Many critics of utilitarianism claim that we should reject interpersonal aggregation because aggregative principles do not take the separateness of persons seriously. In this article, I will reject this claim. I will first elucidate the theoretical structure of aggregation. I will then consider various interpretations of the notion of the separateness of persons and clarify what exactly those critics are trying to reject by appealing to the notion of the separateness of persons. I will argue that none of these interpretations (...) can serve as the ground for rejecting aggregation. (shrink)

I defend the Doctrine of Doing and Allowing: the claim that doing harm is harder to justify than merely allowing harm. A thing does not genuinely belong to a person unless he has special authority over it. The Doctrine of Doing and Allowing protects us against harmful imposition – against the actions or needs of another intruding on what is ours. This protection is necessary for something to genuinely belong to a person. The opponent of the Doctrine must claim that (...) nothing genuinely belongs to a person, even his own body. (shrink)

Thinking is overrated: golfers perform best when distracted and under pressure; firefighters make the right calls without a clue as to why; and you are yourself ill advised to look at your steps as you go down the stairs, or to try and remember your pin number before typing it in. Just do it, mindlessly. Both empirical psychologists and the common man have long worked out that thinking is often a bad idea, but philosophers still hang on to an intellectualist (...) picture of human action. This book challenges that picture and calls on philosophers to wake up to the power of mindlessness: it is our habits, skills and conventions that help us cope with a world way too diverse for us to hope to always reinterpret it. The book presents the empirical evidence that has been accumulating over the last few decades and offers a philosophical analysis of mindless phenomena such as habits, skilled activity, automatic actions, emotional and spontaneous reactions and social conventions, arguing that traditional philosophical theories of action should be revised to do justice to this forgotten but important part of our lives: when we act mindlessly, we are free and fully rational even though we neither deliberate nor are aware of what we are doing. (shrink)

When it comes to epistemic normativity, should we take the good to be prior to the right? That is, should we ground facts about what we ought and ought not believe on a given occasion in facts about the value of being in certain cognitive states (such as, for example, the value of having true beliefs)? The overwhelming answer among contemporary epistemologists is “Yes, we should.” This essay argues to the contrary. Just as taking the good to be prior to (...) the right in ethics often leads one to sanction implausible trade-offs when determining what an agent should do, so too, this essay argues, taking the good to be prior to the right in epistemology leads one to sanction implausible trade-offs when determining what a subject should believe. Epistemic value—and, by extension, epistemic goals—are not the explanatory foundation upon which all other normative notions in epistemology rest. (shrink)

One-third of all human lives end in early death from poverty-related causes. Most of these premature deaths are avoidable through global institutional reforms that would eradicate extreme poverty. Many are also avoidable through global health-system reform that would make medical knowledge freely available as a global public good. The rules should be redesigned so that the development of any new drug is rewarded in proportion to its impact on the global disease burden (not through monopoly rents). This reform would bring (...) drug prices down worldwide close to their marginal cost of production and would powerfully stimulate pharmaceutical research into currently neglected diseases concentrated among the poor. Its feasibility shows that the existing medical-patent regime (trade-related aspects of intellectual property rights—TRIPS—as supplemented by bilateral agreements) is severely unjust—and its imposition a human-rights violation on account of the avoidable mortality and morbidity it foreseeably produces. (shrink)

The concepts of 'ethical' and 'socially responsible' investment (SRI) have become increasingly popular in recent years and funds which offer this kind of investment have attracted many individual inve... merstors. The present book addresses the issue of 'How ought one to invest?' by critically engaging with the ideas of the proponents of this movement about what makes 'ethical' investing ethical. The standard suggestion that ethical investing simply consists in refraining from investing in certain 'morally unacceptable companies' is criticised for being (...) both too rigid (often resting on absolute moral rules which lead to an austere conclusion) and too ineffective for individual investors (investors who after all control only a small part of the investment universe). Furthermore, the idea that ethical investing could consist in engaging more actively with the companies one invests in, in order to make them change their ways and become more socially responsible, is criticised for being just as ineffective for individual investors. Some more radical alternatives are elaborated on and defended - for instance, the suggestion that investors should make as much money from their investments as possible and then donate the proceeds to socially worthwhile charities. From similar suggestions, the common idea that there is no conflict between morality and profitability, or that genuinely ethical investing can be just as profitable as mainstream investing, is criticised for being too naïve. Making a difference may indeed require personal sacrifice of investors, but it is argued that the needs of the possible recipients of philanthropy are morally more important than the luxury of investment returns. (shrink)

Suppose the following: Two groups of people require our aid but we can help only one group; there are more people in the first group than the second group; every person in both groups has an equal claim on our aid; and we have a duty to help and no other special obligations or duties. I argue that there exists at least one fairness function, which is a function that measures the goodness of degrees of fairness, that implies that we (...) should follow a procedure of proportional chances to determine which group to aid. (shrink)

What reasons for action do we have? What explains why we have these reasons? This paper articulates some of the basic structural features of a theory that would provide answers to these questions. According to this theory, reasons for action are all grounded in intrinsic values, but in a way that makes room for a thoroughly non-consequentialist view of the way in which intrinsic values generate reasons for aaction.

On commonsense morality, there are two types of situations where an agent is not required to maximize the impersonal good. First, there are those situations where the agent is prohibited from doing so--constraints. Second, there are those situations where the agent is permitted to do so but also has the option of doing something else--options. I argue that there are three possible explanations for the absence of a moral requirement to maximize the impersonal good and that the commonsense moralist must (...) appeal to all three in order to account for the vast array of constraints and options we take there be. (shrink)

This article considers the possible relation between the idea of parity and some past work on the allocation of scarce resources. Parity of value is first connected with the idea of some goods being irrelevant in interpersonal comparisons. The notion of moral parity is introduced to describe the recognition that people who are moral equals (even when they are not on a par in terms of value) as not substitutable. The relation between a Separability Test and nonsubstitutability of persons is (...) considered. These ideas are then used to discuss various cases in which one must choose to whom to provide medical assistance, including whether and when to distinguish morally between a disabled and a nondisabled person. (shrink)

The main purpose of the paper is to present a new framework of meta-ethics which I call the Functional Model of Analysis. It presupposes that the most important meta-ethical question is not “What is the meaning of normative words, sentences and what is the ontological fabric of the moral world?” but “What should morality and ethics be for?”. It is a form of meta-ethics that focuses on finding theoretical resources that can be helpful in understanding ongoing ethical debates between disciples (...) of Aristotle, Epicurus, the Stoics, Augustine, Hobbes, utilitarians and Kant, and in building normative ethical theories that can help us to answer normative questions. As an example of such output I will present a formal sketch of Hybrid Function Consequentialism – a normative ethical theory based upon the meta-ethical framework proposed here. (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)

When allocating scarce healthcare resources, the expected benefits of alternative allocations matter. But, there are different kinds of benefits. Some are direct benefits to the recipient of the resource such as the health improvements of receiving treatment. Others are indirect benefits to third parties such as the economic gains from having a healthier workforce. This article considers whether only the direct benefits of alternative healthcare resource allocations are relevant to allocation decisions, or whether indirect benefits are relevant too. First, we (...) distinguish different conceptions of direct and indirect benefits and argue that only a recipient conception could be morally relevant. We analyze four arguments for thinking that indirect benefits should not count and argue that none is successful in showing that the indirectness of a benefit is a good reason not to count it. We conclude that direct and indirect benefits should be evaluated in the same way. (shrink)

Physicians have long aided their patients in dying in an effort to ease human suffering. It is only in the nineteenth and twentieth centuries that the prolongation of life has taken on new meaning due to the powers now available to physicians, through new drugs and high technology interventions. Whereas earlier physicians and patients could readily acknowledge that nothing further could be done, today that judgment is problematic.Most often, aiding the dying took the form of not doing anything further to (...) prolong life. Morally, this act of restraint was not difficult, because few options could have been considered. However, some physicians, rarely, would help patients die either by hastening death directly or by increasing pain control with the risk of hastening death, the so-called double effect. When directly hastening death, physicians either directly caused the death of the patient through euthansia, or supplied the means to the patient to bring about death with or without encouragement to use these means. The latter is physician-assisted suicide. (shrink)

A traditional picture is that cases of deontic constraints--- cases where an act is wrong (or one that there is most reason to not do) even though performing that act will prevent more acts of the same morally (or practically) relevant type from being performed---form a kind of fault line in ethical theory separating (agent-neutral) consequentialist theories from other ethical theories. But certain results in the recent literature, such as those due to Graham Oddie and Peter Milne in "Act and (...) Value", do not sit well this traditional wisdom. My aim in this paper is to argue that both the traditional wisdom and Oddie and Milne are mistaken. I begin by looking more closely at the traditional wisdom and why it fails (§1). Then I develop my account of this fault line in ethical theory and its importance (§2). Finally I show that a diagnosis of where Oddie and Milne go wrong follows as a corollary of this new account (§3). An important upshot will be that discussions of cases of deontic constraints would do best to focus on the account of the nature and importance of the cases identified in this paper rather than continuing to work with the mistaken traditional picture. (shrink)

Many authors in ethics, economics, and political science endorse the Lottery Requirement, that is, the following thesis: where different parties have equal moral claims to one indivisible good, it is morally obligatory to let a fair lottery decide which party is to receive the good. This article defends skepticism about the Lottery Requirement. It distinguishes three broad strategies of defending such a requirement: the surrogate satisfaction account, the procedural account, and the ideal consent account, and argues that none of these (...) strategies succeed. The article then discusses and discharges some remaining grounds for resistance to these skeptical conclusions, as well as the possibility of defending a weaker version of a normative lottery principle. The conclusion is that we have no reason to believe that where equal claims conflict, we are morally required to hold a lottery, as opposed to simply picking one of the parties on more subjective grounds or out of pure whim. In addition to the practical consequences of this skeptical view, the article sketches some theoretical implications for debates about saving the greater number and about axiomatic utilitarianism. (shrink)

Sidgwick gives various tests for highest certainty. When he applies these tests to commonsense morality, he finds nothing of highest certainty. In contrast, when he applies these tests to his own axioms, he finds these axioms to have highest certainty. The axioms culminate in Benevolence: “Each one is morally bound to regard the good of any other individual as much as his own, except in so far as he judges it to be less, when impartially viewed, or less certainly knowable (...) or attainable by him.” The axioms face challenges from two sides.First, one test requires that a claim not be denied by someone of whom one has no more reason to suspect of error than oneself. For Sidgwick, then, the egoist must not deny the axioms. But it would seem that an egoist would reject benevolence. Second, Sidgwick thinks he must show that the commonsense moralist agrees to the axioms. Benevolence seems to say that the only reason for departing from being bound to treat others like oneself is that more good would be produced. But the commonsense moralist will not agree that this is the only reason. In reply to the threat of an egoist's disagreement, this essay argues that many of the axioms should be read as having as their antecedent “from the point of view of the universe.” The essay replies to the objection that this makes these axioms analytic. In reply to the threat of a commonsense moralist's disagreement, this essay argues that each axiom states, in effect, a prima facie duty. The argument against the commonsense moralist concerns not benevolence but whether there are further duties that pass the tests. The essay raises the worry that here Sidgwick is unfair since sometimes he criticizes all-things-considered versions of commonsense duties; such criticisms would count against benevolence as well. (shrink)

Suppose you can save only one of two groups of people from harm, with one person in one group, and five persons in the other group. Are you obligated to save the greater number? While common sense seems to say ‘yes’, the numbers skeptic says ‘no’. Numbers Skepticism has been partly motivated by the anti-consequentialist thought that the goods, harms and well-being of individual people do not aggregate in any morally significant way. However, even many non-consequentialists think that Numbers Skepticism (...) goes too far in rejecting the claim that you ought to save the greater number. Besides the prima facie implausibility of Numbers Skepticism, Michael Otsuka has developed an intriguing argument against this position. Otsuka argues that Numbers Skepticism, in conjunction with an independently plausible moral principle, leads to inconsistent choices regarding what ought to be done in certain circumstances. This inconsistency in turn provides us with a good reason to reject Numbers Skepticism. Kirsten Meyer offers a notable challenge to Otsuka’s argument. I argue that Meyer’s challenge can be met, and then offer my own reasons for rejecting Otsuka’s argument. In light of these criticisms, I then develop an improved, yet structurally similar argument to Otsuka’s argument. I argue for the slightly different conclusion that the view proposed by John Taurek that ‘the numbers don’t count’ leads to inconsistent choices, which in turn provides us with a good reason to reject Taurek’s position. (shrink)

In the literature on the so-called numbers problem, some authors have recently argued that the individualist lottery (IL) avoids the flaws of the proportional lottery. This article first presents two recent defenses of the IL, and then argues that both are implausible if we focus, as we should, strictly on their non-consequentialist aspects. This conclusion holds even if we take account of the fact that the IL is arguably that solution to the numbers problem which best meets the marginal difference (...) criterion. The upshot is that non-consequentialists should toss a coin rather than spin a wheel in conflict cases (if and when they must do either). (shrink)

Can we render death harmless to us by perfecting life, as the ancient Epicureans and Stoics seemed to think? It might seem so, for after we perfect life—assuming we can—persisting would not make life any better. Dying earlier rather than later would shorten life, but a longer perfect life is no better than a shorter perfect life, so dying would take nothing of value from us. However, after sketching what perfecting life might entail, I will argue that it is not (...) a desirable approach to invulnerability after all. (shrink)

This article discusses the relation between prioritarian and egalitarian principles, whether and why we need to appeal to both kinds of principle, how prioritarians can answer various objections, especially those put forward by Michael Otsuka and Alex Voorhoeve, the moral difference between cases in which our acts could affect only one person or two or more people, veil of ignorance contractualism and utilitarianism, what prioritarians should claim about cases in which the effects of our acts are uncertain, the relative moral (...) importance of actual and expectable benefits, whether people should sometimes be given various chances of receiving benefits, and principles that appeal to competing claims. (shrink)

Faced with a choice between saving one stranger and saving a group of strangers, some people endorse weighted lotteries, which give a strictly greater chance of being saved to the group of strangers than the single stranger. In this paper I attempt to criticize this view. I first consider a particular version of the weighted lotteries, Frances Kamm's procedure of proportional chances, and point out two implausible implications of her proposal. Then, I consider weighted lotteries in general, and claim (1) (...) that the correct thing to distribute is not the chance of being saved but the good of being saved, (2) that assigning some chance to the single stranger is not the only way to give a positive (and equal) respect to the people concerned, and (3) that the weighted lottery appears to be deceptive since it would show the respect to the single stranger in a negligible way. (shrink)

Anti-abortion violence (‘AAV’) is anathema to almost everyone, on all sides of the abortion debate. Yet, as this article aims to show, it is far more difficult than has previously been recognised to avoid the deeply unpalatable conclusion that it can sometimes be justified. Some of the most frequently-occupied positions on the morality of abortion will imply precisely that conclusion, I argue, unless conjoined with an especially stringent and unattractive form of pacifism. This is true not only of strict anti-abortion (...) views, but also, more surprisingly, of some of the most familiar and influential moderate defences of abortion rights. The latter conclusion raises the question, which further work will be required to fully resolve, of what our account of abortion ethics and prenatal moral status must be if it is to enable reconciliation of the common-sense rejections of both pacifism and AAV. I end with reasons to expect that the path to an account that satisfies this demand, without generating further significant intuitive problems, will be far from straightforward. (shrink)

Largely in response to Epicurus’ famous challenge, philosophers have been quite imaginative in coming up with ways in which death is bad. Most often, death is described as an instrumental bad. Given that I would have obtained additional welfare benefits had I not died when I did, my death causes me to miss out on intrinsic goods I might otherwise have obtained. In this article, however, I argue that the standard account (and its corollaries) misses an important feature of the (...) dis/value of death. I argue that some deaths can be good – intrinsically good – for the person who dies. (shrink)

This chapter suggests a scheme of reconstruction, which explains how scenarios, questions and arguments figure in thought experiments. It then develops a typology of ethical thought experiments according to their function, which can be epistemic, illustrative, rhetorical, heuristic or theory-internal. Epistemic functions of supporting or refuting ethical claims rely on metaethical assumptions, for example, an epistemological background of reflective equilibrium. In this context, thought experiments may involve intuitive as well as explicitly argued judgements; they can be used to generate moral (...) commitments, to explore consequences of moral theories, and to show inconsistencies within or between moral commitments and moral theory; but the results of thought experiments by themselves do not settle what is epistemically justified and may also be rejected. Finally, some prominent challenges are discussed: do unrealistic scenarios undermine epistemic thought experiments? Are ethical thought experiments misleading? Do they rely on weak analogies? Are there specifically moral objections to ethical thought experiments? (shrink)

This file contains the Bibliography of my book Mindlessness.

Utilitarianism and prioritarianism make a strong assumption about the uniqueness of measures of how good things are for people, or for short, individual goodness measures. But it is far from obvious that the presupposition is correct. The usual response to this problem assumes that individual goodness measures are determined independently of our discourse about distributive theories. This article suggests reversing this response. What determines the set of individual goodness measures just is the body of platitudes we accept about distributive theories. (...) When prioritarianism is taken to have an ex ante form, this approach vindicates the utilitarian and prioritarian presupposition, and provides an answer to an argument due to Broome that for different reasons to do with measurement, prioritarianism is meaningless. (shrink)

G. A. Cohen’s critique of standard liberal interpretations of the difference principle has been very influential. According to Cohen, justice is not realized simply because the state’s tax policies and other distributive tools maximize the position of the worst off. Rather – possibly in addition to, but not to the exclusion of, certain state policies – justice requires talented people to improve the position of the worst off through their actions in their daily lives. Specifically, it prohibits talented people from (...) insisting on inequality-causing incentives. To this extent, Cohen’s view of distributive justice is anti-statist. On standard liberal interpretations, human rights are such that, logically, they can be violated only by states, not private individuals. An individual who tortures someone commits a moral wrong but does not violate the victim’s human rights. For this reason, the crime is less problematic than it would have been had a police officer done it on behalf of the state. To this extent the standard liberal understanding of human rights is statist. This parallel between liberal understandings of distributive justice and human rights raises two questions: Is the statist understanding of human rights vulnerable to Cohenian criticisms parallel to those that he canvasses against the statist understanding of distributive justice? If so, should we welcome an anti-statist understanding of human rights, or should we see it as a problem with Cohen’s critique of a statist focus in distributive justice that it commits us to an implausible anti-statist view of human rights? (shrink)

The Doctrine of Double Effect (DDE) is an influential non-consequentialist principle positing a role for intention in affecting the moral permissibility of some actions. In particular, the DDE focuses on the intend/foresee distinction, the core claim being that it is sometimes permissible to bring about as a foreseen but unintended side-effect of one’s action some harm it would have been impermissible to aim at as a means or as an end, all else being equal. This article explores the meaning and (...) application of the DDE along with current debates over the nature of the intend/foresee distinction and its moral significance. How is the line between intended effects and merely foreseen but unintended side-effects to be drawn, and how are problem cases best handled? What is an appropriate methodology for debating the tenability of the DDE? How might the DDE interact with other non-consequentialist principles, and how might it be modified to capture other related factors (resulting perhaps in a Doctrine of Triple Effect) or to avoid certain problem cases? Does the DDE make permissibility turn on the actual intentions of particular agents, as critics such as Thomson and Scanlon assume, or is the role of intention more abstract? (shrink)

This paper examines accounts of the moral wrongness of killing persons in addition to determining what conclusions, if any, can be drawn from the morality of killing persons about the equality of persons, and vice versa. I will argue that a plausible way of thinking about the moral wrongness of killing implies that the permissibility of killing innocent, nonthreatening persons depends on a person’s age. I address objections to this conclusion and discuss some potential implications of the view.

Ethical theory often starts with our intuitions about particular cases and tries to uncover the principles that are implicit in them; work on the ‘trolley problem’ is a paradigmatic example of this approach. But ethicists are no longer the only ones chasing trolleys. In recent years, psychologists and neuroscientists have also turned to study our moral intuitions and what underlies them. The relation between these two inquiries, which investigate similar examples and intuitions, and sometimes produce parallel results, is puzzling. Does (...) it matter to ethics whether its armchair conclusions match the psychologists’ findings? I argue that reflection on this question exposes psychological presuppositions implicit in armchair ethical theorising. When these presuppositions are made explicit, it becomes clear that empirical evidence can (and should) play a positive role in ethical theorising. Unlike recent assaults on the armchair, the argument I develop is not driven by a naturalist agenda, or meant to cast doubt on the reliability of our moral intuitions; on the contrary, it is even compatible with non-naturalism, and takes the reliability of intuition as its premise. The argument is rather that if our moral intuitions are reliable, then psychological evidence should play a surprisingly significant role in the justification of moral principles. (shrink)

In this article I explore a kind of tragic choice that has not received due attention, one in which you have to save only one of two persons but the probability of saving is not equal (and all other things are equal). Different proposals are assessed, taking as models proposals for a much more discussed tragic choice situation: saving different numbers of persons. I hold that cases in which (only) numbers are different are structurally similar to cases in which (only) (...) probabilities are different. After a brief defense of this claim, I conclude that some version of consequentialism seems more promising for offering a plausible solution to the probability case. (shrink)

What makes killing morally wrong? And what makes killing morally worse than letting die? Standard answers to these two questions presuppose that killing someone involves shortening that person's life. Yet, as I argue in the first two sections of this article, this presupposition is false: Life-prolonging killings are conceivable. In the last two sections of the article, I explore the significance of the conceivability of such killings for various discussions of the two questions just mentioned. In particular, I show why (...) the conceivability of life-prolonging killings renders Frances M. Kamm's attempt to provide an answer to the second question problematic. (shrink)

A central strand in philosophical debate over the just distribution of resources attempts to juggle three competing imperatives: helping those who are worst off, helping those who will benefit the most, and then – beyond this – determining when to aggregate such ‘worst off’ and ‘benefit’ claims, and when instead to treat no such claim as greater than that which any individual by herself can exert. Yet as various philosophers have observed, ‘we have no satisfactory theoretical characterization’ as to how (...) to weigh each of the three imperatives against one another, we find it ‘difficult to state... precise or comprehensive conclusions’, and we do not yet have a ‘metric for integrating the three measures’. In what follows, I offer an approach to weighing the three criteria against one another that yields resolutions – in Hard Cases of the ‘saving one infant's life versus replacing ten elderly people's hips’ sort – that are cardinally definitive, intuitively satisfactory and theoretically justified. (shrink)

When do claims to be saved of a small or moderate harm aggregate against a competing claim to be saved from an early death? In this short response to Kamm's Bioethical Prescriptions, I argue for the following answer: aggregation of weaker claims against a life is permitted just in case, in a one-to-one contest, a person with a weaker claim would have a personal prerogative to prioritize her claim over a stranger’s competing claim to life.

Many think that equality is an intrinsic value. However, this view, especially when based on a consequential foundation, faces familiar objections related to the claim that equality is sometimes good for none and bad for some: most notably the levelling down objection. This article explores a unique (consequential) conception of equality, as part of a more general conception of fairness concerning the resolution of interpersonal conflicts, which is not exposed to these objections.

The author argues that only when the two harms are morally relevant to one another may an agent take into account the number of people he can save. He defends an orbital conception of morally relevant harm, according to which harms that fall within the of a given harm are relevant to it, while all other harms are not. The possibility of preventing a harm provides both a first-order reason to prevent that harm, and a second-order reason not to consider (...) preventing irrelevant harms. This understanding of a morally relevant harm avoids two objections to such a concept recently raised by Alastair Norcross: identifying a point along a continuous scale of harms at which the divide between relevant and irrelevant harms occurs, and the entailment that the mere possibility of preventing harm that one is morally forbidden from preventing can determine which of two other actions morality requires. (shrink)

Some moral theories tell you, in some situations in which you are interacting with a group of people, to avoid acting in the way that is expectedly best for everybody. This essay argues that such theories are mistaken. Go ahead and do what is expectedly best for everybody. The argument is based on the thought that when interacting with an individual it is fine for you to act in the expected interests of the individual and that many interactions with individuals (...) may compose an interaction with a group. (shrink)

Cost-effectiveness analysis suggests that a society should allocate its health care budget in order to achieve the greatest total health for its budget. However, in ‘rescue’ cases, where an individual’s life is in immediate peril, reasoning in terms of cost-effectiveness can appear inhumane. Hence considerations of cost-effectiveness and of rescue appear to be in tension. However, by attending to the division of labour in medical decision making it is possible to see how cost-effectiveness analysis and rescue-style reasoning are commonly combined (...) in an ethically acceptable fashion. (shrink)

This article will focus on the ethical issues of vaccine mandates and stake claim to the relatively extreme position that outright requirements for people to receive the vaccine are ethically correct at both the governmental and institutional levels. One novel strategy employed here will be to argue that deontological considerations pertaining to consent rights cut as much in favor of mandating vaccines as against them. The presumption seems to be that arguments from consent speak semi-definitively against forcing people to inject (...) something into their bodies, and so any argument in favor of mandates must produce different and overriding logical and ethical considerations. Our central claim will be that the same logic that might seem to prohibit vaccine mandates as violations of consent actually supports such mandates when viewed from the perspective of the potential bystander who might otherwise be exposed to COVID-19. (shrink)

Two clusters of essays in this issue of The Journal of Medicine and Philosophy provide a critical gaze through which to explore central moral, phenomenological, ontological, and political concerns regarding human moral agency and personal responsibility. The first cluster challenges common assumptions in bioethics regarding the voluntariness of human actions. The second set turns the debate towards morally responsible choice within the requirements of distributive justice. The force of their collective analysis leaves us with a well-founded basis critically to approach (...) any account of bioethics or health policy that is insufficiently attentive to the central challenges of human freedom and responsible free choice. (shrink)

Agent-relative restrictions prohibit minimizing violations: that is, they require us not to minimize the total number of their violations by violating them ourselves. Frances Kamm has explained this prohibition in terms of the moral worth of persons, which, in turn, she explains in terms of persons’ high moral status as inviolable beings. I press the following criticism of this account: even if minimizing violations are permissible, we need not have a lower moral status provided other determinants thereof boost it. Thus, (...) Kamm’s account is incomplete at best. And when, to address this incompleteness, it is insisted that our moral worth derives from specific moral statuses, the inviolability account comes to seem deficient because it begs the question against those who are not initially persuaded that minimizing violations are impermissible. (shrink)

In a series of papers in the early 1970s and in his important book _Abortion and the Sanctity of Human Life_ (1975), Baruch Brody offered what remains to this day one of the most philosophically rigorous contributions to the debate concerning the morality of abortion and the ethics of homicide more generally. In this paper I would like to critically examine Brody’s argument that abortion is sometimes justifiable in some cases even when (1) one cannot claim self-defense, or (2) diminished (...) responsibility, and (3) the abortion is a ‘killing’ rather than a ‘not saving.’ This justification, I argue, is limited to certain cases in which the life of the mother is at stake. The cautious principle which he finally formulates merits serious attention and consideration. While I find a great deal of value in Brody’s discussion, I will argue that there are several difficulties with the principle of justifiable homicide he constructs. Accordingly, I will further amend and supplement his final version by offering my own alternative principle. (shrink)

The distinction between equality and sufficiency, much discussed in the distributive justice literature, is here applied to democratic theory. Overlooking this distinction can have significant normative implications, undermining some defences and criticisms of political equality, as I show by discussing the work of three prominent democratic theorists: Thomas Christiano, David Estlund, and Mark Warren. Most importantly, Christiano sometimes defends egalitarian conclusions using sufficientarian premises, or worries about inequality in situations where insufficiency is also part of the problem; inequality above the (...) level of sufficiency is not always as troubling. Estlund makes the reverse error. He attacks rather than defends political egalitarianism, but insufficiency seems to explain some of his concerns. Nonetheless, I show that political egalitarians may need to specify a sufficientarian threshold, to avoid levelling-down objections. Democratic theorists should thus take seriously the distinction between political equality and political sufficiency. More generally, political theorists and philosophers should be aware of omitted variable bias and interaction effects due to conceptual stretching arising from under-theorised distinctions in their thought experiments. (shrink)

Deprivation offers a plausible explanation for the badness of death, so fear is not unreasonable. But horror at the prospect of one's death is not just extreme fear because horror is structurally different than fear. Horror requires a different explanation. For Sartre, horror is possible only in unique circumstances. I argue that Sartre's view, when combined with the subjective incomprehensibility of one's annihilation, can explain horror and other negative emotions that are not contingent on deprivation. Further, I argue that while (...) fear can be reasonable if one's death will deprive, Lucretius's Symmetry Argument shows that horror is unreasonable. (shrink)

This paper addresses two ways in which scarcity in health care turns up and three ways in which this dual condition of scarcity can be approached. The first approach is the economic approach, which focuses on the causes of cost-increase in health care and on developing various mechanisms of rationing and priority-setting in health care. The second approach is the justice approach, which interprets scarcity as one of the Humean ‹Circumstances of Justice.’ Whereas these approaches interpret scarcity as a given (...) fact, the third approach casts doubt on this interpretation. Rather, it interprets scarcity as a social, anthropological, and technologically induced construction of Modernity. This paper supports the theories of Hans Achterhuis, Ivan Illich, and Nicholas Xenos but also further elaborates their views with regard to health care by offering an approach to scarcity that interprets it as an economic translation of finitude. I argue that this approach, which entails a contemporary revaluation of the ancient Socratic attitude on human life and finitude, will be better able to deal with the pressing contemporary issues of setting limits on health care because it mitigates contemporary health care’s tendency toward infinity in meeting – and creating – health care needs. (shrink)