When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I (...) present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant's life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view. (shrink)

Children are routinely treated paternalistically. There are good reasons for this. Children are quite vulnerable. They are ill-equipped to meet their most basic needs, due, in part, to deficiencies in practical and theoretical reasoning and in executing their wishes. Children’s motivations and perceptions are often not congruent with their best interests. Consequently, raising children involves facilitating their best interests synchronically and diachronically. In practice, this requires caregivers to (in some sense) manage a child’s daily life. If apposite, this management will (...) focus partly on a child’s well-being. To be ably executed, an account of children’s well-being will need to be articulated. This chapter focuses on the nature of children’s well-being. It has five sections. The first section clarifies the focus. The second section examines some hurdles to articulating a view of children’s well-being. The third section evaluates some accounts of children’s well-being. The fourth section addresses the view that children possess features essential to them that make their lives on balance prudentially bad for them. The fifth section sums things up. (shrink)

What is the nature of human well-being? This paper joins the ancient debate by rejuvenating an ancient claim that is quite unfashionable among moral philosophers today, namely, the Aristotelian claim that moral virtue is (non-instrumentally) necessary for human well-being. Call it the Aristotelian Virtue Condition (AVC). This view can be revived for contemporary debate by a state-of-the-art approach that we might call constructivist experimental philosophy, which takes as its goal the achievement of a reasonable constructivist account of well-being and takes (...) the investigation of actual folk intuitions as the central means to achieving that goal. The paper motivates this approach and challenges the commonplace philosophical rejection of AVC by arguing (1) that folk intuitions should count as evidence in the debate, especially if we aim at a constructivist account of well-being, (2) that folk intuitions can be accurately elicited through a thought experiment (the “Crib Test”), and (3) that there is some reason (subject to experimental confirmation) for thinking that folk intuitions, thus elicited, support AVC. Aristotelian ethics, and indeed the entire virtue ethics tradition, has come under fire recently by empirically informed philosophers who question the empirical adequacy of the postulation of robust character traits, but regardless of how that debate turns out, other parts of this tradition might be empirically supported rather than undermined. This paper sketches a promising, empirically informed way of supporting Aristotelian views of well-being. (shrink)

This paper is an attempt to undermine a basic assumption of theories of well-being, one that I call well-being invariabilism. I argue that much of what makes existing theories of well-being inadequate stems from the invariabilist assumption. After distinguishing and explaining well-being invariabilism and well-being variabilism, I show that the most widely-held theories of well-being—hedonism, desire-satisfaction, and pluralist objective-list theories—presuppose invariabilism and that a large class of the objections to them arise because of it. My aim is to show that (...) abandoning invariabilism and adopting variabilism is a sensible first step for those aiming to formulate more plausible theories of well-being. After considering objections to my argument, I explain what a variabilist theory of well-being would be like and show that well-being variabilism need not be any threat to the project of formulating theories of well-being that deliver general principles concerning well-being enhancement. (shrink)

Biocentrism, a prominent view in environmental ethics, is the notion that all and only individual biological organisms have moral status, which is to say that their good ought to be considered for its own sake by moral agents. I argue that biocentrism suffers two serious problems: the Origin Problem and the Normativity Problem. Biocentrism seeks to avoid the absurdity that artifacts have moral status on the basis that organisms have naturalistic origins whereas artifacts do not. The Origin Problem contends that, (...) contra biocentrism, an entity’s origin is not relevant to whether that entity has moral status. The Normativity Problem is that biocentrists are preoccupied with accounting for the goods or interests of nonsentient organisms yet fail to establish why interests so construed confer moral status; biocentrism fails to bridge the good-ought gap. It is shown how these problems emerge in three prominent book-length works representative of the biocentrists’ positions over three decades: Paul Taylor’s Respect for Nature, Gary Varner’s In Nature’s Interests?, and Nicholas Agar’s Life’s Intrinsic Value. At minimum, these criticisms suggest that biocentrism is crucially incomplete as a moral framework at present and, optimistically, where more work remains to be done. If biocentrism really is dead, then moral status should be restricted to a more plausible locus such as sentience or rationality, the value of organisms needs a different expression, and environmental ethics needs an axiological foundation different than bare life. (shrink)

There has been a long tradition of interpreting Plato as a rational egoist. Over the past few decades, however, some scholars have challenged this reading. While Rational Egoism appeals to many ordinary folk, in sophisticated philosophical circles it has fallen out of favor as a general and complete account of the nature of reasons for action. I argue that while the theory of practical rationality that is often equated with rational egoism—a view that I call ‘Simple-Minded Rational Egoism'—is neither plausible (...) nor endorsed by Plato in his Republic, there is a more complex version of Rational Egoism to which Plato is indeed committed. Moreover, such a conception of practical rationality is not vulnerable to the standard set of objections that contemporary philosophers have made against Rational Egoism. (shrink)

“Sophisticated” theories of welfare face two potentially devastating criticisms. They are based upon two claims: that theories of welfare should be tested for what they imply about newborn infants and that even if a theory of welfare is intended to apply only to adults, we might still have sufficient reason to reject it because it implies an implausible divergence between adult and neonatal welfare. It has been argued we ought reject sophisticated theories of welfare because they have significantly counterintuitive implications (...) about neonatal welfare and because they imply an implausible divergence between the welfare of adults and that of newborns. I argue against both claims. (shrink)

I discuss three tiers of technological innovation: mild innovation, or the acceleration by technology of a human activity aimed at a good; moderate innovation, or the obviation by technology of an activity aimed at a good; and radical innovation, or the altering by technology of the human condition so as to change what counts as a good. I argue that it is impossible to morally assess proposed innovations within any of these three tiers unless we rehabilitate a natural-law ethical framework. (...) And I offer some moral starting points within such a framework, in connection with innovations of each of the three types. (shrink)

Philippa Foot’s virtue ethics remains an intriguing but divisive position in normative ethics. For some, the promise of grounding human virtue in natural facts is a useful method of establishing normative content. For others, the natural facts on which the virtues are established appear naively uninformed when it comes to the empirical details of our species. In response to this criticism, a new cohort of neo-Aristotelians like John Hacker-Wright attempt to defend Foot by reminding critics that the facts at stake (...) are not claimed to be explanatory descriptions of the kind provided by empirical science. Instead, they are derived from a logical form that is presupposed when we categorize something as a living organism. Neo-Aristotelian naturalism is therefore said to be immune to the empirical defeaters put forward as criticism of the theory. I argue that neo-Aristotelians like Hacker-Wright can only rescue Foot’s naturalism from being uninformed by exposing it to an indeterminacy objection: if claim.. (shrink)

The article propounds a justification of public health interventionism grounded on personal health as an intermediate human end in the ethical domain, on an interpretation of Aristotle. This goes beyond the position taken by some liberals that health should be understood as a prudential good alone. A second, but independent, argument is advanced in the domain of the political, namely, that population health can be justified as a political value in its own right as a primary social good, following an (...) interpretation of John Rawls’s evolved understanding of such goods in his later works. The article sets the scene for these positions by highlighting how liberal theories focusing on freedom as non-interference, or making the harm principle the basis of legitimate public health interventions, undercut the capacity of the state to actively promote population health. The article points to theoretical resources on legitimacy and liberty—the ‘salient coordinator account’ of authority and freedom as non-domination—that may help avoid this risk. The role of reflective equilibrium incorporating incompletely theorized mid-level principles is emphasized to ensure that interventions are soundly justified. The application of these principles would ensure that interventions do not exceed the proper moral/political boundaries limiting the role of government. (shrink)

Can a person’s degree of wellbeing be affected by things that do not enter her experience? Experientialists deny that it can, extra-experientialists affirm it. The debate between these two positions has focused on an argument against experientialism—the experience machine objection—but few arguments exist for it. I present an argument for experientialism. It builds on the claim that theories of wellbeing should not only state what constitutes wellbeing, but also which entities are welfare subjects. Moreover, the claims it makes about these (...) two issues should have a certain coherence with each other. I argue that if we accept a particular plausible answer to the second question—namely that all and only sentient beings are welfare subjects—extra-experientialist theories face a problem of coherence. While this problem can typically be solved, doing so will involve steps that are unattractive. On experientialist theories, on the other hand, the answer to these questions cohere perfectly. (shrink)

The participation of vulnerable patients in clinical research poses apparent ethical dilemmas. Depending on the nature of the vulnerability, their participation may challenge the ethical principles of autonomy, non-maleficence, or justice. On the other hand, non-participation may preclude the building of a knowledge base that is a prerequisite for defining the optimal clinical management of vulnerable patients. Such clinical uncertainty may also incur substantial economic costs. We present the participation of pre-menopausal women with atrial fibrillation in trials of novel oral (...) anticoagulant drugs as a case study. Due to their non-participation in pivotal trials, it is uncertain whether for them, the risks that are associated with these drugs are outweighed by the advantages compared with conventional treatment. We addressed the question whether research of this new class of drugs in this subgroup would be appropriate from both, an ethical as well an economic perspective. We used the method of specifying norms as a wider framework to resolve the apparent ethical dilemma, while incorporating the question whether research of oral anticoagulants in premenopausal women with atrial fibrillation can be justified on economic grounds. For the latter, the results of a value-of-information analysis were used. Further clinical research on NOACs in premenopausal women with atrial fibrillation can be justified on both, ethical and economic grounds. Addressing apparent ethical dilemmas by invoking a method such as specifying norms can improve the quality of public practical reasoning. As such, the method should also prove valuable to committees that have formally been granted the authority to review trial protocols and proposals for scientific research. (shrink)

In Plato’s dialogue the Republic, Glaucon challenges Socrates to prove that the just (or moral) life is better or more advantageous than the unjust one. Socrates’s answer to the challenge is notoriously unsatisfying. Could new research on well-being in philosophy and psychology allow us to do better? After distinguishing two different approaches to the question “why be moral?” I argue that while new research on well-being does not provide an answer that would satisfy Glaucon, it does shed light on the (...) topic. Empirical research has different implications for our prudential reasons to be moral depending on which philosophical theory of well-being is accepted. Some well-being theories sustain stronger links to morality than others, but any theory of well-being can make use of empirical research to narrow the gap between prudence and morality to some extent. (shrink)

Wisdom, long a topic of interest to moral philosophers, is increasingly the focus of social science research. Philosophers have historically been concerned to develop a rationally defensible account of the nature of wisdom and its role in the moral life, often inspired in various ways by virtue theoretical accounts of practical wisdom (phronesis). Wisdom scientists seek to, among other things, define wisdom and its components so that we can measure them. Are the measures used by wisdom scientists actually measuring what (...) philosophers have in mind when they discuss practical wisdom? I argue that they are not. Contemporary measures of wisdom and its components may pick out some necessary prerequisites of practical wisdom, but they do not measure a philosophically plausible practical wisdom or its components. After explaining the argument and defending it against objections, I consider its implications. Should wisdom scientists ignore the philosophical conception of practical wisdom in favor of other conceptions, revise their methods to try to measure it, or continue the interdisciplinary study of practical wisdom without expecting to measure it? I make a preliminary argument for the third option. (shrink)

Many philosophers have suggested that claims of need play a special normative role in ethical thought and talk. But what do such claims mean? What does this special role amount to? Progress on these questions can be made by attending to a puzzle concerning some linguistic differences between two types of 'need' sentence: one where 'need' occurs as a verb, and where it occurs as a noun. I argue that the resources developed to solve the puzzle advance our understanding of (...) the metaphysics of need, the meaning of 'need' sentences, and the function of claims of need in ethical discourse. (shrink)

Eudaimonistic theorists of welfare have recently attacked conative accounts of welfare. Such accounts, it is claimed, are unable to classify states normally associated with physical and emotional health as non-instrumentally good and states associated with physical and psychological damage as non-instrumentally bad. However, leading eudaimonistic theories such as the self-fulfillment theory and developmentalism have problems of their own. Furthermore, conative theorists can respond to this challenge by dispositionalizing their theories, i.e., by saying that it is not merely the realization of (...) one’s values that is non-instrumentally good for one, but that the disposition to realize one’s values is also non-instrumentally good for one. This approach, properly elaborated, can accommodate the idea that, in many cases, states normally associated with physical and psychological health (or unhealth) are non-instrumentally good (or bad). It also preserves the many well-known advantages of conative theories. (shrink)

This article introduces a non-human version of the non-identity problem and suggests that such a variation exposes weaknesses in several proposed person-focused solutions to the classic version of the problem. It suggests first that person-affecting solutions fail when applied to non-human animals and, second, that many common moral arguments against climate change should be called into question. We argue that a more inclusive version of the person-affecting principle, which we call the ‘patient-affecting principle’, captures more accurately the moral challenge posed (...) by the non-identity problem. We argue further that the failure of person-affecting solutions to solve non-human versions of the problem lend support to impersonal solutions to the problem which avoid issues of personhood or species identity. Finally, we conclude that some environmental arguments against climate change that rely on the notion of personal harm should be recast in impersonal terms. (shrink)

The ‘Big 3’ theories of well-being—hedonism, desire-satisfactionism, and objective list theory—attempt to explain why certain things are good for people by appealing to prudentially good-making properties. But they don’t attempt to explain why the properties they advert to make something good for a person. Perfectionism, the view that well-being consists in nature-fulfilment, is often considered a competitor to these views (or else a version of the objective list theory). However, I argue that perfectionism is best understood as explaining why certain (...) properties are prudentially good-making. This version of perfectionism is compatible with each of the Big 3, and, I argue, quite attractive. (shrink)

The philosophical study of well-being concerns what makes lives good for their subjects. It is now standard among philosophers to distinguish between two kinds of well-being: - lifetime well-being, i.e., how good a person's life was for him or her considered as a whole, and - temporal well-being, i.e., how well off someone was, or how they fared, at a particular moment in time or over a period of time longer than a moment but shorter than a whole life, say, (...) a day, month, year, or chapter of a life. Many theories have been offered of each of these kinds of well-being. A common view is that lifetime well-being is in some way constructed out of temporal well-being. This book argues that much of this literature is premised on a mistake. Lifetime well-being cannot be constructed out of temporal well-being, because there is no such thing as temporal well-being. The only genuine kind of well-being is lifetime well-being. The Passing of Temporal Well-Being will prove essential reading for professional philosophers, especially in moral and political philosophy. It will also be of interest to welfare economists and policy-makers who appeal to well-being. (shrink)

This paper investigates the ethical implications of research at the interface between biodiversity and both human and animal health. Health and sanitary crises often lead to ethical debates, especially when it comes to disruptive interventions such as forced vaccinations, quarantine, or mass culling of domestic or wild animals. In such debates, the emergence of a “Planetary health ethics” can be highlighted. Ethics and accountability principles apply to all aspects of scientific research including its technological and engineering applications, regardless of whether (...) they are considered “hard sciences”, such as state-of-the-art technology in the fields of medicine, veterinary medicine, agronomy, or environment, or “soft”, such as local or global governance, health, socio-ecosystems, and the environment. Ethical reflection in the interdisciplinary field of biodiversity and health requires the examination of relevant scientific domains, such as biology, ecology, evolution, human medicine, animal medicine, anthropology, and law, and their epistemology and representation as well as scientific pluralism, which is crucial to establish genuine interdisciplinarity. Navigating the ethics-scape necessitates going beyond the hierarchy of science by recognising that scientific knowledge has implications for both scientific and non-scientific perspectives on the study of nature. The example of a Nipah virus outbreak is used to illustrate how the so-called “modern epidemiological” approach often focuses on risk factors associated with individual behavioural characteristics or collective practices, whereas the so-called “eco-social” approach focuses on global, socio-economic, and environmental factors that are the contextual causes of the health problem affecting the community. “Modern epidemiologists” aim to “correct” individual or practice factors using a “minimal set” of ethics, whereas “eco-social” scientists have to act systemically, which requires integrated research that acknowledges scientific pluralism, avoids the hierarchy of sciences, but accepts the pluralism of ethics and values. (shrink)

Theories of well-being purport to identify the basic goods and bads whose presence in a person's life determines how well she is faring. Monism is the view that there is only one basic good and one basic bad. Pluralism is the view that there is either more than one basic good or more than one basic bad. In this paper, I give an argument for pluralism that is general in the sense that it does not purport to identify any basic (...) goods or bads. If I am right, then even if you cannot name a single basic good or bad, you can know that pluralism is true. (shrink)

Many philosophers with hedonistic sympathies (e.g., Mill, Sidgwick, Sumner, Feldman, Crisp, Heathwood, and Bradley) have claimed that well-being is necessarily experiential. Kagan once claimed something slightly different, saying that, although unexperienced bodily events can directly impact a person’s well-being, it is nonetheless true that any change in a person’s well-being must involve a change in her (i.e., either in her mind or in her body). Kagan elaborated by saying that a person’s well-being cannot float freely of her such that it (...) is affected by events that do not affect her (Kagan 1992, 169–189). These two claims—that well-being is necessarily experiential and that changes in well-being must involve changes in the person—are two different ways of specifying the general intuition that a person’s well-being must be strongly tied to her. This general intuition imposes an adequacy constraint on welfare theorizing: To be adequate, a welfare theory cannot allow that someone can be directly benefited by events that are not strongly tied to her. Call this the strong-tie requirement. The strong-tie requirement is easily satisfied by welfare hedonism, but it poses problems for desire-fulfillment welfare theories and objective-list welfare theories. Though a great deal has been written about desire-fulfillment welfare theories in relation to the strong-tie requirement, not as much has been written about objective-list welfare theories in relation to the strong-tie requirement. This paper argues that objective-list welfare theories can satisfy the strong-tie requirement, though probably only if they take a perfectionist form, as opposed to a brute-list form. (shrink)

Preventive vaccination can protect not just vaccinated individuals, but also others, which is often a central point in discussions about vaccination. To date, there has been no systematic study of self- and other-directed motives behind vaccination. This article has two major goals: first, to examine and distinguish between self- and other-directed motives behind vaccination, especially with regard to vaccinating for the sake of third parties, and second, to explore some ways in which this approach can help to clarify and guide (...) vaccination debates and policy. I propose conceiving of vaccination in terms of three basic elements: the vaccination decision-maker, the vaccine recipient and the primary beneficiary. I develop a taxonomy based on the relations between these elements to distinguish four kinds of vaccination: self-protective, paternalistic, altruistic and indirect. I finally discuss the case of human papillomavirus vaccine regulation for men and women to show how each kind of vaccination is associated with and raises specific ethical questions. (shrink)

In Welfare, Happiness, and Ethics, L. W. Sumner argues that theories of well-being must not pick out some kinds of human lives as richer in prudential valuethan others. I argue that we should reject this methodological stricture, but should embrace his insight that many kinds of lives are good for people to live. I also reject his claim that a theory of well-being would fail if it took the form of a list of things that are good for us. Nonetheless, (...) I argue, if we construct such a list in a way that caters to the diversity of good human lives, we will be led to the conclusion that they are united by their relationship to the flourishing of our natural capacities. I distinguish between bottom-up and top-down strategies for defending this Aristotelian conception of well-being, and argue in favor of a bottom-up approach. (shrink)

Definition of the problem: Contemporary bioethics as an academic discipline mainly focuses on moral questions – according to its articulated self-concept and the explicit arguments in most areas of bioethical reflection. Concepts and theories of the good life are hardly considered. Arguments: In reality the ‘good life’ plays a much more important role than it is assumed, but mostly only in an implicit way. The article demonstrates this by referencing three selected fields of bioethical discussion. Hence the article argues that (...) bioethics should turn the ‘good life’ into an issue of intense, explicit and systematic consideration. Furthermore, the article provides an initial answer to the questions as to why the ‘good life’ has been marginalized within bioethics up to this point and which function it can assume in future bioethical reflection. Conclusion: The ‘good life’ is the blind spot of bioethics. A more intensive and systematic consideration of the ‘good life’ is a challenge for contemporary and future bioethics. (shrink)

I defend the proposal that certain forms of work—specifically forms that are socially necessary but involve the imposition of considerable burdens—be shared between citizens. I argue that sharing burdensome work would achieve several goals, including a more equal distribution of the benefits and burdens of work, a greater appreciation of each other's labour contributions, and an amelioration of problematic inequalities of status. I conclude by considering three objections: that sharing burdensome work would (1) involve morally unacceptable constraints on freedom, (2) (...) be prohibitively inefficient, and (3) forbid mutually advantageous trades. I argue that none of these objections succeed. (shrink)

This paper challenges the widely held view that ‘good for’, ‘well-being’, and related terms express a distinctive evaluative concept of central importance for ethics and separate from ‘simply good’ as used by G. E. Moore and others. More specifically, it argues that there's no philosophically useful good-for or well-being concept that's neither merely descriptive in the sense of naturalistic nor reducible to ‘simply good’. The paper distinguishes two interpretations of the common claim that the value ‘good for’ expresses is distinctively (...) ‘subject-relative’. One concerns the ground of this value, or the properties that make something good for you; it says these must involve some relation to you. The other concerns the resulting value itself, or what supervenes on this ground; it says that too involves a relation. Neither interpretation, the paper argues, yields a significantly distinct evaluative concept. The ethically fundamental evaluative concept is just ‘simply good’. (shrink)

ZusammenfassungIn this article, I defend a version of moral constitutivism that is based on a theory of goods. It is inspired by ancient philosophy both in claiming that action theory should be formulated in teleological terms and in the idea that a sound theory of goods should be a eudaemonist one. Additionally I argue that morality can be understood on the basis of such an approach.

Recent literature has argued that what makes certain activities ranging from curing cancer to running a marathon count as achievements, and what makes achievements intrinsically valuable is, centrally, that they involve great effort. Although there is much the difficulty-based view gets right, I argue that it generates the wrong results about some central cases of achievement, and this is because it is too narrowly focused on only one perfectionist capacity, the will. I propose a revised perfectionist account on which an (...) achievement is an activity that fully exercises or expresses any number of a range of perfectionist capacities. (shrink)

The potential for healthy development is the key to determining the moral status of mindless and minimally minded organisms. It even provides the basis for a defense of speciesism. Mindless and minimally minded human beings have interests in the healthy development of sophisticated mental capacities, which explains why they are greatly harmed when death, disease, and other events frustrate those interests. Since the healthy development of members of non-human species doesn’t produce the same sophisticated mental capacities, mindless and minimally minded (...) non-human beings lack the interests of mindless and minimally minded human beings. The absence of such interests in developing valuable mental capabilities means non-humans can’t be benefited and harmed to the same degree as human beings. This results in mindless and minimally minded non-humans having lower moral status than human beings. This doesn’t mean that any member of our species is more valuable than any other member of any other possible species. We instead claim that human beings with undeveloped or impaired minds have greater moral status than any member of any other known species that has manifested equivalent mental capacities. (shrink)

Elselijn Kingma maintains that Christopher Boorse and other naturalists in the philosophy of medicine cannot deliver the value-free account of disease that they promise. Even if disease is understood as dysfunction and that notion can be applied in a value-free manner, values still manifest themselves in the justification for picking one particular operationalization of dysfunction over a number of competing alternatives. Disease determinations depend upon comparisons within a reference class vis-à-vis reaching organism goals. Boorse considers reference classes for a species (...) to consist in the properties of age and sex and organism goals to comprise survival and reproduction. Kingma suggests that naturalists are influenced by value judgments and may rely upon implicit assumptions about disease in their choice of reference classes and goals to determine which conditions are diseased. I argue that she is wrong to claim that these choices cannot be defended without arguing in a circular manner or making certain arbitrary or value-driven judgments. (shrink)

ABSTRACT What kind of basic minimum do we owe to others? This paper defends a new procedure for answering this question. It argues that its minimally good life account has some advantages over the main alternatives and that neither the first-, nor third-, person perspective can help us to arrive at an adequate account. Rather, it employs the second-person perspective of free, reasonable, care. There might be other conditions for distributive justice, and morality certainly requires more than helping everyone to (...) secure a basic minimum. Still, if the minimally good life account is correct, and we owe everyone a basic minimum, we must ensure that everyone lives well enough. (shrink)

Proposals for health care cost containment emphasize high-value care as a way to control spending without compromising quality. When used in this context, ‘value’ refers to outcomes in relation to cost. To determine where health spending yields the most value, it is necessary to compare the benefits provided by different treatments. While many studies focus narrowly on health gains in assessing value, the notion of benefit is sometimes broadened to include overall quality of life. This paper explores the implications of (...) using subjective quality of life measures for value assessment. This approach is claimed to be more respectful of patients and better capture the perspectival nature of quality of life. Even if this is correct, though, subjective measurement also raises challenging issues of interpersonal comparability when used to study health outcomes. Because such measures do not readily distinguish benefits due to medical interventions from benefits due to personal or other factors, they are not easily applied to the assessment of treatment value. I argue that when the outcome of interest in value assessment is broadened to include quality of life, the cost side of these measures should also be broadened. I show how one philosophical theory of well-being, Jason Raibley’s “agential flourishing” theory, can be adapted for use in quality of life research to better fit the needs and aims of value assessment in health care. Finally, I briefly note some implications of this argument for debates about fairness in health care allocations. (shrink)

Medical clinicians – doctors, nurses, nurse practitioners etc. – are charged to act for the good of their patients. But not all ways of acting for a patient's good are on par: some are paternalistic; others are not. What does it mean to act paternalistically, both in general and specifically in a medical context? And when, if ever, is it permissible for a clinician to act paternalistically? -/- This paper deals with the first question, with a special focus on paternalism (...) in medicine. While it is easy to give a rough characterization of paternalism (i.e. acting for another's good against that person's will), it is surprisingly difficult to provide a unified account of the myriad of actions that seem to count as paternalistic. After surveying four accounts of paternalism, I argue that two – what I call the authority and beneficence accounts – are the strongest on offer. According to the authority account, a clinician acts paternalistically when, for her patient's good, she usurps his decision-making authority. According to the beneficence account, a clinician acts paternalistically when, for her patient's good, she acts only or overrindingly out of concern for his good. I show how the difference between these accounts matters (in part) for how we should think about the nature of surrogate decision making in medicine. I argue that there are reasons – albeit hardly decisive – to prefer the beneficence account to the authority account. I conclude by considering whether attempts by clinicians to rationally persuade their patients to pursue a particular course of action should be thought of as paternalistic. (shrink)

Patients with severe disorders of consciousness are thought to be unaware of themselves or their environment. However, research suggests that a minority of patients diagnosed as having a disorder of consciousness remain aware. These patients, designated as having “cognitive motor dissociation”, can demonstrate awareness by imagining specific tasks, which generates brain activity detectable via functional neuroimaging. The discovery of consciousness in these patients raises difficult questions about their well-being, and it has been argued that it would be better for these (...) patients if they were allowed to die. Conversely, I argue that CMD patients may have a much higher level of well-being than is generally acknowledged. It is far from clear that their lives are not worth living, because there are still significant gaps in our understanding of how these patients experience the world. I attempt to fill these gaps, by analyzing the neuroscientific research that has taken place with these patients to date. Having generated as comprehensive a picture as possible of the capacities of CMD patients, I examine this picture through the lens of traditional philosophical theories of well-being. I conclude that the presumption that CMD patients do not have lives worth living is not adequately supported. (shrink)

There has been a long tradition of interpreting Plato as a rational egoist. Over the past few decades, however, some scholars have challenged this reading. While Rational Egoism appeals to many ordinary folk, in sophisticated philosophical circles it has fallen out of favor as a general and complete account of the nature of reasons for action. I argue that while the theory of practical rationality that is often equated with rational egoism—a view that I call ‘Simple-Minded Rational Egoism'—is neither plausible (...) nor endorsed by Plato in his Republic, there is a more complex version of Rational Egoism to which Plato is indeed committed. Moreover, such a conception of practical rationality is not vulnerable to the standard set of objections that contemporary philosophers have made against Rational Egoism. (shrink)

THE STRUCTURE OF THIS PAPER IS AS FOLLOWS. I begin §1 by dealing with preliminary issues such as the different relations expressed by the “good for” locution. I then (§2) outline the Locative Analysis of good for and explain its main elements before moving on to (§3) outlining and discussing the positive features of the view. In the subsequent sections I show how the Locative Analysis can respond to objections from, or inspired by, Sumner (§4-5), Regan (§6), and Schroeder and (...) Feldman (§7). I then (§8) reply to an imagined objector who claims that the Locative Analysis generates implausible results with respect to punishment, virtue and agent-centered duties. (shrink)

This paper aims to cast doubt upon a certain way of analysing prudential value (or good for ), namely in the manner of a ‘buck-passing’ analysis. It begins by explaining why we should be interested in analyses of good for and the nature of buck-passing analyses generally (§I). It moves on to considering and rejecting two sets of buck-passing analyses. The first are analyses that are likely to be suggested by those attracted to the idea of analysing good for in (...) a buck-passing fashion (§II). The second are the buck-passing analyses of good for proposed by John Skorupski (§III), Henry Sidgwick (§IV), and Stephen Darwall (§V). Along the way the paper shows that Michael Smith’s and Peter Railton’s analyses of other concepts—analyses that could be (and have been) taken to be analyses of good for —are similarly unsuitable as analyses of it. The paper concludes by suggesting that the fact that none of the buck-passing accounts of good for considered here is satisfactory, coupled with an appreciation of the various problems that a buck-passing analysis of good for would have to avoid, suggests that we should be sceptical about the prospects of finding such an analysis and should look for one of a different type. (shrink)

This paper argues that challenges that are grand in scope such as "lifelong health and wellbeing", "climate action", or "food security" cannot be addressed through scientific research only. Indeed scientific research could inhibit addressing such challenges if scientific analysis constrains the multiple possible understandings of these challenges into already available scientific categories and concepts without translating between these and everyday concerns. This argument builds on work in philosophy of science and race to postulate a process through which non-scientific notions become (...) part of science. My aim is to make this process available to scrutiny: what I call founding everyday ideas in science is both culturally and epistemologically conditioned. Founding transforms a common idea into one or more scientifically relevant ones, which can be articulated into descriptively thicker and evaluatively deflated terms and enable operationalisation and measurement. The risk of founding however is that it can invisibilise or exclude from realms of scientific scrutiny interpretations that are deemed irrelevant, uninteresting or nonsensical in the domain in question-but which may remain salient for addressing grand-in-scope challenges. The paper considers concepts of "wellbeing" in development economics versus in gerontology to illustrate this process. (shrink)

Valuation consists in a positive or negative response by a subject S to an entity X. Any positive or negative response has a structure that involves a cognitive and a non-cognitive component, as well as a reason relationship between these. This structure is shown to be present in the explicit value judgement 'Hans is a kraut', and then also pointed out in the reflex-like feeding behaviour of a frog, where S treats X as providing an affordance. The conclusion is that (...) valuation need not involve mental states. The article ends with a discussion of the elusive question: what makes a response positive or negative? (shrink)

This paper analyses how security affects well-being. Security is understood as someone’s sureness of enjoying some good in the future; well-being is treated as a matter of human flourishing. Security can contribute to our well-being in various ways: if we are in fact bound to enjoy a good, in principle this is positive for our flourishing in the future; if we also believe that we will enjoy this good, we can be more efficient in pursuing our well-being; if we also (...) feel secure, this supports our enjoyment of our physical and mental capacities. For some of these benefits to obtain fully, however, it is important that our beliefs and feelings align with the facts. Furthermore, mirroring security’s upsides, there are also ways in which security can hamper our flourishing: it can obstruct the change, surprise, and pleasurable fear that are sometimes required for a good life too. (shrink)

Even philosophers of religion working on the problem of non-human animal suffering have ignored the suffering of creatures like insects. Sensible as this seems, it’s mistaken. I am not sure whether creatures like these can suffer, but it is plausible, on both commonsensical and scientific and philosophical grounds, that many of them can. If they do, their suffering makes the problem of evil much worse: their vast numbers mean the amount of evil in the world will almost certainly be increased (...) by many, many orders of magnitude, the fact that disproportionately many of them live lives which are nasty, brutish, and short means that the proportion of good to evil in the world will be drastically worsened, and their relative lack of cognitive sophistication means that many theodicies, including many specifically designed to address animal suffering, would apply to their suffering only with much greater difficulty, if at all. Philosophers of religion should therefore more seriously investigate whether these beings can suffer and what, if anything, could justify God in allowing as much. (shrink)

Are Confucian and Buddhist ethical views closer to Kantian, Consequentialist, or Virtue Ethical ones? And how can such comparisons shed light on the unique aspects of Confucian and Buddhist views? This essay (i) provides a historically grounded framework for distinguishing western views, (ii) identifies a series of questions that we can ask in order to clarify the philosophic accounts of ethical motivation embedded in the Buddhist and Confucian traditions, and (iii) then critiques Lee Ming-huei’s claim that Confucianism is closer to (...) Kantianism than virtue ethics and Charles Goodman’s claim that Buddhism is closer to Consequentialism than virtue ethics. (shrink)

Velleman, MacIntyre, and others have argued for the compositional view that lives can be other than equally good for the person who lives them even though they contain all and only the same moments, and that this is explained by their narrative structure. I argue instead for explanation by self-realization, partly by interpreting Siegfried Sassoon’s exemplary life-narrative. I decide between the two explanations by distinguishing the various features of the radial concept of narrative, and showing, for each, either that self-realization (...) is just as good an account, or that we should prefer the self-realization account, of the composition it is supposed to explain. I conclude that, if the shape of a life matters, it matters because some shapes are self-realizations, not because they are narratives. (shrink)

Some goals have special significance to agents. For instance, an agent could find her life worth living because she is pursuing her current goal, and the agent could also think that her previous life has no value because she did not pursue the current goal. If an agent’s current goal has special importance to the agent, then in terms of prudence the agent’s decision to obtain her current goal could be permissible even in the case where achieving her previous goal (...) brings out larger advantages. A widely endorsed thesis of prudence (i.e. the temporal neutrality thesis) does not successfully explain this phenomenon of goal achievement. Furthermore, the present-aim thesis and the harmony thesis also fail in explaining why an agent has prudential reason to prioritize her current goal. This paper introduces a new thesis of prudence, according to which an agent’s caring is significant in deciding whether the agent’s actions are prudentially permissible. In particular, after introducing this thesis named the care thesis, I argue that the care thesis can explain why an agent has reason to prioritize her current goal if the agent finds her life worth living due to her current goal. It is permissible that an agent obtains her current goal rather than previous goal because achieving her current goal benefits the agent’s cared one (i.e. the self who pursues her current goal). (shrink)

A basic challenge to naturalistic moral realism is that, even if moral properties existed, there would be no way to naturalistically represent or track them. Here, the basic structure for a tracking account of moral epistemology is given in empirically respectable terms, based on a eudaimonist conception of morality. The goal is to show how this form of moral realism can be seen as consistent with the details of evolutionary biology as well as being amenable to the most current understanding (...) of representationalist or correspondence theories of truth. (shrink)

To protect children in research, procedures that are not administered in the medical interests of a child must be restricted. The risk threshold for these procedures is generally measured according to the concept of minimal risk. Minimal risk is often defined according to the risks of “daily life.” But it is not clear whose daily life should serve as the baseline; that is, it is not clear to whom minimal risk should refer. Commentators in research ethics often argue that “minimal (...) risk” should refer to healthy children or the subjects of the research. I argue that neither of these interpretations is successful. I propose a new interpretation in which minimal risk refers to children who are not unduly burdened by their daily lives. I argue that children are not unduly burdened when they fare well, and I defend a substantive goods account of children’s welfare. (shrink)

Kraut and other neo-Aristotelians have argued that there is no such thing as absolute goodness. They admit only good in a kind, e.g. a good sculptor, and good for something, e.g. good for fish. What is the view of Aristotle? Mostly limiting myself to the Nicomachean Ethics, I argue that Aristotle is committed to things being absolutely good and also to a metaphysics of absolute goodness where there is a maximally best good that is the cause of the goodness of (...) all other things in virtue of being their end. I begin by suggesting that the notion of good as an end, which is present in the first lines of the NE, is not obviously accounted for by good in a kind or good for something. I then give evidence that good in a kind and good for something can explain neither certain distinctions drawn between virtues nor the determinacy ascribed to what is good “in itself.” I argue contra Gotthelf that because several important arguments in the Nicomachean Ethics rely on comparative judgments of absolute value—e.g. “Man is the best of all animals”—Aristotle is committed to the existence of both absolute goodness and an absolutely best being. I focus on one passage, Aristotle’s division of goods in NE I 12, which presupposes this metaphysical picture. (shrink)