Is it possible to invoke the use of moral responsibility as part of the selection criteria in the allocation of livers for transplant? Criticism has been applied to the difficulties inherent in including such a criterion and also the effect that employing such a judgement might have upon the relationship between the physician and patient. However, these criticisms rely on speculation and conjecture and do not relate to all the arguments put forward in favour of applying moral responsibility. None of (...) the present arguments against using moral responsibility in the allocation of livers for transplant are good enough to warrant its dismissal. (shrink)

In this book, T. M. Scanlon offers new answers to these questions, as they apply to the central part of morality that concerns what we owe to each other.

Autonomy is good for you. A strong sense of competent self-control and effective choice-making promotes both physical and psychological well-being. Loss of autonomous control—and a sense of helplessness—causes depression, increased sensitivity to pain, greater vulnerability to disease, and death. Well established by a wide range of psychological and physiological studies, the positive effects of patient autonomy are well known to competent physicians, nurses, and therapists. Conscientious caregivers are thus moving beyond grudging acceptance of informed consent toward clinical respect for patient (...) autonomy. (shrink)

In recent literature, there has been much debate about whether and how luck egalitarianism, given its focus on personal responsibility, can justify universal health care. In this paper we argue that, whether or not this is so, and in fact whether or not egalitarianism should be sensitive to responsibility at all, the question of personal responsibilization for health is not settled. This is the case because whether or not individuals are responsible for their own health condition is not all that (...) is relevant when considering whether we should somehow hold them responsible for their own health condition, e.g. cost-wise. There may also be efficiency-based reasons to hold them responsible, and there may even be egalitarian reasons. Defining universal health care as an insurance system where everyone’s deductible and premium is 0, we will argue that efficiency-based reasons for cost-responsibilization are not convincing, but that there are egalitarian reasons for cost-responsibilization. Luck egalitarianism, therefore, cannot, at least not on its own term, justify universal health care. (shrink)

When is it morally acceptable to expose others to risk? Most moral philosophers have had very little to say in answer to that question, but here is a moral philosopher who puts it at the centre of his investigations.

Objectives Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. Methods A vignette study was undertaken in participants in a colorectal cancer screening pilot programme in the Netherlands. Screenees with a negative test result received a questionnaire in which nine hypothetical situations were described: three different healthcare settings (screening, lung cancer, chronic (...) obstructive pulmonary disease) combined with three forms of differentiation each: a difference in premium, waiting list ordering or copayment according to lifestyle. We evaluated the responses using a general hierarchical linear model. Results The percentage of participants in agreement with differentiation varied from 20% to 58% (overall mean of 40%). Significantly more participants were in favour of giving a premium discount to those who do not engage in unhealthy behaviour compared with supporters for higher payments for those who do. More differentiation was supported for non-smoking versus smoking cessation than for participation versus non-participation in screening. We observed in-group favouritism in smokers, but no significant effects of age or disease. There was no support for waiting list ordering based on lifestyle. Conclusions Results of this study show that Dutch citizens eligible for colorectal cancer screening are in favour of some form of financial differentiation in the distribution of healthcare, but that significant differences exist between type of setting and the type of behaviour. Our study can be used in the ongoing discussion about solidarity and behaviour in healthcare. (shrink)

consequentialist, even being a utilitarian, allows one still to recognise rights.' I believe that these efforts are well motivated, for I think that any moral doctrine is suspect if one of its effects is to make agents unable to take one another's rights seriously.

This article is an attempt at a systematic account of decision making under greater uncertainty than what traditional, mathematically oriented decision theory can cope with. Four components of great uncertainty are distinguished: (1) the identity of the options is not well determined (uncertainty of demarcation) ; (2) the consequences of at least some option are unknown (uncertainty of consequences); (3) it is not clear whether information obtained from others, such as experts, can be relied on (uncertainty of reliance); and (4) (...) the values relevant for the decision are not determined with sufficient precision (uncertainty of values). Some possible strategy types are proposed for each of these components. Decisions related to environmental issues are used to illustrate the proposals. (shrink)

In epistemology and the philosophy of science, there has been an increasing interest in the social aspects of belief acquisition. In particular, there has been a focus on the division of cognitive labor in science. This essay explores several different models of the division of cognitive labor, with particular focus on Kitcher, Strevens, Weisberg and Muldoon, and Zollman. The essay then shows how many of the benefits of the division of cognitive labor flow from leveraging agent diversity. The essay concludes (...) by examining the benefits and burdens of diversity, particularly in the evaluative diversity that can be found in interdisicplinary science. (shrink)

Does the real difference between non-consequentialist and consequentialist theories lie in their approach to value? Non-consequentialist theories are thought either to allow a different kind of value (namely, agent-relative value) or to advocate a different response to value ('honouring' rather than 'promoting'). One objection to this idea implies that all normative theories are describable as consequentialist. But then the distinction between honouring and promoting collapses into the distinction between relative and neutral value. A proper description of non-consequentialist theories can only (...) be achieved by including a distinction between temporal relativity and neutrality in addition to the distinction between agent-relativity and agent-neutrality. (shrink)

It seems common at the moment to make agent-neutrality a necessary condition of ‘consequentialism” and to hold that deontological ethics are agent-relative. This note argues that both these tendencies regrettably obscure useful terms and distinctions. It concludes by considering what it would be best, now, to mean by ‘utilitarianism” and making a proposal.

Discontented people might talk of corruption in the Commons, closeness in the Commons and the necessity of reforming the Commons, said Mr. Spenlow solemnly, in conclusion; but when the price of wheat per bushel had been the highest, the Commons had been the busiest; and a man might lay his hand upon his heart, and say this to the whole world, – ‘Touch the Commons, and down comes the country!’.

When presented with a situation involving an agent’s choice between alternative actions, a moral oracle says what the agent is allowed to do. The oracle bases her advice on some moral theory, but the nature of that theory is not known by us. The moral oracle’s test consists in determining whether a series of questions to the oracle can be so constructed that her answers will reveal which of two given types of theories she adheres to. The test can be (...) applied to moral theories in order to determine if they differ in their recommendations for action. Based on this test, a terminology is developed to specify different forms and degrees of distinguishability between moral theories, or types of theories, in terms of their recommendations for action. In conclusion, the test is applied to consequentialism and utilitarianism. (shrink)

In the last half century, decision theory has had a deep influence on moral theory. Its impact has largely been beneficial. However, it has also given rise to some problems, two of which are discussed here. First, issues such as risk-taking and risk imposition have been left out of ethics since they are believed to belong to decision theory, and consequently the ethical aspects of these issues have not been treated in either discipline. Secondly, ethics has adopted the decision-theoretical idea (...) that action-guidance has to be based on cause–effect or means–ends relationships between an individual action and its possible outcomes. This is problematic since the morally relevant connections between an action and future events are not fully covered by such relationships. In response to the first problem it is proposed that moral theory should deal directly and extensively with issues such as risk-taking and risk imposition, thereby intruding unabashedly into the traditional territory of decision theory. As a partial response to the second problem it is proposed that moral theorizing should release itself from the decision-theoretical requirement that the moral status of an action has to be derivable from the consequences (or other properties) that are assignable to that action alone. In particular, the effects that an action can have in combination with other actions by the same or other agents are valid arguments in an action-guiding moral discourse, even if its contribution to these combined consequences cannot be isolated and evaluated separately. (shrink)

Cost–benefit analysis (CBA) is much more philosophically interesting than has in general been recognized. Since it is the only well-developed form of applied consequentialism, it is a testing-ground for consequentialism and for the counterfactual analysis that it requires. Ten classes of philosophical problems that affect the practical performance of cost–benefit analysis are investigated: topic selection, dependence on the decision perspective, dangers of super synopticism and undue centralization, prediction problems, the indeterminateness of our control over future decisions, the need to exclude (...) certain consequences for moral reasons, bias in the delimitation of consequences, incommensurability of consequences, difficulties in defending the essential requirement of transferability across contexts, and the normatively questionable but equally essential assumption of interpersonal compensability. (Published Online July 31 2007). (shrink)

This article is an attempt at a systematic account of decision making under greater uncertainty than what traditional, mathematically oriented decision theory can cope with. Four components of great uncertainty are distinguished: (1) the identity of the options is not well determined (uncertainty of demarcation) ; (2) the consequences of at least some option are unknown (uncertainty of consequences); (3) it is not clear whether information obtained from others, such as experts, can be relied on (uncertainty of reliance); and (4) (...) the values relevant for the decision are not determined with sufficient precision (uncertainty of values). Some possible strategy types are proposed for each of these components. Decisions related to environmental issues are used to illustrate the proposals. (shrink)

Reprint of the original, first published in 1869.

The "traditional" view of normative decision theory, as reported (for example) in chapter 2 of Luce and RaiÃa's [1957] classic work, Games and Decisions, proposes a reduction of sequential decisions problems to non-sequential decisions: a reduction of extensive forms to normal forms. Nonetheless, this reduction is not without its critics, both from inside and outside expected utility theory, It islay purpose in this essay to join with those critics by advocating the following thesis.