Fair allocation of scarce healthcare resources has been much studied within philosophy and bioethics, but analysis has focused on a narrow range of cases. The Covid-19 pandemic provided significant new challenges, making powerfully visible the extent to which health systems can be fragile, and how scarcities within crucial elements of interlinked care pathways can lead to cascading failures. Health system resilience, while previously a key topic in global health, can now be seen to be a vital concern in high-income countries (...) too. Unfortunately, mainstream philosophical approaches to the ethics of rationing and prioritisation provide little guidance for these new problems of scarcity. Indeed, the cascading failures were arguably exacerbated by earlier attempts to make health systems leaner and more efficient. This paper argues that health systems should move from simple and atomistic approaches to measuring effectiveness to approaches that are holistic both in focusing on performance at the level of the health system as a whole, and also in incorporating a wider range of ethical concerns in thinking about what makes a health system good. (shrink)

The practical goal of preventing premature death seems uncontroversial. But the term ‘premature death’ is vague with several, sometimes conflicting definitions. This ambiguity results in several conceptions with which not all will agree. Moreover, the normative rationale behind the goal of preventing premature deaths is masked by the operational definition of existing measures. In this article, we argue that ‘premature death’ should be recognized as a normative concept. We propose that normative theories should be used to justify measures of premature (...) death to provide them with normative validity and public legitimacy. (shrink)

Transhumanism at once embodies our most modern thinking and our biggest longstanding problems. Transhumanism aims to enhance human core capacities: health-span, lifespan, and cognition. The thesis answers the following ethical challenges arising from transhumanist aims. First, whether transhumanism can be an ethical endeavour if it relies on authoritarian intervention by governments and governing bodies to change, generate and enforce behaviour, or to influence and enforce the uptake of medical procedures. Second, the thesis answers the challenge that it is unethical deliberately (...) to encourage the uptake of and pursuit of medical transhumanism given the extent of accessibility and distributive issues that remain unresolved in existing medicine. Finally, the thesis addresses a particular mental health crisis that is often predicted for transhuman beings, namely loss of meaning from loss of death and vulnerability, resulting in widespread loss of social cohesion. The thesis argues that the right solution to the first two problems is a libertarian paternalist approach, viz. nudging, and that this approach will also neutralise the risk of widespread and inevitable boredom or alienation that might otherwise result from the widespread introduction of human enhancement if people are nudged to engage more and more reflectively in their enhancement choices. Additionally, lifestyle issues like obesity, heart disease, cancers, and inaccessibility of vaccines and birth control pose unresolved problems for existing general medicine, killing millions every year worldwide. As a result, another serious challenge for enhancement medicine, which I propose would be addressed by the nudge approach, is to justify its place in the professional domain of medicine. (shrink)