Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

In this imaginative and provocative book, Barbara Goodwin explores the question of how lottery systems can achieve egalitarian social justice in societies with seemingly ineradicable inequalities. She begins with the utopian fable of Aleatoria, a country not unlike our own in the not-too-distant-future, where most goods are distributed by lottery--even the right to have children. She then analyzes the philosophical arguments for and against lottery distribution and a comparison of "justice by lottery" with other contemporary theories of justice. Goodwin also (...) applies her theory to practical problems in the real world which could be--or have been--justly resolved by the use of lotteries, such as military drafts, jury duty, and immigration eligibility. She demonstrates that in many areas, including that of political power, a regular and random reallocation of goods would be a fairer and more democratic method than the distributive systems found in liberal democracies today. (shrink)

When making decisions, people naturally face uncertainty about the potential consequences of their actions due in part to limits in their capacity to represent, evaluate or deliberate. Nonetheless, they aim to make the best decisions possible. In Decision Theory with a Human Face, Richard Bradley develops new theories of agency and rational decision-making, offering guidance on how 'real' agents who are aware of their bounds should represent the uncertainty they face, how they should revise their opinions as a result of (...) experience and how they should make decisions when lacking full awareness of, or precise opinions on relevant contingencies. He engages with the strengths and flaws of Bayesian reasoning, and presents clear and comprehensive explorations of key issues in decision theory, from belief and desire to semantics and learning. His book draws on philosophy, economics, decision science and psychology, and will appeal to readers in all of these disciplines. (shrink)

ABSTRACT In a Living Donor List Exchange program, the donor makes his kidney available for allocation to patients on the postmortal waiting‐list and receives in exchange a postmortal kidney, usually an O‐kidney, to be given to the recipient he favours. The program can be a solution for a candidate donor who is unable to donate directly or to participate in a paired kidney exchange because of blood group incompatibility or a positive cross‐match. Each donation within an LDLE program makes an (...) additional organ available for transplantation. But because most of the pairs making use of the program will be A/o incompatible, it will also tend to increase the waiting time for patients with blood group O, who already have the longest waiting time. It has therefore been objected that the program is materially unjust, because it further disadvantages the least advantaged. This objection appeals to John Rawls’ difference principle. However, the context for which Rawls proposed that difference principle, is significantly different from the present one. Applying the principle here amounts to a lop‐sided trade‐off between considerations of need and considerations of overall utility. Considerations of formal justice, however, may lead to a stronger objection to LDLE programs. Such a program means that one O‐patient on the waiting list is exempted from the application of the general criteria used in constructing the list because he has a special bargaining advantage. This objection is spelled out and weighed against the obvious attraction of LDLE in a situation of (extreme) organ scarcity. (shrink)

We are often faced with choices that involve the weighing of people's lives against each other, or the weighing of lives against other good things. These are choices both for individuals and for societies. A person who is terminally ill may have to choose between palliative care and more aggressive treatment, which will give her a longer life but at some cost in suffering. We have to choose between the convenience to ourselves of road and air travel, and the lives (...) of the future people who will be killed by the global warming we cause, through violent weather, tropical disease, and heat waves. We also make choices that affect how many lives there will be in the future: as individuals we choose how many children to have, and societies choose tax policies that influence people's choices about having children. These are all problems of weighing lives. How should we weigh lives? Weighing Lives develops a theoretical basis for answering this practical question. It extends the work and methods of Broome's earlier book Weighing Goods to cover the questions of life and death. Difficult problems come up in the process. In particular, Weighing Lives tackles the well-recognized, awkward problems of the ethics of population. It carefully examines the common intuition that adding people to the population is ethically neutral - neither a good nor a bad thing - but eventually concludes this intuition cannot be fitted into a coherent theory of value. In the course of its argument, Weighing Lives examines many of the issues of contemporary moral theory: the nature of consequentialism and teleology; the transitivity, continuity, and vagueness of betterness; the quantitative conception of wellbeing; the notion of a life worth living; the badness of death; and others. This is a work of philosophy, but one of its distinctive features is that it adopts some of the precise methods of economic theory (without introducing complex mathematics). Not only philosophers, but also economists and political theorists concerned with the practical question of valuing life, should find the book's conclusions highly significant to their work. (shrink)

John Broome; V*—Fairness, Proceedings of the Aristotelian Society, Volume 91, Issue 1, 1 June 1991, Pages 87–102, https://doi.org/10.1093/aristotelian/91.1.87.

John Broome; V*—Fairness, Proceedings of the Aristotelian Society, Volume 91, Issue 1, 1 June 1991, Pages 87–102, https://doi.org/10.1093/aristotelian/91.1.87.

In many societies, the aging of the population is becoming a major problem. This raises difficult issues for ethics and public policy. On what is known as the fair innings view, it is not impermissible to give lower priority to policies that primarily benefit the elderly. Philosophers have tried to justify this view on various grounds. In this article, I look at a consequentialist, a fairness-based, and a contractarian justification. I argue that all of them have implausible implications and fail (...) to correspond to our moral intuitions. I end by outlining a different kind of consequentialist justification that avoids those implications and corresponds better to our considered moral judgments. (shrink)

This paper casts doubts on John Broome's view that vagueness in value comparisons crowds out incommensurability in value. It shows how vagueness can be imposed on a formal model of value relations that has room for different types of incommensurability. The model implements some basic insights of the ‘fitting attitudes’ analysis of value.

This book addresses these three issues: What is discrimination?; What makes it wrong?; What should be done about wrongful discrimination? It argues: that there are different concepts of discrimination; that discrimination is not always morally wrong and that when it is, it is so primarily because of its harmful effects.

Jon Elster reports that in 1940, and again in 1970, the U.S. draft lottery was challenged for falling short of the legally mandated ‘random selection’. On both occasions, the physical mixing of the lots appeared to be incomplete, since the birth dates were clustered in a way that would have been extremely unlikely if the lots were fully mixed. There appears to have been no suspicion on either occasion that the deficiency in the mixing was intended, known, or believed to (...) favor or disfavor any identifiable group. If the selection was non-random in the way charged, Elster asks, was it unfair? (shrink)

Many believe that we ought to save a large number from being permanently bedridden rather than save one from death. Many also believe that we ought to save one from death rather than a multitude from a very minor harm, no matter how large this multitude. I argue that a principle I call “Aggregate Relevant Claims” satisfactorily explains these judgments. I offer a rationale for this principle and defend it against objections.

Perhaps the best-known theory of fairness is John Broome’s: that fairness is the proportional satisfaction of claims. In this article, I question whether claims are the appropriate focus for a theory of fairness, at least as Broome understands them in his current theory. If fairness is the proportionate satisfaction of claims, I argue, then the following would be true: fairness could not help determine the correct distribution of claims; fairness could not be used to evaluate the distribution of claims; fairness (...) could not guide us in distributing claims (or unowed goods); we could not have a claim to be treated fairly; and we would not be wronged when treated unfairly. These entailments mean that it is questionable that fairness is concerned with claims in the way Broome suggests. At the very least, the relationship between fairness and claims appears to be more complex than the picture painted by Broome. (shrink)

Debiasing procedures are experimental methods aimed at correcting errors arising from the cognitive biases of the experimenter. We discuss two of these methods, the predesignation rule and randomization, showing to what extent they are open to the experimenter’s regress: there is no metarule to prove that, after implementing the procedure, the experimental data are actually free from biases. We claim that, from a contractarian perspective, these procedures are nonetheless defensible since they provide a warrant of the impartiality of the experiment: (...) we only need proof that the result has not been intentionally manipulated for prima facie acceptance. (shrink)

Human behaviour, like everything else, has causes. Most of the time, those causes can be described as reasons. Human beings perform actions because they have reasons for performing them. They are capable of surveying the options available and then selecting one based upon those reasons. But invariably occasions arise in which the reasons known to the agent fail to single out a determinate option. When reasons cannot determine the option to select on their own, the agent must resort to some (...) form of non-reasoned decision-making. This paper distinguishes four different forms of NRDM – picking, randomizing, deferring and judging. Each form may be appropriate under different circumstances. The paper concludes by laying out the theoretical assumptions upon which this account of NRDM rests. (shrink)

In this essay, I survey egalitarian and utilitarian approaches to the distribution of scarce life-saving medical resources. In my view, the major criterion for the distribution of scarce life-saving medical resources should be life expectancy: we should distribute life so as to maximize life-years. In Section II, I discuss the life-year maximization approach and situate it within utilitarian theory.

John Broome has proposed a theory of fairness according to which fairness requires that agents’ claims to goods be satisfied in proportion to the relative strength of those claims. In the case of competing claims for a single indivisible good, Broome argues that what fairness requires is the use of a weighted lottery as a surrogate to satisfying the competing claims: the relative chance of each claimant's winning the lottery should be set to the relative strength of each claimant's claim. (...) In this journal, James Kirkpatrick and Nick Eastwood have objected that the use of weighted lotteries in the case of indivisible goods is unacceptable. In this article, I explain why Kirkpatrick and Eastwood's objection misses its mark. (shrink)

Based on a general thesis regarding the proper resolution of interpersonal conflicts, this paper suggests a normative framework for the distribution of scarce health resources. The proposed thesis includes two basic ideas. First, individual well-being is the fundamental value. Second, interpersonal conflicts affecting well-being should be resolved in light of several conceptions of fairness, reflecting the independent value of persons and the moral significance of responsibility of individuals for the existence of interpersonal conflicts. These ideas are elaborated in several principles (...) that are applied with respect to the distribution of scarce health resources. (shrink)

This paper deals with a problem which has received a great deal of attention in the ethical literature, but about which very little is known empirically: the selection of recipients for organs in transplant medicine. Based on a larger study, it is shown how this problem is practically resolved in one European country, Germany. It is demonstrated that most of the criteria used to determine recipients are non-medical in nature, even though they generally tend to be rationalized in medical terms. (...) Moreover, the choice of criteria depends as much on prognostic considerations as on personal indiosyncrasies and values held by individual physicians who are in charge at the various programs. Several examples of the extremely diverse policies in which this results are presented. (shrink)

There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an influential moral theory (...) that states that the right action is the action that is expected to produce the greatest good. It offers clear operationalizable principles. In this paper we provide a summary of how utilitarianism could inform two challenging questions that have been important in the early phase of the pandemic: (a) Triage: which patients should receive access to a ventilator if there is overwhelming demand outstripping supply? (b) Lockdown: how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID‐19 with causing deaths and reductions in well‐being from other causes? Our aim is not to argue that utilitarianism is the only relevant ethical theory, or in favour of a purely utilitarian approach. However, clearly considering which options will do the most good overall will help societies identify and consider the necessary cost of other values. Societies may choose either to embrace or not to embrace the utilitarian course, but with a clear understanding of the values involved and the price they are willing to pay. (shrink)

Over the past 10 years, John Harris has made important contributions to thinking about distributive justice in health care. In his latest work, Harris controversially argues that clinicians should stop prioritising patients according to prognosis. He argues that the good or benefit of health care is providing each individual with an opportunity to live the best and longest life possible for him or her. I call this thesis, opportunism. For the purpose of distribution of resources in health care, Harris rejects (...) welfarism (the thesis that the good of health care is well-being) and argues that utilitarianism in general may lead to de facto discrimination against groups of people needing health care. I argue that well-being is a superior theory of the good of health care to Harris' opportunism. Harris' concerns about utilitarianism can be better addressed by: (i) relating justice more closely to reasons for action; (ii) by conceptualising the relationship between reasons for action and the value of the consequences of those actions as a plateau rather than scalar relationship. Justice can be understood as satisfying as many equally rational claims on resources as possible. The rationality of a person's claim on health resources turns on the strength of that person's reasons to promote certain health-related states of affairs. I argue that the strength of that reason does not track the expected value of that state of affairs in a fully scalar fashion. Rather a person can have most reason to promote some state of affairs, even though he or she could promote other more valuable states of affairs. Thus there can be equal reason for a distributor of public resources to save either of two people, even though one will have a better and more valuable life. This approach, while addressing many of Harris' concerns about utilitarianism, does not imply that doctors should give up prioritising patients according to prognosis altogether, but it does allow that patients with lower but reasonable prognosis should have a share of public resources. (shrink)

Lotteries have long been used to resolve competing claims, yet their recent implementation to allocate school places in Brighton and Hove, England led to considerable public outcry. This article argues that, given appropriate selection is impossible when parties have equal claims, a lottery is preferable to an auction because it excludes unjust influences. Three forms of contractualism are discussed and the fairness of lotteries is traced to the fact that they give each person an equal chance, as a surrogate for (...) their equal claim to the good. It is argued that this can be a reason to favour an artificially-constructed lottery to a 'natural' lottery where there is suspicion that the latter may be biased. (shrink)

Fairness is a central, but under-theorized, notion in moral and political philosophy. This paper makes two contributions. Firstly, it criticizes Broome’s seminal account of fairness in Proc Aristotelian Soc 91:87–101, showing that there are problems with restricting fairness to a matter of relative satisfaction and holding that it does not itself require the satisfaction of the claims in question. Secondly, it considers the justification of lotteries to resolve cases of ties between competing claims, which Broome claims as support for his (...) theory, and contrasts random procedures to contests of skill, which may also be considered lotteries in a broader sense. I offer no alternative account of fairness of my own, but hope to point the way for future research on the nature of fairness. (shrink)

The three most common responses to Taurek’s ‘numbers problem’ are saving the greater number, equal chance lotteries and weighted lotteries. Weighted lotteries have perhaps received the least support, having been criticized by Scanlon What We Owe to Each Other ( 1998 ) and Hirose ‘Fairness in Life and Death Cases’ ( 2007 ). This article considers these objections in turn, and argues that they do not succeed in refuting the fairness of a weighted lottery, which remains a potential solution to (...) cases of conflict. Moreover, it shows how these responses actually lead to a new argument for weighted lotteries, appealing to fairness and Pareto-optimality. (shrink)

Decision-makers face severe uncertainty when they are not in a position to assign precise probabilities to all of the relevant possible outcomes of their actions. Such situations are common—novel medical treatments and policies addressing climate change are two examples. Many decision-makers respond to such uncertainty in a cautious manner and are willing to incur a cost to avoid it. There are good reasons for taking such an uncertainty-averse attitude to be permissible. However, little work has been done to incorporate it (...) into an egalitarian theory of distributive justice. We aim to remedy this lack. We put forward a novel, uncertainty-averse egalitarian view. We analyse when the aims of reducing inequality and limiting the burdens of severe uncertainty are congruent and when they conflict, and highlight practical implications of the proposed view. We also demonstrate that if uncertainty aversion is permissible, then utilitarians must relinquish a favourite argument against egalitarianism. (shrink)

The 2009 pandemic of influenza A (H1N1) was relatively mild, but a subsequent outbreak of pandemic influenza could be much worse. According to projections from the Department of Health and Human Services, the potential health consequences of a severe (1918-like) influenza pandemic in the United States could be literally overwhelming: up to 1.9 million deaths; 90 million people sick; 45 million people needing outpatient care; 9.9 million people hospitalized, of whom 1.485 million would need treatment in an intensive care unit (...) (ICU); and 742,500 patients needing mechanical ventilators. Even a less cataclysmic, moderate pandemic (like 1958 or 1968) would result in 209,000 deaths; 90 million people sick; 45 million people needing outpatient care; 865,000 people hospitalized, of whom 128,750 would need treatment in an ICU; and 64,875 patients needing mechanical ventilators. (shrink)

For nearly twenty-five years, federal regulation of privacy issues in research involving human subjects was the primary province of the federal rule for Protection of Human Subjects. As of April 14, 2003, the compliance date for the Privacy Rule of the Health Insurance Portability and Accountability Act, however, the Common Rule and the Privacy Rule jointly regulate research privacy. Although, in theory, the Privacy Rule is intended to complement the Common Rule, there are several areas in which the rules diverge. (...) In some instances the inconsistencies result in gaps in privacy protection; in other instances the inconsistencies result in added burdens on researchers without additional privacy protections. In all instances, the lack of harmonization of these rules has created confusion, frustration, and misunderstanding by researchers, research subjects, and institutional review boards. In this article, I review the major provisions of the Privacy Rule for research, explain the areas in which the Privacy Rule and Common Rule differ, and conclude that the two rules should be revised to promote consistency and maximize privacy protections while minimizing the burdens on research. (shrink)

The 2009 pandemic of influenza A was relatively mild, but a subsequent outbreak of pandemic influenza could be much worse. According to projections from the Department of Health and Human Services, the potential health consequences of a severe influenza pandemic in the United States could be literally overwhelming: up to 1.9 million deaths; 90 million people sick; 45 million people needing outpatient care; 9.9 million people hospitalized, of whom 1.485 million would need treatment in an intensive care unit ; and (...) 742,500 patients needing mechanical ventilators. Even a less cataclysmic, moderate pandemic would result in 209,000 deaths; 90 million people sick; 45 million people needing outpatient care; 865,000 people hospitalized, of whom 128,750 would need treatment in an ICU; and 64,875 patients needing mechanical ventilators. (shrink)

This article argues for the elimination of the concept of life worth living from philosophical vocabulary on three complementary grounds. First, the basic components of this concept suffer from multiple ambiguities, which hamper attempts to ground informative evaluative and classificatory judgments about the worth of life. Second, the criteria proposed to track the extension of the concept of life worth living rest on unsupported axiological assumptions and fail to identify precise and plausible referents for this concept. And third, the concept (...) of life worth living is not shown to serve any major evaluative or classificatory purpose besides those served by already available axiological concepts. By eliminating the concept of life worth living, philosophers will free themselves of the task of addressing ill-posed axiological questions and ground reflection about the worth of life on more rigorous conceptual foundations. (shrink)

Joseph Raz; VII*—Value Incommensurability: Some Preliminaries, Proceedings of the Aristotelian Society, Volume 86, Issue 1, 1 June 1986, Pages 117–134, https://.

Joseph Raz presents a penetrating exploration of the interdependence of value, reason, and the will. These essays illuminate a wide range of questions concerning fundamental aspects of human thought and action. Engaging Reason is a summation of many years of original, compelling, and influential work by a major contemporary philosopher.

sonable, in this sense, if we ignore, or give too little weight to, some other people's well-being or moral claims.' Some critics have suggested that, because Scanlon appeals to this sense of 'reasonable', his formula is empty. On this objection, whenever we believe that some act is wrong, we shall believe that people have moral claims not to be treated in this way. We could therefore argue that such acts are disallowed by some principle which no one could reasonably reject, (...) since anyone who rejected this principle would be giving too little weight to people's moral claims not to be treated in this way. Since everyone could claim that the principles which they accept could not be reasonably rejected, Scanlon's Formula would make no difference to our moral thinking. That is not so. If we reject the principles that disallow certain acts, we are denying that such acts are wrong. This denial would be unreasonable if it would give too little weight to some other people's moral claims. So Scanlon's Formula implies that.. (shrink)

Philosophy & Public Affairs, 34 (2006): 109-35.

We argue that there is a marked shift in the moral weight of an increment in a person's well-being when one moves from a case involving only intra-personal trade-offs to a case involving only inter-personal trads-offs. This shift, we propose, is required by the separateness of persons. We also argue that the Priority View put forward by Parfit cannot account for such a shift. We also outline two alternative views, an egalitarian view and a claims-based view, that can account for (...) this shift. (shrink)