This article offers a solution to the numbers problem within an individualist moral framework. Its central aims are as follows: to rescue individualist moral theories, such as moral contractualism, from their long-standing problem with interpersonal aggregation; to demonstrate how, proceeding from an individualist mode of justification, we can nevertheless make the numbers count without directly counting the numbers; to provide an individualist rationale for accepting a partially aggregative criterion of adjudication for resolving interpersonal trade-offs; and finally, to develop an extensionally (...) adequate version of partial aggregation that finds application in more structurally complex cases. (shrink)

Pe tradición filosófica umi enfoque moral rehegua oñemopyenda predominantemente umi concepto ha teoría metafísica ha teológica-pe. Umi concepto tradicional ética rehegua apytépe, ojehecharamovéva ha’e Teoría de Comando Divino (TCD). TCD he’iháicha, Ñandejára ome’ẽ pyenda moral yvypórape ojejapo guive ha umi revelación rupive. Péicha, pe moralidad ha divinidad ndojeseparái va’erãmo’ã pe civilización mombyryvéva guive. Ko'ã concepto oime sumergido peteî estructura teológica ha oasepta principalmente mayoría umi omoirûva mbohapy tradición abrahámica: judaísmo, cristianismo ha islam, oimehápe parte considerable población humana. Oñongatúvo jerovia ha (...) Apocalipsis ifundamento ramo, umi Teorías de Mando Divino noĩri estrictamente sujeto mba’eveichagua tipo de demostración-pe. Umi opositor concepción moral Comando Divino rehegua, oñemopyendáva imposibilidad ohechauka haĝua umi suposición metafísica ha religiosa orekóva, oñeha’ã heta siglo aja odevalorávo importancia orekóva. Oipytyvõ hikuái argumento teoría ndohechaukái evidencia material ha coherencia lógica ha, péva rehe, ndikatúi ojeguereko en cuenta propósito científico térã filosófico. Pe entendimiento moral oikotevẽ peteĩ percepción ha acuerdo tuichavéva umi filósofo apytépe, araka’eve ndohupytýiva hikuái. Universo ha atmósfera ojeréva ko estudio rehe ha'e umi dominio opavave ko'ã conflicto conceptual, ojehecháva punto de vista objetivo ha evolutivo. Taha'e ha'éva ko circunstancia ha importancia intrínseca orekóva, ko'ã porandu mombyry eterei enfoque metodológico peteî discusión analítica moralidad objetiva rehe, ha'éva, añetehápe, objetivo ha alcance ko tembiapo. Jahecha jeyva’erã mbykymi ko’ã teoría tradicional iñimportánteva, ko investigación ha’égui peteĩ estudio comparativo, ha umi suposición orekóva por lo menos tuicha iñambue opaite teoría tradicional-gui. Upévare oñeikotevê oñeikuave'ê moñe'êhárape, ko texto-pe, elemento directo ha específico ombojojáva crítica válida-pe guarã, odispensávo investigación interruptiva. Ha katu, jepe jahecha jey umi teoría tradicional, upevarã exposición comparativa ha crítica, oñeñongatúta ñande preocupación principal ykére, ha'eháicha "aliena materia". Hembipotápe ore estudio ohechauka ha ohustifika existencia ha significado arquetipo moral prehistórico heñóiva directamente principio fundamental, tekotevê social ha ñeha'ã sobrevivencia rehe. Ko'ã arquetipo ha'e definición fundamento esencial ética, agregación orekóva organización lógica colectiva inconsciente ha correspondiente ha transmisión umi etapa evolutiva genoma humano ha umi relación espacio-tiempo iñambuéva, independientemente oimeraê experiencia contemporánea umi tapicha. Ko sistema odefiníva ko'ã arquetipo omoheñói modelo social humano evolutivo. Ko razonamiento he'ise pe moralidad ha'eha peteî atributo primario "homo sapiens" rehegua; ndaha’éi peteĩ mba’e ni peteĩ accidente: ombojoaju yvypóra esencia ha oike yvypóra identidad ontológica reino-pe. Pe fenómeno yvypóra ha’e peteĩ proceso continuo, omboguatáva ifunción determinación aleatoria ha libre albedrío apytépe, ha tekotevẽ ñacuestiona mba’éichapa oñepyrũ pe moralidad ha mba’éichapa ou ñandéve ko’áĝa. (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)

This thesis is about the moral reasons we have to do less than best. It consists of six chapters. Part I of the thesis proposes, extends, and defends reasons to do less than best. In Chapter One (“The Conditional Obligation”) I outline and reject two recent arguments from Joe Horton and Theron Pummer for the claim that we have a conditional obligation to bring about the most good. In Chapter Two (“Agglomeration and Agent-Relative Costs”) I argue that agent-relative costs can (...) justify permissions to less than best in a far greater range of decisions contexts than we currently believe. In Chapter Three (“Risk and Aggregation”) I discuss how anti-aggregative moral theories deal with risk, whilst proposing an argument in favour of ex-post moral theories. -/- In Part II of the thesis, I discuss longtermism, presenting a series of reasons to believe we have both significant permissions and obligations to prioritise those in the short-term. In Chapter Four (“Listening to Future People”) I criticise a recent argument presented by Andreas Mogensen for the claim we cannot have obligations grounded in the wellbeing of future people. I then show that, even permitting the existence of obligations to future people, we still have significant reasons to resist longtermism on the grounds of partiality. In Chapter Five (“The Complaints of Future People”) I argue that scepticism about aggregation is inconsistent with an obligation, or indeed even a permission, to help far future people. In Chapter Six (“Leaving the Present Behind”) I explore the moral significance of “dooming”, whilst arguing that we have a pro tanto reason of fairness to prioritise aiding those currently in existence. (shrink)

Limited aggregation holds that we are only sometimes, not always, permitted to aggregate. Aggregation is permissible only when the harms and benefits are relevant to one another. But how should limited aggregation be extended to cases in which we are uncertain about what will happen? In this article, I provide a challenge to ex post limited aggregation. I reconstruct a precise version of ex post limited aggregation that relies on the notion of ex post claims. However, building a theory of (...) limited aggregation based on ex post claims leads to a dilemma. This shows that ex post limited aggregation is currently far away from being a well-defined alternative, strengthening the case for ex ante limited aggregation. (shrink)

In the recent literature across philosophy, medicine and public health policy, many influential arguments have been put forward to support the use of randomization procedures to allocate scarce life-saving resources. In this paper, I provide a systematic categorization and a critical evaluation of these arguments. I shall argue that those arguments justify using RAND to allocate SLSR in fewer cases than their proponents maintain and that the relevant decision-makers should typically allocate SLSR directly to the individuals with the strongest claims (...) to these resources rather than use RAND to allocate such resources. (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)

Many of us believe (1) Saving a life is more important than averting any number of headaches. But what about risky cases? Surely: (2) In a single choice, if the risk of death is low enough, and the number of headaches at stake high enough, one should avert the headaches rather than avert the risk of death. And yet, if we will face enough iterations of cases like that in (2), in the long run some of those small risks of (...) serious harms will surely eventuate. And yet: (3) Isn't it still permissible for us to run these repeated risks, despite that knowledge? After all, if it were not, then many of the risky activities that we standardly think permissible would in fact be impermissible. Nobody has yet offered a principle that can accommodate all of 1-3. In this paper, I show that we can accommodate all of these judgements, by taking into account both ex ante and ex post perspectives. In doing so, I clear aside an important obstacle to a viable deontological decision theory. (shrink)

Faced with the choice between saving one person and saving two others, what should we do? It seems intuitively plausible that we ought to save the two, and many forms of consequentialists offer a straightforward rationale for the intuition by appealing to interpersonal aggregation. But still many other philosophers attempt to provide a justification for the duty to save the greater number without combining utilities or claims of separate individuals. I argue against one such attempt proposed by Iwao Hirose. Despite (...) being consequentialist, his argument is aggregation-free since it relies on a non-aggregative value judgement method, instead of interpersonal aggregation, to establish that (other things being equal) a state of affairs is better when more people survive therein. I do not take issue with its consequentialist element; rather, I claim that there is no good reason to adopt the method in question, and thus no good reason to be moved by his argument overall. What we are in search of is not merely a logically possible method that can produce the conclusion that we already want, but one that we have good reason to adopt. Hirose's argument elegantly demonstrates how it could possibly be true that it is right to save the greater number; but it fails to show that we have reason to believe so - even when we do not combine the interests of different individuals. (shrink)

When one faces competing claims of varying strength on public resources for health, which claims count? This paper proposes the following answer. One should count, or aggregate, a person’s claim just in case one could sympathize with her desire to prioritize her own claim over the strongest competing claim. It argues that this principle yields appealing case judgments and has a plausible grounding in both sympathetic identification with each person, taken separately, and respect for the person for whom most is (...) at stake. It also defends this principle against several heretofore unanswered objections. (shrink)

The three most common responses to Taurek’s ‘numbers problem’ are saving the greater number, equal chance lotteries and weighted lotteries. Weighted lotteries have perhaps received the least support, having been criticized by Scanlon What We Owe to Each Other ( 1998 ) and Hirose ‘Fairness in Life and Death Cases’ ( 2007 ). This article considers these objections in turn, and argues that they do not succeed in refuting the fairness of a weighted lottery, which remains a potential solution to (...) cases of conflict. Moreover, it shows how these responses actually lead to a new argument for weighted lotteries, appealing to fairness and Pareto-optimality. (shrink)

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

Argues that there is no one it is irrational to love, that it is rational to act with partiality to those we love, and that the rationality of doing so is not conditional on love. It follows that Anscombe and Taurek are right: you are not required to save three instead of one, even when those you could save are perfect strangers.

In 'Rethinking the Good', Larry Temkin makes two core claims. First, the goodness of a distribution is sometimes ‘essentially comparative’ – it sometimes depends on which alternative distribution(s) it is compared to. Second, such cases threaten the transitivity of ‘all things considered better than’. I argue that the goodness of a distribution may indeed depend on what other distributions are feasible. But contrary to Temkin, I also argue that transitivity holds even when the goodness of a distribution depends on the (...) feasible set of which it is a member. (shrink)

This paper surveys the current philosophical discussion of the ethics of risk imposition, placing it in the context of relevant work in psychology, economics and social theory. The central philosophical problem starts from the observation that it is not practically possible to assign people individual rights not to be exposed to risk, as virtually all activity imposes some risk on others. This is the ‘problem of paralysis’. However, the obvious alternative theory that exposure to risk is justified when its total (...) benefits exceed its total costs faces the standard distributional challenges of consequentialism. Forms of contractualism have been proposed as a solution, but how exactly such theories can be formulated remains problematic, especially when confronted with the difficult cases of mass, novel, risk such as climate change. (shrink)

I distinguish several arguments Kamm and Scanlon make against Taurek's claim that it is permissible to save smaller groups of people rather than larger. I then argue that none succeeds. This is a companion to my "Saving the Few.".

We shall focus on moral theories that are solely concerned with promoting the benefits (e.g., wellbeing) of individuals and explore the possibility of such theories ascribing some priority to benefits to those who are worse off—without this priority being absolute. Utilitarianism (which evaluates alternatives on the basis of total or average benefits) ascribes no priority to the worse off, and leximin (which evaluates alternatives by giving lexical priority to the worst off, and then the second worst off, and so on) (...) ascribes absolute priority to the worse off (i.e., favors even a very small benefit to a worse off person over very large benefits to large numbers of better off people). Neither extreme view, we assume, is plausible. (shrink)

Greater public awareness of the occurrence of sexual assault has led to the creation of mobile phone apps designed to facilitate consent between sexual partners. These apps exhibit serious practical shortcomings in realistic contexts; however, in this paper I consider the hypothetical case in which these practical shortcomings are absent. The prospect of this viable consent app creates an interesting challenge for consequentialism – one that is comparable to the objection that the theory justifies killing innocent persons to prevent large (...) numbers of less serious harms like experiencing brief, painful headaches. I outline and reject the most straightforward way for consequentialists to address this challenge, and I argue that the empirical calculations at stake reveal something rarely appreciated: consequentialists ought to sometimes favour reinforcing deontological constraints in common-sense morality rather than seeking to undermine them. (shrink)

Most non-consequentialists “let the numbers count” when one can save either a lesser or greater number from equal or similar harm. But they are wary of doing so when one can save either a small number from grave harm or instead a very large number from minor harm. Limited aggregation is an approach that reconciles these two commitments. It is motivated by a powerful idea: our decision whom to save should respect each person who has a claim to our help, (...) including those whom we fail to save. However, it has recently been argued that it is open to decisive objections. I develop a new limitedly aggregative view:Hybrid Balance Relevant Claims. This view is well grounded in the reasons we have to be skeptical of aggregation and resolves all recent challenges by paying careful attention to the rationale for limited aggregation. (shrink)

You and I lead different lives. While we share a society and a world, our existence is separate from one another. You and I matter individually, by ourselves. My dissertation is about this simple thought. I argue that this simple insight, the separateness of persons, tells us something fundamental about morality. My dissertation seeks to answer how the separateness of persons matters. I develop a precise view of the demands of the separateness of persons. The separateness of persons imposes both (...) a requirement on the justification of first-order moral principles as well as a requirement on the content of first-order moral principles. In specifying these demands, I argue that respecting the separateness of persons requires taking into consideration each person’s point of view separately. This requires taking into account the moral relations in which individuals stand to one another. I make use of this relational understanding of the separateness of persons to advance various debates in moral and political philosophy. I argue for a framework to assess to which extent the veil of ignorance can be reconciled with the separateness of persons. I also argue for a new view on the ethics of risk which is a form of contractualism that discounts risks only by their objective risk. Furthermore, I argue for a new solution to the problem of aggregation that is skeptical of aggregation and can set plausible limits to aggregation. Lastly, I provide a new relational agent-based justification for deontological constraints. In addition to answering how the separateness of persons matters, I defend the separateness of persons against challenges. Most importantly, I argue that the importance of the separateness of persons is not undermined even if we believe that our personal identity, i.e. whether we persist as the same person, is unimportant. (shrink)

Utilitarianism is often criticized because of its reliance on the interpersonal aggregation of harms and benefits. However, since the rejection of all forms of interpersonal aggregation strikes most people as implausible, some critics of utilitarianism have proposed theories of Limited Aggregation. These occupy the middle ground between fully aggregative and non-aggregative views. Recently, Limited Aggregation has been criticized for having counterintuitive implications that seem even worse than the counterintuitive implications of fully aggregative and non-aggregative views it tried to escape. I (...) here propose a new view of Limited Aggregation that does better than existing accounts in this regard. It is more modest than existing accounts of Limited Aggregation, but it retains the view's core idea. This, I claim, is the thought that sometimes very strong individual claims stand in the way of realizing the best outcome. (shrink)

After providing a novel taxonomy of lottery procedures for fairly distributing scarce goods, I defend a new weighted lottery theory. This taxonomy is necessary because the debate between unweighted and weighted lottery theorists overlooks a range of cases, overlap cases, in which conducting an unweighted lottery is impossible or implausible. Therefore, to account for all such cases, lottery theorists must adopt a weighted lottery. However, while no extant weighted lottery is adequate in overlap cases, my new weighted lottery theory is. (...) I conclude by discussing my theory’s practical implications. (shrink)

Disability might be relevant to decisions about life support in intensive care in several ways. It might affect the chance of treatment being successful, or a patient’s life expectancy with treatment. It may affect whether treatment is in a patient’s best interests. However, even if treatment would be of overall benefit it may be unaffordable and consequently unable to be provided. In this paper we will draw on the example of neonatal intensive care, and ask whether or when it is (...) justified to ration life-saving treatment on the basis of disability. We argue that predicted disability is relevant both indirectly and directly to rationing decisions. (shrink)

Two generally recognized moral duties are to reciprocate benefits one has received from others and to compensate harms one has done to others. In this paper I want to show that it is not possible to give an adequate account of either duty – or at least one that corresponds to our actual practices – within a contractualist moral theory of the type developed by T. M. Scanlon (1982, 1998). This fact is interesting in its own right, as contractualism is (...) a leading contemporary contender among deontological moral theories, and the two duties I have mentioned are fairly standard ingredients of such theories. But it also serves to highlight a general problem with contractualism, at least in Scanlon’s version – namely its one-dimensional view of the keystone of any plausible deontological theory: the idea of respect for persons. (shrink)

This article discusses some ethical principles for distributing pandemic influenza vaccine and other indivisible goods. I argue that a number of principles for distributing pandemic influenza vaccine recently adopted by several national governments are morally unacceptable because they put too much emphasis on utilitarian considerations, such as the ability of the individual to contribute to society. Instead, it would be better to distribute vaccine by setting up a lottery. The argument for this view is based on a purely consequentialist account (...) of morality; i.e. an action is right if and only if its outcome is optimal. However, unlike utilitarians I do not believe that alternatives should be ranked strictly according to the amount of happiness or preference satisfaction they bring about. Even a mere chance to get some vaccine matters morally, even if it is never realized. (shrink)

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

Ex ante contractualism holds that in situations involving risk we ought to act in accordance with principles that license the action that satisfies the strongest individual claim, where those claims are a function of the expected value that a given policy gives each person ex ante. I here challenge ex ante contractualism on contractualist grounds. I argue that adopting ex ante contractualism would have far reaching implications that contractualists, or many nonconsequentialist in general, would find very hard to accept. I (...) conclude that to block these implications, contractualists should adopt an ex post approach to deal with decisions under risk. (shrink)

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

If we can save the lives of only one of multiple groups of people, we might be inclined simply to save whichever group is largest. We may worry, though, that automatically saving the largest group fails to take each saveable individual sufficiently into account, offering some of these individuals no chance at all of being rescued. Still wanting to give larger groups higher chances of survival, we may then say that we ought to employ a proportionally weighted lottery to determine (...) which group to save. In this paper, I argue that this would be a mistake. Given the most plausible way of specifying it, the weighted-lottery view itself fails to treat each saveable individual with equal moral respect. (shrink)

This paper surveys the current philosophical discussion of the ethics of risk imposition, placing it in the context of relevant work in psychology, economics and social theory. The central philosophical problem starts from the observation that it is not practically possible to assign people individual rights not to be exposed to risk, as virtually all activity imposes some risk on others. This is the ‘problem of paralysis’. However, the obvious alternative theory that exposure to risk is justified when its total (...) benefits exceed its total costs faces the standard distributional challenges of consequentialism. Forms of contractualism have been proposed as a solution, but how exactly such theories can be formulated remains problematic, especially when confronted with the difficult cases of mass, novel, risk such as climate change. (shrink)

Common-sense morality seems to tell us that a rescuer who can save either one individual or five other individuals from death has a duty to save the greater number. But contractualism, a moral theory on which principles must be justifiable to individuals, seems to imply that it is permissible to save the one. This is because a commitment to individual justification blocks the possibility of appealing to the aggregate amount of lives saved. Does contractualism really have this implication? If so, (...) should we side with the common-sense approach, or is there any reason to side with the contractualist? In this paper, I first examine a new argument from Jay Wallace which claims to reconcile contractualism with a duty to save the greater number. I find the argument to be unsuccessful. I then suggest that common-sense morality doesn't support a duty to save the greater number as straightforwardly as it might initially seem as it might initially seem. I introduce two mundane cases in which the permissibility of saving either the lesser or greater number is intuitively plausible, and I offer some reasons to think that the permissibility of saving the lesser number coheres with our value judgements more generally. (shrink)

This thesis defends John Rawls’s constructivist theory of justice against three distinct challenges. -/- Part one addresses G. A. Cohen’s claim that Rawls’s constructivism is committed to a mistaken thesis about the relationship between facts and principles. It argues that Rawls’s constructivist procedure embodies substantial moral commitments, and offers an intra-normative reduction rather than a metaethical account. Rawls’s claims about the role of facts in moral theorizing in A Theory of Justice should be interpreted as suggesting that some of our (...) moral beliefs, which we are inclined to hold without reference to facts, are, in fact, true, because certain facts obtain. This thesis and the acknowledgement of the moral assumptions of Rawls’s constructivism help to show that Rawls does not, and does not need to, deny Cohen’s thesis. -/- Part two defends the characterization of the decision problem in Rawls’s original position as a decision problem under uncertainty. Rawls stipulates that the denizens of the original position lack information that they could use to arrive at estimates of the likelihood of ending up in any given social position. It has been argued that Rawls does not have good grounds for this stipulation. I argue that given the nature of the value function we should attribute to the denizens of the original position and our cognitive limitations, which also apply to the denizens of the original position, their decision problem can be characterized as one under uncertainty even if we stipulate that they know that they have an equal chance of being in any individual’s place. -/- Part three assesses the claim that a true commitment to Rawls’s difference principle requires a further commitment to an egalitarian ethos. This egalitarian ethos is offered as a means to bring about equality and Pareto-optimality. Accordingly, I try to undermine the case for an egalitarian ethos by challenging the desirability of the ends it is supposed to further or by showing that it is redundant. I argue that if primary goods are the metric of justice, then Pareto optimality in the space of the metric of justice is undesirable. I then argue that if the metric of justice is welfare, depending on the theory of welfare we adopt, an egalitarian ethos will either be redundant or will have objectionably paternalistic consequences. (shrink)

Orphan drug policy often gives ‘special treatment’ to rare diseases, by giving additional priority or making exceptions to specific drugs, based on the rarity of the conditions they aim to treat. This essay argues that the goal of orphan drug policy should be to make prevalence irrelevant to funding decisions. It aims to demonstrate that it is severity, not prevalence, which drives our judgments that important claims are being overlooked when treatments for severe rare diseases are not funded. It shows (...) that prioritising severity avoids problems caused by prioritising rarity, and that it is compatible with a range of normative frameworks. The implications of a severity-based view for drug development are then derived. The severity-based view also accounts for what is wrong with how the current system of drug development unfairly neglects common diseases that burden the developing world. Lastly, the implications of a severity-based view for current orphan drug policies are discussed. There are no data in this work. (shrink)

In 'How Should We Aggregate Competing Claims', Alex Voorhoeve suggests accommodating intuitions about duties in rescue cases by combining aggregative and non-aggregative elements into one theory. In this paper, I discuss two problems Voorhoeve’s theory faces as a result of requiring a cyclic pattern of choice, and argue that his attempt to solve them does not succeed.