In the recent literature across philosophy, medicine and public health policy, many influential arguments have been put forward to support the use of randomization procedures to allocate scarce life-saving resources. In this paper, I provide a systematic categorization and a critical evaluation of these arguments. I shall argue that those arguments justify using randomization procedures to allocate scarce life-saving resources in fewer cases than their proponents maintain and that the relevant decision makers should typically allocate scarce life-saving resources directly to (...) the individuals with the strongest claims to these resources rather than use randomization procedures to allocate such resources. (shrink)

According to a common view, in a case involving an indivisible good and several potential beneficiaries, who are equal in every relevant respect, there is a non-instrumental reason to allocate the benefit in a way that gives each an equal chance to receive the benefit. In this paper, I argue that this view is incompatible with several plausible and widely held assumptions. I emphasize especially the assumption that the distributive role of chances is secondary to that of benefits in an (...) important sense: the value of allocating chances is related to the ways in which it is possible to allocate the relevant benefits. Specifically, chances should be allocated only when it is impossible or too costly to allocate benefits in accordance with the relative importance of the reasons in favor of allocating the relevant benefit to each potential beneficiary. Given this assumption, I argue that the fact that there is no relation between the distributive concern for chances and other distributive concerns suggests that we should reject the view that chances have a distributive role that is not merely instrumental. (shrink)

Thinking about misleading higher-order evidence naturally leads to a puzzle about epistemic rationality: If one’s total evidence can be radically misleading regarding itself, then two widely-accepted requirements of rationality come into conflict, suggesting that there are rational dilemmas. This paper focuses on an often misunderstood and underexplored response to this (and similar) puzzles, the so-called conflicting-ideals view. Drawing on work from defeasible logic, I propose understanding this view as a move away from the default metaepistemological position according to which rationality (...) requirements are strict and governed by a strong, but never explicitly stated logic, toward the more unconventional view, according to which requirements are defeasible and governed by a comparatively weak logic. When understood this way, the response is not committed to dilemmas. (shrink)

This article addresses a previously overlooked problem in the ethics of defensive killing. Everyone agrees that defensive killing can only be justified when it is necessary. But necessary for what? That seemingly simple question turns out to be surprisingly difficult to answer. Imagine Attacker is trying to kill Victim, and the only way one could save Victim is by killing Attacker. It would seem that, in such a case, killing is necessary. But now suppose there is some other innocent person, (...) suffering some entirely distinct threat, whose life one could save instead. Is killing still necessary? The seemingly obvious answer is “yes.” Killing is necessary since it is the only means to achieve the goal that stands to justify killing. The problem with this answer is that it presupposes a certain description of that goal as something like “saving Victim’s life” or “saving Victim’s life from Attacker.” Other descriptions are plausible, such as “saving a life.” On that latter description, killing is unnecessary in this case. The problem we are encountering is the problem of finding the right description of the goal of killing. Call this the “description problem.” This article sets out to solve the description problem and arrives at a radical conclusion. In a variety of cases, we should describe the goal of killing in broad terms, without reference to a specific victim or a specific threat. These broad descriptions—such as “saving a life”—make it easier to find relevant alternatives. Killing, it turns out, is much harder to justify than we might otherwise have thought. (shrink)

Philosophical theories of fairness propose to divide a good that several individuals have a claim to in proportion to the strength of their respective claims. We suggest that currently, these theories face a dilemma when dealing with a good that is indivisible. On the one hand, theories of fairness that use weighted lotteries are either of limited applicability or fall prey to an objection by Brad Hooker. On the other hand, accounts that do without weighted lotteries fall prey to three (...) fairness paradoxes. We demonstrate that division methods from apportionment theory, which has hitherto been ignored by philosophical theories of fairness, can be used to provide fair division for indivisible goods without weighted lotteries and without fairness paradoxes. (shrink)

According to psychological research, people are more eager to help identified individuals than unidentified ones. This phenomenon significantly influences many important decisions, both individual and public, regarding, for example, vaccinations or the distribution of healthcare resources. This paper aims at presenting definitions of various levels of identifiability as well as a critical analysis of the main philosophical arguments regarding the normative significance of the identifiability effect, which refer to: (1) ex ante contractualism; (2) fair distribution of chances and risks; (3) (...) anti-aggregationist principles that recommend the distribution of bad effects and the concentration of good ones. I will show that these arguments, although connected with interesting philosophical problems regarding e.g. counterfactuals, aggregation, or probability, are unconvincing. (shrink)

Waiting time is widely used in health and social policy to make resource allocation decisions, yet no general account of the moral significance of waiting time exists. We provide such an account. We argue that waiting time is not intrinsically morally significant, and that the first person in a queue for a resource does not ipso facto have a right to receive that resource first. However, waiting time can and sometimes should play a role in justifying allocation decisions. First, there (...) is a duty of fairness prohibiting line-cutting where a sufficiently just queue exists. Second, waiting time has several morally attractive features that can justify its incorporation into allocation schemes. Where candidates are in relevantly similar circumstances, allocating by waiting time is relatively efficient, maximizes distribution equality relative to other Pareto efficient distributions, and treats candidates fairly. The claim that allocation using waiting time is fair is controversial. Some have claimed that formal lotteries are a fairer way to select among equal beneficiaries. We argue that lotteries are no fairer than allocation based on waiting time when it is equiprobable how a prospective queue will be ordered. In practice, lotteries share many of the disadvantages of queues; which is fairer will depend on contingent features of the allocation scenario. The upshot is that first-come, first-served is in fact a just way to allocate resources in many of the cases where it seems pre-theoretically compelling, and waiting time has unique normative properties which frequently justify its incorporation into resource allocation schemes. (shrink)

Given the inevitability of scarcity, should public institutions ration healthcare resources so as to prioritize those who contribute more to society? Intuitively, we may feel that this would be somehow inegalitarian. I argue that the egalitarian objection to prioritizing treatment on the basis of patients’ usefulness to others is best thought of as semiotic: i.e. as having to do with what this practice would mean, convey, or express about a person's standing. I explore the implications of this conclusion when taken (...) in conjunction with the observation that semiotic objections are generally flimsy, failing to identify anything wrong with a practice as such and having limited capacity to generalize beyond particular contexts. (shrink)

This article addresses a dilemma about autonomous vehicles: how to respond to trade-off scenarios in which all possible responses involve the loss of life but there is a choice about whose life or lives are lost. I consider four options: kill fewer people, protect passengers, equal concern for survival, and recognize everyone’s interests. I solve this dilemma via what I call the new trolley problem, which seeks a rationale for the intuition that it is unethical to kill a smaller number (...) of people to avoid killing a greater number of people based on numbers alone. I argue that killing a smaller number of people to avoid killing a greater number of people based on numbers alone is unethical because it disrespects the humanity of the individuals in the smaller-numbered group. I defend the recognize-everyone’s-interests algorithm, which will probably kill fewer people but will not do so based on numbers alone. (shrink)

I analyze recent discussions about making moral decisions under normative uncertainty. I discuss whether this kind of uncertainty should have practical consequences for decisions and whether there are reliable methods of reasoning that deal with the possibility that we are wrong about some moral issues. I defend a limited use of the decision theory model of reasoning in cases of normative uncertainty.