Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis (...) is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment. (shrink)

The nudge approach seeks to improve people’s decisions through small changes in their choice environments. Nudge policies often work through psychological mechanisms that deviate from traditional notions of rationality. Because of that, some critics object that nudging treats people as irrational. Such treatment might be disrespectful in itself and might crowd out more empowering policies. I defend nudging against these objections. By defending a nonstandard, ecological model of rationality, I argue that nudging not only is compatible with rational agency but (...) can even support it. Accordingly, a concern with rationality speaks for more rather than less public policy nudging. (shrink)

Freedom is one of the central values in political and moral philosophy. A number of theorists hold that freedom should either be the only or at least one of the central distribuenda in our theories of distributive justice. Moreover, many follow Mill and hold that a concern for personal freedom should guide, and limit, how paternalist public policy can be. For the most part, theorists have focussed on a person’s freedom at one specific point in time but have failed to (...) give proper attention to freedom across time. Given that we care about personal freedom now, we have reason to care about future freedom too. But what kind of distribution of freedom across a person’s lifetime should we promote as a matter of legislation and public policy? I argue that none of the candidate principles for the distribution of freedom across time is plausible. Neither a starting gate view, nor a maximisation nor a sufficientarian view is satisfactory, because none adequately reflects our various reasons to value freedom. I show that this result presents a tough challenge for theories of distributive justice and paternalism that set great store by personal freedom. (shrink)

Nudging is a tool of libertarian paternalism. It involves making use of certain psychological tendencies in order to help people make better decisions without restricting their freedom. However, some have argued that nudging is objectionable because it interferes with, or undermines, the rational decision-making of the nudged agents. Opinions differ on why this is objectionable, but the underlying concerns appear to begin with nudging’s threat to rational decision-making. Those who discuss this issue do not make it clear to what this (...) threat to rationality amounts. In this paper I evaluate what effect nudging has on our decision-making and I argue that it does not typically interfere with our rationality in a problematic way. Perhaps nudging is objectionable for other reasons, but we should not argue that nudging is objectionable based on concerns about rational decision-making. (shrink)

The debate for and against making e-cigarettes available to smokers is to a large extent empirical. We do not know the long-term health effects of vaping and we do not know how smokers will respond to e-cigarettes over time. In addition to these empirical uncertainties, however, there are difficult moral issues to consider. One such issue is that many smokers in some sense choose to smoke. Though smoking is addictive and though many start young, it does not seem impossible to (...) plan for and implement cessation. Yet many choose not to do so and we arguably have some reason to respect this choice. I propose that liberal opposition to strict tobacco control, based on respect for choice, is mitigated when e-cigarettes are available, since they are such a close substitute. Making e-cigarettes available to smokers might therefore not only enable switching in practice, but may make tougher tobacco control more justified. Another moral issue is that making e-cigarettes widely available might induce many people to vape, who would otherwise have neither vaped nor smoked. If this is so, the price of using e-cigarettes to accelerate smoking cessation may be a long-term vaping epidemic. Since vaping is less harmful than smoking, both individuals and society will have less reason to end this epidemic and so it may endure longer than the smoking epidemic would otherwise have done. This raises further questions around the weighing of reduced harm to current smokers against increased harm to future vapers. (shrink)

Considerations of objective-value freedom and status freedom do impose constraints on policies that restrict access to cigarettes. As to the objective-value freedom, something of value is lost when anti-alcohol policies lead to pub closures interfering with valued life styles, and a similar, though weaker, argument can be made for cigarettes. As to status freedom, non-arbitrariness requires consultation with vulnerable populations to learn what might aid them with smoking cessation.

Science is widely regarded as the most reliable epistemic source of providing knowledge about the world. Policymakers intend to make purposeful changes in the world. The practice of policymakers relying on scientific experts to make informed decisions about which policies to implement is called Evidence Based Policymaking. This thesis provides a perspective from the philosophy of science in order to discuss the justifiability of Evidence Based Policymaking (EBP) with respect to broadly democratic and liberal values. Justifying EBP with broadly democratic (...) and liberal values entails that the practices of EBP promote, or at least are in harmony with, values such as democratic governance and enhancement of people’s freedom and autonomy. Identifying the conditions under which practices of EBP meet such desiderata minimally requires an understanding of how sciences and scientific experts are instrumental in realizing the public’s values, needs, interests, and pursuit of freedom. In order to approach this project, the thesis adopts a philosophical perspective to conceptualize how sciences are supposed to be guided by or promote society’s values, needs, and interests. Specifically, it adopts a perspective from the philosophy of science that focuses on the relationship between science and (societal) values. The kind of philosophy of science perspective on “values in science” that this thesis adopts has two overarching pursuits relevant for the project of the thesis. Firstly, it seeks to inform the debates about which values and non-epistemic considerations are supposed to inform scientific research. For instance, it discusses the proper sources/owners of the non-epistemic desiderata that inform scientific research and the proper social mechanisms to identify these non-epistemic desiderata (e.g. Kourany, 2010; Kitcher, 2011). Second, it offers theories of the non-epistemic values’ proper roles in scientific reasoning and research that specify how their involvement in science does not unduly compromise the epistemic pursuits of science. The values-in-science perspective thereby seeks to balance the instrumental value of science (i.e., its use to pursue certain societal projects and values) with its epistemic authority (i.e., its objectivity, non-dogmatism, and reliability). The thesis advances an understanding of EBP from the perspective of the values in science by addressing issues that come to the fore when EBP is acknowledged as a value-laden practice of informed decision-making. (shrink)