Benefit/cost analysis is a technique for evaluating programs, procedures, and actions; it is not a moral theory. There is significant controversy over the moral justification of benefit/cost analysis. When a procedure for evaluating social policy is challenged on moral grounds, defenders frequently seek a justification by construing the procedure as the practical embodiment of a correct moral theory. This has the apparent advantage of avoiding difficult empirical questions concerning such matters as the consequences of using the procedure. So, for example, (...) defenders of benefit/cost analysis (BCA) are frequently tempted to argue that this procedurejust isthe calculation of moral Tightness – perhaps that what itmeansfor an action to be morally right is just for it to have the best benefit-to-cost ratio given the accounts of “benefit” and “cost” that BCA employs. They suggest, in defense of BCA, that they have found the moral calculus – Bentham's “unabashed arithmetic of morals.” To defend BCA in this manner is to commit oneself to one member of a family of moral theories (let us call thembenefit/cost moral theoriesorB/C moral theories) and, also, to the view that if a procedure is (so to speak) the direct implementation of a correct moral theory, then it is a justified procedure. Neither of these commitments is desirable, and so the temptation to justify BCA by direct appeal to a B/C moral theory should be resisted; it constitutes an unwarranted short cut to moral foundations – in this case, an unsound foundation. Critics of BCA are quick to point out the flaws of B/C moral theories, and to conclude that these undermine the justification of BCA. But the failure to justify BCA by a direct appeal to B/C moral theory does not show that the technique is unjustified. There is hope for BCA, even if it does not lie with B/C moral theory. (shrink)

An argument against the bias towards the near; how a defence of temporal neutrality is not a defence of S; an appeal to inconsistency; why we should reject S and accept CP.

Utilitarianism has a curious history. Its most celebrated founders—Jeremy Bentham and John Stuart Mill—were radical progressives, straddling the worlds of academic philosophy, political science, economic theory and practical affairs. They made innumerable recommendations for legal, social, political and economic reform, often (especially in Bentham’s case) described in fine detail. Some of these recommendations were followed, sooner or later, and many of their radical ideas have become close to articles of faith of western liberalism. Furthermore many of these recommendations were made (...) expressly to improve the condition of the deprived, or of oppressed groups. Yet the moral theory which inspired this reforming zeal is, at least officially, utilitarianism, and when we teach this theory to our students we feel it our duty to point out the horrors that could be justified by any theory which assesses the moral quality of actions in terms of the maximization of good consequences over bad. No consequence is so bad that it cannot, in principle, be outweighed by a large aggregation of smaller goods. Hence there are circumstances in which utilitarianism can require slavery, the punishment of the innocent, and redistribution of resources from the poor to the rich, or from the disabled and the sick to the able bodied and healthy. Indeed, in the right circumstances, it can justify pretty much anything you can think of. For all their intelligence and imagination neither Bentham nor Mill seemed to recognise or discuss these catastrophic possibilities. (shrink)

In bioethical discussions of preimplantation genetic diagnosis and prenatal screening, accusations of eugenics are commonplace, as are counter-claims that talk of eugenics is misleading and unhelpful. This paper asks whether “eugenics talk”, in this context, is legitimate and useful or something to be avoided. It also looks at the extent to which this linguistic question can be answered without first answering relevant substantive moral questions. Its main conclusion is that the best and most non-partisan argument for avoiding eugenics talk is (...) the Autonomy Argument. According to this, eugenics talk per se is not wrong, but there is something wrong with using its emotive power as a means of circumventing people’s critical–rational faculties. The Autonomy Argument does not, however, tell against eugenics talk when such language is used to shock people into critical–rational thought. These conclusions do not depend on unique features of eugenics: similar considerations apply to emotive language throughout bioethics. (shrink)

It often appears that the most appropriate form of addressing disadvantage related to disability is through policies that can be called “status enhancements”: changes to the social, cultural and material environment so that the difficulties experienced by those with impairments are reduced, even eradicated. However, status enhancements can also have their limitations. This paper compares the relative merits of policies of status enhancement and “personal enhancement”: changes to the disabled person. It then takes up the question of how to assess (...) the priority of the claims of disabled people in the face of scarcity of resources for which there can be many competing social claims, arguing for the theory of “declustering disadvantage”. (shrink)

The illusory appeal of double effect -- The significance of intent -- Means and ends -- Blame.

Women as commercial baby factories, nature as an economic resource, life as one big shopping mall: This is what we get when we use the market as a common ...

Challenging, with several powerful arguments, some of our deepest beliefs about rationality, morality, and personal identity, Parfit claims that we have a false view about our own nature. It is often rational to act against our own best interersts, he argues, and most of us have moral views that are self-defeating. We often act wrongly, although we know there will be no one with serious grounds for complaint, and when we consider future generations it is very hard to avoid conclusions (...) that most of us will find very disturbing. (shrink)

This book is a major contribution to the current theory of liberalism by an eminent political theorist. It challenges the views of such theorists as Rawls, Dworkin, and Ackerman who believe that the essence of liberalism is that it should remain neutral concerning different ways of life and individual conceptions of what is good or valuable. Professor Galston argues that the modern liberal state is committed to a distinctive conception of the human good, and to that end has developed characteristic (...) institutions and practices - representative governments, diverse societies, market economies, and zones of private action - in the pursuit of specific public purposes that give unity to the liberal state. These purposes guide liberal public policy, shape liberal justice, require the practice of liberal virtues, and rest on a liberal public culture. Consequently the diversity characteristic of liberal societies is limited by their institutional, personal, and cultural preconditions. (shrink)

What next? We are forever making decisions. Typically, when unsure, we try to identify, then compare, our options. We weigh pros and cons. Occasionally, we make the weighing explicit, listing pros and cons and assigning numerical weights. What could be wrong with that? In fact, things sometimes go terribly wrong. This paper considers what cost-benefit analysis can do, and also what it cannot.

What do we owe to our descendants? How do we balance their needs against our own? Tim Mulgan develops a new theory of our obligations to future generations, based on a new rule-consequentialist account of the morality of individual reproduction. He also brings together several different contemporary philosophical discussions, including the demands of morality and international justice. His aim is to produce a coherent, intuitively plausible moral theory that is not unreasonably demanding, even when extended to cover future people. While (...) the book focuses on developing this new account, there are also substantial discussions of alternative views, especially contract-based accounts of intergenerational justice and competing forms of consequentialism. (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)

Everyone wants to be healthy, but many of us decline to act in healthy ways. Should these choices have any bearing on the ethics of clinical practice and health policy? How may personal responsibility for health be manipulated in health policy debates.

In at least some of their forms, Cost-Benefit techniques for the evaluation of environmental projects and policies treat the preferences of citizens as the sole determinants of the value of outcomes. There are two salient ways in which this supposition might be defended. The first is metaethical and appeals to considerations about how we must understand talk of environmental and other values. The second is political and appeals to considerations about democratic legitimacy and the proper aims of public policy. Metaethical (...) considerations, I argue, are something of a red herring here. Roughly subjectivist understandings of our talk of values may be appealingly metaphysically unassuming, but in their most plausible formulations they do not support a view of preferences as the sole determinants of value. Political considerations, on the other hand, are to be taken very seriously. They offer, however, no straightforward rationale for any crudely preferentialist measure of social value. Findings obtained from the use of cost-benefit techniques might sometimes have a legitimate role as an input into, but not as a substitute for, political deliberation. Questions about the scope and limits of such legitimacy are properly addressed in political and not in metaethical terms. (shrink)

How far should we go in protecting and promoting public health? Can we force people to give up unhealthy habits and make healthier choices, or does everyone have the right to decide their own lifestyle? Should we stop treating smokers who refuse to give up smoking? Should we put a tax on fatty foods and ban vending machines in schools to address the obesity epidemic? Should parents be required to have their children vaccinated? Are some of our screening programmes unethical (...) Downs syndrome screening, for example or should we be screening people for more conditions, such as Huntington disease? Such questions are at the heart of public health ethics. Holland shows that to understand and debate these issues requires philosophy: moral philosophies, such as utilitarianism and deontology, as well as political philosophies such as liberalism and communitarianism. And philosophy informs other aspects of public health, such as epidemiology and health promotion. The aim of this book is to provide a lively, accessible and philosophically informed introduction to such issues. It is an ideal textbook for students taking courses in public health ethics. And since this book develops systematic discussions of issues in public health ethics, there is also much here to engage and challenge the more advanced reader. (shrink)

Inequalities that arise because of the influence of arbitrary factors of social or natural contingency, as opposed to choices, are unjust. But whilst liberals wish to preserve and protect the affective family, parental partiality to their own children can result in an inequality that is unjust on account of it being attributable to arbitrary factors. Children's access to resources and opportunities should not be significantly determined by parental entitlement to resources. Justice requires not the abandonment of the family, but it (...) does impose constraints on the ways in which parents can permissibly express their partiality for their children. (shrink)

Bonuses, as incentives or rewards for health -related behavior, feature prominently in German social health insurance. Their goal is centered around promoting personal responsibility, but reducing overall health -care expenditure and enabling competition between sickness funds also play a role. The central position of personal responsibility in German health -care policy is described, and a framework is offered for an analysis of the ethical issues raised by policies seeking to promote responsibility. The framework entails seven tests relating to: solidarity; equality (...) and equity; intrusiveness; attributability and opportunity of choice; evidence, rationale, and feasibility; affected third parties; and coherence. It is contended that a focus on tests, in particular from within contractualism, is the most appropriate way of addressing the question of health responsibility in pluralistic societies. However, taken by themselves, the tests also allow an identification of the key ethical issues by particular policies, which are illustrated by applying the framework to particular bonus polices. (shrink)

Individual decisions about how to exercise the legal right to procreative liberty may generate either positive or negative externalities. From within a resource egalitarian perspective, such as that of Ronald Dworkin, it can be argued that procreative justice is asymmetric in the following respect. Justice need not require that parents be subsidised if they produce a public good, yet its ideal achievement may require their activities be taxed if they threaten to produce a public bad.

abstract A police technique known as racial profiling draws on statistical beliefs about crime rates in racial groups. Supposing that such beliefs are true, and that racial profiling is effective in fighting crime, is such profiling morally justified? Recently, Risse and Zeckhauser have explored the racial profiling of African‐Americans and argued that justification is forthcoming from a utilitarian as well as deontological point of view. Drawing on criticisms made by G. A. Cohen of the incentives argument for inequality, I argue (...) that, assuming that crime rates between different racial groups would converge in the absence of racial discrimination and unjust inequality, racial profiling is comprehensively unjustified. I also explain that, because Risse and Zeckhauser simply compare the status quo with an outcome that differs from it only in respect of the practice of racial profiling, they fail to show that such profiling is non‐comprehensively justified. And, exploring the problem from the point of view of a deontological concern for fairness, I identify a number of situations in which it would be non‐comprehensively unjustified to implement racial profiling (as well as some in which it might be non‐comprehensively unjustified not to implement racial profiling). (shrink)

In my paper “Parental Love and the Ethics of Sex Selection,” published in the previous issue of the Cambridge Quarterly of Healthcare Ethics, I set out to determine whether a plausible argument could be constructed in support of a common intuition about the ethics of sex selection. The intuition in question is that sex selection for nonmedical reasons is incompatible with a proper parental love: that is, with the sort of love that a parent ought to have for her child (...) or, equivalently, with the sort of love that someone accurately describable as a good parent will have for her child. I concluded that there is a prima facie compelling argument that fits the bill, though I did little more than introduce and set that argument out. In the current paper, my aim will be to subject it to closer scrutiny, by considering a number of possible objections to it. I will start by asking why the argument should be thought to apply only to sex selection for nonmedical reasons and not to cases in which selection is employed in order to prevent the birth of children with serious sex-linked genetic conditions. (shrink)

It is widely recognized that prioritizing health care resources by their relative cost-effectiveness can result in lower priority for the treatment of disabled persons than otherwise similar non-disabled persons. I distinguish six different ways in which this discrimination against the disabled can occur. I then spell out and evaluate the following moral objections to this discrimination, most of which capture an aspect of its unethical character: it implies that disabled persons' lives are of lesser value than those of non-disabled persons; (...) it constitutes “double jeopardy” or violates Frances Kamm's non-linkage principle; it conflicts with equality of opportunity; it conflicts with fairness, which requires ignoring (some/most) differential impacts of treatment; it wrongly gives lower priority to disabled persons for equally effective treatment; it conflicts with giving all persons an equal chance to reach their full potential; and, it is in conflict with giving priority to the worse off. (shrink)

Introduction ADAM CURETON AND KIMBERLEY BROWNLEE Disability and disadvantage are interrelated topics that raise important and sometimes overlooked issues in ...

ABSTRACT We argue that in societies like our own the prevailing view that parents have both special responsibilities for and special rights over their children fails to give a proper understanding of the autonomy both of parents and of children. It is our claim that there is a logical priority of the separable interests of a child over the autonomy of its parents in the fulfilment of their special responsibilities for and the exercise of their special rights over their children. (...) However, we believe that in acknowledging the child as a distinct locus of interests appropriate weight can still be given to parental autonomy. In particular, since raising a child is a long‐term commitment which plays a central role in the life‐plans of many adults it will be a legitimate exercise of an adult's autonomy strongly to influence the future of any children involved in such a plan. Such influence will be quite separate from paternalistic concern for those children. But the logical priority of the child's interests will at the same time show why parents are not entitled to behave proprietorially toward their children, even when paternalistic concern is called for. (shrink)