This project considers whether and how research ethics can contribute to the provision of cost-effective medical interventions. Clinical research ethics represents an underexplored context for the promotion of cost-effectiveness. In particular, although scholars have recently argued that research on less-expensive, less-effective interventions can be ethical, there has been little or no discussion of whether ethical considerations justify curtailing research on more expensive, more effective interventions. Yet considering cost-effectiveness at the research stage can help ensure that scarce resources such as tissue (...) samples or limited subject popula- tions are employed where they do the most good; can support parallel efforts by providers and insurers to promote cost-effectiveness; and can ensure that research has social value and benefits subjects. I discuss and rebut potential objections to the consideration of cost-effectiveness in research, including the difficulty of predicting effectiveness and cost at the research stage, concerns about limitations in cost-effectiveness analysis, and worries about overly limiting researchers’ freedom. I then consider the advantages and disadvantages of having certain participants in the research enterprise, including IRBs, advisory committees, sponsors, investigators, and subjects, consider cost-effectiveness. The project concludes by qualifiedly endorsing the consideration of cost-effectiveness at the research stage. While incorporating cost-effectiveness considerations into the ethical evaluation of human subjects research will not on its own ensure that the health care system realizes cost-effectiveness goals, doing so nonetheless represents an important part of a broader effort to control rising medical costs. (shrink)

Certain methods and weapons are traditionally considered to be?mala in se?, i.e. evil in themselves. Examples are mass rape campaigns and land mines. This article examines different interpretations of the principle that belligerents ought not to use such means. Some interpretations are reductionist in the sense that they see the principle as an instance of other principles regulating conduct in war, namely the principles of discrimination and proportionality. I suggest a horizontal and a vertical dimension of the latter. Resort to (...) violence can then be unjustified if the persons are not liable to be attacked because they bear no responsibility for the relevant threat, the amount of harm is disproportionate compared to what can be achieved by the resort to violent force, or the kind of harm is disproportionate by making individual persons suffer in ways that no one should have to endure. I defend the vertical dimension of proportionality as a key to understanding the principle of mala in se and consider whether it leads to an absolute prohibition against such means. (shrink)

Proportionality has long been considered a pillar of just war theory, requiring that the goods achieved in an action outweigh the collateral harms it causes. In this article, I argue that the in bello principle of proportionality cannot serve its intended function of limiting the destructiveness of actions during war. I illustrate the features of war that make the in bello proportionality constraint not merely impossible to follow, but perhaps even self-defeating. I conclude by suggesting ways in which theorists and (...) policymakers concerned with justice in war might attempt to respond to this dilemma. (shrink)

Philosophy &Public Affairs, Volume 51, Issue 3, Page 294-326, Summer 2023.