HEALTH,VITAL GOALS,AND CENTRAL HUMAN CAPABILITIES

I argue for a conception of health as a person's ability to achieve or exercise a cluster of basic human activities. These basic activities are in turn specified through free‐standing ethical reasoning about what constitutes a minimal conception of a human life with equal human dignity in the modern world. I arrive at this conception of health by closely following and modifying Lennart Nordenfelt's theory of health which presents health as the ability to achieve vital goals. Despite its strengths I transform Nordenfelt's argument in order to overcome three significant drawbacks. Nordenfelt makes vital goals relative to each community or context and significantly reflective of personal preferences. By doing so, Nordenfelt's conception of health faces problems with both socially relative concepts of health and subjectively defined wellbeing. Moreover, Nordenfelt does not ever explicitly specify a set of vital goals. The theory of health advanced here replaces Nordenfelt's (seemingly) empty set of preferences and society‐relative vital goals with a human species‐wide conception of basic vital goals, or ‘central human capabilities and functionings’. These central human capabilities come out of the capabilities approach (CA) now familiar in political philosophy and economics, and particularly reflect the work of Martha Nussbaum. As a result, the health of an individual should be understood as the ability to achieve a basic cluster of beings and doings—or having the overarching capability, a meta‐capability, to achieve a set of central or vital inter‐related capabilities and functionings.     

More on the genetical theory of multilevel selection

In my article The genetical theory of multilevel selection, I provided a synthesis of the theory of multilevel selection (MLS) and the theory of natural selection in class‐structured populations. I framed this synthesis within Fisher's genetical paradigm, taking a strictly genetical approach to traits and fitness. I showed that this resolves a number of long‐standing conceptual problems that have plagued the MLS literature, including the issues of ‘aggregate’ vs. ‘emergent’ group traits, ‘collective fitness₁’ vs. ‘collective fitness₂’ and ‘MLS1’ vs. ‘MLS2 ‘. In his commentary, Goodnight suggests this theoretical and conceptual synthesis is flawed in several respects. Here, I show this is incorrect, by: reiterating the theoretical and conceptual goals of my synthesis; clarifying that my genetical approach to traits is necessary for a proper analysis of the action of MLS independently of non‐Darwinian factors; emphasizing that the Price–Hamilton approach to MLS provides a consistent, useful and conceptually superior theoretical framework; and explaining the role of reproductive value in the study of natural selection in class‐structured populations. I also show that Goodnight's contextual analysis treatment of MLS in a class‐structured population is mathematically, biologically and conceptually inadequate.     

What really is the nature of suffering? Three problems with Eric Cassell’s concept of distress

Eric Cassell famously defined suffering as a person’s severe distress at a threat to their personal integrity. This article draws attention to some problems with the concept of distress in this theory. In particular, I argue that Cassell’s theory turns on distress but does not define it, which, in light of the complexity of distress, problematizes suffering in three ways: first, suffering becomes too equivocal to apply in at least some cases that Cassell nevertheless identifies as suffering; second, Cassell’s account does not explain what sort of experience suffering is, resulting in theoretical and practical difficulties in distinguishing it from other medical conditions; third, there is good reason to believe that, in medical contexts, ‘distress’ just means ‘suffering’ or some cognate concept not yet distinguished from it, rendering Cassell’s theory circular. I consider a rebuttal to my objections and reply, concluding that Cassell’s theory of suffering needs a definition of distress to settle what the nature of suffering really is.     

END‐OF‐LIFE CARE IN THE 21st CENTURY: ADVANCE DIRECTIVES IN UNIVERSAL RIGHTS DISCOURSE

This article explores universal normative bases that could help to shape a workable legal construct that would facilitate a global use of advance directives. Although I believe that advance directives are of universal character, my primary aim in approaching this issue is to remain realistic. I will make three claims. First, I will argue that the principles of autonomy, dignity and informed consent, embodied in the Oviedo Convention and the UNESCO Declaration on Bioethics and Human Rights, could arguably be regarded as universal bases for the global use of advance directives. Second, I will demonstrate that, despite the apparent consensus of ethical authorities in support of their global use, it is unlikely, for the time being, that such consensus could lead to unqualified legal recognition of advance directives, because of different understandings of the nature of the international rules, meanings of autonomy and dignity which are context‐specific and culture‐specific, and existing imperfections that make advance directives either unworkable or hardly applicable in practice. The third claim suggests that the fact that the concept of the advance directive is not universally shared does not mean that it should not become so, but never as the only option in managing incompetent patients. A way to proceed is to prioritize work on developing higher standards in managing incompetent patients and on progressing towards the realization of universal human rights in the sphere of bioethics, by advocating a universal, legally binding international convention that would outlaw human rights violations in end‐of‐life decision‐making.     

Global Health Care Justice,Delivery Doctors and Assisted Reproduction: Taking a Note From Catholic Social Teachings

This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the wealthy. After exploring specific discrepancies in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution.     

The Limits of Authenticity in Vietnamese Consumer Markets

In this article, I address the saliency of the concept of "authenticity" in contexts of international law and anthropological inquiry. Using my research findings in Ho Chi Minh City (HCMC), Vietnam, I show that although Vietnamese shoppers distinguish between what they term real and fake goods, they do not share with foreign corporations and international trade organizations a preoccupation with product and brand authenticity. To make this point, I describe four types of goods—model goods, mimic goods, real goods, and fake goods—employed by shoppers in HCMC, and discuss why they have little in common with notions of "authenticity" and "ownership" inherent in international standards of intellectual property. I argue that these conceptual differences in the commercial sphere challenge claims about the universal applicability of intellectual property rights laws and also encourage anthropologists to ask whether authenticity is always a useful tool of cross-cultural understanding.     

Agents and acacias: replies to Dennett,Sterelny, and Queller

The commentaries by Dennett, Sterelny, and Queller on Darwinian Populations and Natural Selection (DPNS) are so constructive that they make it possible to extend and improve the book’s framework in several ways. My replies will focus on points of disagreement, and I will pick a small number of themes and develop them in detail. The three replies below are mostly self-contained, except that all my comments about genes, discussed by all three critics, are in the reply to Queller. Agential views of evolution, discussed by Queller and Dennett, are addressed in my reply to Dennett.     

Wrongness,Responsibility, and Conscientious Refusals in Health Care

In this article, I address what kinds of claims are of the right kind to ground conscientious refusals. Specifically, I investigate what conceptions of moral responsibility and moral wrongness can be permissibly presumed by conscientious objectors. I argue that we must permit HCPs to come to their own subjective conclusions about what they take to be morally wrong and what they take themselves to be morally responsible for. However, these subjective assessments of wrongness and responsibility must be constrained in several important ways: they cannot involve empirical falsehoods, objectionably discriminatory attitudes, or unreasonable normative beliefs. I argue that the sources of these constraints are the basic epistemic, relational, and normative competencies needed to function as a minimally decent health‐care professional. Finally, I consider practical implications for my framework, and argue that it shows us that the objection raised by the plaintiffs in Zubik v. Burwell is of the wrong sort.     

Discussion: Reply to Hitchcock

Christopher Hitchcocks discussion of my use of screening-off in analyzing the causal process of natural selection raises some interesting issues to which I am pleased to reply. The bulk of his article is devoted to some fairly general points in the theory of explanation. In particular, he questions whether or not my point that phenotype screens off genotype from reproductive success (in cases of organismic selection) supports my claim that the explanation of differential reproductive success should be in terms of phenotypic differences, not genotypic differences. I will respond to this and show why the two supposed counter-examples to my position fail.     

A plea for ‘genealogical thinking’ in comparative biology – a rebuttal to the reply of Szucsich,Wirkner, and Pass to my article ‘Deconstructing Morphology’

Scholtz G. in press. A plea for ‘genealogical thinking’ in comparative biology – a rebuttal to the reply of Szucsich, Wirkner, and Pass to my article ‘Deconstructing Morphology’. —Acta Zoologica (Stockholm) 00 : 1–4. Szucsich et al. (in press) claim that – in contrast to my statement – morphological thinking has to be ‘cladistic.’ Based on this premise, they stress the difference between the relationships among states of characters versus those among structures assigned to the same character state as implemented in numerical cladistic reasoning. SEA claim that my approach to the homology concept only deals with the problem of the integration of various character states into the same character, whereas the necessary relationships among structures assigned to the same state are not covered. Based on this distinction, SEA also criticise the application of similarity in my definition of homology. Furthermore, they address the issue of evolutionarily independent units.     

An African theory of bioethics: reply to MacPherson and Macklin

In a prior issue of Developing World Bioethics, Cheryl Macpherson and Ruth Macklin critically engaged with an article of mine, where I articulated a moral theory grounded on indigenous values salient in the sub-Saharan region, and then applied it to four major issues in bioethics, comparing and contrasting its implications with those of the dominant Western moral theories, utilitarianism and Kantianism. In response to my essay, Macpherson and Macklin have posed questions about: whether philosophical justifications are something with which bioethicists ought to be concerned; why something counts as 'African'; how medicine is a moral enterprise; whether an individual right to informed consent is consistent with sub-Saharan values; and when thought experiments help to establish firm conclusions about moral status. These are important issues for the field, and I use this reply to take discussion of them a step or two farther, defending my initial article from Macpherson's and Macklin's critical questions and objections.     

Property as sovereignty in micro: the state/property nexus and the Cyprus Problem

This article shows that landed property can be an exercise of state sovereignty in micro. I argue that property tightly relates to statehood and that the concept of ‘community’ offers us a lens with which to investigate that relation. Property's ‘communal’ character in Cyprus often transcends individual rights to ownership. A house belongs not to an individual, but to persons in their capacity as members of either the Greek-Cypriot or Turkish-Cypriot constitutional communities of the Republic. Focusing on the moral and political claims that ensue from this premise, I show how refugee Cypriots encounter and rearticulate the state in a variety of institutions as they lay claims to property (periousia) – their own or others’. Consequently, I argue that thinking through ‘community’ contributes to understandings of the linkage between property and statecraft (what I call the state/property nexus). In turn, this allows us to better comprehend statehood in post-conflict domains.     

Treatment engagement of individuals experiencing mental illness: review and update

Individuals living with serious mental illness are often difficult to engage in ongoing treatment, with high dropout rates. Poor engagement may lead to worse clinical outcomes, with symptom relapse and rehospitalization. Numerous variables may affect level of treatment engagement, including therapeutic alliance, accessibility of care, and a client's trust that the treatment will address his/her own unique goals. As such, we have found that the concept of recovery‐oriented care, which prioritizes autonomy, empowerment and respect for the person receiving services, is a helpful framework in which to view tools and techniques to enhance treatment engagement. Specifically, person‐centered care, including shared decision making, is a treatment approach that focuses on an individual's unique goals and life circumstances. Use of person‐centered care in mental health treatment models has promising outcomes for engagement. Particular populations of people have historically been difficult to engage, such as young adults experiencing a first episode of psychosis, individuals with coexisting psychotic and substance use disorders, and those who are homeless. We review these populations and outline how various evidence‐based, recovery‐oriented treatment techniques have been shown to enhance engagement. Our review then turns to emerging treatment strategies that may improve engagement. We focus on use of electronics and Internet, involvement of peer providers in mental health treatment, and incorporation of the Cultural Formulation Interview to provide culturally competent, person‐centered care. Treatment engagement is complex and multifaceted, but optimizing recovery‐oriented skills and attitudes is essential in delivery of services to those with serious mental illness.     

The United States of the United Races: a rejoinder

I respond to a review by C. Matthew Snipp, revisiting how my book connects abolitionist leanings to acceptance of racial mixing in the Early Republic. I reiterate that, contrary to the reviewer's claims, the book does not suggest that the defence of interracial marriage has been a thriving social movement. I correct his reading of my chapter on the Civil War era, referring to both the variety of voices present, and the claims of reformers' opponents, who were the only ones who claimed racial mixing was an aim of the abolitionist movement. Lastly, I defend The United States of the United Races against Professor Snipp's characterization of it as a work anticipating a ‘post-racial’ ideal, embodied by racially mixed people, who would be the end point of the obsolescence of race as a relevant analytic tool.     

Active Memory

Collective memory is a phenomenon that receives a different interpretation depending on the discipline within which it is examined. In my research, I will employ ideas and concepts developed within the framework of a sociocultural approach (Wertsch, 2002; Cole, 1996). In particular, I will proceed from the definition of collective memory developed by James Wertsch (2002), who treats collective memory as textually mediated memory, conditioned by various—mainly historical—narratives. Historical narratives (annals, chronicles, history textbooks, etc.) are considered to be cultural instruments promoting collective remembrance. A category I borrow from Wertsch's work (2002) is the concept of the "schematic narrative template," which I will apply as analytic tool in my investigation of the phenomenon of collective memory phenomenon.     

What's in a (Big) Name? The Art and Agency of a Bornean Photographic Collection

This article concerns the photographic collection of Paka anak Otor, the Bidayuh owner of a ‘mini-museum’ in Sarawak, Malaysian Borneo, and how it became entangled in his claims to status within and beyond his village. Superficially, the situation is easily apprehended via two analogous approaches within photographic theory and Southeast Asianist ethnography, which treat objects and images as representations or bearers of power and meaning. Here I suggest that such approaches end up eliding the action-centred nature of Paka's ‘big name’-making ambitions. In response, I approach his photographic collection through an analytical framework deriving from Alfred Gell's seminal theory, Art and Agency (1998), which has hitherto remained marginal to Southeast Asianist anthropology. I argue that, more than merely symbolising or bearing his ‘big name’, Paka's photographs were agentive image-objects that actively instantiated it. I conclude by asking how such an analytical shift might encourage a reconceptualisation of ‘power’ and ‘objecthood’ in Southeast Asianist anthropology.     

Objectivity and Illusion in Evolutionary Ethics: Comments on Waller

In this paper I argue that any adequate evolutionary ethical theory needs to account for moral belief as well as for dispositions to behave altruistically. It also needs to be clear whether it is offering us an account of the motivating reasons behind human behaviour or whether it is giving justifying reasons for a particular set of behaviours or, if both, to distinguish them clearly. I also argue that, unless there are some objective moral truths, the evolutionary ethicist cannot offer justifying reasons for a set of behaviours. I use these points to refute Waller's claims that the illusion of objectivity plays a dispensable role in Ruse's theory, that my critique of Ruse's Darwinian metaethics is built on a false dilemma, that there is nothing to be distressed about if morality is not objective, and that ethical beliefs are subject to a kind of causal explanation that undermines their objectivity in a way that scientific beliefs are not.     

Moral Philosophers Are Moral Experts! A Reply to David Archard

In his article ‘Why Moral Philosophers Are Not and Should Not Be Moral Experts’ David Archard attempts to show that his argument from common‐sense morality is more convincing than other competing arguments in the debate. I examine his main line of argumentation and eventually refute his main argument in my reply.     

Levels of biological plausibility

Notions of mechanism, emergence, reduction and explanation are all tied to levels of analysis. I cover the relationship between lower and higher levels, suggest a level of mechanism approach for neuroscience in which the components of a mechanism can themselves be further decomposed and argue that scientists'' goals are best realized by focusing on pragmatic concerns rather than on metaphysical claims about what is ‘real''. Inexplicably, neuroscientists are enchanted by both reduction and emergence. A fascination with reduction is misplaced given that theory is neither sufficiently developed nor formal to allow it, whereas metaphysical claims of emergence bring physicalism into question. Moreover, neuroscience''s existence as a discipline is owed to higher-level concepts that prove useful in practice. Claims of biological plausibility are shown to be incoherent from a level of mechanism view and more generally are vacuous. Instead, the relevant findings to address should be specified so that model selection procedures can adjudicate between competing accounts. Model selection can help reduce theoretical confusions and direct empirical investigations. Although measures themselves, such as behaviour, blood-oxygen-level-dependent (BOLD) and single-unit recordings, are not levels of analysis, like levels, no measure is fundamental and understanding how measures relate can hasten scientific progress.This article is part of the theme issue ‘Key relationships between non-invasive functional neuroimaging and the underlying neuronal activity''.