Increasing philosophical attention is being directed to the rapidly growing discipline of evidence-based medicine. Philosophical discussions of EBM, however, remain narrowly focused on randomization, mechanisms, and the sociology of EBM. Other aspects of EBM have been all but ignored, including the nature of clinical reasoning and the question of whether it can be standardized; the application of EBM principles to the logic, value, and ethics of diagnosis and prognosis; evidence synthesis ; and the nature and ethics of placebo controls. Philosophical (...) analysis in each of these areas has the potential to enhance the discussion of EBM methodology and practice. (shrink)

In his famous lecture on ‘The Concept of Preference’ Amartya Sen (1982) opened up the topic of preference and preference-satisfaction to critical, philosophical debate. He pointed out that preference in the sense in which choice reveals one’s preference need not be preference in the sense in which people are personally better off for having their preferences satisfied. And on the basis of that observation he built a powerful critique of some common assumptions in welfare economics.

“ >. Das hiess doch: Wenn du dir gewisse Tatsachen anders denkst,sie anders beschreibst, als sie sind, dann kannst du die Anwendung gewisser Begriffe dir nicht mehr vorstellen, weil die Regeln ihrer Anwendung kein Analogon unter den neuen Umständen haben.”.

Normative ethics usually presupposes background accounts of human agency, and although different ethical theorists might have different pictures of human agency in mind, there is still something like a standard account that most of mainstream normative ethics can be understood to rest on. Ethical theorists tend to have Rational Man, or at least some close relative to him, in mind when constructing normative theories. It will be argued here that empirical findings raise doubts about the accuracy of this kind of (...) account; human beings fall too far short of ideals of rationality for it to be meaningful to devise normative ideals within such a framework. Instead, it is suggested, normative ethics could be conducted more profitably if the idea of unifying all ethical concerns into one theoretical account is abandoned. This disunity of ethical theorizing would then match the disunited and heuristic-oriented nature of our agency. (shrink)

If a person, A, branches into B and C, then it is widely held that B and C are not identical to one another. Many think that this is because B and C have contradictory properties at the same time. In this paper, I show why this explanation cannot be right. I argue that contradictory properties at times are not necessary for non-identity between descendants, and that contradictory properties at times are not sufficient for non-identity. I also argue that the (...) standard explanation cannot be salvaged by a shift to personal time. Appeals to a lack of continuity, or to the absence of unity of consciousness likewise fail. Rather, B and C are non-identical simply because A branched into B and C. Why branching should be problematic for personal identity remains a deep puzzle though I offer some tentative suggestions. (shrink)

This Dissertation argues for a care-centrically grounded account of relational personhood and widely realized diachronic personal identity. The moral distinction between persons and non-persons is arguably one of the most salient ethical lines we can draw since many of our most fundamental rights are delineated via the bounds of personhood. The problem with drawing such morally salient lines is that the orthodox, rationalistic definition of personhood, which is widespread within philosophical, medical, and colloquial spheres, excludes, and thereby de-personifies, a large (...) number and a great variety of human beings such as neonates, young children, the elderly who suffer from dementia, individuals with severe cognitive disabilities, and patients in vegetative states. The reconceptualization of personhood necessary for a more inclusive definition ought to originate with an appropriate moral grounding. To this end, this Dissertation grounds the notion of personhood in the care ethical sphere, thereby emphasizing the role of care relations in the maintenance of the moral consideration of vulnerable individuals. This Dissertation argues that grounding the concept of a person in care relations entails a relational account of personhood, which, along with the insights of the Extended Mind and Social Manifestation Theses, leads to an extended and externalized understanding of diachronic identity, which allows fragile people to be held in their personal identities even if they themselves lack the capacities usually associated with moral personhood. As we trace a person’s identity through time, we track the various relational properties, which constitute personal narratives and thus act as a glue that binds such dynamic and often unique properties into stable, trackable narratives. Since care relations are morally relevant on a care-centric account of personhood, what is lost in cases where such care relating ceases is not merely of sentimental value, but of great moral importance as well. Morally meaningful care relations are not replaceable, and, by extension, neither are the narratives that are constituted by such unique and irreplaceable instances of relating. This Dissertation argues that the constitutive care relational nature of personal narratives makes such narratives irreplaceable and is precisely what makes persons so morally precious. (shrink)

In this article I want to construct in a simple and systematic way an ethical theory of animal equality. The goal is a consistent theory, containing a set of clear and coherent universalized ethical principles that best fits our strongest moral intuitions in all possible morally relevant situations that we can think of, without too many arbitrary elements. I demonstrate that impartiality with a level of risk aversion and empathy with a need for efficiency are two different approaches that both (...) result in the same consequentialist principle of prioritarianism. Next, I discuss that this principle can be trumped by an ethic of care principle of tolerated partiality, and a deontological principle of basic right. These three principles represent different kinds of equality that can be applied to animal ethics. Finally, the predation problem leads to the introduction of a triple-N-principle that is related to the value of biodiversity. (shrink)

Poverty indexes are essential for monitoring poverty, setting targets for poverty reduction, and tracking progress on these goals. This paper suggests that further justification is necessary for using the main poverty indexes in the literature in any of these ways. It does so by arguing that poverty should not decline with the mere addition of a rich person to a population and showing that the standard indexes do not satisfy this axiom. It, then, suggests a way of modifying these indexes (...) to avoid this problem. (shrink)

The first impacts of climate change have become evident and are expected to increase dramatically over the next decades. Thus, it becomes more and more pressing to decide who has to compensate those people who suffer from negative impacts of climate change but have neither contributed to the problem nor possess the resources to cope with the consequences. Since the frequently invoked Polluter Pays Principle cannot account for all climate-related harm, I will take a closer look at the much more (...) controversial Beneficiary Pays Principle. It is argued that, appropriately qualified, the Beneficiary Pays Principle can help to identify additional duty-bearers. Based on these results, I briefly comment on three different policy options to generate funds for compensation. (shrink)

The article examines four principles of cost allocation (cost of mitigation, of adaptation, and of compensation) for environmental policies that aim to address climate change: “the polluter pays”, “who benefits pays”, “who is able to pay, pays”, and “the equal per capita”. It shows that they are all problematic. A better case can be built by the joint work of only the two principles of “the polluter pays” and “who benefits pays”.

Thought experiments about personal identity have generated conflicting conclusions. Unger attempts, but fails, to refine the thought experimental approach, so as to yield consistent results -- in support of a novel analysis of personal identity. A better strategy is to regard the thought experiments as posing a problem rather than providing a solution. The problem they raise concerns the basis of self-concern. Examining this problem provides grounds for a psychological analysis of personal identity that differs substantially from Unger's.

Conventionalists about promising believe that it is wrong to break a promise because the promisor takes advantage of a useful social convention only to fail to do his part in maintaining it. Anti-conventionalists claim that the wrong of breaking a promise has nothing essentially to do with a social convention. Anti-conventionalists are right that the social convention is not necessary to explain the wrong of breaking most promises. But conventionalists are right that the convention plays an essential role in any (...) satisfactory account of promising. A new conventionalism can explain this by appealing to special features of social conventions. Two of these special features have important implications for any moral requirements they mediate, such as the requirement to keep one's promises and the moral requirements attached to social or occupational roles. First, these requirements will not depend on features of a situation that are inaccessible to typical participants in the convention. Second, these requirements often cannot be tailored to fit the overly unusual circumstances of participants. (shrink)

The paper starts with a presentation of the pure happiness theory, i.e. the idea that the quality a person’s life is dependent on one thing only, viz. how happy that person is. To find out whether this type of theory is plausible or not, I examine the standard arguments for and against this theory, including Nozick’s experience machine argument. I then investigate how the theory can be modified in order to avoid the most serious objections. I first examine different types (...) of epistemic modifications of the theory (e.g. the idea that a person’s happiness is more valuable for her if it is based on a correct perception of her own life), and then turn to a number of modifications which all make the value of a person’s happiness depend on whether the evaluative standard on which her happiness is based satisfies certain requirements. In connection with this, I present and defend my own modified version of the happiness theory. (shrink)

Fritz Allhoff has recently offered an extremely compelling challenge to the morality of human cloning. He argues that a biological phenomenon, that of telomere shortening, undermines the moral permissibility of human cloning. Telomere shortening is caused by cell replication, and appears to be one of the central reasons that cells and organisms age and die. Allhoff considers a thirty-year-old woman who wishes to create a genetic clone. He notes that the DNA from her cell that would be used to create (...) the clone would have shortened telomeres—as it would have gone through many generations of cell replication. As a result, the clone would begin its existence with shortened telomeres; the clone’s telomeres would be the same length as the woman’s telomeres at the time of cloning. The moral problem lies in the fact that because of shortened telomeres, the clone will senesce more rapidly as compared with noncloned organisms, and would have increased susceptibility to degenerative conditions and diseases. Allhoff then goes on to argue that earlier senescence and disease susceptibility constitute a moral ground for rejecting cloning because “the life of a clone would be worse than that of a non-clone”. This line of argument is rooted in Parfit’s The Same Number Quality Claim : “If in either of two outcomes the same number of people would ever live, it would be bad if those who live are worse off, or have a lower quality of life, than those who would have lived”. Applying Parfit’s Q principle to cases of cloning, it could be argued that parents ought to produce children that would be maximally well off, and since clones would be worse off than children produced “normally,” it follows that parents should avoid cloning. As Allhoff puts it, “obviously sexual reproduction would not transfer shortened telomeres to offspring so, all else being equal, sexual reproduction is better than cloning ”. For this sort of line to pack any moral punch, Q must be interpreted rather strongly. (shrink)

In recent years the distinction between agent-relative and agent-neutral reasons has been taken by many to play a key role in distinguishing deontology from consequentialism. It is central to all universalist consequentialist theories that value is determined impersonally; the real value of any state of affairs does not depend on the point of view of the agent. No reference, therefore, to the agent or to his or her position in the world need enter into a consequentialist understanding of what makes (...) an action right or wrong or morally permissible. Consequentialism thus provides an agent-neutral account of both the right and the good. (shrink)

In this paper, I hope to i. briefly explain Nyaya dualist ontology and identify the implications involved in accepting this view, ii. provide a comparison of Nyaya dualism to Cartesian dualism, and iii. provide an analysis of Nyaya dualism vis-à-vis some contemporary non-dualist theories of mind, in an attempt to gauge the viability of Nyaya Dualism as a theory of mind. I will briefly identify the context and history of this school in Indian Philosophy and will attempt to describe how (...) this paper approaches and interprets Nyaya thinking. (shrink)

This paper argues that from an ethical point of view tolerance, which is simply one of a number of possible responses to ethical pluralism, is not an acceptable ideal. It fails to acknowledge and appreciate the good in other forms of life and thereby does not adequately respect the people who live these lives. Toleration limits the range of goods we might appreciate in our own lives and in the lives of those we care most about, and it tends to (...) lead to a number of deformations or personal failures of character. In place of tolerance, we should embrace ethical promiscuity—a view that not only acknowledges ethical pluralism but also offers good reasons to celebrate this state of affairs. (shrink)

Imagining a future world in which people no longer die provides a helpful tool for understanding our present ethical views. It becomes evident that the cardinal virtues of prudence, temperance, and courage are options for reasonable people rather than rational requirements. On the assumption that the medical means to immortality are not universally available, even justice becomes detached from theories that tie the supposed virtue to the protection of human rights. Several stratagems are available for defending a categorical right to (...) life under these circumstances, but none is compelling. Justice and human rights should therefore be understood as social conventions whose stability depends upon rejecting a tyranny of the immortals in favour of cultural traditions that connect rights and liberties with the means for their enjoyment. (shrink)

The article traces origins of the contradiction that calls into being the polemics on the moral status of duties to close persons. Special obligations are created by the unique life narrative of an actor that makes different recipients of her actions more or less distant. Those who are less distant are “close ones.” Those who are more distant are “strangers.” The basis of this distance can be different: individual sympathy, consanguinity, belonging to cultural, territorial and political communities. Special obligations presuppose (...) that the preferential treatment of “close ones” is not only permissible but obligatory. This feature of moral duties to close persons makes moral philosophers suspicious because they are prone to endow moral requirements with two interrelated properties: universality and the high level of generality. The main reason for this is that the typical moral duty is a duty of every human being to another human being without any further qualifications. Against the background of such duties, any preference to close persons looks like the breach of moral equality and manifestation of impermissible partiality. Though, common moral beliefs persistently include special obligations in the whole system of moral duty. R. Goodin thinks that they have a priority over positive general duties and yield to negative general duties. The empirical researches of moral evaluations which reviewed in this article in general confirm this conclusion. The ethical theory cannot ignore fundamental features of common moral beliefs. That is why it is doomed to look for ways of reconciling the moral equality and impartiality with the preferential treatment of close persons embedded into special obligations. (shrink)

While philosophers generally accept some version of the principle ‘ought’ implies ‘can’, recent work in experimental philosophy and cognitive science provides evidence against a presupposition or a conceptual entailment from ‘ought’ to ‘can’. Here, we review some of this evidence, its effect on particular formulations of the principle, and future directions for cognitive scientists and philosophers.

Balfe argues against enhanced interrogation. He particularly focuses on the involvement of U.S. healthcare professionals in enhanced interrogation. He identifies several empirical and normative factors and argues that they are not good reasons to morally justify enhanced interrogation. I argue that his argument can be improved by making two points. First, Balfe considers the reasoning of those healthcare professionals as utilitarian. However, careful consideration of their ideas reveals that their reasoning is consequential rather than utilitarian evaluation. Second, torture is a (...) serious human rights abuse. When healthcare professionals become involved in enhanced interrogation, they violate not only human rights against torture but also human rights to health. Considering the consequential reasoning against human rights abuses, healthcare professionals’ involvement in enhanced interrogation is not morally justified. Supplementing Balfe’s position with these two points makes his argument more complete and convincing, and hence it can contribute to the way which shows that enhanced interrogation is not justified by consequential evaluation. (shrink)

Parfit’s Repugnant Conclusion argues, against intuition, that for any world A, another world Z with higher population and minimal well-being is better. That intuition is incorrect because the argument has not considered resources that support well-being. Z must have many more resources supporting well-being than A does. Z is repugnant because it spreads those resources among too many people; another world with Z’s resources and fewer people, if available, would be far superior. But Z is still better than A; it (...) is worth accepting its very large population to get the resources needed to support their well-being. (shrink)

Should we be time-biased on behalf of other people? ‘Sometimes yes, sometimes no’—it is tempting to answer. But this is not right. On pain of irrationality, we cannot be too selective about when we are time-biased on behalf of other people.

This article argues that it is possible to act paternalistically towards future people, as long as the following requirements are met: the act/choice is not such that it will prevent the future person from coming into existence; the action/choice is such that it can be taken by the future person herself without significant disadvantage to her; and the act/choice is not such that there is significant uncertainty at the time of choice about the preferences of the future person. I argue (...) that the possibility of acting paternalistically towards future people is of practical as well as theoretical importance. This is true since some of the policies we might choose to pursue on behalf of future people are paternalistic, in particular constitutional policies implemented because we do not trust future people to choose wisely. I end the paper by pointing out why it is valuable to approach intergenerational issues through both the paternalistic prism and the prism of theories of justice. (shrink)

In an earlier paper, Stephen Kershnar argued for the following thesis: An instance of trash-talking is permissible if and only if the relevant sports organization’s system of rules permits the expression. One person trash-talks a second if and only if the first intentionally insults the second during competition. The above theory sounds implausible. Surely, the conditions under which a player may insult another do not depend on what the owners arbitrarily decide. Such an approach doesn’t appear to be true in (...) the workplace, bar, or sandlot, so it is hard to see why it should be true in sport. With this general skepticism in mind, this paper evaluates Nicholas Dixon’s objections. Dixon rejects Kershnar’s argument because trash-talking conflicts with the internal value of a sport, violates a right, and degrades the person toward whom the trash-talking is directed. (shrink)

Though consequentialist theories of political obligation have been widely criticized in recent years, a series of arguments presented by Derek Parfit, in Reasons and Persons, are now believed to have given this position new life.

In Wuthering Heights a man and a woman fall in love and their passion for each other wreaks havoc on several lives, theirs included. Long after his beloved is dead, Heathcliff’s life revolves entirely around his love for her. Frustrated by events, his grand romantic passion expresses itself in destructive spasms of antisocial behavior. Catherine, the object of this passion, marries another man on a whim, but describes her feelings for him as like superficial foliage, whereas ‘her love for Heathcliff (...) resembles eternal rocks beneath.’ ‘I am Heathcliff,’ she declares, shortly before dying at the age of nineteen. (shrink)

Against non-analytic naturalism and quietist realism, I defend a robust form of non-naturalism. The argument proceeds as follows: In the face of extensional underdetermination, quietist realism cannot non-question-beggingly respond to alternative accounts that offer formally identical but substantively different interpretations of what reasons are. They face what we might call the reasons appropriation problem. In light of this problem, quietists ought to abandon their view in favor of robust realism. By permitting substantive metaphysical claims we can then argue, based on (...) reasonhood being a relation, that reasonhood is an abstract universal. If reasonhood is an abstract universal, then we can non-question-beggingly assert that the counting in favor of relation is a general kind or genus. This poses a dilemma for non-analytic naturalists: either they need to give the same reductive analysis for epistemic and practical reasons, or they can give a different analyses by treating epistemic and practical reasons as a species of the larger genus. However, the former looks extensionally implausible epistemic reasons are not desire-based and the latter entails that the reduction, via a violation of irreflexivity, fails to ground reasonhood. Naturalistic reductions of the normative, accordingly, face a damning dilemma. We should, in the face of this argument, thus accept a robust form of non-naturalist realism. (shrink)

What does it mean to say that an emotional response fits the situation? This question cannot be answered simply by specifying the core relational theme (loss or risk, say) associated with each emotion: we must also explain what constitutes an emotionally significant loss or risk. It is sometimes suggested that emotionally significant situations are those that bear on the subject’s interests or concerns. I accept that this claim is plausible for some emotional responses, and I propose a particular way of (...) interpreting it. I suggest that, for many emotions, emotional significance is determined by the subject’s likes and dislikes – that is, settled dispositions to find a certain situation pleasant or distressing. I contrast this account with other preference-based accounts and with an account that appeals to the subject’s interests. I argue that we should prefer the likes-based account to these rival views. (shrink)

It is commonly claimed that rule consequentialism (utilitarianism) collapses into act consequentialism, because sometimes there are benefits from breaking the rules. I suggest this argument is less powerful than has been believed. The argument requires a commitment to a very particular (usually implicit) account of feasibility and constraints. It requires the presupposition that thinking of rules as the relevant constraint is incorrect. Supposedly we should look at a smaller unit of choice—the single act—as the relevant choice variable. But once we (...) see feasibility as a matter of degree, there is no obvious cut-off point for how broadly we should think about the constraints on our choices. Treating “a bundle of choices” as a relevant free variable is no less defensible than treating “a single act” as the relevant free variable. Rule utilitarianism, rule consequentialism, and other rules-based approaches are stronger than their current reputation. (shrink)

Here I argue that the hyper-individualistic and rationalistic ethical paradigms – originating in the late eighteenth century and dominating moral philosophy, in various permutations, ever since – cannot capture the moral concerns evoked by the prospect of global climate change. Those paradigms are undone by the temporal and spatial scales of climate change. To press my argument, I deploy two famous philosophical tropes – John Rawls's notion of the original position and Derek Parfit's paradox – and another that promises to (...) become famous: Dale Jamieson's six little ditties about Jack and Jill. I then go on to argue that the spatial and especially the temporal scales of global climate change demand a shift in moral philosophy from a hyper-individualistic ontology to a thoroughly holistic ontology. It also demands a shift from a reason-based to a sentiment-based moral psychology. Holism in environmental ethics is usually coupled with non-anthropocentrism in theories constructed to provide moral considerability for transorganismic entities – such as species, biotic communities, and ecosystems. The spatial and temporal scales of climate, however, render non-anthropocentric environmental ethics otiose, as I more fully explain. Thus the environmental ethic here proposed to meet the moral challenge of global climate change is holistic but anthropocentric. I start with Jamieson's six little ditties about Jack and Jill. (shrink)

One prevalent type of slippery slope argument has the following form: (1) by doing some initial act now, we will bring it about that we subsequently do some more extreme version of this act, and (2) we should not bring it about that we do this further act, therefore (3) we should not do the initial act. Such arguments are frequently regarded as mistaken, often on the grounds that they rely on speculative or insufficiently strong empirical premises. In this article (...) I point out another location at which these arguments may go wrong: I argue that, in their standard form, the truth of their empirical premises constitutes evidence for the falsity of their normative premises. If we will, as predicted, do the further act in the future, this gives us at least a prima facie reason to believe that the performance of this further act would be good, and thus something we should try to bring about. I end by briefly assessing the dialectic implications of my argument. I delineate a subset of slippery slope arguments against which my objection may be decisive, consider how the proponents of such arguments may evade my objection by adding further premises, and examine the likely plausibility of these additional premises. (shrink)

What is the relationship between moral responsibility and causation? Plainly, we are not morally responsible for everything that we cause. For we cause a multitude of things, including things that we couldn't possibly foresee we would cause and with respect to which we cannot be assessed morally. Thus, it is clear that causing something does not entail being morally responsible for it. But, does the converse entailment hold? Does moral responsibility require causation? Intuitively, it does: intuitively, we can only be (...) morally responsible for things that we cause. (shrink)