David Cummiskey

Reference Failure and Scientific Realism: a Response to the Meta-induction

Pure causal theories of reference cannot account for cases of theoretical term reference failure and do not capture the scientific point of introducing new theoretical terminology. In order to account for paradigm cases of reference failure and the point of new theoretical terminology, a descriptive element must play a role in fixing the reference of theoretical terms. Richard Boyds concept of theory constituitive metaphors provides the necessary descriptive element in reference fixing. In addition to providing a plausible account of reference failure and success, a metaphor approach to reference fixing provides the basis for a plausible realist account of the progress of science. Indeed, the metaphor approach undermines the sceptical force of the meta-induction and Laudans objections to scientific realism.

Dignity, Contractualism and Consequentialism

Kantian respect for persons is based on the special status and dignity of humanity. There are, however, at least three distinct kinds of interpretation of the principle of respect for the dignity of persons: the contractualist conception, the substantive conception and the direct conception. Contractualist theories are the most common and familiar interpretation. The contractualist assumes that some form of consent or agreement is the crucial factor that is required by respect for persons. The substantive conceptions of dignity, on the other hand, treat the concept of dignity as a substantive value that justifies a deontological conception of respect for persons. A third conception of respect for the dignity of persons, the conception that I favor, focuses directly on the special value of our rational nature. According to this consequentialist conception, we respect the dignity of persons by promoting the flourishing of rational nature.

Health Care Justice: The Social Insurance Approach

There are four basic models for health care systems: the private market insurance model, the national single-payer model, the national health service model, and the social insurance model. The social justice debate over health care usually focuses on the comparative efficiency and quality of competitive private market insurance and the universal coverage and equity of national health care systems. It is a mistake, however, to think that a universal right to health care services requires a single-payer, government-run, national health care system. The social insurance model of Germany, France, Japan, and many other countries, deserves more attention, as it incorporates the strengths of both market models and national health care models.

The Right to Die and the Right to Health Care

Two central issues that shape contemporary medical ethics are, on the one hand, the nature and basis of rights to health care, and, on the other hand, the rights of the dying and the role of the physician when death is imminent. The right to health care and the right to die are typically treated as two distinct sets of issues. These issues, however, are not distinct. As we shall see, if there is a right to die, which I argue there is, then there is also a right to health care. In particular, I argue that respect for the autonomy of persons requires that we respect a person’s informed and considered request to hasten death but that concern for persons also supports strong procedural safeguards governing assisted dying. In addition to the normal conditions limiting physician assisted suicide and active euthanasia, I also argue that the right to die provides a justification for a right to health care services.