Though the revised edition of A Theory of Justice, published in 1999, is the definitive statement of Rawls's view, so much of the extensive literature on Rawls's theory refers to the first edition. This reissue makes the first edition once again available for scholars and serious students of Rawls's work.

The study of metaphysical possibility involves two central questions: What are possible worlds? Is there an empty possible world? In looking at the first question we consider the different accounts of possible worlds—Lewisian realism, ersatzism, etc. In looking at the second question we consider the discussions of metaphysical nihilism, the modal ontological arguments, etc. In this paper I am drawing these two questions together in order to show how the position we hold on one of these issues affects the position (...) we should hold on the other. (shrink)

The human right to health has been established in international law since 1976. However, philosophers have often regarded human rights doctrine as a marginal contribution to political philosophy, or have attempted to distinguish ‘human rights proper’ from ‘aspirations’, with the human right to health often considered as falling into the latter category. Here the human right to health is defended as an attractive approach to global health, and responses are offered to a series of criticisms concerning its demandingness.

I distinguish between two opposing intuitions about the nature of the singular causal relation. The first stresses the nomological character of causation, while the second emphasises is seemingly local character. My question is this: is it possible to formulate an account of causation which incorporates both intuitions? Anscombe gives us reason to think that these intuitions could not be jointly met in an account of causation. Foster and Tooley's acount seems to provide a counter‐instance to her claim, but this proves (...) to be a false start. I put forward an alternative suggestion which, by utilising tropes, manages to reconcile both the local and nomological character of causation. (shrink)

There are two discourses that are used in connection with the provision of good healthcare: a rights discourse and a beneficial design discourse. Although the logical force of these two discourses overlaps, they have distinct and incompatible implications for practical reasoning about health policy. The language of rights can be interpreted as the ground of a well-designed healthcare system stressing the values of equality and inclusion, but it has less application when dealing with questions of cost-effectiveness. This difference reflects the (...) distinction between the deontological status of rights claims and a teleological approach presupposed in the language of beneficial design. However, the value of the separateness of persons contained in the discourse of rights can impose constraints on the adoption of a simple maximizing principle when thinking about the allocation of healthcare resources within a social contract for health. Throughout these issues are discussed by reference to the work of Peter Jones. (shrink)

A defence of the idea that there are sui generis duties of love: duties, that is, that we owe to people in virtue of standing in loving relationships with them. I contrast this non‐reductionist position with the widespread reductionist view that our duties to those we love all derive from more generic moral principles. The paper mounts a cumulative argument in favour of the non‐reductionist position, adducing a variety of considerations that together speak strongly in favour of adopting it. The (...) concluding section connects this debate with larger issues in moral theory concerning the general idea of obligation. (shrink)

A just social arrangement must guarantee a right to health care for all. This right should be understood as a positive right to basic human functional capabilities. The present article aims to delineate the right to health care as part of an account of distributive justice in health care in terms of the sufficiency of basic human functional capabilities. According to the proposed account, every individual currently living beneath the sufficiency threshold or in jeopardy of falling beneath the threshold has (...) a legitimate claim to justice. People's entitlements to health care should not be determined on the basis of brute luck and their efforts to maintain healthy lifestyles. The prioritization of competing claim-rights of individuals is guided by two allocation principles: number and benefit-size weighted sufficiency (among people beneath the threshold) and need-weighted utilitarianism (among people above the threshold). (shrink)

Despite a high and growing global average income, billions of human beings are still condemned to lifelong severe poverty, with all its attendant evils of low life expectancy, social exclusion, ill health, illiteracy, dependency, and effective enslavement. This problem is solvable, despite its magnitude.

Drawing upon a conception of the metaphysics of conscious states and of first-person content, we can argue that Descartes's transition ‘Cogito ergo sum’ is both sound and one he is entitled to make. We can nevertheless formulate a version of Lichtenberg's objection that can still be raised after Bernard Williams's discussion. I argue that this form of Lichtenberg's revenge can also be undermined. In doing so it helps to compare the metaphysics of subjects, worlds and times. The arguments also apply (...) to Descartes's ‘second Cogito’, that it is one and the same subject that thinks, wills, imagines. (shrink)

The obligations we owe to those with whom we share a valuable relationship (like friendship) cannot be reduced to the obligations we owe to others simply as fellow persons (e.g. the duty to reciprocate benefits received). Wallace suggests that this is because such valuable relationships are loving relationships. I instead propose that it is because, unlike general moral obligations, such valuable relationships (and their constitutive obligations) serve our normative interests. Part of what makes friendship good for us is that it (...) involves bonds of loyalty. Our lives go better if we are bound to others in this way. (shrink)

In this discussion, we will consider arguments against the view that one person is entitled to medical care at the expense of another person, just because the one person might be able to extend it to the other. We all accept the view that we are entitled to nonviolence from each other, which in the medical case is roughly that we are entitled to other people not making us sick, at least insofar as this is something they can readily avoid. (...) But how are we also entitled to their help in making us well when we are sick? Few of us think that we are entitled to other people's new cars, or half of their incomes for our general use. Why, then, are we entitled to a hefty fraction of that income to pay our medical bills? (shrink)

This paper considers whether Rawls' theory of justice as fairness may be used to justify a human right to health care. Though Rawls himself does not discuss health care, other writers have applied Rawls' theory to the provision of health care. Ronald Green argues that contractors in the original position would establish a basic right to health care. Green's proposal, however, requires considerable relaxation of the constraints Rawls places on the original position and thus jeopardizes Rawls' arguments for the two (...) principles of justice. Norman Daniels claims that health care is best understood as a means for helping to achieve Rawls' goal of equality of fair opportunity. Daniels acknowledges, however, that his interpretation cannot justify a basic right to health care; rather, it would at best require that certain kinds of care be made available to certain kinds of individuals. Finally, in place of the notion of health care is a human right, it is suggested that the provision of health care is a social ideal which may inspire the creation of specific legal rights. On this view, social provision of health care may properly vary significantly from culture to culture. Despite this variability, social systems may still be criticized on moral grounds. Keywords: justice, right to health care, equality, fair opportunity. (shrink)

There are striking structural similarities between Freud's ego and Kant's transcendental unity of apperception, which for Kant grounds our use of ‘I’ in ‘I think’. There are also striking similarities between Freud's superego and Kant's account of the mental structure that grounds our use of ‘I’ in the moral ‘I ought to’. The paper explores these similarities on three main points: the conflict of motivations internal to the mind, the relation between discursive and pre‐discursive representation of moral motivation, and the (...) unconscious character of moral motivation. The suggestion is that Freud offers resources for a naturalized account of just those features of our moral motivation that, according to Kant, seem to make it least amenable to a naturalistic explanation. How much of a revision of Kant's analysis of moral justification is thereby entailed is beyond the purview of the paper. (shrink)

This discussion piece critically examines some of the key ideology that figures in Elizabeth Fricker's ‘Stating and Insinuating’, raises a number of queries about the details of Fricker's argumentation, and develops some ideas about the normative structure of testimony that relate to the themes of that paper.

I critically discuss two claims which Hannah Ginsborg makes on behalf of her account of meaning in terms of ‘primitive normativity’: first, that it avoids the sceptical regress articulated by Kripke's Wittgenstein; second, that it makes sense of the thought—central to Kripke's Wittgenstein—that ‘meaning is normative’, in a way which shows this thought not only to be immune from recent criticisms but also to undermine reductively naturalistic theories of content. In the course of the discussion, I consider and attempt to (...) shed light on a number of issues: the structure of the sceptical regress; the content of the thought that ‘meaning is normative’, and its force against reductive theories; the connection between meaning and justification; and the notion of ‘primitive normativity’. (shrink)

Recent years have seen an increase in the turn to rights discourse within the context of access to health and specifically health care. Developments took place at both the national and global levels, with a significant increase in right to health litigation around the world1 and developments at the international level, such as the appointment of a Special Rapporteur on the Right to Health and the adoption of a “General Comment” on the topic by the UN Committee on Economic, Social (...) and Cultural Rights. (shrink)

In recent years we have noticed an increase in the turn to rights analysis in litigation relating to access to health care. Examining litigation, we can notice a contradiction between on the one hand the ability of the right to health to reinforce privatization and commodification of health care, by rearticulating claims to private health care in terms of human rights, and on the other hand, its ability to reinforce and reinstate public values, especially that of equality, against the background (...) of privatization and commodification. While many hope that rights discourse will do the latter, and secure that access to health care should occur on the basis of need as opposed to ability to pay, it has actually been used to attempt to advance arguments that will allow access to private or semiprivate health insurance in ways that may exacerbate inequality. These types of arguments won ground in the Canadian Supreme Court, but were rejected by the Israeli Supreme Court. In order to avoid this co-optation of right to health, a notion of rights that incorporates the principles of substantive equality is required. Otherwise, one of the unintended consequences of inserting rights analysis into public health care may be that it will reinforce rather than challenge privatization in a way that may increase inequalities. (shrink)

This article challenges the widespread contention - promoted by the World Health Organization, the U.N. Human Rights Commission, and certain non-governmental organizations - that health care should be regarded as an individual human right. Like other "post-modern" rights, the asserted individual right to health care is a positive claim on the resources of others; it is unlimited by corresponding responsibilities; and it pertains exclusively to the individual. In fact, an individual human right to health, enforceable against either governments or corporations, (...) does not currently exist in law. If established, such a right would portend a dramatic expansion of government control over health care, with negative consequences for efficiency and patient welfare. Voluntary efforts based on partnership, rather than the imposition of legal requirements, are the most productive means of expanding access to health care while preserving incentives for continued development of innovative health technologies. (shrink)

I defend the normativity of meaning against recent objections by arguing for a new interpretation of the ‘ought’ relevant to meaning. Both critics and defenders of the normativity thesis have understood statements about how an expression ought to be used as either prescriptive or semantic. I propose an alternative view of the ‘ought’ as conveying the primitively normative attitudes speakers must adopt towards their uses if they are to use the expression with understanding.

An utterer may convey a message to her intended audience by means of an explicit statement; or by a non‐conventionally mediated one‐off signal from which the audience is able to work out the intended message; or by conversational implicature. I investigate whether the last two are equivalent to explicit testifying, as communicative act and epistemic source. I find that there are important differences between explicit statement and insinuation; only with the first does the utterer assume full responsibility for the truth (...) of what she communicates to her audience. (shrink)

Do we have a legal and moral right to health care against others? There are international conventions and institutions that say emphatically yes, and they summarize this in the expression of “the right to health,” which is an established part of the international human rights canon. The International Covenant on Social and Economic Rights outlines this as “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” but declarations such as this remain tragically (...) unfulfilled. According to recent figures, roughly two billion people lack access to essential drugs or to primary health care. Millions are afflicted by infections and illnesses that are easily avoidable or treatable. In the developing world many children die or grow stunted and damaged for lack of available treatments. Tropical diseases receive little or no attention by the major pharmaceutical companies’ research departments. Is this a massive violation of the right to health? And if so, why does it attract so little attention? Is it because our supposed commitment to human rights and the rule of law is hypocritical and hollow? Or is it because the right to health is a special case of a right, so that these tragedies are no violation at all? Jennifer Prah Ruger summarized this puzzle when she wrote: “one would be hard pressed to find a more controversial or nebulous human right than the right to health.” In this essay I discuss three different theories of a right to health care. I conclude by offering my own reconstruction of one such theory. (shrink)

In recent years there has been growing scholarly interest in the relationship between bioethics and human rights. The majority of this work has proposed that the normative and institutional frameworks of human rights can usefully be employed to address those bioethical controversies that have a global reach: in particular, to the genetic modification of human beings, and to the issue of access to healthcare. In response, a number of critics have urged for a degree of caution about applying human rights (...) to such controversies. In particular, they have claimed that human rights have unresolved distributive and foundational problems. Interestingly, however, some of these critics have gone on to suggest that it might be possible to draw on certain bioethical insights to remedy these problems with human rights. This paper evaluates these recent attempts to apply insights from bioethics to the theory and practice of human rights. It argues that while these insights do not constitute an entirely new and original contribution to human rights thinking, they do force human rights scholars and campaigners to reflect on some key issues. First of all, they force us to question the prevalent idea that human rights are always ‘inviolable trumps’. Secondly, they demand that we pay close attention to the ‘fairness’ of the institutions we charge with determining our concrete rights. And finally, and perhaps most radically, these insights challenge the notion that human rights are held exclusively by members of the human species. (shrink)

Is it true that utilitarianism can accommodate the modern belief that human beings have certain moral rights against everybody ‘just in virtue of their human nature?’ I should have thought the most a utilitarian could grant was that we had rights just in virtue of the utility of respecting such rights, not just in virtue of our human nature. In fact, that is more like the view Professor Brandt actually supports. What he argues is that there is not the a (...) priori difficulty with the idea of utilitarian moral rights that some philosophers have thought there was. However, I think the possibility of utilitarian moral rights is not the same as the view that we all have human rights against everybody just in virtue of our human nature. As I hear it, ‘just in virtue of our human nature’ is an alternative to a utilitarian basis for rights. I'll return to that. (shrink)

I discuss how modern cosmology illustrates underdetermination of theoretical hypotheses by data, in ways that are different from most philosophical discussions. I confine the discussion to the history of the observable universe from about one second after the Big Bang, as described by the mainstream cosmological model: in effect, what cosmologists in the early 1970s dubbed the ‘standard model’, as elaborated since then. Or rather, the discussion is confined to a (very!) few aspects of that history. I emphasize that despite (...) the underdetermination, a scientific realist can, and should, endorse this description. (shrink)

There are many good reasons for a merger between bioethics and human rights. First, though, significant philosophical groundwork must be done to clarify what a human right to health would be and—if we accept that it exists—exactly how it might influence the practical decisions we face about who gets what in very different contexts.

Feinberg is one of the leading philosophers of law of the last forty years. This volume collects recent articles, both published and unpublished, on what he terms "basic questions" about the law, particularly in regard to the relationship to morality. Accessibly and elegantly written, this volume's audience will reflect the diverse nature of Feinberg's own interests: scholars in philosophy of law, legal theory, and ethical and moral theory.

Notwithstanding the expectations related to the ‘invasion’ of human rights into the field of healthcare, the complexity of this field raises some problematic questions about the applicability of such a legal instrument. The present paper analyses the possible limits to the content of the core right to healthcare. These limits are discussed through the examination of two normative pillars of health law: the right to individual self-determination (or the principle of individual autonomy) and the right to healthcare itself. The authors (...) conclude that in the context of the scarcity of resources the effectiveness of the guarantees of the right to healthcare will depend on the narrowing of the concept of the right by choosing the biomedical definition of health as the basis. (shrink)