Michael Bloomberg's three terms in New York City's mayoral office are coming to a close. His model of governance for public health influenced cities and governments around the world. What should we make of that model? This essay introduces a symposium in which ethicists Sarah Conly, Roger Brownsword and Alex Rajczi discuss that legacy.

In recent years, ‘nudge’ theory has gained increasing attention for the design of population-wide health interventions. The concept of nudge puts a label on efficacious influences that preserve freedom of choice without engaging the influencees’ deliberative capacities. Given disagreements over what it takes genuinely to preserve freedom of choice, the question is whether health influences relying on automatic cognitive processes may preserve freedom of choice in a sufficiently robust sense to be serviceable for the moral evaluation of actions and policies. (...) In this article, I offer an argument to this effect, explicating preservation of freedom of choice in terms of choice-set preservation and noncontrol. I also briefly explore the healthcare contexts in which nudges may have priority over more controlling influences. (shrink)

Adversarial scheme points to situations of rivalry like auctions, public tendering, sports competitions, elections or trials. Thomas Pogge suggested that these schemes have great advantage: they force agents to reveal their full performance. But they also incentivize agents to manipulate the rules. In other schemes with incentives, he also suggests, agents can easily downplay their performance, but won’t engage in rule manipulation to the same extent. In this paper, I will argue that adversarial schemes and other schemes with incentives advantages (...) or disadvantages do not map from one to the other as Pogge suggests. Performance-downplaying also takes place in adversarial schemes, as well as in other schemes with incentives also lead to rule manipulation. I will also argue that there are genuine differences between these two types of schemes. Adversarial schemes have three unique advantages: first, they may be more effective in producing motivational improvements at a lower cost, second, they may lead to an automatic optimization of performances and, third, they may produce unique system benefits. In order to produce these advantages, we must design adversarial schemes properly and use them in the right situation. (shrink)

Rawls’ The Law of Peoples does not offer a clear principled account of the way in which liberal and decent peoples should deal with benevolent absolutisms. Within the Rawlsian framework, benevolent absolutisms are a type of society that respects basic human rights and is not externally aggressive. Rawls rules out the use of coercion to engage with benevolent absolutisms but does not provide an alternative strategy. The article develops one, namely, it argues that liberal and decent peoples should use positive (...) incentives to induce benevolent absolutisms to make their transition to the status of well-ordered peoples. In so doing, it offers a principled way to expand Rawls’ international nonideal theory and, in the process, provides a more nuanced approach to the promotion of political participation in international society. The article draws on the literature on economic statecraft and political theory and constructs an incentive model with seven distinct parameters attached to its definition of incentives. Finally, the article provides a real-world example, of how to concretely implement the incentive mechanism. (shrink)

Public health policies typically assume that there are characteristics and constraints over health that an individual cannot control and that there are choices that an individual could change if he is nudged or provided with incentives. We consider that health is determined by a range of personal, social, economic and environmental factors and we discuss to what extent an individual can control these factors. In particular, we assume that the observed health status of an individual is a result of factors (...) within the individual’s control and constraints the individual faces. We suggest three different constraints: budget, time and psychological constraints and position various determinants of health according to increasing levels of constraint and increasing degrees of individual control. We finally discuss public health policies such as nudging, intervening and rewarding within this new framework and show that the level of constraints and the degree of individual control on health status are essential dimensions to consider when designing and implementing public health policies. (shrink)

Gamification is the use of elements and techniques from video game design in non-game contexts. Amid the rapid growth of this practice, normative questions have been under-explored. The primary goal of this article is to develop a normatively sophisticated and descriptively rich account for appropriately addressing major ethical considerations associated with gamification. The framework suggests that practitioners and designers should be precautious about, primarily, but not limited to, whether or not their use of gamification practices: takes unfair advantage of workers (...) ; infringes any involved workers’ or customers’ autonomy ; intentionally or unintentionally harms workers and other involved parties; or has a negative effect on the moral character of involved parties. (shrink)

Recently, business organizations have increasingly turned to a novel form of non-monetary incentives—that is, “gamification,” which refers to a motivation technique using video game elements, such as digital points, badges, and friendly competition in non-game contexts like workplaces. The introduction of gamification to the context of human resource management has immediately become embroiled in serious moral debates. Most notable is the accusation that using gamification as a motivation tool, employers exploit workers. This article offers an in-depth analysis of the moral (...) charge of exploitation. This article maintains that there are no clear grounds for believing that gamification of labor is exploitative and that if gamification of labor involves a wrong or vice, it must be something other than exploitation. (shrink)

Many public debates over policies aimed at curbing alcohol consumption start from an assumption that policies should not affect ‘responsible’ drinkers. In this article, I examine this normative claim, which I call prudentialism. In the first part of the article, I argue that prudentialism is both a demanding and distinctive doctrine, which philosophers should consider seriously. In the middle sections, I examine the relationship between prudentialism and two familiar topics in public health ethics: the prevention paradox and the relationship between (...) responsibility and solidarity. I argue that standard positions in these debates do not necessarily undermine prudentialism. In the final part of the article, I outline an alternative, more successful, argument against prudentialism: that the categories of ‘responsible’ and ‘irresponsible’ drinking behaviour are not ‘apt’ for use in policy. I show how this objection relates to Elizabeth Anderson's arguments against the more familiar doctrine of ‘luck egalitarianism’. (shrink)

Incentives are typically conceived as a form of trade, and so voluntariness appears to be the only ethical concern. As a consequence, incentives are often considered ethically superior to regulations because they are voluntary rather than coercive. But incentives can also be viewed as one way to get others to do what they otherwise would not; that is, as a form of power. When incentives are viewed in this light, many ethical questions arise in addition to voluntariness: What are the (...) responsibilities of the powerful in using incentives? Can incentives be manipulative or exploitative, even if people are free to refuse them? Like all other forms of power, incentives can be abused. This paper develops criteria for distinguishing their legitimate from their illegitimate uses, viz. legitimacy of purpose, voluntariness, and effect on character. The criteria are then applied to three cases: plea bargaining, recruiting medical research subjects, and motivating children to learn. Thinking of incentives in terms of.. (shrink)

Background There has been growing interest in the use of incentives to increase the uptake of health-related behaviours and achieve desired health outcomes at the individual and population level. However, the use of incentives remains controversial for ethical reasons. An area in which incentives have been not only proposed but used is HIV prevention, testing, treatment and care—each one representing an interconnecting step in the "HIV Cascade." Methods The main objective of this qualitative case study was to document the experiences (...) of health care and service providers tasked with administrating incentivized HIV testing, treatment, and care in British Columbia, Canada. A second objective was to explore the ethical and professional tensions that arise from the use of incentives as well as strategies used by providers to mitigate them. We conducted interviews with 25 providers and 6 key informants, which were analyzed using applied thematic analysis. We also collected documents and took field notes. Results Our findings suggest that incentives target populations believed to pose the most risk to public health. As such, incentives are primarily used to close the gaps in the HIV Cascade by getting the "right populations" to test, start treatment, stay on treatment, and, most importantly, achieve viral suppression. Participants considered that incentives work because they "bring people through the door." However, they believed the effectiveness of incentives to be superficial, short-lived and one-dimensional—thus, failing to address underlying structural barriers to care and structural determinants of health. They also raised concerns about the unintended consequences of incentives and the strains they may put on the therapeutic relationship. They had developed strategies to mitigate the ensuing ethical and professional tensions and to make their work feel relational rather than transactional. Conclusions We identify an urgent need to problematize the use of incentives as a part of the "HIV Cascade" agenda and interrogate the ethics of engaging in this practice from the perspective of health care and service providers. More broadly, we question the introduction of market logic into the realm of health care—an area of life previously not subject to monetary exchanges. (shrink)

In mainstream business and economics, prizes such as the Presidential Medal of Freedom are understood as special types of incentives, with the peculiar features of being awarded in public, and of having largely symbolic value. Informed by both historical considerations and philosophical instances, our study defines fundamental theoretical differences between incentives and prizes. The conceptual factors highlighted by our analytical framework are then tested through a laboratory experiment. The experimental exercise aims to analyze how prizes and incentives impact actual individuals’ (...) behavior differently. Our results show that both incentives (monetary and contingent) and prizes (non-monetary and discretional rewards) boost motivation to perform if awarded publicly, but only prizes crowd in motivation promoting virtuous attitude. (shrink)

We aim to show anti-commodification theorists that their complaints about the scope of the market are exaggerated. There are we agree things that should not be bought and sold but that’s only because they are things people shouldn’t have or do or exchange in the first place. Beyond that we argue there are legitimate moral worries about how we buy trade and sell but no legitimate worries about what we buy trade and sell. In almost every interesting case where they (...) have argued markets are morally impermissible on the contrary we argue such markets are permissible. Where they see the market as having a fundamentally amoral ethos or as tending to corrupt us we see it as moral and morally ameliorative. Where they think the solution is to contract the market we think the solution is to expand it. (shrink)

This is a comprehensive anthology of works concerning the nature of economics as a science, including classic texts and essays exploring specific branches and schools of economics. Apart from the classics, most of the selections in the third edition are new, as are the introduction and bibliography. No other anthology spans the whole field and offers a comprehensive introduction to questions about economic methodology.

(Expected) adverse effects of the ‘ICT Revolution’ on work and opportunities for individuals to use and develop their capacities give a new impetus to the debate on the societal implications of technology and raise questions regarding the ‘responsibility’ of research and innovation (RRI) and the possibility of achieving ‘inclusive and sustainable society’. However, missing in this debate is an examination of a possible conflict between the quest for ‘inclusive and sustainable society’ and conventional economic principles guiding capital allocation (including the (...) funding of research and innovation). We propose that such conflict can be resolved by re-examining the nature and purpose of capital, and by recognising mainstream economics’ utilitarian foundations as an unduly restrictive subset of a wider Aristotelian understanding of choice. (shrink)