In virtue of what is something a reason for action? That is, what makes a consideration a reason to act? This is a metaphysical or meta-normative question about the grounding of reasons for action. The answer to the grounding question has been traditionally given in ‘pure’, univocal terms. This paper argues that there is good reason to understand the ground of practical normativity as a hybrid of traditional ‘pure’ views. The paper 1) surveys the three leading ‘pure’ answers to the (...) question of a normative ground, 2) examines one or two of the most difficult problems for each, proposing along the way a new objection to one, and 3) argues that a particular hybrid view about normative grounds –‘hybrid voluntarism’ – avoids each of the main problems faced by the three leading ‘pure’ views. (shrink)

Davidson attacks the intelligibility of conceptual relativism, i.e. of truth relative to a conceptual scheme. He defines the notion of a conceptual scheme as something ordering, organizing, and rendering intelligible empirical content, and calls the position that employs both notions scheme-content dualism. He argues that such dualism is untenable since: not only can we not parcel out empirical content sentence per sentence but also the notion of uninterpreted content to which several schemes are relative, and the related notion of a (...) theory ”fitting the evidence’, can be shown to lack intelligibility too. Davidson argues further that belief in incommensurable schemes or non-intertranslatable languages is possible only on violating a correct understanding of interpretability : if we succeed in interpreting someone else then we have shown there is no need to speak of two conceptual schemes, while if we fail ”there is no ground for speaking of two.’. (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.

This paper argues for the existence of a fourth positive generic value relation that can hold between two items beyond ‘better than’, ‘worse than’, and ‘equally good’: namely ‘on a par’.

What challenges must a principle of need for prioritisations in health care meet in order to be plausible and practically useful? Some progress in answering this question has recently been made by Hope, Østerdal and Hasman. This article continue their work by suggesting that the characteristic feature of principles of needs is that they are sufficientarian, saying that we have a right to a minimally acceptable or good life or health, but nothing more. Accordingly, principles of needs must answer two (...) distributive questions: when do we have sufficient and how should we prioritise among those who do not yet have a sufficiency? Furthermore, it is argued that Roger Crisp’s theory of need, which combines sufficientarianism with prioritarianism below the threshold of need, is better equipped than alternatives to answer these questions as well as meeting the challenges formulated by Hope, Østerdal and Hasman. However, Crisp’s theory faces two major challenges. First, it has to say something about the currency of distribution: a principle of need must be complemented either with a theory on the human good or a theory about the proper goals of health care. Second, it has to say something about where the threshold should be set. However, any attempt to set a threshold seems morally arbitrary in the light of the sufficientarian idea that those just above the threshold never should be given priority over those just below the threshold. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

This paper compares and contrasts three different substantive principles of justice for making health care priority-setting or “rationing” decisions: need principles, maximising principles and egalitarian principles. The principles are compared by tracing out their implications for a hypothetical rationing decision involving four identified patients. This decision has been the subject of an empirical study of public opinion based on small-group discussions, which found that the public seem to support a pluralistic combination of all three kinds of rationing principle. In conclusion, (...) it is suggested that there is room for further work by philosophers and others on the development of a coherent and pluralistic theory of health care rationing which accords with public opinions. (shrink)

A notorious debate in the ethics of healthcare rationing concerns whether to address rationing decisions with substantial principles or with a procedural approach. One major argument in favour of procedural approaches is that substantial principles are indeterminate so that we can reasonably disagree about how to apply them. To deal with indeterminacy, we need a just decision process. In this paper I argue that it is a mistake to abandon substantial principles just because they are indeterminate. It is true that (...) reasonable substantial principles designed to deal with healthcare rationing can be expected to be indeterminate. Yet, the indeterminacy is only partial. In some situations we can fully determine what to do in light of the principles, in some situations we cannot. The conclusion to draw from this fact is not that we need to develop procedural approaches to healthcare rationing, but rather that we need a more complex theory in which both substantial principles and procedural approaches are needed. (shrink)