How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health (...) care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

The promise and the peril of our are inextricably linked with the promise and the peril of modern science. On the one hand, the spread of knowledge has overcome superstition and reduce fear born of ignorance, and the application of science through technology has made life less poor, nasty, brutish and short.

American doctors in the 1990s are being asked to serve as "double agents," weighing competing allegiances to patients' medical needs against the monetary costs to society. This situation is a reaction to rapid cost increases for medical services, themselves the result of the haphazard development since the 1920s of an inherently inflationary, open-ended system for funding and delivering health care. The answer to an inefficient system, however, is not to stint on care, but rather to restructure the system to remove (...) the inflationary pressures. As long as we are spending enormous resources on an inherently inefficient and inflationary system we cannot justify asking doctors to withhold beneficial care to save money for third-party payers. Doing so serves a largely political agenda and endangers the patient-centered ethic that is central to medicine. (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.

A discussion of egoism and altruism as related both to ethical theory and moral psychology. Williams considers and rejects various arguments for and against the existence of egoistic motives and the rationality of someone motivated by self-interest. He ultimately attempts to give a more Humean defense of altruism, as opposed to the more Kantian defenses found in Thomas Nagel, for example.

Immanuel Kant's Groundwork of the Metaphysics of Morals ranks alongside Plato's Republic and Aristotle's Nicomachean Ethics as one of the most profound and influential works in moral philosophy ever written. In Kant's own words its aim is to search for and establish the supreme principle of morality, the categorical imperative. Kant argues that every human being is an end in himself or herself, never to be used as a means by others, and that moral obligation is an expression of the (...) human capacity for autonomy or self-government. This edition presents the acclaimed translation of the text by Mary Gregor, together with an introduction by Christine M. Korsgaard that examines and explains Kant's argument. (shrink)

Most people believe that there are limits to the sacrifices that morality can demand. Although it would often be meritorious, we are not, in fact, morally required to do all that we can to promote overall good. What's more, most people also believe that certain types of acts are simply forbidden, morally off limits, even when necessary for promoting the overall good. In this provocative analysis Kagan maintains that despite the intuitive appeal of these views, they cannot be adequately defended. (...) In criticizing arguments for limited moral requirements as well as those for unconditionally prohibited acts, Kagan offers a sustained attack on two of the most basic features of ordinary common sense morality. (shrink)

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Healthcare (including public health) is special because it protects normal functioning, which in turn protects the range of opportunities open to individuals. I extend this account in two ways. First, since the distribution of goods other than healthcare affect population health and its distribution, I claim that Rawls's principles of justice describe a fair distribution of the social determinants of health, giving a partial account of when health inequalities are unjust. Second, I supplement a principled account of justice for health (...) and healthcare with an account of fair process for setting limits or rationing care. This account is provided by three conditions that comprise "accountability for reasonableness.". (shrink)

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

: Managed care per se is a morally neutral concept; however, as practiced today, it raises serious ethical issues at the clinical, managerial, and social levels. This essay focuses on the ethical issues that arise at the bedside, looking first at the ethical conflicts faced by the physician who is charged with responsibility for care of the patient and then turning to the way in which managed care exacts costs that are measured not in dollars but in compromises in the (...) caring dimensions of the patient-physician relationship. (shrink)

A volume of philosophical studies, centred on problems of personal identity and extending to related topics in the philosophy of mind and moral philosophy.

According to liberal egalitarian morality, all human beings are one another's moral equals. Nonhuman animals, by contrast, are not considered to be our moral equals. This essay considers two challenges to the liberal egalitarian view. One is the ``separation problem,'' which is the challenge to identify a morally significant intrinsic difference between all human beings and all nonhuman animals. The other is the “equality problem,” which is to explain how all human beings can be morally equal when there are some (...) human beings whose psychological capacities are no higher than those of certain nonhuman animals. The focus throughout is on the ethics of killing but the arguments are of broader relevance. The essay reaches a skeptical conclusion about our ability to meet these challenges. (shrink)

Christine Korsgaard has become one of the leading interpreters of Kant's moral philosophy. She is identified with a small group of philosophers who are intent on producing a version of Kant's moral philosophy that is at once sensitive to its historical roots while revealing its particular relevance to contemporary problems. She rejects the traditional picture of Kant's ethics as a cold vision of the moral life which emphasises duty at the expense of love and value. Rather, Kant's work is seen (...) as providing a resource for addressing not only the metaphysics of morals, but also for tackling practical questions about personal relations, politics, and everyday human interaction. This collection contains some of the finest current work on Kant's ethics and will command the attention of all those involved in teaching and studying moral theory. (shrink)

This book follows hard upon Korsgaard's The Sources of Normativity. Both present the author's influential version of a Kantian theory of normative ethics and metaethics. Whereas The Sources of Normativity was a systematic investigation of "normativity" written as a single unit, the present volume is a collection of previously published papers, some of them already well known and much discussed, dating between 1983 and 1993. By the nature of the case, one might expect less thematic unity in this book than (...) in the other one, but the present book is a deeper and more wide ranging presentation of the author's views. Korsgaard's historical focus in The Sources of Normativity is less on Kant and more on the British moralists. Creating the Kingdom of Ends deals quite explicitly with the interpretation of Kant's moral philosophy. The papers in this book contain, in my judgment, the heart of Korsgaard's work: a variety of fresh and illuminating insights into Kant's moral theory and its relation to contemporary ethical theory which have helped to reshape the image of Kant's ethics and to refocus the issues dealt with in current moral philosophy. Or to make claims less grand but of more immediate relevance to this review, there is no question that some of the papers in this book have helped to reshape both the present writer's image of Kant's ethics and his conception of the way questions of ethical theory should be addressed. I hope below to say something both about where I think Korsgaard has gotten these matters right, and where I find her position either unclear or dubious. (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)

Review of Norman Daniels' 'Am I My Parents' Keeper?', and Daniel Callahan's 'Setting Limits'.

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)

The principle that people's lives and fundamental interests are of equal value and that they must therefore be given equal weight has immense intellectual appeal and intuitive force. It is often enough to discredit a theory or proposal simply to show that it violates this principle. When measures are said to be discriminatory or unfair it is this principle which is in play. Recent philosophers of widely differing schools and outlooks give versions of this principle a central role in their (...) theories. (shrink)

Book reviewed in this article: Toward a More Natural Science: Biology and Human Affairs. By Leon R. Kass.

Book reviewed in this article: The Needs of Strangers. By Michael Ignatieff. The Health Economy. By Victor Fuchs. Just Health Care. By Norman Daniels.

In this article I will argue that there are two theories of distributive justice hidden in Walzer's Spheres of Justice. The first one emphasises the separation of distributive spheres. It tries to formulate distributive criteria by sticking faithfully to sphere‐specificity. I shall refer to this theory as ‘pure pluralism’. The second theory downplays the separation of spheres and emphasises ‘across spheres’ or ‘between spheres’ criteria instead. I shall call this theory ‘mitigated pluralism’. Mitigated pluralism has become popular among Walzer's friendly (...) critics who apparently do not want to charge him with a distributive theory as clear and rigid as pure pluralism. Although I consider myself another friendly critic, I shall argue in favour of pure pluralism. (shrink)

"Fascinating....An imaginative, deeply engaging philosophical adventure."--Ethics. "Will quickly become, in debates concerning the sorts of distribution problems Kamm is concerned with, what Rawls's Theory of Justice is for more general debates about distributive justice."--Journal of Medical Ethics.

Kamm applies her non-consequentialist theory to practical ethical problems involving life and death, including the distinction between killing and letting die, and the permissibility of harming some to save others.