reject a widely accepted conception of individual self-interest. The article has eight sections. Section I is introductory. Section II offers a general account of aggregation. Section III presents two examples of problems of additive aggregation across lives: Derek Parfit's Repugnant Conclusion, and my Lollipops for Life Case Section (...) IV suggests that many may have misdiagnosed the source and scope of anti-additive aggregationist considerations, due to the influence of Rawls's and Nozick's claims about the separateness of individuals. Accordingly, many leave Sidgwick's conception of self-interest—which incorporates an additive aggregationist approach to valuing individual lives—unchallenged. Section V suggests that the separateness of individuals may have led some to conflate the issues of compensation and moral balancing. Section VI argues that an additive aggregationist approach is often deeply implausible for determining the overall value of a life. Section VII discusses a Single Life Repugnant Conclusion, first considered by McTaggart. Section VIII concludes with a summary, and a brief indication of work remaining. (shrink)

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In this bookLarry Temkin examines the concepts of equality and inequality, and addresses one particular question in depth: how can we judge between different sorts of inequality? When is one inequality worse than another? Temkin shows that there are many different factors underlying and influencing our egalitarian judgments and that the notion of inequality is surprisingly complex. He looks at inequality as applied to individuals and to groups, and at the standard measures of inequality employed by economists and (...) others, and considers whether inequality matters more in a poor society than a rich one. The arguments of non-egalitarians are also examined. Temkin's book presents a new way of thinking about equality and inequality which challenges the assumptions of philosophers, welfare economists, and others concerned with these notions on a practical as well as a theoretical level. (shrink)

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How should the well-off respond to the world's needy? Renowned ethicistLarry S. Temkin challenges common beliefs about philanthropy and Effective Altruism, exploring the complex ways that global aid may do more harm than good, and considers the alternatives available when neglecting the needy is morally impermissible.

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Can a society be just if it ignores the plight of other societies? Does it matter whether those societies are contemporaries? Moral “purists” are likely to assume that the answer to these questions must be “no.” Relying on familiar claims about impartiality or universalizability, the purist is likely to assert that the dictates of justice have no bounds, that they extend with equal strength across space and time. On this view, if, for example, justice requires us to maximize the expectations (...) of the worst-off group in our society, it also requires us to maximize the expectations of the worst-off group in any society, at any time, so far as it is in our power to do so. Is such a position plausible? Is it more plausible than alternative positions? I am unsure about the answers to these questions, but both the questions, and the answers, are important. Clearly, the nature and extent of a just society's obligations will vary markedly depending on the scope of the correct principles of justice. (shrink)

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Temkin's book is a very original and deeply unsettling work of skeptical philosophy that mounts an important new challenge to contemporary ethics.

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Temkin presents a new way of thinking about equality and inequality that challenges the assumptions of philosophers, welfare economists, and others, and has significant implications on both a practical and theoretical level.

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In "Futurc Generations: Further Problems,"‘ and Part Four of Reasons and Persons} Derek Pariit raises many perplexing questions. Although some think his ingenious arguments little more than delightful puzzles, I believe they challenge some of our deepest beliefs. In this article, I examine some of Pariit’s arguments, focusing mainly on "The Mere Addition Paradox." If my analysis is correct, Parfit’s arguments have extremely interesting and important implications that not even Pariit rcalized. In Part I, I present ParHt’s argument for the (...) Merc Addition Paradox, and show that given Pa.rHt’s assumptions, a radical conclusion seems t0 follow; the notion of "bctter th2m"—indced, even the notion of "aH things.. (shrink)

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This article explores and challenges several common assumptions regarding what neutrality requires of us in assessing outcomes. In particular, I consider whether we should be neutral between different possible locations of the good: space, time, and people. I suggest that from a normative perspective we should treat space differently than time, and people differently than space and time. I also argue that in some cases we should give priority to people over space and time, and to time over space, but (...) that, controversially, in some cases we should give priority to time over people. (shrink)

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In "Equality, Priority, and Compassion," Roger Crisp rejects both egalitarianism and prioritarianism. Crisp contends that our concern for those who are badly off is best accounted for by appealing to "a sufficiency principle" based -- indirectly, via the notion of an impartial spectator -- on compassion for those who are badly off" (p. 745). A key example of Crisp's is the Beverly Hills case (discussed below). This example is directed against prioritarianism, but it also threatens egalitarianism. In this article, I (...) respond to the Beverly Hills case. I also challenge the wide person-affecting principle and Crisp's welfarist restriction, which some believe underlie the Levelling Down Objection against egalitarianism. My aim in this article is to defend egalitarianism by illuminating both its nature and appeal. (shrink)

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This paper aims to illuminate some issues in the equality, priority, or what debate. I characterize egalitarianism and prioritarianism, respond to the view that we should care about sufficiency or compassion rather than equality or priority, discuss the levelling down objection, and illustrate the significance of the distinction between prioritarianism and egalitarianism, establishing that the former is no substitute for the latter. In addition, I respond to Bertil Tungodden's views regarding the Slogan, the levelling down objection, the Pareto Principle, leximin, (...) the principle of personal good, strict moderate egalitarianism, the Hammond Equity Condition, the intersection approach, and non-aggregative reasoning. (shrink)

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This article gives a brief overview of Rethinking the Good, whose impossibility arguments illuminate the difficulty of arriving at a coherent theory of the good. I show that an additive-aggregationistprinciple is plausible for some comparisons, while an anti- additive-aggregationistprinciple is plausible for others. Invoking SpectrumArguments, I show that these principles are incompatible with an empirical premise, and various Axioms of Transitivity. I argue that whether the “all-things-considered better than” relation is transitive is not a matter of language or logic, but (...) the nature of moral ideals. If an Internal Aspects View holds, then many standard assumptions about rationality follow, including the Axioms of Transitivity, but not if an Essentially Comparative View holds. Yet many important ideals are essentially comparative. My results have important implications for the normative significance of economics, and require substantial revision in our understanding of the good, moral ideals, and the nature of practical reasoning. (shrink)

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abstract Some day, perhaps soon, we may have genetic enhancements enabling us to conquer aging. Should we do so, if we can? I believe the topic is both interesting and important, and that it behoves us to think about it. Doing so may yield important insights about what we do care about, what we should care about, and how we should seek to live our lives, both individually and collectively. My central question is this: Is living longer, living better? My (...) paper does not offer a sustained argument for a single, considered, thesis. Rather, it offers a number of snippets of often-unconnected thoughts relevant to the issues my question raises. The paper contains seven sections. Part one is introductory. Part two comments on some current longevity research. Part three indicates the attitudes towards death and science with which I approach these questions. Parts four and five, respectively, discuss some worries about immortality raised by Leon Kass and Bernard Williams. Part six points to some practical, social, and moral concerns that might arise if society's members lived super long lives. Part seven concludes by suggesting that we should favour living well over living longer, and ongoing reproduction over immortality; correspondingly, I suggest that we should think long and hard before proceeding with certain lines of longevity research. (shrink)

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In this article, I present some worries about the possible impact of global efforts to aid the needy in some of the world’s most desperate regions. Among the worries I address are possible unintended negative consequences that may occur elsewhere in a society when aid agencies hire highly qualified local people to promote their agendas; the possibility that foreign interests and priorities may have undue influence on a country’s direction and priorities, negatively impacting local authority and autonomy; and the related (...) problem of outside interventions undermining the responsiveness of local and national governments to their citizens. -/- Another issue I discuss is the possibility that efforts to aid the needy may involve an Each-We Dilemma, in which case conflicts may arise between what is individually rational or moral, and what is collectively rational or moral. Unfortunately, it is possible that if each of us does what we have most reason to do, morally, in aiding the needy, we together will bring about an outcome which is worse, morally, in terms of its overall impact on the global needy. -/- The article ends by briefly noting a number of claims and arguments that I made in my 2017 Uehiro Lectures regarding how good people should respond in a world of need. As I have long argued, I have no doubt that those who are well off are open to serious moral criticism if they ignore the plight of the needy. Unfortunately, however, for a host of both empirical and philosophical reasons, what one should do in light of that truth is much more complex, and murky, than most people have realized. (shrink)

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There is a rich tradition within game theory, decision theory, economics, and philosophy correlating practical rationality with impartiality, and spatial and temporal neutrality. I argue that in some cases we should give priority to people over both times and places, and to times over places. I also show how three plausible dominance principles regarding people, places, and times conflict, so that we cannot accept all three. However, I argue that there are some cases where we should give priority to times (...) over people, suggesting that there is impersonal value to the distribution of high quality life over different times. (shrink)

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This article has three main parts, Section 2 considers the nature and extent to which individuals who are well-off have a moral obligation to aid the worlds needy. Drawing on a pluralistic approach to morality, which includes consequentialist, virtue-based, and deontological elements, it is contended that most who are well-off should do much more than they do to aid the needy, and that they are open to serious moral criticism if they simply ignore the needy. Part one also focuses on (...) the United States, and illustrates both how incredibly wealthy the U.S. is and some of the spending habits of its citizens; however, its considerations apply to the well-off generally. Section 3 considers whether justice provides reasons for helping the needy. Noting that justice in an extremely complex notion, it discusses numerous considerations relevant to justices scope and implications, including an extended Rawlsian conception of justice, an absolute conception, a comparative conception, the distinction between natural and social justice, and various elements of common-sense morality. Section 2 also distinguishes between agent-relative justice-based reasons, which are relevant to whether we act justly, and agent-neutral justice-based reasons, which are relevant to whether we have reasons of justicefor acting. Correspondingly, it argues that even if one can ignore the needy without acting unjustly, as philosophers like Robert Nozick and Jan Narveson contend, there may be powerful reasons of justicefor addressing their plight. Section 4 briefly address the responsibilities of international organizations like the World Bank, the International Monetary Fund (IMF), and World Trade Organization (WTO). Drawing on Section 2, it is suggested that in addition to standard reasons to act justlytowards needy members of the worlds community, there will be reasons of justicefor such organizations to aid the needy in both present, and future, generations. The article concludes by contending that the well-off in countries like the U.S. have reason to view international organizations like the World Bank, IMF, and WTO as their agents, and to seek to insure that they alleviate misfortunes amongst the worlds needy. (shrink)

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This chapter contains sections titled: Distinguishing Different Kinds of Egalitarianism Equality, Fairness, Luck, and Responsibility Equality of What? The Subsistence Level, Sufficiency, and Compassion Prioritarianism and the Leveling Down Objection19 Equality or Priority? Illustrating Egalitarianism's Distinct Appeal Conclusion Notes.

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In "Intrzmsitivity and thc Person-Affecting Principlc,"‘ (IPAP) Alastair Norcross attacks several key claims of my "Intransitivity and thc Merc Addition Paradox" (IMAP).2 This article suggests that N0rcross’s arguments despite: their appca1——lcavc IMAP’s claims mostly intact. Bcforc assessing N0rcross’s arguments, lct mc characterize two key notions distinguished in IMAP: an essentially comparative view of moral ideals and an intrinsic aspect view. On an essentially comparative view (ECU, different factors might bc relevant for comparing diffcrcnt alternatives regarding a given idcal. On such (...) a view, how bad a situation is regarding E1 given ideal is not an intrinsic feature of that situation. There is 110 fact of thc matter.. (shrink)

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In recent years, there has been a growing groundswell of support for the idea that universal health coverage should be provided even in the developing world. While I wholeheartedly agree with the eventual goal of attaining universal health coverage globally, and the sooner the better, I have worries as to whether the world's rich countries, or institutions like the World Health Organization, should be pushing the world's poorest countries to take whatever steps are necessary to achieve that goal. My fear (...) is that universal health coverage in the developing world is an intoxicating, but potentially dangerous, idea whose time may not yet have come. This article's aim is not to settle the question of whether the developing world should be urged, or pushed, to adopt policies of universal health coverage. It is merely to explore some worries about the wisdom of such a tack. The article is divided into eight sections. In Section 1, I give a brief introduction. In Section 2, I provide some background for my topic. In Section 3, I discuss the notion of universal health coverage, and what the push for such a goal in the developing world seemingly involves. In Section 4, I raise some general worries I have about the push for universal health coverage in the developing world. In Section 5, I present a wide range of possible justifications for universal health coverage in the developing world. In Section 6, I discuss whether any of the purported justifications of universal health coverage in the developing world actually do so. In Section 7, I consider some comments, objections, and responses. Finally, in Section 8, I offer a brief conclusion. (shrink)

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This article discusses Jan Narveson's "Welfare and Wealth, Poverty and Justice in Today's World," and "Is World Poverty a Moral Problem for the Wealthy?" and their relation to my "Thinking about the Needy, Justice, and International Organizations." Section 2 points out that Narveson's concerns differ from mine, so that often his claims and mine fail to engage each other. For example, his focus is on the poor, mine the needy, and while many poor are needy, and vice versa, our obligations (...) may differ regarding the poor than regarding the needy. Also, Narveson invokes a narrow conception of morality as those rules that government or society may compel people to follow. Given a broader, more plausible, conception of morality, many of Narveson's claims actually support my substantive views. Section 3 shows that many of Narveson's claims are relevant to the best means of aiding the needy, but do not challenge the validity of that end. This is true, for example, of his claims about the role of poor governments, the importance of freedom, the undesirability of mere "handouts," and the effects of bad economic policies. Section 4 defends the importance of my distinction between acting justly and acting for reasons of justice. It illustrates that on several widely shared conceptions of justice there might be agent-neutral reasons of justice to aid the needy, even if from an agent-relative perspective one would not be acting unjustly if one failed to do so. Section 5 contests Narveson's portrayal of egalitarianism as concerned about inequality of wealth, per se, as insensitive to prior wrongs, and as holding that the worse-off have a right to be made better off at the expense of the well-off. In addition, it rejects Narveson's contention that egalitarians violate impartiality, and aim to impose their personal tastes on others. Section 6 challenges a fundamental assumption underlying Narveson's doctrine of mutual advantage. In addition, it denies that egalitarians are irrational merely because equality can conflict with the pareto principle. More generally, by appealing to impersonal ideals, it challenges the widely held view that the pareto principle is a condition of rationality. Section 7 argues that Narveson's meta-ethical assumptions are controversial, internally inconsistent, in tension with his normative views, and ultimately a version of skepticism. In addition, it challenges Narveson's view about the role intuitions play in moral theory. Section 8 clarifies points where Narveson's discussion of my views may be misleading. Finally, the paper notes the role that moral reasons may play in deliberation and action, but emphasizes the philosophical and theoretical nature of my work. My aim is to determine the moral considerations that are relevant to how people should act regarding the needy. Whether people will actually be moved to so act, for those reasons or otherwise, is another matter. (shrink)

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This article is divided into two main sections. In section 1, I highlight some of the most significant results of Parfit's discussion of self-defeating theories in Part I of Reasons and Persons. I then argue, against Parfit, that, depending on the nature of the good, the structure of consequentialist, or agent-neutral, theories does not preclude the possibility that such theories may be self-defeating. In section 2, I discuss Parfit's ingenious argument against the self-interest theory, to the effect that as a (...) “hybrid” theory, which is “partial” with respect to people but “neutral” with respect to time, the self-interest theory occupies a dangerous middle ground that is open to attack from two sides: on one side, by a “pure” theory that is partial with respect to both people and times, and on the other side, by a “pure” theory that is neutral with respect to both people and times. I then raise doubts, prompted by the form of Parfit's argument, as to whether there is a general requirement that we treat people, places and times the same, except, perhaps, in cases involving special relations. Specifically, I suggest that there may be reason to treat space differently than time, and that there are compelling reasons to treat persons differently than time. (shrink)

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As I read Paula Casal's excellent paper, ‘Sexual Dimorphism and Human Enhancement,’1 three thoughts kept circulating through my mind. First, I found myself largely in agreement with virtually everything she wrote. In particular, if Casal was being accurate and fair in writing that ‘Robert Sparrow alleges that those who…advocate biomedical welfare enhancements are committed to selecting only female embryos because women live longer than men,’1 then she has given compelling reasons for believing that that claim is, on reflection, as ludicrous (...) as it first sounds! In fact, I can think of many additional reasons to those which Casal forcefully adduced for rejecting the view in question, but I do not see the need to present them here, given the abundance of sufficiently compelling reasons Casal already presented.Second, I confess that as I read Casal's article a strong feeling of shame washed over me in virtue of my being a man! Indeed, I found myself thinking that Jonathan Glover's important and chilling book Humanity: A Moral History of the Twentieth Century2 was misleadingly, and somewhat unfairly, titled. Heretofore, when I have read Glover's powerful book, which details many of the twentieth century's worst instances of large-scale crimes against humanity, I have often been overcome by a sense of shame of the actions of my species, homo sapiens; but Casal's article suggests that perhaps the scope of my shame has been too wide, and grossly unfair to the distaff members of our species! In the well-worked expression ‘man's inhumanity to man,’ the second use of the word ‘man’ undoubtedly extends to all humans, but the first use overwhelming picks out men insofar as it denotes the actual flesh and blood perpetrators of the horrific actions in question . Accordingly, perhaps a …. (shrink)

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Are individuals responsible for the consequences of actions taken by their community? What about their community's inaction or its attitudes? In this innovative book,Larry May departs from the traditional Western view that moral responsibility is limited to the consequences of overt individual action. Drawing on the insights of Arendt, Jaspers, and Sartre, he argues that even when individuals are not direct participants, they share responsibility for various harms perpetrated by their communities.

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This book is a systematic reappraisal of Leibniz’s philosophy of mind. The main argument of this book is easy to state: Leibniz offers a fully natural theory of mind. In today’s philosophical climate, in which much effort has been put into discovering a naturalized theory of mind, Leibniz’s efforts to reach a similar goal 300 years earlier will provide a critical stance from which we can assess our own theories. But while the goals might be similar, the content of Leibniz’s (...) theory significantly diverges from the majority of today’s theories. Leibniz’s philosophy of mind meets the standards of what he would regard as a fully natural theory. Perhaps surprisingly, Leibniz’s theological commitments yield a thoroughgoing naturalizing methodology: the properties of an object are explicable in term of the object’s nature. This book argues that Leibniz pursued his philosophy of mind with this methodology in hand. If we keep this commitment to a naturalizing project in mind, then we will find in Leibniz a rich and interesting philosophy of mind. -/- This book provides an account of Leibniz’s naturalizing constraints and traces them through Leibniz’s philosophy of mind. It covers issues relating to mental representation, perception, sensation, consciousness, memory, and moral identity. (shrink)

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Are individuals responsible for the consequences of actions taken by their community? What about their community's inaction or its attitudes? In this innovative book,Larry May departs from the traditional Western view that moral responsibility is limited to the consequences of overt individual action. Drawing on the insights of Arendt, Jaspers, and Sartre, he argues that even when individuals are not direct participants, they share responsibility for various harms perpetrated by their communities.

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This book presents a comprehensive overview of what the criminal law would look like if organised around the principle that those who deserve punishment should receive punishment commensurate with, but no greater than, that which they deserve.Larry Alexander and Kimberly Kessler Ferzan argue that desert is a function of the actor's culpability, and that culpability is a function of the risks of harm to protected interests that the actor believes he is imposing and his reasons for acting in (...) the face of those risks. The authors deny that resultant harms, as well as unperceived risks, affect the actor's desert. They thus reject punishment for inadvertent negligence as well as for intentions or preparatory acts that are not risky. Alexander and Ferzan discuss the reasons for imposing risks that negate or mitigate culpability, the individuation of crimes, and omissions. (shrink)

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This book introduces Hegel's best-known and most influential work, Phenomenology of Spirit, by interpreting it as a unified argument for a single philosophical claim: that human beings achieve their freedom through retrospective self-understanding. In clear, non-technical prose,Larry Krasnoff sets this claim in the context of the history of modern philosophy and shows how it is developed in the major sections of Hegel's text. The result is an accessible and engaging guide to one of the most complex and important (...) works of nineteenth-century philosophy, which will be of interest to all students and teachers working in this area. (shrink)

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