Limited aggregation holds that we are only sometimes, not always, permitted to aggregate. Aggregation is permissible only when the harms and benefits are relevant to one another. But how should limited aggregation be extended to cases in which we are uncertain about what will happen? In this article, I provide a challenge to ex post limited aggregation. I reconstruct a precise version of ex post limited aggregation that relies on the notion of ex post claims. However, building a theory of (...) limited aggregation based on ex post claims leads to a dilemma. This shows that ex post limited aggregation is currently far away from being a well-defined alternative, strengthening the case for ex ante limited aggregation. (shrink)

Many epidemics consist in individuals spreading infection to others. From the population perspective, they also have population characteristics important in modeling, explaining, and intervening in epidemics. I analyze epidemiology’s contemporary population perspective through the example of epidemics by examining two central principles attributed to Geoffrey Rose: a distinction between the causes of cases and the causes of incidence, and between “high-risk” and “population” strategies of prevention. Both principles require revision or clarification to capture the sense in which they describe distinct (...) perspectives on the same phenomenon, each perspective capturing a different level of contrastive analysis. (shrink)

Lockdown measures in response to the COVID-19 pandemic involve placing huge burdens on some members of society for the sake of benefiting other members of society. How should we decide when these policies are permissible? Many writers propose we should address this question using cost-benefit analysis, a broadly consequentialist approach. We argue for an alternative non-consequentialist approach, grounded in contractualist moral theorising. The first section sets up key issues in the ethics of lockdown, and sketches the apparent appeal of addressing (...) these problems in a CBA frame. The second section argues that CBA fundamentally distorts the normative landscape in two ways: first, in principle, it allows very many morally trivial preferences—say, for a coffee—might outweigh morally weighty life-and-death concerns; second, it is insensitive to the core moral distinction between victims and vectors of disease. The third section sketches our non-consequentialist alternative, grounded in Thomas Scanlon’s contractualist moral theory. On this account, the ethics of self-defence implies a strong default presumption in favour of a highly restrictive, universal lockdown policy: we then ask whether there are alternatives to such a policy which are justifiable to all affected parties, paying particular attention to the complaints of those most burdened by policy. In the fourth section, we defend our contractualist approach against the charge that it is impractical or counterintuitive, noting that actual CBAs face similar, or worse, challenges. (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)

Many of us believe (1) Saving a life is more important than averting any number of headaches. But what about risky cases? Surely: (2) In a single choice, if the risk of death is low enough, and the number of headaches at stake high enough, one should avert the headaches rather than avert the risk of death. And yet, if we will face enough iterations of cases like that in (2), in the long run some of those small risks of (...) serious harms will surely eventuate. And yet: (3) Isn't it still permissible for us to run these repeated risks, despite that knowledge? After all, if it were not, then many of the risky activities that we standardly think permissible would in fact be impermissible. Nobody has yet offered a principle that can accommodate all of 1-3. In this paper, I show that we can accommodate all of these judgements, by taking into account both ex ante and ex post perspectives. In doing so, I clear aside an important obstacle to a viable deontological decision theory. (shrink)

One proposal to significantly reduce cardiovascular disease is the idea of administering a ‘polypill’—a combination of drugs that reduce the risk of heart disease and carry few side effects—to everyone over the age of 55. Despite their promise, population strategies like the polypill have not been well-accepted. In this article, I defend the polypill by appealing to fairness. The argument focuses on the need to fairly distribute the costs to individuals. While the fact that population strategies like the polypill impose (...) minor costs on everyone has primarily been used to criticize such strategies, I argue that it gives us a reason to support them. I argue that implementing a population strategy with the polypill contributes to the public good of ‘health system capacity’. I then explain that public goods have widely accepted obligations: they carry an obligation to fairly distribute the costs of the goods and prevent free-riding. Thus, we have at least one pro tanto moral reason to implement the polypill. As such, this article challenges the current literature on the topic, which has largely held adopting population strategies like the polypill to be unjustifiable. (shrink)

We frequently engage in activities that impose a risk of serious harm on innocent others in order to realise trivial benefits for ourselves or third parties. Many moral theories tie the evidence-relative permissibility of engaging in such activities to the size of the risk that an individual agent imposes. I argue that we should move away from such a reliance on quantified individual risks when conceptualising morally permissible risk imposition. Under most circumstances of interest, a conscientious reasoner will identify a (...) gap between the factors they deem potentially relevant to the riskiness of an agent’s behaviour, and the factors they are reasonably able to quantify. This then leads a conscientious reasoner to conclude that they cannot, in good faith, come up with a quantitative risk estimate that is genuinely tailored to the agent’s particular situation. Based on this, I argue that principles of morally permissible risk imposition fail to provide us with practical guidance if they ask us to take into account our agent-specific risks in a quantified manner. I also argue that principles of permissible risk imposition which appeal to quantified individual risks implausibly imply that it is frequently indeterminate whether engaging in some risky activity is morally permissible. For both of these reasons, I contend that principles of morally permissible risk imposition should make no reference to quantified individual risks. They should instead acknowledge that any quantitative estimates that an agent might usefully be able to consider will likely not be tailored to the agent’s idiosyncratic situation. (shrink)

Philosophy of epidemiology has recently emerged as a distinct branch of philosophy. The field will surely benefit from pluralism, reflected in the broad range of topics and perspectives in this special issue. Here, I argue that a healthy pluralistic field of philosophy of epidemiology has social responsibilities that require the field as a whole to engage actively with research on social determinants of health and health disparities. Practicing epidemiologists and the broader community of public health scientists have gradually acknowledged that (...) much of their attention ought to be paid to these, i.e. inequitable between-population health variations that largely reflect the world’s inequitable distribution of resources and social conditions. The paper illustrates how and why health disparities and social determinants of health, through no ill will, become de facto secondary concerns in Alex Broadbent’s field-defining Philosophy of Epidemiology, showing the ease with which these topics can be incidentally sidelined. As means for philosophy of epidemiology to meet its social responsibility obligations, I suggest philosophy of epidemiology expand its attention to two particular lines research. First, the paper discusses Geoffrey Rose’s concept of “causes of incidence”—causes of disparities between populations—and argues for the importance of engaging with these causes. Second, the paper argues for the value of engaging with Bruce Link and Jo Phelan’s “fundamental causes” model of how flexible social resources serve as buffers from harms, generating a plethora of shifting and locally-contingent health effects. (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)

Medical interventions that cure or prevent medical conditions are central to medicine; and thus, understanding them is central to our understanding of medicine. My purpose in this paper is to explore the conceptual foundations of medicine by providing a singular analysis of the concept of a ‘preventive or curative medical intervention’. Borrowing a general account of prevention from Phil Dowe, I provide an analysis of prevention, cure, risk reduction, and a preventive or curative intervention, before turning to preventive and curative (...) medical interventions. The resulting counterfactual-mechanistic account holds that preventive and curative medical interventions reduce the probability of a medical condition in an actual population compared to their counterfactual omission, commonly by disrupting an etiological or constitutive mechanism for the condition. (shrink)