It is a commonplace that in making decisions agents often have to juggle competing values, and that no choice will maximise satisfaction of them all. However, the prevailing account of these cases assumes that there is always a single ranking of the agent's values, and therefore no unresolvable conflict between them. Isaac Levi denies this assumption, arguing that agents often must choose without having balanced their different values and that to be rational, an act does not have to be optimal, (...) only what Levi terms 'admissible'. This book explores the consequences of denying the assumption and develops a general approach to decision-making under unresolved conflict. Professor Levi discusses conflicts of value in several domains - those arising in moral dilemmas, the drawing of scientific inferences, decisions taken under uncertainty, and in social choice. In each of these he adapts his theoretical framework, showing how conflict may often be reduced though not always altogether eliminated. (shrink)

We all have beliefs, even strong convictions, about what is just and fair in our social arrangements. How should these beliefs and the theories of justice that incorporate them guide our thinking about practical matters of justice? This wide-ranging collection of essays by one of the foremost medical ethicists in the USA explores the claim that justification in ethics, whether of matters of theory or practice, involves achieving coherence between our moral and non-moral beliefs. Amongst the practical issues addressed in (...) the volume are the design of health-care institutions, the distribution of goods between the old and the young, and fairness in hiring and firing. In combining ethical theory and practical ethics this volume will prove especially valuable to philosophers concerned with ethics and applied ethics, political theorists, bioethicists, and others involved in the study of public policy. (shrink)

In Intricate Ethics, Kamm questions the moral importance of some non-consequentialist distinctions and then introduces and argues for the moral importance of other distinctions. The first section discusses nonconsequentialist ethical theory and the trolley problem; the second deals with the notions of moral status and rights; the third takes up the issues of responsibility and complicity and the possible moral significance of distance; and the fourth section analyzes the views of others in the non-consequentialist and consequentialist camps.

Suppose that we can help either one person or many others. Is it a reason t0 help the many that We should thus be helping more people? John Taurek thinks not. We may learn from his arguments.

In Goodness and Justice, Joseph Mendola develops a unified moral theory that defends the hedonism of classical utilitarianism, while evading utilitarianism's familiar difficulties by adopting two modifications. His theory incorporates a developed form of consequentialism. When, as is common, someone is engaged in conflicting group acts, it requires that one perform one's role in that group act that is most beneficent. The theory also holds that overall value is distribution-sensitive, ceding maximum weight to the well-being of the worst-off sections of (...) sentient lives. It is properly congruent with commonsense intuition and required by the true metaphysics of value, by the unconstituted natural good found in our world. (shrink)

How should modern medicine's dramatic new powers to sustain life be employed? How should limited resources be used to extend and improve the quality of life? In this collection, Dan Brock, a distinguished philosopher and bioethicist and co-author of Deciding for Others (Cambridge, 1989), explores the moral issues raised by new ideals of shared decision making between physicians and patients. The book develops an ethical framework for decisions about life-sustaining treatment and euthanasia, and examines how these life and death decisions (...) are transformed in health policy when the focus shifts from what is best for a patient to what is just for all patients. Professor Brock combines acute philosophical analysis with a deep understanding of the realities of clinical health policy. This is a volume for philosophers concerned with medical ethics, health policy professionals, physicians interested in bioethics, and undergraduate courses in biomedical ethics. (shrink)

Background Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. Discussion In this paper, we present an ethical framework for pandemic influenza planning. The ethical (...) framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. Summary The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust. (shrink)

This book is a collection of essays on various problems arising in connection with John Rawls's theory of justice. Its focus is the method of wide reflective equilibrium. The first half of the book begins with Daniels's well-known essay "Wide Reflective Equilibrium and Theory Acceptance in Ethics" and ends with an excellent discussion of the role of reflective equilibrium in Rawls's Political Liberalism. The essays in the second part discuss justice in health care. They are of interest in their own (...) right, and also as illustrating Daniels's view that for those practicing the method of reflective equilibrium, applied moral philosophy is integral to the process of moral theorizing. Daniels says that the essays do not constitute a systematic treatment of wide reflective equilibrium. But they display a much higher degree of thematic coherence than is usual in a collection, and they read much like the chapters of a monograph. (shrink)

In this paper I argue that resource allocation in publicly funded medical systems cannot be done using a purely substantive theory of justice, but must also involve procedural justice. I argue further that procedural justice requires institutions and that these must be “local” in a specific sense which I define. The argument rests on the informational constraints on any non-market method for allocating scarce resources among competing claims of need. However, I resist the identification of this normative account of local (...) justice with the actual approach to local decision-making taken within the UK National Health Service. I illustrate my argument with reference to the case of provision of In Vitro Fertilisation within the UK NHS. (shrink)