The articles in this issue of the Journal of Medicine and Philosophy explore emerging technologies, medical innovations, and shifting moral norms, expanding present discussions around topics in bioethics both old and new. Some question whether novel definitions of death and harm change the moral permissibility of killing, particularly at the hands of a physician. Others question how increased or decreased abilities affect responsibility and achievement. Another illustrates how rhetorical appeals to character have been used to justify otherwise morally illicit actions (...) within the clinic. Together, these articles shed new light on topics in the field of bioethics. (shrink)

Sufficientarians face a problem of arbitrariness: why place a sufficiency threshold at any particular point? One response is to seek universal goods to justify a threshold. However, this faces difficulties (despite sincere efforts) by either being too low, or failing to accommodate individuals with significant cognitive disabilities. Some sufficientarians have appealed to individuals’ subjective evaluations of their lives. I build on this idea, considering another individualized threshold: ‘tolerability’. I respond to some traditional challenges to individualistic approaches to justice: ‘expensive’ tastes, (...) and adaptive preferences. Finally, I end by offering some suggestions about how this relates to policymaking. (shrink)

It is generally accepted that morally justified healthcare rationing must be non-discriminatory and cost-effective. However, given conventional concepts of cost-effectiveness, resources spent on disabled people are spent less cost-effectively, ceteris paribus, than resources spent on non-disabled people. Thus, it is reasonable to assume that standard cost-effectiveness discriminates against the disabled. Call this thedisability discrimination problem.Part of the disability discrimination involved in cost-effectiveness stems from the way in which health-related quality of life is accounted for and measured. This paper offers and (...) defends a patient-sensitive account of health-related quality of life, which can effectively make cost-effectiveness less discriminatory against the disabled and thus more morally justified. (shrink)

Quality-Adjusted Life Years (QALYs) and Disability-Adjusted Life Years (DALYs) are two of the most commonly used health measures to determine resource prioritization and the population burden of disease, respectively. There are different types of problems with the use of QALYs and DALYs for measuring health benefits. Some of these problems have to do with measurement, for example, the weights they ascribe to health states might fail to reflect with exact accuracy the actual well-being or health levels of individuals. But even (...) if these weights represent accurately the well-being levels of individuals, there is room for questioning whether these measures capture everything that we care about in these cases, or whether there are important issues that they leave out, including considerations of fairness or equality. In this regard, the measures have been criticized for treating the aggregation of small benefits as greater than the aggregation of fewer but bigger benefits,1for disregarding fair chances in favor of utility maximization,2and for raising problems when applied in the context of variable population size.3Perhaps one of the most pervasive ethical issues that has been associated with the use of these measures is the fact that they seem to discriminate against disabled people.4Since the measures assume that disabled people have lower well-being and a shorter life span, treating a disabled person’s medical condition contributes less to the maximization of years of life with good health than treating a non-disabled patient’s medical condition. (shrink)

In this article, I explore the impact of disability on one of life’s goods: achievement. Contra Campbell, Nyholm, and Walter, I argue that construing the magnitude of achievements in terms of subjective effort trivializes what it means to achieve. This poses a problem for the authors’ argument that disability, in general, does not reduce access to this good. I draw on an alternative construal of achievement that I have proposed elsewhere in order to show that, indeed, many disabilities do not (...) restrict access to achievement. I defend this argument against an objection that it problematically relativizes the achievements of persons with disability, and I close with general lessons for future work. (shrink)

This introduction to the special issue on well-being and health explores the ways that philosophical inquiry into well-being can play a productive role in understanding health and medicine. We offer an explanation of the concept of well-being, central theories of well-being, and how these key topics, along with other cutting-edge issues such as disability and cross-cultural reflections, can contribute to the discourse on the nature of health and medicine. We also provide brief overviews of the essays in this special issue (...) and highlight the significant philosophical implications they have for understanding both well-being and health. (shrink)