Kidneys for transplantation are scarce, and many countries give priority to children in allocating them. This paper explains and criticizes the paediatric priority. We set out the relevant ethical principles of allocation, such as utility and severity, and the relevant facts to do with such matters as sensitization and child development. We argue that the facts and principles do not support and sometimes conflict with the priority given to children. We next consider various views on how age or the status (...) of children should affect allocation. Again, these views do not support priority to children in its current form. Since distinctions based on age ought to be positively justified, the failure of all these attempts at justification implies that the priority to children is ethically mistaken. Finally, the paper points to evidence that the paediatric priority reduces the overall supply of kidneys, at least in the United States. Paediatric priority is a real-world policy that seems discriminatory, in some places probably reduces the supply of organs, has no robust official defence, and is unsupported by mainstream ethical principles. Consequently, it should be ended. (shrink)

In this paper, I explore the connection between certain metaphysical views of time and emotional attitudes concerning one’s own death and mortality. I argue that one metaphysical view of time, B-theory, offers consolation to mortals in the face of death relative to commonsense and another metaphysical view of time, A-theory. Consolation comes from three places. First, B-theory implies that time does not really pass, and as a result one has less reason to worry about one’s time growing short. Second, B-theory (...) entails that there is a real sense in which one’s death does not result in one’s annihilation, and this fact can temper feelings of existential distress. Third, B-theory has the consequence that the benefits one has lost have concrete existence, and this fact can mitigate the emotional significance of the losses of death. (shrink)

Psychologists and philosophers often work hand in hand to investigate many aspects of moral cognition. In this paper, we want to highlight one aspect that to date has been relatively neglected: the stability of moral judgment over time. After explaining why philosophers and psychologists should consider stability and then surveying previous research, we will present the results of an original three-wave longitudinal study. We asked participants to make judgments about the same acts in a series of sacrificial dilemmas three times, (...) 6–8 days apart. In addition to investigating the stability of our participants’ ratings over time, we also explored some potential explanations for instability. To end, we will discuss these and other potential psychological sources of moral stability (or instability) and highlight possible philosophical implications of our findings. (shrink)

It has recently been argued by Miller and Truog (2008) that, while procuring vital organs from transplant donors is typically the cause of their deaths, this violation of the requirement that donors be dead prior to the removal of their organs is not a cause for moral concern. In general terms, I endorse this heterodox conclusion, but for different and, as I think, more powerful reasons. I end by arguing that, even if it is agreed that retrieval of vital organs (...) causes the deaths of those who provide them, that does not pose any new substantive difficulties for efforts to justify “opt-out” organ procurement systems. (shrink)

This article introduces an intuitive conservation dilemma called the Canyon Dilemma: Is it possible to condemn the mining of the Grand Canyon, even by a poor generation, while also permitting this generation’s mining of an unremarkable small canyon? It then argues that not one of several prominent theories of environmental justice, including various forms of egalitarianism, welfarism, deep-ecological theories, communitarianism and free-market environmentalism, can navigate this dilemma. The article concludes by highlighting the dilemma-navigating potential of the equal-claims idea – the (...) idea that the natural world is something to which every human being, present and future, has an equal, substantive claim. (shrink)

Non-Consequentialist moral theories posit the existence of moral constraints: prohibitions on performing particular kinds of wrongful acts, regardless of the good those acts could produce. Many believe that such theories cannot give satisfactory verdicts about what we morally ought to do when there is some probability that we will violate a moral constraint. In this article, I defend Non-Consequentialist theories from this critique. Using a general choice-theoretic framework, I identify various types of Non-Consequentialism that have otherwise been conflated in the (...) debate. I then prove a number of formal possibility and impossibility results establishing which types of Non-Consequentialism can -- and which cannot -- give us adequate guidance through through a risky world. (shrink)

Interpersonal aggregation involves the combining and weighing of benefits and losses to multiple individuals in the course of determining what ought to be done. Most consequentialists embrace thoroughgoing interpersonal aggregation, the view that any large benefit to each of a few people can be morally outweighed by allocating any smaller benefit to each of many others, so long as this second group is sufficiently large. This would permit letting one person die in order to cure some number of mild headaches (...) instead. Most non-consequentialists reject thoroughgoing interpersonal aggregation despite also believing it is permissible to let one person die in order to prevent many cases of paraplegia instead. Non-consequentialists defend this asymmetry largely on the basis of intuition, and some rely on the notion of relevance to formalize the grounding intuitions. This article seeks to clarify and strengthen the non-consequentialist notion of relevance by engaging with three objections to it. (shrink)

Means-based harms are frequently seen as forbidden, even when they lead to a greater good. But, are there mitigating factors? Results from five experiments show that judgments about means-based harms are modulated by: 1) Pareto considerations (was the harmed person made worse off?), 2) the directness of physical contact, and 3) the source of the threat (e.g. mechanical, human, or natural). Pareto harms are more permissible than non-Pareto harms, Pareto harms requiring direct physical contact are less permissible than those that (...) do not, and harming someone who faces a mechanical threat is less permissible than harming someone who faces a non-mechanical threat. These results provide insight into the rich representational structure underlying folk-moral computations, including both the independent and interacting roles of the inevitability, directness and source of harm. (shrink)

Is there any number of people you should save from paralysis rather than saving one person from death? Is there any number of people you should save from a migraine rather than saving one person from death? Many people answer ‘yes’ and ‘no’, respectively. The aim of partially aggregative moral views is to capture and justify combinations of intuitions like these. These views contrast with fully aggregative moral views, which imply that the answer to both questions is ‘yes’, and with (...) non-aggregative moral views, which imply that the answer to both questions is ‘no’. In this paper, I review the most natural and influential ways of developing partially aggregative views and explain the main problems they face. (shrink)

To what extent do moral judgments depend on conscious reasoning from explicitly understood principles? We address this question by investigating one particular moral principle, the principle of the double effect. Using web-based technology, we collected a large data set on individuals' responses to a series of moral dilemmas, asking when harm to innocent others is permissible. Each moral dilemma presented a choice between action and inaction, both resulting in lives saved and lives lost. Results showed that: (1) patterns of moral (...) judgments were consistent with the principle of double effect and showed little variation across differences in gender, age, educational level, ethnicity, religion or national affiliation (within the limited range of our sample population) and (2) a majority of subjects failed to provide justifications that could account for their judgments. These results indicate that the principle of the double effect may be operative in our moral judgments but not open to conscious introspection. We discuss these results in light of current psychological theories of moral cognition, emphasizing the need to consider the unconscious appraisal system that mentally represents the causal and intentional properties of human action. (shrink)

In 2008 New Zealand's pharmaceutical management agency, PHARMAC, made its final decision on the funding of trastuzumab (Herceptin) for HER2-positive early stage breast cancer. PHARMAC declined to fund the 12-month Herceptin regimen requested by the drug's manufacturer, funding instead a 9-week treatment regimen. The decision was justified on the grounds that there was insufficient evidence of additional long-term health benefits from the longer treatment course, which, coupled with the high cost of the drug, did not make the 12-month regimen sufficiently (...) cost-effective. This paper examines the criticism of PHARMAC's decision that ultimately led to the government's decision to expand the health budget in order to fund the 12-month regimen. It defends PHARMAC's decision against the charge of unfairness, arguing that for high-cost drugs with limited proven effectiveness it is not unfair to deny funding on grounds of cost-effectiveness, since although some moral priority must be given to helping those with serious diseases like breast cancer, the capacity of such drugs to swamp health care budgets is itself a significant moral issue. It concludes that the decision to expand the health budget to pay for Herceptin exacerbates rather than solves the political and moral problems involved in prioritizing health care resources. (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)

The trolley problem, first described by Foot (1967) and Thomson (The Monist, 59, 204–217, 1976), is one of the most famous and influential thought experiments in deontological ethics. The general story is that a runaway trolley is threatening the lives of five people. Doing nothing will result in the death of those persons, but acting in order to save those persons would unavoidably result in the death of another, sixth person. It appears that, depending on the situation, we have different (...) moral judgments about the permissibility of action. We will review and systematize all the proposals in the literature of the past 35 years that have attempted to grasp our moral intuitions in a simple deontological principle. In particular, seventeen proposals will be classified: six algorithmic, seven psychological, and four other invalid accounts. This review and classification sheds light on some subtle differences and clarify a few issues. (shrink)

Most people believe that death is bad for the one who dies. Much attention has been paid to the Epicurean puzzle about death that the rests on a tension between that belief and another—that death is the end of one’s existence. But there is nearby puzzle about death that philosophers have largely left untouched. This puzzle rests on a tension between the belief that death is bad for the one who dies and the belief that that death is not the (...) end of one’s existence. Many philosophers have responded to the Epicurean puzzle with the deprivation account of the badness of death, which seeks to make sense of the badness of death given that there is no life after death. This paper focus on the other puzzle, and advances the argument that the deprivation account can also make sense of the badness of death given that there is life after death. (shrink)

In refutation of hedonism, Nozick offered a hypothetical thought experiment, known as the Experience Machine. This paper maintains that end-of-life-suffering of the kind that is resistant to state-of-the-art palliation provides a conceptually equal experiment which validates Nozick’s observations and conclusions. The observation that very many terminal patients who suffer terribly do no wish for euthanasia or terminal sedation is incompatible with motivational hedonism. Although irreversible vegetative state and death are equivalently pain-free, very many people loath the former even at the (...) price of the latter. This attitude cannot be accounted for by hedonism. Following these observations, the goals of palliative care are sketched along four circles. The first is mere removal or mitigation of noxious symptoms and suffering. The second targets sufferings that stymie patients’ life-plans and do not allow them to be happy, the third targets sufferings that interfere with their pursuance of other goods (palliation as a primary good). The fourth is the control of sufferings that do not allow the person to benefit from any human good whatsoever (“total pain” or critical suffering). Only in the fourth circle are people hedonists. (shrink)

Nobody's going to object to the advice "Do the right thing", but that doesn't mean everyone's always going to follow it. Sometimes this is because of our volitional limitations; we cannot always bring ourselves to make the sacrifices that right action requires. But sometimes this is because of our cognitive limitations; we cannot always be sure of what is right. Sometimes we can't be sure of what's right because we don't know the non-normative facts. But sometimes, even if we were (...) to know all of the non-normative facts, we'd still not be sure about what's right, because we're uncertain about the normative reasons those facts give us. In this dissertation, I attempt to answer the question of what we're to do when we must act under fundamentally normative uncertainty. It's tempting to think that, in such circumstances, we should do what we regard as most probably right. I argue that this view is mistaken, for it is insensitive to how degrees of actions' values compare across different normative hypotheses; if an action is probably right, but, if wrong, is terribly, terribly, wrong, it may be rational not to do that action. A better answer is that we should do the action with the highest expected value. I spend the first part of the dissertation providing arguments for and rebutting arguments against this view of action under normative uncertainty. I spend the next part of the dissertation explaining what degrees of value are, and showing how they can be compared across normative hypotheses. In the remaining parts of the dissertation, I consider two questions related to our primary question -- first, what is one required, or obligated, to do under normative uncertainty; and second, what is it rational for one to do when one is not only normatively uncertain in the way we've been discussing, but also uncertain about what it is rational to do under this sort of normative uncertainty. (shrink)