Common principles for resource allocation in health care can prioritize the alleviation of small health burdens over lifesaving treatment. I argue that there is some evidence that these principles are at odds with a sizable share of public opinion, which holds that saving a life should take priority over any number of cures for minor ailments. I propose two possible explanations for this opinion, one debunking and one vindicatory. I also outline how well-designed surveys and moral inquiry could help decide (...) between them. Finally, I consider how priority-setting principles could be adjusted if the view that saving a life always trumps alleviating small burdens were vindicated. (shrink)

I defend a weak version of the Pigou-Dalton principle for chances. The principle says that it is better to increase the survival chance of a person who is more likely to die rather than a person who is less likely to die, assuming that the two people do not differ in any other morally relevant respect. The principle justifies plausible moral judgements that standard ex post views, such as prioritarianism and rank-dependent egalitarianism, cannot accommodate. However, the principle can be justified (...) by the same reasoning that has recently been used to defend the core axiom of ex post prioritarianism and egalitarianism, namely, Pigou-Dalton for well-being. The arguably biggest challenge for proponents of Pigou-Dalton for chances is that it violates State Dominance for social prospects. However, I argue that we have independent reason for rejecting State Dominance for social prospects, since it prevents a social planner from properly respecting people's preferences. (shrink)

This paper has two aims. The first is to present and defend a new argument for rights contributionism – the view that the notion of a moral claim-right is a contributory (or pro tanto) rather than overall normative notion. The argument is an inference to the best explanation: it is argued that (i) there are contributory moral factors that contrast with standard moral reasons by way of having a number of formal properties that are characteristic of rights, even though they (...) can be overridden, and (ii) that this is best explained by a view that takes these factors to correlate with rights. The second aim is to show that the truth of rights contributionism matters for normative ethics. More specifically, it is argued that rights contributionism clears the way for deontologists to justify the pre-theoretically plausible verdict that we have a duty to save the greater number in so-called Taurek scenarios – scenarios in which we have to choose between saving either a greater or a smaller number of different people. The chapter offers a novel and distinctively deontological explanation of this verdict that is based on the assumption that everyone has a pro tanto right to be saved in a Taurek scenario. (shrink)

A number of philosophers have argued that if you care about how much goodness your actions generate, or how good the state-of-affairs you actions bring about are, then your attention should be directed towards the very far future. But many don’t care about how much goodness their actions generate, nor do they care about things like “states-of-affairs”. Amongst a multitude of things, many people care about how their actions impact individuals. And they also care about the sorts of justifications they (...) are able to offer for those actions. One moral theory which captures this moral viewpoint is contractualism. In this chapter, I argue that contractualism is, in large part, incompatible with longtermism – the view that, in many contexts, we ought to do that which will most improve the prospects of future people. I then discuss what advice, if any at all, contractualism can offer to the longtermist. (shrink)

Norman Daniels’s theory of ‘accountability for reasonableness’ is an influential conception of fairness in healthcare resource allocation. Although it is widely thought that this theory provides a consistent extension of John Rawls’s general conception of justice, this paper shows that accountability for reasonableness has important points of contact with both utilitarianism and intuitionism, the main targets of Rawls’s argument. My aim is to demonstrate that its overlap with utilitarianism and intuitionism leaves accountability for reasonableness open to damaging critiques. The important (...) role that utilitarian-like cost-effectiveness calculations are allowed to play in resource allocation processes disregards the separateness of persons and is seriously unfair towards individuals whose interests are sacrificed for the sake of groups. Furthermore, the function played by intuitions in settling frequent value conflicts opens the door for sheer custom and vested interests to steer decision-making. (shrink)

Artificial intelligence (AI) ethics is proposed as an emerging and interdisciplinary field concerned with addressing the ethical issues of AI, such as the issue of moral decision-making. The conflict between our intuitive moral judgments constitutes an inevitable obstacle to decision-making in AI ethics. This article outlines the Moral Relevance Approach, which could provide a considerable moral foundation for AI ethics. Taking moral relevance as the precondition of the consequentialist principles, the Moral Relevance Approach aims to plausibly consider individual moral claims. (...) It is not only the common ethical target shaping our moral consensus but also the inherent moral ability connecting others with us. (shrink)

This paper presents some impossibility results for certain views about what you should do when you are uncertain about which moral theory is true. I show that under reasonable and extremely minimal ways of defining what a moral theory is, it follows that the concept of expected moral choiceworthiness is undefined, and more generally that any theory of decision-making under moral uncertainty must generate pathological results.

How should we choose on behalf of people with different attitudes to risk? Simon Blessenohl has recently argued that this question poses a dilemma: it seems that sometimes we must choose either acts that everyone disprefers or else acts that are sure to turn out worse than some other act. In this article, I offer a complaints-centered account of how to take people’s attitudes to risk into consideration in our decision-making, and then I show that it provides a way out (...) of Blessenohl’s dilemma. (shrink)

The good of those who are worse off matters more to the overall good than the good of those who are better off does. But being worse off than one’s fellows is not itself bad; nor is inequality itself bad; nor do differences in well-being matter more when well-being is lower in an absolute sense. Instead, the good of the relatively worse-off weighs more heavily in the overall good than the good of the relatively better-off does, in virtue of the (...) fact that the former are relatively worse off. This paper articulates and defends the view just described. (shrink)

Should we allow grave harm to befall one individual so as to prevent minor harms befalling sufficiently many other individuals? This is a question of aggregation. Can many small harms ‘add up’, so that, collectively, they morally outweigh a greater harm? The ‘Close Enough View’ supports a moderate position: aggregation is permissible when, and only when, the conflicting harms are sufficiently similar, or ‘close enough’, to each other. This paper surveys a range of formally precise interpretations of this view, and (...) reveals some of the problems they face. It also proposes a novel interpretation which avoids these problems. (shrink)

Should harms to different individuals be aggregated? Moderate views answer yes and no. Aggregation is appropriate in some but not all cases. Such views need to determine a threshold at which aggregation switches from appropriate to inappropriate. Alex Voorhoeve proposes a method for determining this threshold which links other-regarding and self-regarding ethics. This proposal, however, implies a spurious correlation between favoring aggregation and egoism.

Haecceitism is the thesis that, necessarily, in addition to its qualities, each thing has a haecceity or individual essence. The purpose of this paper is to expose a flaw in haecceitism: it entails that familiar cases of fission and fusion either admit of no explanation or else only admit of explanations too bizarre to warrant serious consideration. Because the explanatory problem we raise for haecceitism closely resembles the Euthyphro problem for divine command theory, we refer to our objection as the (...) haecceitic Euthyphro problem, or the Haecceitic Euthyphro for short. We conclude that the objection is decisive against haecceitism. (shrink)

This paper investigates the circumstances under which it is morally permissible to impose non-negligible risks of serious harm on innocent civilians in order not to endanger tangible cultural heritage during armed conflict. Building on a previous account of the value of cultural heritage, it is argued that tangible cultural heritage is valuable because of how it contributes to valuable and meaningful human lives. Taking this account as the point of departure I examine the claim that commanders should be prepared to (...) risk lives of innocent civilians in order to avoid harm to tangible cultural heritage. I argue that imposing high risks of serious harm on innocent civilians without their consent constitutes a wrong that can be justified only in order to avoid a greater evil. It is then argued that damage to cultural heritage sites rarely constitutes the greater evil when weighed against the imposition of non-consensual risks of serious harm on innocent civilians, especially when the risk is substantial. Still, imposing substantial risks might be morally permissible under the condition that they are consensually imposed, even if they are not the lesser evil. However, I argue that even if one has reason to suspect that there are civilians who might consent to at least some significant risks in order to avoid damage to their cultural heritage, it is not clear that commanders should take this into account when deciding what to do. Unless all of those who are at risk consent, the fact that some of those whose lives are at risk consent to the risk of being killed do not make it morally permissible to impose this risk on the group as a whole. (shrink)

On some accounts of vagueness, predicates like “is a heap” are tolerant. That is, their correct application tolerates sufficiently small changes in the objects to which they are applied. Of course, such views face the sorites paradox, and various solutions have been proposed. One proposed solution involves banning repeated appeals to tolerance, while affirming tolerance in any individual case. In effect, this solution rejects the reasoning of the sorites argument. This paper discusses a thorny problem afflicting this approach to vagueness. (...) In particular, it is shown that, on the foregoing view, whether an object is a heap will sometimes depend on factors extrinsic to that object, such as whether its components came from other heaps. More generally, the paper raises the issue of how to count heaps in a tolerance-friendly framework. (shrink)

There is a well-known moral quandary concerning how to account for the rightness or wrongness of acts that clearly contribute to some morally significant outcome – but which each seem too small, individually, to make any meaningful difference. One consequentialist-friendly response to this problem is to deny that there could ever be a case of this type. This paper pursues this general strategy, but in an unusual way. Existing arguments for the consequentialist-friendly position are sorites-style arguments. Such arguments imagine varying (...) a subject’s predicament bit by bit until it is clear that a relevant difference has been achieved. The arguments offered in this paper are structurally different, and do not rely on any sorites series. For this reason, they are not vulnerable to objections that have been leveled against the sorites-style arguments. (shrink)

The aim of this paper is to analyze the simplest type of case in which need-based positive rights to aid are often attributed. In such "two-person cases" there is just one agent and one patient, and the agent can aid the patient. Two questions are asked about such cases: why does the agent in such a case lack a negative right he would normally have? And why does the patient have a positive right he would not normally have? The main (...) focus in on question, though an answer to question is briefly sketched. The paper presupposes a view of negative rights as the authority to make demands of others. To explain why such authority is lacking in two person cases, it is suggested that such authority requires being able to demand non-interference "decently." This idea of a "decent", or non-selfish, demand is then elucidated, and an argument is offered for the suggested explanation. Finally there is a brief look at two-person cases involving significant cost to the agent. (shrink)

An adequate theory of rights ought to forbid the harming of animals to promote trivial interests of humans, as is often done in the animal-user industries. But what should the rights view say about situations in which harming some animals is necessary to prevent intolerable injustices to other animals? I develop an account of respectful treatment on which, under certain conditions, it’s justified to intentionally harm some individuals to prevent serious harm to others. This can be compatible with recognizing the (...) inherent value of the ones who are harmed. My theory has important implications for contemporary moral issues in nonhuman animal ethics, such as the development of cultured meat and animal research. (shrink)

Derek Parfit held that in evaluating the future, we should ignore the difference between necessary persons and merely possible persons. In this article, I look at one of the most prominent alternatives to Parfit's view, namely Michael Otsuka and Larry Temkin ‘shortfall complaints’ view. In that view, we aggregate future persons’ well-being and deduct intrapersonal shortfall complaints, giving extra weight to the complaints of necessary persons. I offer here a third view. I reject Parfit's no difference view in that I (...) register a difference between necessary and possible persons. But I also reject the Shortfall View and replace its intra-personal complaints with an inter-personal complaints mechanism. I argue that the value of a population is its aggregate prioritarian value minus the egalitarian complaints that necessary persons hold. I show that the egalitarian view has all the explanatory power of the Shortfall view in easy cases, while significantly improving on it in three sorts of tough cases. (shrink)

Limited aggregationists argue that when deciding between competing claims to aid we are sometimes required and sometimes forbidden from aggregating weaker claims to outweigh stronger claims. Joe Horton presents a ‘fatal dilemma’ for these views. Views that land on the First Horn of his dilemma suggest that a previously losing group strengthened by fewer and weaker claims can be more choice-worthy than the previously winning group strengthened by more and stronger claims. Views that land on the Second Horn suggest that (...) combining two losing groups together and two winning groups together can turn the losing groups into the winning groups and the winning groups into the losing groups. This paper demonstrates that the ‘fatal dilemma’ is neither fatal nor a dilemma. The First Horn is devastating but avoidable and the Second Horn is unavoidable but not devastating. Nevertheless, Horton’s argument does help to narrow down the acceptable range of views. (shrink)

Despite growing interest in workplace democracy, the question whether nonworker stakeholders, like suppliers and local communities, warrant inclusion in the governance of democratic companies, as workers do, has been largely neglected. We inspect this question by leaning on the boundary problem in democratic theory. We first argue that the question of who warrants inclusion in democratic workplaces is best addressed by examining why workplace democracy is warranted in the first place, and offer a twofold normative benchmark—addressing objectionable corporate power and (...) upholding efficiency—to assess the principles of democratic inclusion on offer. Against this benchmark, we next argue that the All-Affected Principle is unfit due to its over- and underinclusive extensional results, and that the All-Subjected Principle, whose variants we examine alongside their extensional results, holds more promise when coupled with independent considerations of justice or a constrained variant of the All-Affected Principle. These combinations need not entirely preclude, but speak against, nonworker stakeholder inclusion. (shrink)

Limited Aggregation is the view that when there are competing moral claims that demand our attention, we should sometimes satisfy the largest aggregate of claims, depending on the strength of the claims in question. In recent years, philosophers such as Patrick Tomlin and Alastair Norcross have argued that Limited Aggregation violates a number of rational choice principles such as Transitivity, Separability, and Contraction Consistency. Current versions of Limited Aggregation are what may be called Comparative Approaches because they involve assessing the (...) relative strengths of various claims. In this paper, we offer a non-comparative version of Limited Aggregation, what we call the Threshold Approach. It states that there is a non-relative threshold that separates various claims. We demonstrate that the Threshold Approach does not violate rational choice principles such as Transitivity, Separability, and Contraction Consistency, and we show that potential concerns regarding such a view are surmountable. (shrink)

The standard argument for longtermism assumes that we should care as much about far future people as about our contemporaries. I challenge this assumption. I first consider existing interpretations of ‘temporal discounting’, and argue that such discounting seems either unwarranted or insufficient to block the argument. I then offer two alternative reasons to care less about far future people: caring as much about them as about our contemporaries would make our lives less authentic and less meaningful. If I’m right, this (...) undermines at least the strongest versions of longtermism. Plausibly, we should do much more for the far future than we’re currently doing. Still, we often ought to act for contemporaries’ sakes, even if longtermist actions would expectably do more good. (shrink)

Ruth Chang and Joseph Raz have both drawn far-reaching consequences for agency from the phenomenon of incommensurability. After criticizing their arguments, I outline an alternative view: if incommensurability is vagueness, then there are no substantial implications for agency, except perhaps a limited form of naturalistic voluntarism if our reasons are provided by desires.

Often institutions or individuals are faced with decisions where not all claims can be satisfied. Sometimes, these claims will be of differing strength. In such cases, it must be decided whether or not weaker claims can be aggregated in order to collectively defeat stronger claims. Many are attracted to a view, which this chapter calls Limited Aggregation, where this is sometimes acceptable and sometimes not. A new version of this view, Local Relevance, has recently emerged. This chapter seeks to explore (...) and evaluate this view. In order to do so, the chapter offers a more precise interpretation of this basic approach, calling it ‘Sequential Claims-Matching’. The chapter shows how Sequential Claims-Matching avoids problems that dog other Limited Aggregation views but suffers from difficulties and ambiguities of its own. In particular, the chapter shows that it is hard to accommodate some core Limited Aggregation intuitions around tie-break cases within the Local Relevance view. (shrink)

Autonomous systems are machines that can alter their behavior without direct human oversight or control. How ought we to program them to behave? A plausible starting point is given by the Reduction to Acts Thesis, according to which we ought to program autonomous systems to do whatever a human agent ought to do in the same circumstances. Although the Reduction to Acts Thesis is initially appealing, we argue that it is false: it is sometimes permissible to program a machine to (...) do something that it would be wrong for a human to do. We advance two main arguments for this claim. First, the way an autonomous system will behave can be known in advance. This knowledge can indirectly affect the behavior of other agents, while the same may not be true at the time the system actually executes its programming. Second, a lack of knowledge of the identities of the victims and beneficiaries can provide a justification during the programming phase that would be unavailable to an agent at the time the autonomous system executes its programming. (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)

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)

Philosophers have spent a great deal of time debating whether intransitive preferences can be rational. I present a risky decision that poses a challenge for the defender of intransitivity. The defender of intransitivity faces a trilemma and must either: (i) reject the rationality of intransitive preferences, (ii) deny State-wise Dominance, or (iii) accept the bizarre verdict that you can be required to pay to relabel the tickets of a fair lottery. If we take the first horn, then we have a (...) synchronic refutation of intransitivity, an improvement on widely criticized diachronic arguments. I sketch possible responses that may rescue intransitivity and argue that each response is possible but generates an explanatory debt. I conclude by showing how the challenge here clarifies the foundations of decision theory without transitivity, conditional on some explanatory debt being payable. (shrink)

Priority setting in healthcare is a highly contentious area of public decision making, in which different values often support incompatible policy options and compromise can be elusive. One promising approach to resolving priority-setting conflicts divides the decision-making process into two steps. In the first, a set of eligible options is identified; in the second, one of those options is chosen by a deliberative process. This paper considers the first step, examining proposals for identifying a set of options eligible for deliberation. (...) It focuses on the approach proposed by Anders Herlitz, which limits deliberation to options that are on a par; neither better or worse than, nor strictly equal to the alternatives. Once these “maximal” options are identified, the choice among them is made though a deliberative process that acknowledges the difficult tradeoffs which must be made. While parity and kindred notions are clearly useful in resolving some priority-setting conflicts, this paper argues that the conflicts that arise in setting priorities make it as difficult to decide which options are on a par as it is to decide among those options. The paper draws on priority-setting debates that occurred during the recent pandemic to illustrate the challenges in identifying eligible options: There may be sharp disagreement about how to understand and individuate relevant values; about whether certain values are relevant in a priority-setting context; about how to establish parity between “consequential” and “deontic” options, and about whether one option remains on a par with others after it is modified in various ways. (shrink)

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)

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)

When do claims to be saved of a small or moderate harm aggregate against a competing claim to be saved from an early death? In this short response to Kamm's Bioethical Prescriptions, I argue for the following answer: aggregation of weaker claims against a life is permitted just in case, in a one-to-one contest, a person with a weaker claim would have a personal prerogative to prioritize her claim over a stranger’s competing claim to life.

Imagine that one must either lose all of one’s certainty about some very important topic – about the meaning of life, for example – or a small amount of certainty about each of one’s more “mundane” beliefs – beliefs about the color of one’s socks, where one’s keys are, whether it will rain, etc. One ought to take the latter loss, no matter how many mundane beliefs are at stake. Conversely, if one had to give up a tiny bit of (...) certainty about the important topic, or all of one’s certainty about most mundane topics, one ought to take the former loss. These two judgments generate what I call the “epistemic headaches-for-lives challenge,” so called because it resembles a challenge in ethics about the relative values of headaches and lives. In this paper, I argue for two things. First, our epistemic theories should accord with these types of judgments, and so must deal with the headaches-for-lives challenge. Second, this is a serious challenge for formal epistemology. (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)

How should contractualists assess the permissibility of risky actions? Both main views on the question, ex ante and ex post, fail to distinguish between different kinds of risk. In this article, I argue that this overlooks a third alternative that I call “objective ex ante contractualism”. Objective ex ante substitutes discounting complaints by epistemic risk in favor of discounting by objective risk. I further argue in favor of this new view. Objective ex ante contractualism provides the best model of justifiability (...) to each. (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)

According to the Competing Claims View we decide between alternatives by looking at the competing claims held by affected individuals. The strength of these claims is a function of two features: how much they stand to benefit by each alternative, and how badly off they would be in its absence. The view can be, and is, endorsed by both egalitarians and prioritarians. For the former the second condition will concern looking at how badly off the person is relative to others, (...) whereas for the latter it will be how badly off she is in absolute terms. In this paper I want to argue that neither should be endorsed. The egalitarian version of CCV breaks down when attempting to assess the competing claims of possible persons who may never exist. Also, the view, on at least one plausible interpretation, leads to intransitive judgements. The prioritarian version of CCV, in turn, is vulnerable to its own unique objection, namely delivering an anti-prioritarian and rather implausible verdict in certain Single Person Cases. (shrink)

A common concern regarding affirmative action is that it sanctions the selection of candidates whose qualifications are not the best overall and that this is inefficient or unjust or both. I argue that this concern is misguided, since there is no independent concern regarding qualifications with respect to the moral status of affirmative action. The only sense in which qualifications are not morally arbitrary—and the only sense in which there is a reason to select the most qualified candidate—is purely instrumental (...) to the promotion of moral values whose fundamental concern is not qualifications. (shrink)

There is no large number of very small bads that is worse than a small number of very large bads – or so, some maintain, it seems plausible to say. In this article, I criticize and reject two recently proposed vindications of the above intuition put forth by Dale Dorsey and Alex Voorhoeve. Dorsey advocates for a threshold marked by the interference with a person's global life projects: any bad that interferes with the satisfaction of a life project is worse (...) than any number of bads that don't interfere with such a life project. Such thresholds, I argue, are broadly implausible. Voorhoeve gives a contractualist account for the irrelevance of minor bads. His account, I argue, does not, among other things, provide the right kind of reason in defence of the above intuition. (shrink)

In their insightful article, ‘The Disvalue of Death in the Global Burden of Disease’, Solberg et al argue that there is a potential incoherence in the way disability-adjusted life years are calculated. Morbidity is measured in years lived with disability in a way quite unlike the way mortality is measured in years of life lost. This potentially renders them incommensurable, like apples and oranges, and makes their aggregate—DALYs—conceptually unsound. The authors say that it is ‘vital’ to address this problem, that (...) ‘[n]eglecting [it] is not an option’, and that ‘one cannot add YLLs and YLDs together in [their] current form’.1 Though one might object to their argument in various ways, let us assume the authors are correct that there is a potential inconsistency here. I want to ask why we should be troubled by that. Now, this question may scarcely seem worth asking. Consistency and coherence are regarded as non-negotiable in so many domains that of course we should demand them in a measure such as the DALY. And this desire for coherence is clearly shared by both the architects of the DALY and their critics.2 3 I think, though, that things are more complicated. In 2012, I wrote an article discussing the epidemiological perspective from which DALYs should be calculated.4 Simplifying greatly, here is the problem: both YLDs and YLLs can be calculated either from prevalence data or from incidence data. The most natural way to calculate YLDs bases them on prevalences, because when we think about morbidity our initial thought is of people who are suffering. The most natural way to calculate YLLs bases them on an incidence measure, because when …. (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)

Suppose you can save one group of people or a larger group of different people, but you cannot save both groups. Are you morally required, ceteris paribus, to save the larger group? Some say, “No.” Far more say, without qualification, “Yes.” But some say, “It depends on the sizes of the groups.” In this paper, I argue that an attractive moral principle that seems on its face to support the second answer in fact supports a version of the third. In (...) the process, I defend some revisionary claims about how the lives and deaths of different people compare evaluatively to one another. The most important of these for my purposes is the claim that the deaths of different people are on a par, other things being equal. (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.

I consider the plausibility of discounting for kinship, the view that a positive rate of pure intergenerational time preference is justifiable in terms of agent-relative moral reasons relating to partiality between generations. I respond to Parfit's objections to discounting for kinship, but then highlight a number of apparent limitations of this approach. I show that these limitations largely fall away when we reflect on social discounting in the context of decisions that concern the global community as a whole, such as (...) those related to global climate change. (shrink)

The Relevance View, exemplified by Alex Voorhoeve's Aggregate Relevant Claims, has considerable appeal. It accommodates our reluctance to aggregate weak claims in canonical cases like Life for Headaches, while permitting aggregation of claims in a range of other cases. But it has been the target of significant criticism. In an important recent paper, Patrick Tomlin argues that the view suffers from failures of internal logic, violating plausible consistency constraints and generating incoherent combinations of verdicts on cases. And in cases resembling (...) real-world healthcare allocation problems, Tomlin argues that the view offers no guidance at all. In response, I argue that the internal logic of the Relevance View is sound, and the view's core principles, suitably clarified, support a significant extension of the view beyond the simple cases to which it is typically applied. (shrink)

In this paper, I explore the ethics of subject selection in the context of biomedical research. I reject a key principle of what I shall refer to as the standard view. According to this principle, investigators should select participants so as to minimise aggregate risk to participants and maximise aggregate benefits to participants and society. On this view, investigators should exclude prospective participants who are more susceptible to risk than other prospective participants. I argue instead that investigators should select subjects (...) in accordance with an alternative principle: formal equality of opportunity. According to this principle, investigators must treat all prospective participants the same unless differential treatment is warranted by the scientific goals of the study or the need to promote participants' medically related interests. All prospective participants (1) who meet the scientifically defined eligibility criteria and (2) for whom participation is consistent with their medically related interests should have an equal, formal opportunity to participate in the study. Prospective participants should not be excluded simply because they are more susceptible to risk than others. (shrink)