Background: Flourishing and belonging are key concepts for the wellbeing of staff and the success of a profession. Alienation and anomie are distinct types of psycho-social ills which inhibit flourishing and belonging. A better understanding of these may offer hope in preventing many negative work endpoints, including burnout and intention to leave. Objectives: To systematically review and narratively synthesise alienation and/or anomie in pharmacists across the globe, reviewing all types of methodological designs, published in peer-reviewed journals. Methods: We identified published peer-reviewed research through searching eight electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science - Core Collection, Scopus, and Google Scholar) and extensive hand/citation searching. Two independent reviewers identified and critiqued eligible studies, extracted data, and synthesised the findings. The synthesis evaluated the focuses, causes, associated factors, and/or consequences of alienation and/or anomie and aligned these to six deductive themes from alienation theory: care; values; meaning; recognition; autonomy; and shared responsibility. Results: Searches identified 886 papers, with 47 included in the final results. From the synthesis, ten key causes of alienation and/or anomie were identified; 1) Changing Professional Identity, 2) Reimbursement Models & Corporatisation, 3) Focus on Medicines Rather than People, 4) Misunderstanding & Deprofessionalisation, 5) Environments & Culture, 6) Suboptimal Societal Mandate, 7) Roles Misaligned with Aspirations, 8) Systematic Underutilisation, 9) Lack of Professional Agency, and 10) Value Conflict. From the evidence, there was high confidence that inhibitions of care, values, recognition, and/or autonomy (four of the six deductive themes) were associated with alienation and/or anomie. Conclusion: Alienation and/or anomie are present across many countries and regions. This paper helps us understand the aetiology of this complex psycho-social syndrome, a necessary first step in creating an inclusive profession where all pharmacists can flourish. Future research needs to trial new interventions targeted at correcting this professional malady.

The term ‘clinician’ is not reserved for any healthcare professional group. However, there is a general acceptance that a clinician would have the knowledge, skills and behaviours to enable them to clinically assess and manage a patient autonomously. The expectation, in a modern collaborative healthcare system, is that this work would be completed as a part of a planned and integrated multi-disciplinary care delivery structure, where any given clinician delivers a devolved element of that patient’s care. Forthcoming changes to regulation and professional development pathways in the UK will have a profound impact on pharmacist professional identity and practice. From 2026, all new UK pharmacist registrants will have full independent prescribing rights. A paradigm shift is expected to enable the development of a Pharmacist Clinician Model, incorporating pharmaceutical care needs with wider clinical assessment, diagnostic, and clinical management responsibilities. Consideration is given to this model and its implications. Changes to regulation, policy, education, and the governance required to deliver safe and effective pharmacist clinicians are outlined. A philosophical critique on the nature of being a clinician, and the differentiation of pharmacist clinician roles compared to other healthcare professions, is given. A further examination of the projected risks and expected benefits of this transformative practice model are then explored.

IntroductionEpisodes of alienation and/or anomie in pharmacists have been reported in historical accounts since the 19th century. Alienation and anomie are distinct types of psychological or social ills where people are problematically separated from, or their skills and values are misaligned with, others and their environment. Alienation and/or anomie can be important precursors of many negative work experiences, including job dissatisfaction, burnout and/or intention to leave.Methods and analysisWe aim to study alienation and/or anomie in pharmacists from across the globe, reviewing all types of methodological designs, published in peer-reviewed journals, including all primary qualitative, quantitative and/or mixed-method research studies. We will narratively describe any focuses, causes, associated factors and/or consequences of alienation and/or anomie. We will identify all published peer-reviewed research by searching seven electronic databases (MEDLINE, Embase, APA PsychINFO, CINAHL Plus, Cochrane Library, Web of Science Core Collection and Scopus) and Google Scholar in May 2024. Extensive hand and citation-searching will also take place. Two independent reviewers will identify eligible studies, conduct a critical appraisal of the study conduct, extract data and synthesise reported findings by narratively exploring relationships within and between studies. The synthesis will follow a hybrid thematic analysis. Initially, we will deductively structure the findings according to six themes from underpinning alienation and anomie theory: Care, Values, Meaning, Recognition, Autonomy and Shared Responsibility. This structure may thereafter be inductively adapted, by creating new additional themes, if required from the data. A GRADE Confidence in the Evidence from Reviews of the Qualitative research approach will be used to determine a confidence profile of each theme. A thematic map showing the links between themes will also be produced.Ethics and disseminationEthical permission is not required, as this study uses data from published research. Dissemination will be through publication in peer-reviewed journals and conference presentations.PROSPERO registration numberCRD42024536336.

In his Notes on James Mill, in 1844, Karl Marx complained that: … the mediating process between men engaged in exchange is not a social or human process, not human relationship; it is the abstract relationship of private property to private property … men engaged in exchange do not relate to each other as men.And here's Friedrich Engels (1845):The relation of the manufacturer to his operatives has nothing human in it; it is purely economic.I offer a contemporary version of this old objection to markets.I argue that efficient markets alienate us from one another by inhibiting care in market contexts.Alienation objections to markets have surprisingly few defenders in contemporary moral or political philosophy -certainly as contrasted with distributive objections or concerns about exploitation. 1 One explanation of the waning influence of alienation objections to markets is a problematic inference from the fact that individuals can enter into exchanges for lots of different kinds of reasons.You can sell your cow to help yourself, to help the buyer, or perhaps to help the cow.It 1.For a sense of the richness of these other discussions, see Cohen (2008), Roemer (2017), Anderson (1993), andSatz (2010).As for the alienation objection: liberal egalitarians generally avoid critiquing economic motives beyond the basic structure (for discussion, see Scheffler 2010, ch. 4, and Cohen 2008, chs. 1 and 3).Libertarians are satisfied with exchanges that respect basic rights (cf.Friedman 1970, Brennan & Jaworski 2015).Discussions among socialists tend to be either uncritical of market alienation (Cohen (2001, 81); Honneth (2017, 16)); or unduly optimistic that the basis for would-be alienation in market relationships can be compensated by other areas of social and political life (Miller 1989, ch.8; Carens 1981, 204-206).There are two exceptional accounts of Marxian alienation: Brudney 1998 and Kandiyali 2020.However, these theorists do not engage directly with the arguments for markets.Meanwhile, a related alienation objection to impartial moral theories has been extremely influential in contemporary moral philosophy: especially Williams 1973, Railton 1984, Wolf 2012b.There are no applications of these contemporary discussions of alienation in moral philosophy back to political economy.

We use normative reasons in a bewildering variety of different ways. And yet, as many recent theorists have shown, one can discern systematic distinctions underlying this complexity. This paper is a contribution to this project of constructive normative metaphysics. We aim to bring a black sheep back into the flock: the balancing model of weighing reasons. This model is threatened by a variety of cases in which distinct reasons overlap, in the sense that they do not contribute separate weight for or against an option. Our response is to distinguish between derivative reasons and load-bearing reasons, only the latter of which contribute non-overlapping weight to an option. This distinction is close at hand for analyses of reasons in terms of the promotion of significant outcomes. But we also develop an account of this distinction for fundamentalist theories of normative reasons.

An ethical theory is alienating if accepting the theory inhibits the agent from fitting participation in some normative ideal, such as some ideal of integrity, friendship, or community. Many normative ideals involve nonconsequentialist behavior of some form or another. If such ideals are normatively authoritative, they constitute counterexamples to consequentialism unless their authority can be explained or explained away. We address a range of attempts to avoid such counterexamples and argue that consequentialism cannot by itself account for the normative authority of all plausible such ideals. At best, consequentialism can find a more modest place in an ethical theory that includes nonconsequentialist principles with their own normative authority.

It is plausible that there is a distinctively epistemic standard of correctness for belief. It is also plausible that there is a range of practical reasons bearing on belief. These theses are often thought to be in tension with each other. To resolve the tension, the authors draw on an analogy with a similar distinction between types of reasons for actions in the context of activities. This motivates a two-level account of the structure of normativity. The account relies upon a further distinction between normative reasons and authoritatively normative reasons. Only the latter constitutively play the functional role of explaining what state one just plain ought to be in. The authors conjecture that all and only practical reasons are authoritative. Hence, in one important sense, all reasons for belief are practical reasons. But this account also preserves the autonomy and importance of epistemic reasons.

It is plausible that there are epistemic reasons bearing on a distinctively epistemic standard of correctness for belief. It is also plausible that there are a range of practical reasons bearing on what to believe. These theses are often thought to be in tension with each other. Most significantly for our purposes, it is obscure how epistemic reasons and practical reasons might interact in the explanation of what one ought to believe. We draw an analogy with a similar distinction between types of reasons for actions in the context of activities. The analogy motivates a two-level account of the structure of normativity that explains the interaction of correctnessbased and other reasons. This account relies upon a distinction between normative reasons and authoritatively normative reasons. Only the latter play the reasons role in explaining what state one ought to be in. All and only practical reasons are authoritative reasons. Hence, in one important sense, all reasons for belief are practical reasons. But this account also preserves the autonomy and importance of epistemic reasons. Given the importance of having true beliefs about the world, our epistemic standard typically plays a key role in many cases in explaining what we ought to believe. In addition to reconciling (versions of) evidentialism and pragmatism, this two-level account has implications for a range of important debates in normative theory, including the interaction of right and wrong reasons for actions and other attitudes, the significance of reasons in understanding normativity and authoritative normativity, the distinction between ‘formal’ and ‘substantive’ normativity, and whether there is a unified source of authoritative normativity. Section One: Introduction It is exceedingly plausible that there are distinctively epistemic reasons that provide normative support for or against beliefs.2 Call this thesis evidentialism. For instance, the fact that you see a walrus on the ottoman is a reason to believe there is a walrus on the ottoman. A stronger thesis, anti-pragmatism, maintains that epistemic reasons are the only kinds of reasons for belief. This thesis is significantly less attractive than evidentialism since a range of different cases provide support for the idea that we have practical reasons for belief. 1 Both authors contributed equally. 2 For simplicity, we talk as though all epistemic reasons are evidential; for some reasons to doubt this restriction, see, e.g., Wright (2004) and Schroeder (2015). Throughout, we will be neutral between different varieties of evidentialism and different ways of distinguishing epistemic reasons.

It is plausible that there is a distinctively epistemic standard of correctness for belief. It is also plausible that there are a range of practical reasons bearing on belief. These theses are often thought to be in tension with each other. To resolve the tension, we draw on an analogy with a similar distinction between types of reasons for actions in the context of activities. This motivates a two-level account of the structure of normativity. The account relies upon a further distinction between normative reasons and authoritatively normative reasons. Only the latter constitutively play the functional role of explaining what state one just plain ought to be in. We conjecture that all and only practical reasons are authoritative. Hence, in one important sense, all reasons for belief are practical reasons. But this account also preserves the autonomy and importance of epistemic reasons. Section One: Introduction It is exceedingly plausible that there are distinctively epistemic reasons that provide normative support for or against beliefs.2 Call this thesis evidentialism. For instance, the fact that you see a walrus on the ottoman is a reason to believe there is a walrus on the ottoman. A stronger thesis, anti-pragmatism, maintains that epistemic reasons are the only kinds of reasons for belief. This thesis is significantly less attractive than evidentialism since a range of different cases provide support for the idea that we have practical reasons for belief. Special thanks to two anonymous referees for extraordinarily helpful feedback, and to Sinan Doğramacı, who gave comments on a predecessor at the Southern California Epistemology Workshop at the Pacific APA in 2017. Thanks to Derek Baker, Rima Basu, Selim Berker, Darren Bradley, Michael Bratman, Chris Cowie, Jorah Dannenberg, Edward Elliot, Matti Eklund, Chris Howard, Nadeem Hussain, Jessica Isserow, Jessica Keiser, Benjamin Kiesewetter, Matt Kotzen, Krista Lawlor, Taylor Madigan, Meghan Maguire, Susanne Mantel, Milan Mossé, Austen McDougal, Erum Naqvi, Ram Neta, David Plunkett, Andrew Reisner, Susanna Rinard, Kate Ritchie, Léa Salje, Geoff Sayre-McCord, Karl Schafer, Daniel Star, Pekka Väyrynen, Robbie Williams, and to participants at the Pacific APA in 2017, the Normativity Workshop, NYU Abu Dhabi in 2016, the Workshop on Epistemic Consequentialism at the University of Kent, June 2015, the Centre for Ethics and Metaethics (at Leeds), and a graduate seminar at Stanford in 2017. 1 Order is alphabetical. Both authors contributed equally. Contractions are all Jack’s. 2 For simplicity, we assume all epistemic reasons are evidential; for some arguments against this, see, for example, Wright (2004), Talbot (2014), Schroeder (2015). Throughout, we will be neutral between different varieties of evidentialism and different ways of distinguishing epistemic reasons.

Semiotic objections to market exchange of goods or services maintain that such markets signal an inappropriate attitude to the goods or to associated individuals, and that this provides a weighty reason against having or participating in such markets. Such objections are to be distinguished from more familiar worries, for instance that markets in particular goods lead to exploitation (e.g. markets in prostitution or child labor), promote harmful behavior (e.g. markets in chemical weapons), or violate people’s rights (e.g. markets in slaves). Semiotic objections focus on the meaning, signal, or expressive significance of an exchange. According to Michael Walzer, for example, “... when medieval Christians condemned the sin of simony, they were claiming that the meaning of a particular social good, ecclesiastical office, excluded its sale and purchase.”1 Elizabeth Anderson has said that “prostitution is the classic example of how commodification debases a gift value and its giver.” Similar claims have been advanced with reference to a wide variety of goods by scholars like Debra Satz, Michael Sandel, David Archard, Peter Singer, Margaret Radin, and others.2 Recently, Jason Brennan and Peter Jaworski have developed an important argument that aims to undermine all semiotic arguments against markets in one fell swoop.3

An autonomy thesis maintains that facts or propositions in some domain are isolated in some respect from those in some other domain, or perhaps all other domains. This chapter explores the general question of the autonomy of the ethical domain from the non-ethical domain. It discusses three types of ethical autonomy thesis, distinguished by the types of relation maintained not to obtain between the antecedents and consequents in arguments such as these: logical relations, metaphysical relations, and epistemic relations. The chapter suggests that the real motivation for metaphysical and logical autonomy arises from the importance of an epistemological thesis, namely the thesis that non-ethical propositions are irrelevant to the justification of non-derivative ethical propositions. Versions of non-identity restricted to value or morality are inconsistent with familiar brands of ethical naturalism: straightforward reductive realism, analytical naturalism and synthetic naturalism. One can use metaphysical autonomy as a fulcrum to argue that many enthymematic premises are ethical principles.

There are several powerful motivations for neutral value-based deontic theories such as Act Consequentialism. Traditionally, such theories have had great difficulty accounting for partiality towards one's personal relationships and projects. This paper presents a neutral value-based theory that preserves the motivations for Act Consequentialism while vindicating some crucial intuitions about reasons to be partial. There are two central ideas. The first is that when it comes to working out what you ought to do, your friends' interests, the needs of your family, the significance of your own projects and ideals, etc. have more weight than the interests and needs of strangers. Your friends' interests are not (thereby) more neutrally valuable than the interests of others. So there is a difference between the value of an outcome and its deontic significance. The second familiar idea is that reasons are modifiable. Reasons of partiality are reasons the weights of which are a function of the value of the relevant outcome modified by facts about the value of caring about the outcome in question. The resulting principle has various further explanatory advantages; in particular, it accounts for project- and relationship-specific permissions and requirements, both at a time and across time.

It is regrettably common for theorists to attempt to characterize the Humean dictum that one can't get an 'ought' from an 'is' just in broadly logical terms. We here address an important new class of such approaches which appeal to model-theoretic machinery. Our complaint about these recent attempts is that they interfere with substantive debates about the nature of the ethical. This problem, developed in detail for Daniel Singer's and Gillian Russell and Greg Restall's accounts of Hume's dictum, is of a general type arising for the use of model-theoretic structures in cashing out substantive philosophical claims: the question of whether an abstract model-theoretic structure successfully interprets something often involves taking a stand on non-trivial issues surrounding the thing. In the particular case of Hume's dictum, given reasonable conceptual or metaphysical claims about the ethical, Singer's and Russell and Restall's accounts treat obviously ethical claims as descriptive and vice versa. Consequently, their model-theoretic characterizations of Hume's dictum are not metaethically neutral. This encourages skepticism about whether model-theoretic machinery suffices to provide an illuminating distinction between the ethical and the descriptive.

A dogma of contemporary ethical theory maintains that the nature of normative support for affective attitudes is the very same as the nature of normative support for actions. The prevailing view is that normative reasons provide the support across the board. I argue that the nature of normative support for affective attitudes 10 is importantly different from the nature of normative support for actions. Actions are indeed supported by reasons. Reasons are gradable and contributory. The support relations for affective attitudes are neither. So-called reasons of the right kind for affective attitudes are facts that make those very attitudes fitting. Unlike reasons, fit-making facts for affective attitudes do not conflict with each other or combine in 15 the explanation of further normative facts. More fit-making facts just make a more complex set of reactions fitting. This result undermines various analyses and unity theses in the philosophy of normativity.

This paper develops the Value-Based Theory of Reasons in some detail. The central part of the paper introduces a number of theoretically puzzling features of normative reasons. These include weight, transmission, overlap, and the promiscuity of reasons. I argue that the Value-Based Theory of Reasons elegantly accounts for these features. This paper is programmatic. Its goal is to put the promising but surprisingly overlooked Value-Based Theory of Reasons on the table in discussions of normative reasons, and to draw attention to a number of areas for fruitful further research.

Since at least 1930, theorists working in moral philosophy and normativity more generally have recognized the importance of accounting for trade-offs in normative theories of what we ought to do.1 The most common way to do this is to appeal to contributory or pro tanto reasons. The thought is that the reasons for and against the options open to the agent interact and compete—in highly complex ways—to support a conclusion about what the agent ought to do, all things considered. On most views, the reasons compete by contributing normative weight for or against the relevant option.2 This thought already raises many interesting questions, and this paper will interact directly with these issues. One goal of the paper, as we’ll see, is to bring out an underappreciated complication for this picture. But our main goal concerns what is largely an orthogonal issue, about the nature of reasons themselves, rather than how they interact to support conclusions about what we ought to do. We argue for what we call a ‘bottom up’ theory of normative reasons, according to which reasons are grounded in some underlying property or state. The most popular bottom up theories are desire-based theories (e.g., Schroeder (2007), Manne (2016)) and value-based theories (e.g., Wedgwood (2009), Maguire (2016)); we also include duty-based theories such as Ross (1930). These theories share a common structure (or at least certain structural features); since our argument is primarily about the structure of reasons, we remain neutral about which bottom up theory is correct. The main goal here is to argue in favor of bottom up theories, as compared to Reasons Fundamentalism, as defended by Scanlon (2014), Parfit (2011), and others. What’s distinctive of Reasons Fundamentalism, for our purposes, is the claim that reasons are not grounded in anything at all, but are rather fundamental. (More carefully, reason relations are fundamental.) The argument turns on a class of phenomena that we group under the heading overlapping reasons. As we’ll see, we group several different kinds of cases under this heading. What they have in common is that they are cases in which the reasons—that is, the facts which are reasons—come apart in some way from what we call the normative contributors—the things that contribute normative weight for or against an option.

There is an interesting tension between certain value-based deontic theories (such as act consequentialism) and certain value-based theories of virtue (such as Thomas Hurka’s Recursive account). The tension arises in cases involving non-instrumental extrinsic value, for instance the value of sadness in response to tragedy. This tension prompts us to look for more sophisticated value-based deontic principles than act consequentialism. This chapter develops such principles. It argues that the weights of reasons to promote extrinsically valuable states of affairs are a function of the value of extrinsically valuable state of affairs and also the value of its condition. This yields a systematic restriction on the separability of reasons. The broadest goal of the chapter is to exhibit some of the resources available to value-based theories of reasons as part of a deontic theory sensitive to pretheoretic intuitions.