The allocation of scarce health care resources such as flu treatment or organs for transplant presents stark problems of distributive justice. Persad, Wertheimer, and Emanuel have recently proposed a novel system for such allocation. Their “complete lives system” incorporates several principles, including ones that prescribe saving the most lives, preserving the most life-years, and giving priority to persons between 15 and 40 years old. This paper argues that the system lacks adequate moral foundations. Persad and colleagues' defense of giving priority (...) to those between 15 and 40 leaves them open to the charge that they discriminate unfairly against children. Second, the paper contends that the complete lives system fails to provide meaningful practical guidance in central cases, since it contains no method for balancing its principles when they conflict. Finally, the paper proposes a new method for balancing principles of saving the most lives and maximizing life-years. (shrink)

In this short response to Kerstein and Bognar, we clarify three aspects of the complete lives system, which we propose as a system of allocating scarce medical interventions. We argue that the complete lives system provides meaningful guidance even though it does not provide an algorithm. We also defend the investment modification to the complete lives system, which prioritizes adolescents and older children over younger children; argue that sickest-first allocation remains flawed when scarcity is absolute and ongoing; and argue that (...) Kerstein and Bognar are mistaken to base their allocation principles on differences in personhood. (shrink)

Limited aggregationists argue that when deciding between competing claims to aid we are sometimes required and sometimes forbidden from aggregating weaker claims to outweigh stronger claims. Joe Horton presents a ‘fatal dilemma’ for these views. Views that land on the First Horn of his dilemma suggest that a previously losing group strengthened by fewer and weaker claims can be more choice-worthy than the previously winning group strengthened by more and stronger claims. Views that land on the Second Horn suggest that (...) combining two losing groups together and two winning groups together can turn the losing groups into the winning groups and the winning groups into the losing groups. This paper demonstrates that the ‘fatal dilemma’ is neither fatal nor a dilemma. The First Horn is devastating but avoidable and the Second Horn is unavoidable but not devastating. Nevertheless, Horton’s argument does help to narrow down the acceptable range of views. (shrink)

After 50 years of debate, the ethics of aggregation has reached a curious stalemate, with both sides arguing that only their theory treats people as equals. I argue that, on the issue of equality, both sides are wrong. From the premise that “each counts for one,” we cannot derive the conclusion that “more count for more” or its negation. The familiar arguments from equality to aggregation presuppose more than equality: the Kamm/Scanlon “Balancing Argument” rests on what social choice theorists call (...) “(Positive) Responsiveness,” Kamm’s “Aggregation Argument” assumes that “equal” lives are fungible, and Hsieh et al. have it that spreading goods broadly best approximates equality. In each case, the crucial premise is not equality itself but a further idea that Taurek, I argue, can safely reject. I conclude with a conjecture: there is no theory-neutral argument that settles the question of whether the numbers count. (shrink)

Some theorists of normative explanation argue that we can make sense of debates between first-order moral theories such as consequentialism and its rivals only if we understand their explanations of why the right acts are right and the wrong acts are wrong as generative (e.g. grounding) explanations. Others argue that the standard form of normative explanation is, instead, some kind of unification. Neither sort of explanatory monism can account for all the explanations of particular moral facts that moral theorists seek (...) to state and defend. This paper argues that we can do better if we accept normative explanatory pluralism, the view that at least some particular explananda in normative inquiry have more than one type of correct complete explanation. Such pluralism is supported by what goes on in actual moral inquiry, parallels an independently plausible form of pluralism about scientific explanation, and can offer principled responses to central objections. (shrink)

A number of philosophers have argued that if you care about how much goodness your actions generate, or how good the state-of-affairs you actions bring about are, then your attention should be directed towards the very far future. But many don’t care about how much goodness their actions generate, nor do they care about things like “states-of-affairs”. Amongst a multitude of things, many people care about how their actions impact individuals. And they also care about the sorts of justifications they (...) are able to offer for those actions. One moral theory which captures this moral viewpoint is contractualism. In this chapter, I argue that contractualism is, in large part, incompatible with longtermism – the view that, in many contexts, we ought to do that which will most improve the prospects of future people. I then discuss what advice, if any at all, contractualism can offer to the longtermist. (shrink)

Value pluralists believe in multiple dimensions of value. What does betterness along a dimension have to do with being better overall? Any systematic answer begins with the Strong Pareto principle: one thing is overall better than another if it is better along one dimension and at least as good along all others. We defend Strong Pareto from recent counterexamples and use our discussion to develop a novel view of dimensions of value, one which puts Strong Pareto on firmer footing. We (...) conclude by defending Dimensionalism, the hypothesis that overall value relations are determined solely by how things compare along value dimensions. These are first steps towards a more systematic value pluralism. (shrink)

A person is biased toward the future when she prefers, other things being equal, bad events to be in her past rather than her future or good ones to be in her future rather than her past. In this paper, I explain why both critics and defenders of future bias have failed to consider the best version of the view. I distinguish external time from personal time, and show that future bias is best construed in terms of the latter. This (...) understanding of future bias avoids several standard objections. I then consider a new justification of future bias which is consistent with that construal. My discussion points to a new position regarding the basic relation that grounds rational egoistic concern over time, according to which that relation is asymmetric between person-stages. I also explain how this way of justifying future bias would resolve the apparent tension between the future bias we display in our own case and our relative indifference toward the timing of the good and bad things that happen to other people. (shrink)

In this paper, I investigate backward-looking accounts of death's badness. I begin by reviewing deprivationism—the standard, forward-looking account of death's badness. On deprivationism, death is bad for its victims when it deprives them of a good future. This account famously faces two problems—Lucretius’s symmetry problem and the preemption problem. This motivates turning to backward-looking accounts of death's badness on which death is bad for its victim (in a respect) when it involves a decline from a good life. I distinguish three (...) different backward-looking accounts of death's badness in terms of decline, and I argue for the attractiveness of one in particular. I conclude by considering how the backward-looking consideration of decline might factor into our overall account of death's badness. (shrink)

Is an outcome where many people are saved and one person dies better than an outcome where the one is saved and the many die? According to the standard utilitarian justification, the former is better because it has a greater sum total of well-being. This justification involves a controversial form of moral aggregation, because it is based on a comparison between aggregates of different people's well-being. Still, an alternative justification—the Argument for Best Outcomes—does not involve moral aggregation. I extend the (...) Argument for Best Outcomes to show that any utilitarian evaluation can be justified without moral aggregation. (shrink)

John Taurek argues that, in a choice between saving the many or the few, the numbers should not count. Some object that this view clashes with the transitivity of ‘better than’; others insist the clash can be avoided. I defend a middle ground: Taurek cannot have transitivity, but that doesn’t doom his view, given a suitable conception of value. I then formalize and explore two conceptions: one context-sensitive, one multidimensional.

In this article, I critique a moral argument developed in Frances Kamm’s Intricate Ethics: Rights, Responsibilities, and Permissible Harm. The argument, which I label the Best Outcome Argument, aims to criticize the Taurekian idea that it is not worse if more people die than if fewer do in conflict situations, where it is hard to distinguish individuals from one another solely by reference to the relative strength of their claims. I argue that the Best Outcome Argument is flawed for three (...) reasons: the symmetry feature defined by the impartiality principle holds only in a limited class of conflict situations; individuals should be treated in a consistent way throughout the whole process of reasoning; comparative evaluations gained in different contexts, at least in some cases, cannot be used in one and the same argument. (shrink)

Many people believe that the wrongness of killing a person does not depend on factors like her age, condition, or how much she has to lose by dying – a view Jeff McMahan calls the ‘Equal Wrongness Thesis’. This article argues that we should reject the Equal Wrongness Thesis on the basis of the moral equivalence between killing a person and knocking her unconscious.

A coherent practice of mens rea (‘guilty mind’) ascription in criminal law presupposes a concept of mens rea which is insensitive to the moral valence of an action’s outcome. For instance, an assessment of whether an agent harmed another person intentionally should be unaffected by the severity of harm done. Ascriptions of intentionality made by laypeople, however, are subject to a strong outcome bias. As demonstrated by the Knobe effect, a knowingly incurred negative side effect is standardly judged intentional, whereas (...) a positive side effect is not. We report the first empirical investigation into intentionality ascriptions made by professional judges, which finds (i) that professionals are sensitive to the moral valence of outcome type, and (ii) that the worse the outcome, the higher the propensity to ascribe intentionality. The data shows the intentionality ascriptions of professional judges to be inconsistent with the concept of mens rea supposedly at the foundation of criminal law. (shrink)

Many prominent ethicists, including Shelly Kagan, John Rawls, and Thomas Scanlon, accept a kind of epistemic modesty thesis concerning our capacity to carry out the project of ethical theorizing. But it is a thesis that has received surprisingly little explicit and focused attention, despite its widespread acceptance. After explaining why the thesis is true, I argue that it has several implications in metaethics, including, especially, implications that should lead us to rethink our understanding of Reductive Realism. In particular, the thesis (...) of epistemic modesty in ethics implies a kind of epistemic modesty about the metaphysical nature of ethics, if Reductive Realism about the metaphysical nature of ethics is true, and it implies that normative concepts are indispensable to practical deliberation in a way that answers an influential objection to Reductive Realism from Jonathan Dancy, David Enoch, William FitzPatrick, and Derek Parfit. (shrink)

The ‘standard interpretation’ of John Taurek’s argument in ‘Should the Numbers Count?’ imputes two theses to him: first, ‘numbers scepticism’, or scepticism about the moral force of an appeal to the mere number of individuals saved in conflict cases; and second, the ‘equal greatest chances’ principle of rescue, which requires that every individual has an equal chance of being rescued. The standard interpretation is criticized here on a number of grounds. First, whilst Taurek clearly believes that equal chances are all-important, (...) he actually argues for a position weaker than the equal greatest chances principle. Second, the argument Taurek gives for the importance of equal chances ought to commit him to being more hospitable to the significance of numbers than he seems to be. Third, and as a result, Taurek should not have dismissed the significance of numbers but embraced a form of pluralism instead. Fourth, this result should be welcomed, because pluralism is more plausible than either the equal greatest chances principle or the saving the greater number principle. (shrink)

Many of us feel existential terror when contemplating our future nonexistence. I examine several attempts to rationally justify existential terror. The most promising of these appeals to the effects of future nonexistence on the meaningfulness of our lives. I argue that even this justification fails, and therefore existential terror is irrational.

In Meaning in Life: An Analytic Study, Thaddeus Metz advocates a kind of naturalistic objective theory of meaning in life, through a rejection of supernaturalism. In this paper, I examine Metz’s argument on supernaturalism, in particular, soul-centered theory and immortality. I will argue that his objection to supernaturalism is inadequate because he does not treat properly a familiar idea about the relationship between death and meaning, namely, the idea that a person’s death itself makes her life meaningless. Metz interprets immortality (...) as a condition for obtaining meaning, but in view of the idea that I present, immortality means the negation of the death of a person whose life already has meaning. As I see it, this idea about death and meaning is also one of the motivations to accept a soul-centered theory and therefore key to a fuller rejection of supernaturalism. (shrink)

Sometimes we must choose between competing claims to aid or assistance, and sometimes those competing claims differ in strength and quantity. In such cases, we must decide whether the claims on each opposing side can be aggregated. Relevance views argue that a set of claims can be aggregated only if they are sufficiently strong (compared to the claims with which they compete) to be morally relevant to the decision. Relevance views come in two flavours: Local Relevance and Global Relevance. This (...) paper presents a trilemma for both. Namely, that neither view can capture our intuition in tie-break cases, without forfeiting our intuitions in other important cases. The paper then presents a way to salvage relevance views and capture all our intuitions using a Hybrid view. By distinguishing between two types of relevance we can combine the strengths of Local and Global Relevance views such that we can hold all our intuitions, consistently and in a non-ad-hoc manner. Building on this, the paper demonstrates how we might amend the strongest formulation of a Relevance view, into a Hybrid account. The main focus of this paper is to develop a relevance view that can capture all the intuitions we have; however deeper justifications will still be needed for a full account of any relevance view. Thus, the end of the paper briefly considers what deeper justification might support the Hybrid view, indicating the direction such literature might go. Lastly, the paper considers the advantages of this view over a rival Hybrid view. (shrink)

It seems that people typically prefer dying later to dying earlier. It also seems that people typically do not prefer having been created earlier to having been created later. Lucretius’ Puzzle is the question whether anything typically rationally recommends having a preference for dying later to dying earlier over having a preference for having been created earlier to having been created later. In this paper, I distinguish among three ways in which Lucretius’ Puzzle can be understood and say how I (...) think they ought to be answered. (shrink)

In this thesis, I discuss the aggregation problem for T. M. Scanlon’s “contractualism”. I argue that Scanlonian contractualists have the following two options when it comes to the aggregation problem. First, they can choose to limit aggregation directly via a specific version of the Relevance View, “Sequential Claims-Matching”. Second, Scanlonian contractualists can adopt a so-called “mixed solution” of which I propose a specific version. My mixed solution does not limit aggregation. Rather, it either avoids some of the counterintuitive results in (...) certain cases, or at least makes these same results look a lot less counterintuitive by putting them into perspective thanks to a plausible plurality of precisely specified values. The stakes between these two options are as follows. The first option justifies Scanlon’s intuition in one vs. many cases of which his “World Cup Case” is one example, but it comes at the cost of a seemingly quite limited range of application: any version of the Relevance View only works in cases in which we have no more than two groups of competing claimants. The second option has the exact opposite implications: my mixed solution cannot justify Scanlon’s intuition in one vs. many cases, but it could be applied to any case with any number of groups of competing claimants. In this choice between pre-theoretical intuition and feasibility, I would urge Scanlonian contractualists to choose feasibility. (shrink)

abstractBy appealing to the similarity between pre-vital and post-mortem nonexistence, Lucretius famously tried to show that our anxiety about death was irrational. His so-called Symmetry Argument has been attacked in various ways, but all of these strategies are themselves problematic. In this paper, I propose a new approach to undermining the argument: when Parfit’s distinction between identity and what matters is applied, not diachronically but across possible worlds, the alleged symmetry can be broken. Although the pre-vital and posthumous time spans (...) that we could have experienced are indeed analogous with respect to our identity, they are not analogous with respect to psychological continuity, which forms the basis of prudential concern. Lucretius even anticipated the Parfitian distinction. He did not, however, notice the significance that it has for his Symmetry Argument. (shrink)

There is a rich tradition within game theory, decision theory, economics, and philosophy correlating practical rationality with impartiality, and spatial and temporal neutrality. I argue that in some cases we should give priority to people over both times and places, and to times over places. I also show how three plausible dominance principles regarding people, places, and times conflict, so that we cannot accept all three. However, I argue that there are some cases where we should give priority to times (...) over people, suggesting that there is impersonal value to the distribution of high quality life over different times. (shrink)

When facing a choice between saving one person and saving many, some people have argued that fairness requires us to decide without aggregating numbers; rather we should decide by coin toss or some form of lottery, or alternatively we should straightforwardly save the greater number but justify this in a non-aggregating contractualist way. This paper expands the debate beyond well-known number cases to previously under-considered probability cases, in which not (only) the numbers of people, but (also) the probabilities of success (...) for saving people vary. It is shown that, in these latter cases, both the coin toss and the lottery lead to what is called an awkward conclusion, which makes probabilities count in a problematic way. Attempts to avoid this conclusion are shown to lead into difficulties as well. Finally, it is shown that while the greater number method cannot be justified on contractualist grounds for probability cases, it may be replaced by another decision method which is so justified. This decision method is extensionally equivalent to maximising expected value and seems to be the least problematic way of dealing with probability cases in a non-aggregating manner. (shrink)

In healthcare, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the “Rule of Rescue”). This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue (...) in public resource allocation decisions by health technology funding advisory bodies such as the National Institute for Health and Clinical Excellence. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that that whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, exempt any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others. (shrink)

This thesis takes up a rights-based perspective to discuss a number of issues related to the problem of permissible harm. It appeals to a person’s capacity to shape her life in accordance with her own ideas of the good to explain why her death can be bad for her, and why each of us should have primary say over what may be done to her. The thesis begins with an investigation of the badness of death for the person who dies. (...) If death is bad for us, this helps explain the wrongness of killing. The thesis defends the deprivation account—i.e. the idea that death is bad for us when and because it deprives us of good life—against two Epicurean challenges. It adds that death is also bad when and because it thwarts our agency. Next, the thesis deals with the logic of our moral rights to non-interference. It proposes a conception of rights according to which the stringency of our rights derives from and is justified by the rational aspect of our human nature. It argues that this conception of moral rights solves the paradox of deontology. While our rights to non-interference are stringent, they are not absolute. The thesis considers two possible exceptions to the general rule that it is impermissible to harm an innocent person against her consent. First, using an actual case from WWII, it investigates the circumstances under which a government may expose some parts of its population to an increased risk of harm in order to decrease the risk to others. Second, it considers the permissibility of self-defence against an innocent threat. It argues that the potential victim of an innocent threat has a justice-based reason to treat her own interests as on a par with those of the threat. (shrink)

This paper examines the efforts of contractualists to develop an alternative to aggregation to govern our duty not to harm (duty to rescue) others. I conclude that many of the moral principles articulated in the literature seem to reduce to aggregation by a different name. Those that do not are viable only as long as they are limited to a handful of oddball cases at the margins of social life. If extended to run-of-the-mill conduct that accounts for virtually all unintended (...) (in the sense of undesired) harm to others—noncriminal activities that impose some risk of harm on others—they would rule out all action. Moreover, because such conduct poses an irreducible conflict between freedom of action and freedom from expected harm, it can be regulated only by principles that accept the necessity of making precisely the sorts of interpersonal trade-offs that contractualism is foundationally committed to reject: trade-offs in which the numbers count, such that a risk of serious harm to one person can be justified by small benefits to the many. (shrink)

Kerstein and Bognar (2010) and Persad, Wertheimer, and Emanuel (2009) defend specific principles for the allocation of health care resources, but their choice of principles is influenced by the exa...

Some empirical findings seem to show that people value health benefits differently depending on the age of the beneficiary. Health economists and philosophers have offered justifications for these preferences on grounds of both efficiency and equity. In this paper, I examine the most prominent examples of both sorts of justification: the defence of age-weighting in the WHO's global burden of disease studies and the fair innings argument. I argue that neither sort of justification has been worked out in satisfactory form: (...) age should not be taken into account in the framework of the burden of disease measure, and on the most promising formulations of the fair innings argument, it turns out to be merely an indicator of some other factor. I conclude by describing the role of age in theories of justice of healthcare resource allocation. (shrink)

It is commonly asserted that “death is not a welfare issue” and this has been reflected in welfare legislation and policy in many countries. However, this creates a conflict for many who consider animal welfare to be an appropriate basis for decision-making in animal ethics but also consider that an animal’s death is ethically significant. To reconcile these viewpoints, this paper attempts to formulate an account of death as a welfare issue. Welfare issues are issues that refer to evaluations concerning (...) an animal’s interests. This includes evaluations that refer only to comparisons between the presence and absence of states, including positive states. This means that an animal’s death may be a welfare issue insofar as it leads to the exclusion of relevant positive states. This allows us to deny that death is necessarily not a welfare issue. (shrink)

This paper reflects on the relationship between theory and practice in bioethics, by using various concepts drawn from debates on innovation in healthcare research—in particular debates around how best to connect up blue skies ‘basic’ research with practical innovations that can improve human lives. It argues that it is a mistake to assume that the most difficult and important questions in bioethics are the most abstract ones, and also a mistake to assume that getting clear about abstract cases will automatically (...) be of much help in getting clear about more complex cases. It replaces this implicitly linear model with a more complex one that draws on the idea of translational research in healthcare. On the translational model, there is a continuum of cases from the most simple and abstract to the most concrete and complex. Insights need to travel in both directions along this continuum—from the more abstract to the more concrete and from the more concrete to the more abstract. The paper maps out some difficulties in moving from simpler to more complex cases, and in doing so makes recommendations about the future of bioethics. (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)

The current voluntary posthumous organ donation policy fails to provide sufficient organs to meet the demand. In these circumstances xenografts have been regarded as an expedient solution. The public perception seems to be that the only impediments to this technology are technical and biological. There are, however, important ethical issues raised by xenotransplantation that need to be considered as a matter of urgency. When the ethical issues raised by using non-human animals to provide replacement organs for human beings are considered (...) in a wider context and the possible alternatives to xenotransplantation are taken into account, a new dimension is added to the debate. In this broader context it is argued that a less ethically problematic solution is to adopt a presumed consent or opt-out organ procurement policy to regulate posthumous organ harvesting from humans. If there are still too few organs available, then the whole question of transplantation must be reassessed. (shrink)

This thesis discusses the possibility of limited moral trade-offs between different people’s welfare. In chapter 2, I introduce the two central limited trade-off conditions. First, according to minimal infinite superiority, significantly benefiting one person matters more than slightly benefiting each of any number of better-off people. Second, according to minimal finite superiority, significantly benefiting many people matters more than slightly benefiting one person. I consider both axiological and deontic interpretations of these conditions. However, I explain why none of the simple (...) classic moral principles—the simple total and the maximin principles—satisfy both conditions. Furthermore, in chapter 3, I strengthen several proved impossibility results according to which no moral theory satisfies weak interpretations of these central trade-off conditions and several other seemingly plausible minimal conditions. I show that giving up structural axiological and deontic conditions is not a satisfactory solution to these paradoxes. In chapter 4, I discuss the modification of a background assumption of these impossibility results on the measurement of welfare. I show that, given a modification that allows for lexicographically ordered welfare components, a total principle can satisfy all the conditions of the impossibility results. However, I argue that such a modification is not entirely satisfactory because it does not apply in certain instances of the paradoxes. In chapter 5, I discuss a further weakening of minimal infinite superiority. However, I show that a suggested possibility result based on this modification is not valid and that further moral conditions, such as minimal finite superiority, need to be modified. Moreover, I argue that these modified conditions and the principle suggested in the possibility proof—a minimax complaint principle—do not capture the basic idea of the two central limited trade-off conditions sufficiently well. In chapter 6, I argue that other principles suggested for the task—the total claim principles—share the same fate as the simple total principles or the minimax complaint principle. In chapter 7, I propose new principles that take their structural roots from voting theory. I show that, in contrast to the other principles discussed, these principles give plausible verdicts where the other principles failed. Finally, in chapter 8, I consider possible objections levelled against this proposal, and I suggest solutions and avenues for future research. (shrink)

In recent years, bariatric surgery has become an increasingly popular treatment of obesity. The amount of resources spent on this kind of surgery has led to a heated debate among health care professionals and the general public, as each procedure costs at minimum $14,500 and thousands of patients undergo surgery every year. So far, no substantial argument for or against giving this treatment a high priority has, however, been presented. In this article, I argue that regardless which moral perspective we (...) consider—greatest need, utility or personal responsibility—the conclusion is that we should give bariatric surgery a high priority when allocating scarce resources in health care. (shrink)

Longevity is valuable. Most of us would agree that it’s bad to die when you could go on living, and death’s badness has to do with the value your life would have if it continued. Most of us would also agree that it’s bad if life expectancy in a country is low, it’s bad if there is high infant mortality and it’s bad if there is a wide mortality gap between different groups in a population. But how can we make (...) such judgments more precise? How should we evaluate the harm of mortality in a population? Although philosophers have written a lot about the harm of death for individuals, very little work has been done on the harm of mortality for populations. In this article, I take the first steps towards developing a theory of the harm of population mortality. Even these first steps, I argue, lead to surprising results. (shrink)

The numbers problem concerns the question of what is the right thing to do in trade-off cases where one can save different non-overlapping groups of persons, but not everyone. Proponents of mixed solutions argue that both saving the many and holding a lottery to determine whom to save can each be morally right in such cases, depending on the relative sizes of the groups involved. In his book The Dimensions of Consequentialism, Martin Peterson presents an ingenious version of such an (...) approach that avoids a commitment to interpersonal value aggregation, which is highly controversial and rejected by many philosophers for a number of reasons. I criticise Peterson’s proposal by first arguing that it cannot account for the idea that holding a lottery is morally wrong if differences in numbers are very large, and by second pointing out that it relies on implausible assumptions about what is good for an individual. Given the shortcomings of Peterson’s non-aggregationist version of a mixed solution, I next address the issue of how problematic a commitment to interpersonal aggregation really is. To this end, I present an aggregationist version of a mixed solution that is reason-based and bypasses most standard objections to interpersonal value aggregation. I conclude that although there is reason to be optimistic, it remains to be seen whether a mixed solution can be worked out in a fully satisfying way. (shrink)