In this article, I propose a novel characterization of sufficientarianism. I argue that sufficientarianism combines three claims: a priority claim that we have non-instrumental reasons to prioritize benefits in certain ranges over benefits in other ranges; a continuum claim that at least two of those ranges are on one continuum; and a deficiency claim that the lower a range on a continuum, the more priority benefits in that range have. This characterization of sufficientarianism sheds new light on two long-standing philosophical (...) debates, namely about the distinctiveness of sufficientarianism as a distributive principle and about the common objections to sufficientarianism. (shrink)

There are great health disparities in the world today, both between countries and within them. This problem might be seen as related to the access to various kinds of capabilities. It is not fully clear, however, what the exact relation is between health and capabilities. Neither Amartya Sen nor Martha Nussbaum has explicitly formulated a theory of health to go with their theories of capabilities. This paper attempts to present a clarification of the conceptual relation between health and capabilities. Health, (...) it is argued, should be seen as a holistic multi-dimensional phenomenon, made up of basic abilities and subjective well-being, and of fundamental states and processes. Using this theory, the paper shows how health is related to Nussbaum’s ten capabilities. It is argued that health, in the senses described, is a necessary part of all ten capabilities. Moreover, some of the capabilities on Nussbaum’s list, such as thinking and imagining, and practical reasoning, refer to health. Finally, it is shown that even though health is part of all capabilities, health cannot itself primarily be seen as a capability. An acceptable degree of health is required as a functioning for any theory of human flourishing to be reasonable. (shrink)

Typically, philosophers analysing well-being’s nature maintain three claims. First, that well-being has essential properties. Second, that the concept of well-being circumscribes those properties. Third, that well-being theories should capture them exhaustively and exclusively. This predominant position is called well-being monism. In opposition, contextualists argue that no overarching concept of well-being referring to a universally applicable well-being standard exists. Such a standard would describe what is good, bad, and neutral, for us without qualification. Instead, well-being research is putatively about several central (...) phenomena. If several phenomena are central, a proliferation of concurrently acceptable well-being theories and operationalisations is expected. However, contextualists are challenged to explain how those analysing well-being are not systematically talking past each other. In this paper, I address that challenge. The upshot is that contextualist well-being theories can be justifiably context-sensitive and applied to tailor-made policy-making efforts. I illustrate the benefits by connecting contextualism to the capability approach. (shrink)

Central capabilitarian theories of well-being focus exclusively on actual opportunities to attain states of being and doing that people have reason to value. Consequently, these theories characterise ill-being and disadvantage as deprivations of such opportunities and attainments. However, some well-being aspects are inherently negative. They make up the difference between not being well and being unwell in that they constitute ill-being. While disadvantage can be plausibly captured by deprivations, ill-being cannot be fully captured by them. I support this claim by (...) analysing cases involving inherently negative aspects of homelessness that are not mere deprivations of opportunities to attain beings and doings that people have reason to value. I conclude that ill-being is not only about what one cannot be and do, but also about one’s enduring, and opportunities to avoid, negative beings and doings. Theories and policies should reflect this to get things right, and to do right by people. (shrink)

Ethicists of care have objected to traditional moral philosophy's reliance upon abstract universal principles. They claim that the use of abstraction renders traditional theories incapable of capturing morally relevant, particular features of situations. I argue that this objection sometimes conflates two different levels of moral thinking: the level of justification and the level of deliberation. Specifically, I claim that abstraction or attention to context at the level of justification does not entail, as some critics seem to think, a commitment to (...) abstraction or attention to context at the level of deliberation. It follows that critics who reject a theory's use of abstraction at the level of justification have not shown that the theory recommends abstraction at the level of deliberation and that it, therefore, compels the deliberating agent to overlook morally salient details. (shrink)

This paper explores the relationship between dignity and robot care for older people. It highlights the disquiet that is often expressed about failures to maintain the dignity of vulnerable older people, but points out some of the contradictory uses of the word ‘dignity’. Certain authors have resolved these contradictions by identifying different senses of dignity; contrasting the inviolable dignity inherent in human life to other forms of dignity which can be present to varying degrees. The Capability Approach (CA) is introduced (...) as a different but tangible account of what it means to live a life worthy of human dignity. It is used here as a framework for the assessment of the possible effects of eldercare robots on human dignity. The CA enables the identification of circumstances in which robots could enhance dignity by expanding the set of capabilities that are accessible to frail older people. At the same time, it is also possible within its framework to identify ways in which robots could have a negative impact, by impeding the access of older people to essential capabilities. It is concluded that the CA has some advantages over other accounts of dignity, but that further work and empirical study is needed in order to adapt it to the particular circumstances and concerns of those in the latter part of their lives. (shrink)

According to relational egalitarians, equality is not primarily about the distribution of some good but about people relating to one another as equals. However, compared with other theorists in political philosophy – including other egalitarians – relational egalitarians have said relatively little on what role personal responsibility should play in their theories. For example, is equality compatible with responsibility? Should economic distributions be responsibility-sensitive? This article fills this gap. I develop a relational egalitarian framework for personal responsibility and show that (...) relational equality commits us to responsibility. I develop two sets of arguments. First, I draw on relational theories of moral responsibility – particularly Strawsonian views – to show that valuable egalitarian relationships require responsibility. Second, I show why relational equality sometimes requires that economic distributions be sensitive to responsibility and choice. I also defend a seemingly paradoxical result: being committed to responsibility, relational egalitarianism not only justifies some distributive inequalities but some relational inequalities too. Overall, relational egalitarianism gives a nuanced and coherent answer as to why and how responsibility matters from within egalitarianism. That it does should be an important argument in its favour. (shrink)

Is equality a distributive value or does it rather point to the quality of social relationships? This article criticizes the distributive character of luck egalitarian theories of justice and fleshes out the central characteristics of an alternative, relational approach to equality. It examines a central objection to distributive theories: that such theories cannot account for the significance of how institutions treat people (as opposed to the outcomes they bring about). I discuss two variants of this objection: first, that distributive theories (...) fail to account for the importance of how institutions cause good shortfalls and, second, that they fail to account for the normative attitude of social and political institutions expressed in different ways of treating people. The article argues that the causal variant of the objection has only very limited reach, and endorses the expressive variant: the attitudes expressed by institutions in their treatment of persons, such as contempt or neglect, generate potentially unjust social relationships and hierarchies. This should be the focus of a relational egalitarian approach to social justice. The article proceeds to explain how it is possible that artificial agents such as institutions have attitudes and how these attitudes are not reducible to those of the individuals that sustain them, and argues that distributive theories cannot be so modified as to account for such attitudes. It concludes by indicating several directions for the development of more worked-out conceptions of relational equality on this basis. (shrink)

Must a society aim indefinitely for continued economic growth? Proponents of economic growth advance three central challenges to the idea that a society, having attained high levels of income and wealth, may justly cease to pursue further economic growth: if environmentally sustainable and the gains fairly distributed, first, continued economic growth could make everyone within a society and globally, and especially the worst off, progressively better off; second, the pursuit of economic growth spurs ongoing innovation, which enhances people’s opportunities and (...) protects a society against future risks; and third, continued economic growth fosters attitudes of openness, tolerance, and generosity, which are essential to the functioning of a liberal democratic society. This article grants these challenges’ normative foundations, to show that, even if one accepts their underlying premises as requirements of justice, a society may still justly cease to aim for economic growth, so long as it continues to aim for and realize gains on other dimensions. I argue that, while continued economic growth might instrumentally serve valuable ends, it is not necessary for their realization, as a society can achieve these ends through other means. (shrink)

In this paper, I argue that health plays a special role in the promotion of well-being within the capabilities approach framework. I do this by first presenting a scenario involving two individuals, both of whom lack access to only one capability. The first cannot secure the capability of bodily health due to an unhealthy lifestyle, whilst the second lacks access to bodily integrity due to a life of celibacy. Second, I explore these scenarios by assessing the nature of disadvantage suffered (...) in both instances. I suggest that corrosive disadvantage (or the type of disadvantage that adversely impacts one’s ability to secure other valuable things) is what leads us to conclude that health is of special moral importance in the promotion of justice and the endorsing of well-being. (shrink)

The American Journal of Bioethics, Volume 11, Issue 7, Page 53-55, July 2011.

In controlled human infection (CHI) studies, investigators deliberately infect healthy individuals with pathogens in order to study mechanisms of disease or obtain preliminary efficacy data on investigational vaccines and medicines. CHI studies offer a fast and cost‐effective way of generating new scientific insights, prioritizing investigational products for clinical testing, and reducing the risk that large numbers of people are exposed to ineffective or harmful substances in research or in practice. Yet depending on the pathogen, CHI studies can involve significant risks (...) or burdens for participants, pose risks to individuals or communities not involved in the research, and lead to public controversy. It is therefore essential to ensure that the risks of CHI studies are justified by their social value—that is, their potential to generate benefits for society—and that public trust can be maintained. In this paper, we aim to clarify how research sponsors, research ethics committees and other reviewers should judge the social value of CHI studies. We develop a list of relevant considerations for making social value judgments based on the standard view of social value. We then use this list to discuss the example of potentially conducting dengue virus CHI studies in endemic settings. We argue that dengue virus CHI studies in endemic settings would fall on the higher end of the spectrum of social value, mostly because of their potential to redirect all fields of future dengue research. Drawing on this discussion, we derive several general recommendations for how reviewers should judge the social value of CHI studies. (shrink)

While libertarians affirm personal responsibility as a central moral and political value, libertarian theorists write relatively little about the theory and practice of this value. Focusing on the work of F. A. Hayek and David Schmidtz, this article identifies the core of a libertarian approach to personal responsibility and demonstrates the ways in which this approach entails a radical revision of the ethics and American politics of personal responsibility. Then, I highlight several central implications of this analysis in the American (...) political and economic status quo. First, this analysis makes a mockery of so-called libertarian/conservative ‘fusionism’, such that libertarian personal responsibility cannot partner with meritocratic conservative thought to provide a plural grounding for rejecting progressive or redistributive economic policy. Next, preferred libertarian policies threaten the status, esteem and social bases of self-respect of citizens who are worse-off through little or no fault of their own. Finally, these policies undermine the ethics of personal responsibility that Americans from across the ideological spectrum value and many conservatives and libertarians celebrate. In the American status quo, those who value personal responsibility must reserve a central place for policies that mitigate opportunity and distributive inequalities. (shrink)

In this article I review Jonathan Wolff and Avner de‐Shalit’s recent book Disadvantage (2007), highlighting its many contributions to egalitarian theory and practice. These contributions build to the authors’ central prescription: that policy‐makers work to create a society of equals by reducing the tendency for disadvantages to cluster around certain individuals or groups. From there, I discuss the idea of declustering disadvantage in an American context, and consider its implications for the politically salient ideal of equality of opportunity. The purpose (...) of this discussion is not to posit Wolff and de‐Shalit’s theory of disadvantage as a theory of justice as equal opportunity. Instead, I illustrate their approach by reference to an influential theory of justice, whose proponents include those taken to affirm the authors’ consensual starting point. (shrink)

Social justice has been identified as a foundational moral commitment for global health research ethics. Yet what a commitment to social justice means for community engagement in such research has not been critically examined. This paper draws on the rich social justice literature from political philosophy to explore the normative question: What should the ethical goals of community engagement be if it is to help connect global health research to social justice? Five ethical goals for community engagement are proposed that (...) promote well-being, agency, and self-development, particularly for those considered disadvantaged and marginalized. The paper also considers how key terms used in the proposed goals should be defined using existing theories of health and social justice. This analysis is done to give global health researchers and their partners a better idea of what the ethical goals mean. Patterns of convergence amongst different theories are identified that support relying on particular definitions of key terms. (shrink)

The ageing populations of the Western world present a wide range of economic, social, and cultural implications, and given the challenges posed by deteriorating maintenance ratios, the scenario is somewhat worrying. In this paper, I investigate whether Martha C. Nussbaum's capabilities approach could secure dignity for older people in long‐term care, despite the per capita decreases in resources. My key research question asks, ‘What implications does Nussbaum's list of central human capabilities have for practical social care?’ My methodology combines Nussbaum's (...) list with ethnographic data gathered from a Finnish sheltered home for older people. On the basis of this study, it seems that the capabilities approach is a plausible framework for the ethics of care because it highlights differences in the ability to function and thus differences in opportunities to pursue a good life. The ideas presented in this article could assist social policy planners and executives in creating policies and practices that help old people to maintain their dignity until the end of their days. (shrink)

When it comes to improving the health of the general population, mHealth technologies with self-monitoring and intervention components hold a lot of promise. We argue, however, that due to various factors such as access, targeting, personal resources or incentives, self-monitoring applications run the risk of increasing health inequalities, thereby creating a problem of social justice. We review empirical evidence for “intervention-generated” inequalities, present arguments that self-monitoring applications are still morally acceptable, and develop approaches to avoid the promotion of health inequalities (...) through self-monitoring applications. (shrink)

The capability approach, originated by Amartya Sen is among the most comprehensive and influential accounts of justice that applies to issues of health and health care. However, although health is always presumed as an important capability in Sen’s works, he never manages to fully explain why health is distinctively valuable. This paper provides an explanation. It does this by firstly laying out the general capability-based argument for health justice. It then discusses two recent attempts to justify why health is distinctively (...) valuable from within a capability framework – these are Sridhar Venkatapuram’s conception of health as the central human meta-capability and, respectively, Norman Daniels’ embrace of the capability metric in his use of Rawls’ principle of fair equality of opportunity. The paper argues that none of these accounts succeed in providing a plausible justification of the value of health. Finally, the paper suggests an alternative more complex justification, closely tied to different but central element of the capability view, that captures the core intuitions of both Venkatapuram and Daniels’ accounts but without being vulnerable to the objections raised against each of them. This, the paper concludes, provides a promising ground on which the capability view on health justice should be founded. (shrink)

Many consider play a natural part of childhood, and although there is disagreement in the literature on what essentially defines “play” in childhood, philosophical theories of play tend to support this initial consideration. But is childhood play also something we owe each other within a framework of educational justice? This is a question yet to be addressed. In this paper, I answer this question affirmatively. I take off from a generic account of educational justice and argue that childhood play should (...) be considered a central entitlement of this account. I then argue in line with the capability approach that if we ought to protect childhood play, it should be children’s capability for play rather than the functioning of play that needs protection. I end by offering an account of the capability for childhood play. (shrink)

This article claims that the protection of children’s capability for play is a central social-political goal. It provides the following three-premise argument in defense of this claim: we have strong and wide-ranging normative reasons to be concerned with clusters of social deficiency; particular fertile functionings play a key role for tackling clusters of social deficiency; and finally the capability for childhood play is a crucial, ontogenetic prerequisite for the development of those particular fertile functionings. Thus, in so far as we (...) consider it a central political goal to tackle social deficiency, we should be concerned with protection of childhood play capability. This conclusion raises new insights on the importance – for global development policy as well as for welfare states’ aim to secure social justice – of protecting children’s capability to engage in playful activities. (shrink)

Much research has studied the importance of play for children’s development. However, questions of its political importance and our public institutions’ duties to protect it have been largely neglected. This article argues that childhood play is politically important due to having both intrinsic and instrumental value, and it suggests that the duty to protect the capability for play in childhood falls especially on the public health system. If this argument succeeds, it follows that we have stronger duties toward our children (...) than we currently believe. (shrink)

According to prominent bioethics scholars and international guidelines, researchers and sponsors have obligations to ensure that the products of their research are reasonably available to research participants and their communities. In other words, the claim is that research is unethical unless it has local social value. In this article, we argue that the existing conception of reasonable availability should be replaced with a social value obligation that extends to the global poor. To the extent the social value requirement has been (...) understood as geographically constrained to the communities that host research and the countries that can afford the products of research, it has neglected to include the global poor as members of the relevant society. We argue that a new conception of social value obligations is needed for two reasons. First, duties of global beneficence give reason for researchers, sponsors, and institutions to take steps to make their products more widely accessible. Second, public commitments made by many institutions acknowledge and engender responsibilities to make the products of research more accessible to the global poor. Future research is needed to help researchers and sponsors discharge these obligations in ways that unlock their full potential. (shrink)

The American Journal of Bioethics, Volume 11, Issue 7, Page 55-57, July 2011.

‘Zero tolerance’ of avoidable infection events is explicit in UK and international policy documents describing strategies for the control of healthcare-associated infection. I consider what principles governing avoidable infections acquired in healthcare institutions might be reasonably rejected from the contractualist perspective of Thomas Scanlon. Many hospital infections can be cost-effectively avoided. There would seem to be additional reasons to take the prevention of avoidable infection acquired in hospitals seriously in addition to optimizing the cost-effectiveness of healthcare. These include the irretrievable (...) nature of the harm of some of the infections; the reasonable rejection of avoidable harm when the patient could not rationally consent to the risk of harm and the social consequences such as loss of trust in healthcare providers. Despite these reasons, a principle of ‘zero tolerance’ has implausible implications, promotes unrealistic patient expectations and can be reasonably rejected from the perspective of those who will suffer unacceptable opportunity costs. However, the contractualist perspective would also seem to reject a principle of tolerance of harm when there is a feasible reconfiguration of institutional arrangements that reduces the risk of harm without a redistribution of a proportionate or greater burden to others. (shrink)

The paper begins with the prerequisite assumption that social deprivation is a fragile and porous category. Thus, our hypothesis is, that how people are affected by the restrictions against the spreading of the coronavirus is often discussed in far too general and simplistic terms. It is often taken as a given, that the virus and the restriction measures not only have caused severe difficulties for us all (due to social distancing, fear, affected health, etc.), but that the measures have exacerbated (...) already previously existing forms of social deprivation. Therefore, it is assumed that marginalized groups are particularly affected by these effects of the pandemic. Two major German studies show the alleged effects of the relevant measures on adolescents and emerging adults (COPSY and FIBS) against the backdrop of social and economic deprivation; their results confirmed that social deprivation entails a higher degree of being affected by the pandemic.However, this picture becomes thwarted by considering the results of 10 narrative interviews, that were conducted by us with emerging adults in a German vocational training institute between April and August 2021 and showed variegated forms of experiencing issues related to the pandemic. In our analysis, we used the method of objective hermeneutics. In this paper, we present our considerations by outlining two contrastive experiences with the Covid-19 pandemic, in order to highlight the divergent ways in which the pandemic has been experienced even among individuals who previously had been affected by social deprivation – at least at first glance – in similar ways. The conceptual lens through which we interpret these two examples is, firstly, the one of precariousness and precarity (Butler 2009). And secondly, the concept of recognition derived from Honneth’s pertinent theory and Butler’s account of recognizability will play a pivotal role. While Honneth’s approach allows us to emphasize the normative and existential role of the fulfilment of our basic desire for recognition and the detrimental implications of disregard, Butler provides us with the means to thoroughly analyse the socio-historical conditions of misrecognition and social invisibility. Moreover, Butler focuses specifically on the recognizability of precariousness (Honneth’s triad of love, being respected as a rights bearer and solidarity shows a different focus). Combining qualitative research on precarious live circumstances with a theoretical perspective on recognition can also be found in a stunning research on couples in atypical working relations (Wimbauer and Motakef 2019). Proceeding from these theories and ‘applying’ them to our empirical material, we seek to call into question a too generalizing and hegemonic picture of how people were affected by pertinent restrictions. Qualitative interviews are able to point us to significant differences in the experience of the restrictions.In terms of an outlook, we suggest that a sensitization for previously excluded kinds of experiences forms a crucial basis for a less normalizing, that is, more inclusive account of interpreting the affectedness and needs of variegated social groups; the pandemic has influenced and altered structures of the recognition of vulnerability and, by the same token, made them more explicit. It thus is an occasion for a critical engagement with the recognizability of needs, deprivation, discrimination, and related phenomena. (shrink)

We sought to assess formally the extent to which different control and elimination strategies for human African trypanosomiasis Trypanosoma brucei gambiense would exacerbate or alleviate experiences of societal disadvantage that traditional economic evaluation does not take into account. Justice-enhanced cost-effectiveness analysis is a normative approach under development to address social justice considerations in public health decision-making alongside other types of analyses. It aims to assess how public health interventions under analysis in comparative evaluation would be expected to influence the clustering (...) of disadvantage across three core dimensions of well-being: agency, association and respect. As a case study to test the approach, we applied it to five strategies for Gambiense HAT control and elimination, in combination with two different other evaluations: a cost-effectiveness analysis and a probability of elimination analysis. We have demonstrated how JE-CEA highlights the ethical importance of adverse social justice impacts of otherwise attractive options and how it indicates specific modifications to policy options to mitigate such impacts. JE-CEA holds promise as an approach to help decision makers and other stakeholders consider social justice more fully, explicitly and systematically in evaluating public health programs. (shrink)

This article carves out a new path between the two dominant wings of contemporary egalitarianism. The luck egalitarian emphasis on choice and personal responsibility is misplaced because individuals differ so deeply, and arbitrarily, in their choice-making capacities. Allowing inequalities to result from ‘choice’ is akin to allowing inequalities to stem from the possession of any other morally arbitrary factor – such as skin colour or gender. The move towards relational egalitarianism has been a case of two-steps forward, one-step back. While (...) the shift away from the focus on choice is salutary, the concurrent rejection of luck is problematic, given the prevalence and importance of luck-based discrepancies in opportunities to lead a good life. A new conceptual framework is presented: good life egalitarianism. The guiding idea is that given the unavoidable arbitrariness of human capacities, the foundation for a good life should be assured for people regardless of the actual choices that they make. The essential goods necessary for leading a good life – such as the opportunities to self-determine and to enjoy non-dominating social relationships – should be guaranteed to all. (shrink)

What is wrong with imposing pure risks, that is, risks that don’t materialize into harm? According to a popular response, imposing pure risks is pro tanto wrong, when and because risk itself is harmful. Call this the Harm View. Defenders of this view make one of the following two claims. On the Constitutive Claim, pure risk imposition is pro tanto wrong when and because risk constitutes diminishing one’s well-being viz. preference-frustration or setting-back their legitimate interest in autonomy. On the Contingent (...) Claim, pure risk imposition is pro tanto wrong when and because risk has harmful consequences for the risk-bearers, such as psychological distress. This paper argues that the Harm View is plausible only on the Contingent Claim, but fails on the Constitutive Claim. In discussing the latter, I argue that both the preference and autonomy account fail to show that risk itself is constitutively harmful and thereby wrong. In discussing the former, I argue that risk itself is contingently harmful and thereby wrong but only in a narrow range of cases. I conclude that while the Harm View can sometimes explain the wrong of imposing risk when risk itself is contingently harmful, it is unsuccessful as a general, exhaustive account of what makes pure imposition wrong. (shrink)

While some trust theorists have adverted to the vulnerabilities involved in trust, especially vulnerability to betrayal, the literature on trust has not engaged with recent work on the ethics of vulnerability. This paper initiates a dialogue between these literatures, and in doing so begins to explore the complex interrelations between vulnerability and trust. More specifically, it aims to show how trust can both mitigate and compound vulnerability. Through a discussion of two examples drawn from literary sources, the paper also investigates (...) the effects of pathogenic vulnerability on the psychic economies of trust and distrust. (shrink)

: Accidents will survive the outbreak of driverless cars, but their moral implications will suffer substantial changes. The decision made today by a human in a fraction of a second will eventually be replaced by an algorithm subject to moral scrutiny. This not only raises the question of how the algorithm should work, or whether alternatives solutions are indeed comparable, but also changes the essence of the problem: from ascertaining liability to defining desired outcomes. In this paper, I first contest (...) two possible approaches to resolving the driverless car dilemma – which I call statistical and nominal – to conclude that neither is morally sound. I then propose an alternative solution based on “time-relative equality”, or always sparing younger people. This follows from seeking an egalitarian solution, that is the least intrusive – a position I defend from a possible ageist critique. Keywords: Driverless Cars; Accident; Algorithm; Age-relative Equality Condotti verso un incidente morale Riassunto: Vi saranno incidenti anche dopo la diffusione delle auto a guida autonoma, ma le loro implicazioni morali subiranno mutamenti sostanziali. Le decisioni prese oggi in una frazione di secondo dagli esseri umani saranno alla fine sostituite da un algoritmo soggetto a controllo morale. Sorge non solo il problema di come dovrebbe funzionare questo algoritmo – o se vi siano soluzioni alternative comparabili –, ma cambia anche la sostanza del problema: dall’accertamento dell’imputabilità alla definizione dell’esito auspicato. In questo lavoro discuterò due possibili approcci per risolvere il dilemma – che chiamerò “statistico” e “nominale” –, per concluderne che non sono moralmente corretti. Proporrò quindi una soluzione alternativa, basata sulla “eguaglianza tempo-relativa”, il principio per cui bisogna sempre salvare il più giovane. Questo segue dal cercare una soluzione egalitarista, che sia la meno intrusiva – una posizione che difenderò da una possibile critica che la vede come discriminatoria verso gli anziani. Parole chiave: Automobili a guida automatica; Incidenti; Algoritmo; Eguaglianza relativa all’età. (shrink)

Recent epidemiological reports of associations between socioeconomic status and epigenetic markers that predict vulnerability to diseases are bringing to light substantial biological effects of social inequalities. Here, we start the discussion of the moral consequences of these findings. We firstly highlight their explanatory importance in the context of the research program on the Developmental Origins of Health and Disease (DOHaD) and the social determinants of health. In the second section, we review some theories of the moral status of health inequalities. (...) Rather than a complete outline of the debate, we single out those theories that rest on the principle of equality of opportunity and analyze the consequences of DOHaD and epigenetics for these particular conceptions of justice. We argue that DOHaD and epigenetics reshape the conceptual distinction between natural and acquired traits on which these theories rely and might provide important policy tools to tackle unjust distributions of health. (shrink)

Effective altruism is purportedly ecumenical towards different moral views, charitable causes, and evidentiary methods. I argue that effective altruists’ criticisms of purportedly less effective charities are inconsistent with their commitment to ecumenicity. Individuals may justifiably support charities other than those recommended by effective altruism. If effective altruists take their commitment to ecumenicity seriously, they will have to revise their criticisms of many of these charities.

Public health policies typically assume that there are characteristics and constraints over health that an individual cannot control and that there are choices that an individual could change if he is nudged or provided with incentives. We consider that health is determined by a range of personal, social, economic and environmental factors and we discuss to what extent an individual can control these factors. In particular, we assume that the observed health status of an individual is a result of factors (...) within the individual’s control and constraints the individual faces. We suggest three different constraints: budget, time and psychological constraints and position various determinants of health according to increasing levels of constraint and increasing degrees of individual control. We finally discuss public health policies such as nudging, intervening and rewarding within this new framework and show that the level of constraints and the degree of individual control on health status are essential dimensions to consider when designing and implementing public health policies. (shrink)

Pervasive feminism is a component located in emotionality—feminist emotion—and contains women's primary agency. Because affect and emotions are elusive, an interpretive conceptual tool is necessary and is key to making use of their potential for feminist politics aimed at women's empowerment and well-being and to build gender equality. This essay builds on contemporary feminist theory and affect theory and draws from multidisciplinary research. It presents a new theoretical framework anchored in hermeneutics and phenomenology to pin down the affective component of (...) women's multifaceted, intersectional emotional experiences of gender. A case study also illustrates how the theoretical premises around the concept of feminist emotion are compatible with and useful for feminist praxis. (shrink)

How do social norms influence our choices? And does the presence of biased norms affect what we owe to each other? Looking at empirical research relating to PrEP rollout in HIV prevention policy, a...

I defend the proposal that certain forms of work—specifically forms that are socially necessary but involve the imposition of considerable burdens—be shared between citizens. I argue that sharing burdensome work would achieve several goals, including a more equal distribution of the benefits and burdens of work, a greater appreciation of each other's labour contributions, and an amelioration of problematic inequalities of status. I conclude by considering three objections: that sharing burdensome work would (1) involve morally unacceptable constraints on freedom, (2) (...) be prohibitively inefficient, and (3) forbid mutually advantageous trades. I argue that none of these objections succeed. (shrink)

This paper develops a recognition-theoretical analysis of human dignity. I argue that a life with dignity requires social esteem (recognition for one’s contribution to socially shared goals) as well as respect (recognition of one’s equal status). I illustrate this through an empirically informed discussion of three aspects of the current social organization of labour which threaten human dignity: unemployment, precarity and low pay. I also argue that in class societies the assertion of dignity as a positional good can undermine its (...) general progressive appeal. (shrink)

This article presents the framework Capability Sensitive Design (CSD), which consists of merging the design methodology Value Sensitive Design (VSD) with Martha Nussbaum's capability theory. CSD aims to normatively assess technology design in general, and technology design for health and wellbeing in particular. Unique to CSD is its ability to account for human diversity and to counter (structural) injustices that manifest in technology design. The basic framework of CSD is demonstrated by applying it to the hypothetical design case of a (...) therapy chatbot for mental health. By applying CSD to a design case, the merits of this new framework over the standard VSD approach become apparent. Also, the application demonstrates what a technology design would look like when attention is paid to capabilities right from the start of the design process. (shrink)

in recent years, policy makers have shown increasing interest in implementing policies aimed at promoting individual well-being. But how should policy makers choose their well-being policies? a seemingly reasonable first step is to settle on an agreed-upon definition of well-being. yet there currently is significant disagreement on how well-being ought to be characterized, and agreement on the correct view of well-being does not appear to be forthcoming. Nevertheless, i argue in this paper that there are several reasons to think that (...) the domain of well-being in the public policy context is narrower than that of well-being in general, which makes agreement on how to understand well-being in the public policy context more likely. (shrink)

The harms of climate change are deeply uncertain. Though climate change will render most individuals more vulnerable to harm, many individuals will not actually suffer climate-related harms. In this paper, I argue that vulnerability to harms is itself a harm, because it undermines our enjoyment of the good of security. After some brief remarks on the concept of security, I give three reasons for thinking that depriving an individual of the security of basic goods harms them: it has a strong (...) contingent connection to fear and anxiety, it directly undermines their ability to make reasonable plans, and security may reasonably be valued as an end in itself. This suggests that one of our goals in determining climate policy ought to be mechanisms which ensure the security of basic goods. (shrink)

The August 2011 riots in England occasioned widespread condemnation from government and the media. Here, we apply the concepts of hypocrisy and affiliation to explore reactions to these riots. Initially acknowledging that politics necessitates a degree of hypocrisy, we note that some forms of hypocrisy are indefensible: they compromise integrity. With rioters condemned as thugs and members of a feral underclass, some reactions exemplified forms of corrosive hypocrisy that deflected attention away from economic, social and cultural problems. Moreover, such reactions (...) omitted to attend to the concept of [dis]affiliation amongst young rioters. Accordingly, we look to the role that education might play in re-affiliating those who do not feel they belong to, or have a sufficient stake in, society. Whilst our focus is on the riots in England, the exploration of hypocrisy and affiliation, and discussion of education for re-affiliation, transcends that national context. (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)

In this article, we argue that apart from evaluating the causes and the social determinants of health inequalities, an evaluation of the effects of health inequalities is due. For this, we propose the ideal of relational equality as an evaluative framework, and test to what extent health inequalities threaten this ideal of a society of equals. We identify three ways in which they do and argue that these risks are especially great for those lower down the socio-economic strata. We thus (...) conclude that equality in health is instrumental to social justice, and that socio-economic inequalities in health are not only unjust due to their causes but also due to their consequences. We continue to argue that our instrumental approach opens a perspective to mitigate the identified injustices by changing society, rather than reducing inequalities in health, and argue that this is an advantage in the light of the realistic assumption that of the socio-economic health inequalities will persist. The article thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socio-economic inequalities in health. (shrink)

Carina Fourie and Annette Rid, eds. What is Enough? Sufficiency, Justice, and Health. New York, Oxford University Press, 2017. 336 p.

A key question in disability studies, philosophy, and bioethics concerns the relationship between disability and well-being. The mere difference view, endorsed by Elizabeth Barnes, claims that physical and sensory disabilities by themselves do not make a person worse off overall—any negative impacts on welfare are due to social injustice. This article argues that Barnes’s Value Neutral Model does not extend to intellectual disability. Intellectual disability is (1) intrinsically bad—by itself it makes a person worse off, apart from a non-accommodating environment; (...) (2) universally bad—it lowers quality of life for every intellectually disabled person; and (3) globally bad—it reduces a person’s overall well-being. While people with intellectual disabilities are functionally disadvantaged, this does not imply that they are morally inferior—lower quality of life does not mean lesser moral status. No clinical implications concerning disability-based selective abortion, denial of life-saving treatment, or rationing of scarce resources follow from the claim that intellectual disability is bad difference. (shrink)

Three claims about love and justice cannot be simultaneously true and therefore entail a paradox: (1) Love is a matter of justice. (2) There cannot be a duty to love. (3) All matters of justice are matters of duty. The first claim is more controversial. To defend it, I show why the extent to which we enjoy the good of love is relevant to distributive justice. To defend (2) I explain the empirical, conceptual and axiological arguments in its favour. Although (...) (3) is the most generally endorsed claim of the three, I conclude we should reject it in order to avoid the paradox. (shrink)

Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were (...) examined to identify further eligible studies. Forty two articles were identified as eligible. Seventeen used an implicit measure, to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed. (shrink)

Various authors hold that what is wrong with risk imposition is that being at risk diminishes the opportunities available to an agent. Arguably, even when risk does not result in material or psychological damages, it still represents a setback in terms of some legitimate interests. However, it remains to be specified what those interests are. This article argues that risk imposition represents a diminishment of overall freedom. Freedom will be characterized in empirical terms, as the range of unimpeded actions available (...) to an agent. After briefly outlining the main characteristics of overall freedom as defended by Hillel Steiner and Ian Carter, the article shows that this notion is able to capture many of our intuitions about when and how risk imposition disadvantages an agent, without reference to welfare indicators. The article argues that if this non-welfarist perspective can be defended, then it would be easier to approach a number of applied questions about risk, including the questions of when risk imposition is permissible or legitimate, in which ways risk can be an object of distributive justice and how one can be compensated for being subject to a risk. (shrink)