In this article, I discuss whether intuitive moral judgements have epistemic value. Are they mere expressions of irrational feelings that should be disregarded or should they be taken seriously? In section 2, I discuss the view of some social psychologists that moral intuitions are, like other social intuitions, under certain conditions more reliable than conscious deliberative judgements. In sections 3 and 4, I examine whether intuitive moral judgements can be said not to need inferential justification. I outline a concept of (...) moral intuition as a seeming whose seemingness resides in special, phenomenological features such as a felt veridicality, appropriateness, familiarity, or confidence, and whose justificatory force is influenced by the reliability of the belief-producing procedures and by a subject's competence in applying moral concepts. I argue that subjects can come to realise that the beliefs expressed in their intuitive judgements evoke a sense of non-inferential credibility. In section 5, I first discuss the contribution of moral expertise to the non-inferential credibility of a person's intuitions. Subsequently, I discuss whether Walter Sinnott-Armstrong is right in saying that we can never claim non-inferential justification for our intuitions because they are subject to all kinds of distorting influences. (shrink)

This essay argues on behalf of a hybrid theory for an ethics of self-defense understood as the Forfeiture-Partiality Theory. The theory weds the idea that a malicious attacker forfeits the right to life to the idea that we are permitted to prefer one's life to another's in cases of involuntary harm or threat. The theory is meant to capture our intuitions both about instances in which we can draw a moral asymmetry between attacker and victim and cases in which we (...) cannot. I develop the theory by attending to instances of intentional, villainous harm and instances of involuntary danger—the latter of which are a matter of bad luck. I call some bad luck cases "Interpersonal Lottery Conflicts." These cases refer to potentially lethal conflicts into which parties are thrown as victims of circumstance. Although neither party has a moral advantage over another, that fact does not preclude permissible self-defense. (shrink)

The participation of vulnerable patients in clinical research poses apparent ethical dilemmas. Depending on the nature of the vulnerability, their participation may challenge the ethical principles of autonomy, non-maleficence, or justice. On the other hand, non-participation may preclude the building of a knowledge base that is a prerequisite for defining the optimal clinical management of vulnerable patients. Such clinical uncertainty may also incur substantial economic costs. We present the participation of pre-menopausal women with atrial fibrillation in trials of novel oral (...) anticoagulant drugs as a case study. Due to their non-participation in pivotal trials, it is uncertain whether for them, the risks that are associated with these drugs are outweighed by the advantages compared with conventional treatment. We addressed the question whether research of this new class of drugs in this subgroup would be appropriate from both, an ethical as well an economic perspective. We used the method of specifying norms as a wider framework to resolve the apparent ethical dilemma, while incorporating the question whether research of oral anticoagulants in premenopausal women with atrial fibrillation can be justified on economic grounds. For the latter, the results of a value-of-information analysis were used. Further clinical research on NOACs in premenopausal women with atrial fibrillation can be justified on both, ethical and economic grounds. Addressing apparent ethical dilemmas by invoking a method such as specifying norms can improve the quality of public practical reasoning. As such, the method should also prove valuable to committees that have formally been granted the authority to review trial protocols and proposals for scientific research. (shrink)

In his seminal work Moral Notions , Julius Kovesi presents a novel account of concept formation. At the heart of this account is a distinction between what he terms the material element and the formal element of concepts. This paper elucidates his distinction in detail and contrasts it with other distinctions such as form-matter, universal-particular, genus-difference, necessary-sufficient, and open texture-closed texture. We situate Kovesi’s distinction within his general philosophical method, outlining his views on concept formation in general and explain how (...) his theory of concept formation is applied in moral philosophy. (shrink)

Two answers to the question ‘how can we allocate health care resources fairly?’ are introduced and discussed. Both utilitarian and egalitarian approaches are found relevant, but both exhibit considerable theoretical and practical difficulties. Neither seems capable of solving the problem on its own. It is suggested that, for practical purposes, a version of Rawls' famous thought experiment might provide at least some enlightenment about which theoretical approach should be used to address the question.

Immediately after the September 11, 2001 terrorist strikes on the World Trade Center Towers, the Pentagon, and a plane over Pennsylvania, many in the West, but particularly the United States of America, felt urgently the pain of the question ‘Why do they hate us?’ in relation both to those who directly perpetrated those dreadful events and to those who sympathised with their perpetrators. In this paper, I will offer an account of some of the conceptual issues at stake in addressing (...) seriously such a question as an opportunity for self-examination. I will argue that questions of this kind are the very warp and weft of international relations at their most serious levels and that the often glib demonisation of ‘them’ who hate us serves us badly in coming to terms with the problems the West faces in its relations with the Muslim world. I use this most pressing of international relations issues as a test of the prospects of Utilitarianism as a viable ‘ethics of international relations’ arguing that its notions of the good and its resources for criticism of desires and preferences are a cause for scandal in our inter-cultural negotiations with other traditions of civilization, particularly the Muslim civilization. In many ways, rather than being part of the solution, Utilitarianism is part of the problem. (shrink)

A comprehensive assessment of a health technology requires that a wide variety of questions are addressed. These range from whether the use of a technology results in achievement of its intended effects (e.g., better tumour control, pain relief, improved mobility, etc.) at acceptable costs and without incurring undue risks to the patient, to whether its use may challenge existing social arrangements and values (e.g., individual responsibility for preserving good health, the value of human life, etc.). Clearly, this is a major (...) challenge, since it requires the use of quite different methods of inquiry. In the past decades, we have rarely witnessed assessments where both types of questions were addressed in a balanced way. Rather, a wide gap exists between inquiries with a strong empirical focus and an almost complete neglect of underlying normative issues, and inquiries which are largely discursive, but with a serious disregard of relevant empirical data. The complex interplay between normative frameworks and empirical data in the assessment of health technologies is illustrated in two case studies: the assessment of surgical management of children with glue ears, and the assessment of Extra Corporeal Membrane Oxygenation in neonates. (shrink)

Health technology assessment (HTA) is often biased in the sense that it neglects relevant perspectives on the technology in question. To incorporate different perspectives in HTA, we should pursue agreement about what are relevant, plausible, and feasible research questions; interactive technology assessment (iTA) might be suitable for this goal. In this way a kind of procedural ethics is established. Currently, ethics too often is focussed on the application of general principles, which leaves a lot of confusion as to what really (...) is the matter in specific cases; in an iTA clashes of values should not be approached by use of such ethics. Instead, casuistry, as a tool used within the framework of iTA, should help to articulate and clarify what is the matter, as to make room for explication and consensus building. (shrink)