According to evidentialist views, credence in a proposition p should be proportional to the degree of evidential support that one has in favor of p. However, empirical evidence suggests that our credences are systematically sensitive to practical factors. In this article, I provide a cost–benefit analysis of credences' practical sensitivity. The upshot of this analysis is that credences sensitive to practical factors fare better than practically insensitive ones along several dimensions. All things considered, our credences should (...) be sensitive to practical factors. (shrink)

In this extended book review, I summarize Adler's views and critically analyze his key arguments on the measurement of well-being and the foundations of prioritarianism.

This article considers some different views of fairness and whether they conflict with the use of a version of Cost Effectiveness Analysis (CEA) that calls for maximizing health benefits per dollar spent. Among the concerns addressed are whether this version of CEA ignores the concerns of the worst off and inappropriately aggregates small benefits to many people. I critically examine the views of Daniel Hausman and Peter Singer who defend this version of CEA and Eric Nord among others (...) who criticize it. I come to focus in particular on the use of CEA in allocating scarce resources to the disabled. (shrink)

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)

Many human decisions and behaviors in daily life entail a cost-benefit analysis. From selecting what to eat for dinner to determining the career to pursue, we more or less assess the cost and benefit of each choice. Given the frequent occurrences of cost-benefit thinking in our minds, some intriguing questions arise: how do the cost-benefit thinking processes emerge? How does the brain function to generate such thoughts? Although these inquiries have yet (...) to be thoroughly answered, scientists are adding new clues to our knowledge, such as the neural representation of our subjective cost-benefit judgments. (shrink)

The central thesis of this essay is that basic income experiments are justified if their expected benefits in terms of justice exceed their expected costs in terms of justice. The benefits are a function of basic income’s effect on the level of justice attained in the context in which it is implemented, and the experiment’s impact on future policy-making. The costs comprise the sacrifices made as a result of the experiment’s interventional character, as well as the study’s opportunity costs. In (...) light of the proposed standard of justification for basic income experiments, the factors that play a role in it, and the way these interact with one another, this essay provides some practical recommendations for researchers hoping to conduct such an experiment. (shrink)

Longtermists have argued that humanity should significantly increase its efforts to prevent catastrophes like nuclear wars, pandemics, and AI disasters. But one prominent longtermist argument overshoots this conclusion: the argument also implies that humanity should reduce the risk of existential catastrophe even at extreme cost to the present generation. This overshoot means that democratic governments cannot use the longtermist argument to guide their catastrophe policy. In this paper, we show that the case for preventing catastrophe does not depend on (...) longtermism. Standard cost-benefit analysis implies that governments should spend much more on reducing catastrophic risk. We argue that a government catastrophe policy guided by cost-benefit analysis should be the goal of longtermists in the political sphere. This policy would be democratically acceptable, and it would reduce existential risk by almost as much as a strong longtermist policy. (shrink)

This Note offers a normative critique of cost-benefit analysis, one informed by deontological moral theory, in the context of the debate over whether tort litigation or a non-tort approach is the appropriate response to mass harm. The first Part argues that the difference between lay and expert intuitions about risk and harm often reflects a difference in normative judgments about the existing facts, rather than a difference in belief about what facts exist, which makes the lay intuitions (...) more defensible. The second Part considers how tort has dealt with this divergence between lay and expert perspectives. It also evaluates how tort's approach has differed from that of public law approaches to accident law, such as legislative compensation and risk regulation by administrative agencies. Ultimately, tort's ability to recognize the value of lay intuitions supports retaining the tort perspective as part of our societal arsenal of responses to risk and harm. This ability can also support a pro-tort perspective in two practical debates in the arena of tort law: that over preemption of tort law by administrative agency judgments, and that over access to tort recovery as part of a no-fault system. (shrink)

Economic policy decisions require comparisons of the gains and losses from policy choices to different people. If those gains can be valued in monetary terms, than all that is needed is a comparison of the value of income to different persons, which can be weights in cost-benefit analysis. An objective comparison of the value of income to different people has been long sought but never found. I propose that when money to be allocated is controlled by a (...) group of people with equal control over that money, then a hypothetical auction for transfers of income between people can produce a collective judgment about the value of income that provides suitable weights, and is morally defensible in cases where the decision is made by the group collectively, e.g. when making government policy choices. I provide a method for calculating such weights from observed choices about distributing income, and discuss several desirable properties that they have. (shrink)

Background: Food fortification refers to the process of adding nutrients to foods during their production. It is a cost-effective strategy with well-documented health, economic, and social benefits. Food fortification practices in school meal programs need guidance and legal support from various national policies. Aim: This study aims to analyze how various national policies—such as those related to school feeding, nutrition, health, food safety, agriculture, and the private sector—associate with the implementation of in-school food fortification among countries with school meals (...) programs. Methods: The Bayesian Mindsponge Framework, combining the reasoning strengths of Mindsponge Theory and inference advantages of Bayesian analysis, was employed on a dataset of 126 government representatives who manage large-scale school meal programs in 126 different countries. Results: Findings showed that food safety policy and agriculture policy were positively and significantly associated with the in-school food fortification practices, while school feeding policy and private sector policy had ambiguous relationships with these practices. Nutrition policy and health policy had a significant negative association with food fortification practices among countries implementing school meal programs. Conclusions: Findings underscore the strong position of food safety policy and agriculture policy in guiding food fortification practices in school meal programs. There is a need to re-assess the implemented nutrition policy and health policy due to their significant negative associations with these practices. Enhancing and strengthening the school feeding policy and private sector policy may increase their potencies in giving positive impacts on in-school food fortification practices. (shrink)

Health policy is only one part of social policy. Although spending administered by the health sector constitutes a sizeable fraction of total state spending in most countries, other sectors such as education and transportation also represent major portions of national budgets. Additionally, though health is one important aspect of economic and social activity, people pursue many other goals in their social and economic lives. Similarly, direct benefits—those that are immediate results of health policy choices—are only a small portion of the (...) overall impact of health policy. This chapter considers what weight health policy should give to its “spill-over effects,” namely non-health and indirect benefits. (shrink)

The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA’s provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither (...) uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the health care system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry. (shrink)

Joseph Heath sometimes plays the role of a gadfly in climate and environmental ethics. He often defends conventional, economics-focused claims which rub many philosophers the wrong way—claims that are at the heart of issues raised in these pages, claims such as that discounting is justifiable, growth is good, or cost-benefit analysis is appropriate in liberal democracies. I think we can all agree that sophisticated defences of conventional positions play an important part in the ecosystem. For philosophers, a (...) gadfly can challenge entrenched conceptions. If we agree that these goals are worthwhile, then this book serves as a useful summary and synthesis of the ways Heath has ably defended conventional claims about climate policy. (shrink)

This project considers whether and how research ethics can contribute to the provision of cost-effective medical interventions. Clinical research ethics represents an underexplored context for the promotion of cost-effectiveness. In particular, although scholars have recently argued that research on less-expensive, less-effective interventions can be ethical, there has been little or no discussion of whether ethical considerations justify curtailing research on more expensive, more effective interventions. Yet considering cost-effectiveness at the research stage can help ensure that scarce resources (...) such as tissue samples or limited subject popula- tions are employed where they do the most good; can support parallel efforts by providers and insurers to promote cost-effectiveness; and can ensure that research has social value and benefits subjects. I discuss and rebut potential objections to the consideration of cost-effectiveness in research, including the difficulty of predicting effectiveness and cost at the research stage, concerns about limitations in cost-effectiveness analysis, and worries about overly limiting researchers’ freedom. I then consider the advantages and disadvantages of having certain participants in the research enterprise, including IRBs, advisory committees, sponsors, investigators, and subjects, consider cost-effectiveness. The project concludes by qualifiedly endorsing the consideration of cost-effectiveness at the research stage. While incorporating cost-effectiveness considerations into the ethical evaluation of human subjects research will not on its own ensure that the health care system realizes cost-effectiveness goals, doing so nonetheless represents an important part of a broader effort to control rising medical costs. (shrink)

This paper shows that implicit assumptions about the numeraire good in the Kaldor-Hicks efficiency-equity analysis involve a "same-yardstick" fallacy (a fallacy pointed out by Paul Samuelson in another context). These results have negative implications for cost-benefit analysis, the wealth-maximization approach to law and economics, and other parts of applied welfare economics--as well as for the whole vision of economics based on the "production and distribution of social wealth.".

When probability discounting (or probability weighting), one multiplies the value of an outcome by one's subjective probability that the outcome will obtain in decision-making. The broader import of defending probability discounting is to help justify cost-benefit analyses in contexts such as climate change. This chapter defends probability discounting under risk both negatively, from arguments by Simon Caney (2008, 2009), and with a new positive argument. First, in responding to Caney, I argue that small costs and benefits need to (...) be evaluated, and that viewing practices at the social level is too coarse-grained. Second, I argue for probability discounting using a distinction between causal responsibility and moral responsibility. Moral responsibility can be cashed out in terms of blameworthiness and praiseworthiness, while causal responsibility obtains in full for any effect which is part of a causal chain linked to one's act. With this distinction in hand, unlike causal responsibility, moral responsibility can be seen as coming in degrees. My argument is, given that we can limit our deliberation and consideration to that which we are morally responsible for and that our moral responsibility for outcomes is limited by our subjective probabilities, our subjective probabilities can ground probability discounting. (shrink)

In this book some options concerning the greenhouse effect are assessed from a welfarist point of view: business as usual, stabilization of greenhouse gas emissions and reduction by 25% and by 60%. Up to today only economic analyses of such options are available, which monetize welfare losses. Because this is found to be wanting from a moral point of view, the present study welfarizes (among others) monetary losses on the basis of a hedonistic utilitarianism and other, justice incorporating, welfare ethics. (...) For these welfarist evaluations information about the social consequences of the four options are collected from the literature and eventually corrected; then the consequences for individual well-being are assessed based on psychological research about well-being dependent on the social situation of the individual; finally the aggregation formulas of the respective welfare ethics are applied to these data. Assessments by other types of ethics, e.g. Kantian ethic, are included. The strongest abatement option is found to be optimum with great unanimity. - In addition a cost-welfare analysis of greenhouse gas abatement is undertaken revealing efficient cost-welfare ratios for these measures and the most efficient ratio for the strongest option. - A final, more theoretical part discusses the moral obligations following from such evaluations. The notion of 'moral obligation' is explained in a way that, apart from moral goodness of the required act, reinforcement by formal or informal sanctions is another necessary condition for moral obligations. This leads to a conception of a historical morality according to which the demands of morality rise in the long run. Applying this conception to the greenhouse effect implies that presently we have the moral duty to raise the standards of greenhouse gas abatement as much as is politically feasible. (shrink)

In debates over the regulation of communication related to dual-use research, the risks that such communication creates must be weighed against against the value of scientific autonomy. The censorship of such communication seems justifiable in certain cases, given the potentially catastrophic applications of some dual-use research. This conclusion however, gives rise to another kind of danger: that regulators will use overly simplistic cost-benefit analysis to rationalize excessive regulation of scientific research. In response to this, we show how (...) institutional design principles and normative frameworks from free speech theory can be used to help extend the argument for regulating dangerous dual-use research beyond overly simplistic cost-benefit reasoning, but without reverting to an implausibly absolutist view of scientific autonomy. (shrink)

This chapter introduces several distinctions relevant to what is called the “discounting problem”, since the issue is how (future) costs and benefits are discounted to make them comparable in present terms. The author defends the claim that there are good reasons to adopt Ramsey-style discounting in the context of climate change: the Ramsey rule is robust, flexible, and well-understood. An important distinction involved in discounting—“descriptivism” and “prescriptivism”—is discussed. It is argued that, even if we adopt prescriptivism, and accept that this (...) means there is need for moral experts in parameter assignments, there is a significant issue. The type of moral expertise required for the discounting problem will not involve knowledge of moral theory—thus making moral philosophy unhelpful in terms of making particular parameter assignments, despite these being substantive moral judgments. (shrink)

John and Curran have convincingly shown that Scanlonian contractualism is a valuable resource for evaluating pandemic response policies, and that we should reject cost–benefit analysis in favour of a contractualist framework. However, they fail to consider the part of contractualism that Scanlon constructed precisely to deal with the question of when the state can restrict individuals from making choices that are harmful to themselves and others: the value of choice view. In doing so, they leave it open (...) for opponents of lockdowns to misuse contractualism to justify mistaken policies. This is because the most powerful contractualist objections to locking down are likely to be based on the VoC. When we apply the value of choice view, we see that a lockdown policy’s justifiability depends on the extent to which particular values of choice are found to be threatened by the policy in question, and what safeguards policy-makers have put in place to increase the value of choice and protect people from the harmful consequences of lockdown. Without the VoC, it is harder to explain why lockdowns, to be non-rejectable, must have certain features. With the VoC, the case for contractualism over cost benefit analysis can be made even stronger. (shrink)

Cheating is a major problem in society, especially in the educational system. From the viewpoint of subjective cost-benefit analysis, concerns about reputation damage as well as considerations of cultural values against unethical behavior can help increase the perceived costs of cheating. To explore deeper into the psychological processes in such assessments, we employ Bayesian Mindsponge Framework (BMF) analytics – an information-processingbased method. Conducting Bayesian analysis on 493 university students from Germany, Vietnam, China, Taiwan, and Japan, we (...) found that reputation concern is negatively associated with cheating behavior. If a student embraces Confucian values, the above negating effect is stronger. Our findings support the notion that mentally simulated negative consequences of cheating reduce the probability of carrying out such behavior. As the educational system is changing rapidly due to technological advancement, a better understanding of the influences of sociocultural factors can be helpful in cheating prevention efforts. (shrink)

What is coercion and why do we care? Coercion is widespread and used especially when raising children, but on its darker side coercion can have devastating consequences. We are worried about coercion as it can invalidate consent. This is seen in the USA where campus rape cases have soared in recent years and brought consent and coercion back to the forefront of debate. Coercion is a hotly debated legal, political and ethical concept. However, in all this debate we have seen (...) little in the way of what coercion means exactly and how we determine it is taking place. Wertheimer and Garnett have interesting views about how coercion can be understood, from the morally wrong side of coercion to the situations where people are left much worse off because of its use. Only the morally wrong situations are subject to the law but there is a whole set of coercive situations that could take place which look bad to the outsider but are not necessarily morally wrong. This is the area of coercion I wish to discuss further. Wertheimer states that there are two types of coercion, moralised and non moralised. Moralised coercion concerns whether it was ‘wrongful’ to propose the offer and the non-moralised notion examines whether the coerced had any other reasonable choice. In a similar vein to Wertheimer, Garnett believes that coercion has two roles, Deontic (wrong) and Eudaimonic (bad). This would vaguely map to Deontic as Moralised and Eudaimonic as Non Moralised. Garnett discusses the eudaimonic version at length believing it is relatively unexplored in situations of coercion. This paper consists of 4 sections: • Section 1 discusses what Coercion is • Section 2 reviews Wertheimer’s view of Moralised and Non Moralised Consent • Section 3 discusses Garnett’s View • Section 4 considers a cost-benefit analysis of eudaimonically wrong situations. In conclusion it is apparent that, in order to have a full picture of what kind of situations coercion actually covers we must not simply rely on the deontic concept. The Deontic way of looking at situations will tell us what is morally wrongful and possibly redressable in court but many situations simply sit badly with us. It is here, in this arena, that the eudaimonic concept comes into its own. (shrink)

Martin Peterson’s The Ethics of Technology: A Geometric Analysis of Five Moral Principles offers a welcome contribution to the ethics of technology, understood by Peterson as a branch of applied ethics that attempts ‘to identify the morally right courses of action when we develop, use, or modify technological artifacts’ (3). He argues that problems within this field are best treated by the use of five domain-specific principles: the Cost-Benefit Principle, the Precautionary Principle, the Sustainability Principle, the Autonomy (...) Principle, and the Fairness Principle. These principles are, in turn, to be understood and applied with reference to the geometric method. This method is perhaps the most interesting and novel part of Peterson’s book, and I’ll devote the bulk of my review to it. (shrink)

A challenge faced by defenders of the precautionary principle is to clarify when the evidence that a harmful event might occur suffices to regard this prospect as a real possibility. Plausible versions of the principle must articulate some epistemic threshold, or de minimis requirement, which specifies when precautionary measures are justified. Critics have argued that formulating such a threshold is problematic in the context of the precautionary principle. First, this is because the precautionary principle appears to be ambiguous about the (...) distinction between risk and uncertainty: should the principle merely be invoked when evidential probabilities are absent, or also when probabilities have low epistemic credentials? Secondly, defenders of the precautionary principle face an aggregation puzzle: in judging whether or not the de minimis requirement has been met, how should first-order evidential probabilities and their second-order epistemic standing be aggregated? This article argues that the ambiguity can be resolved, and the epistemological puzzle can be solved. Focusing on decisions in the context of climate uncertainty, I advance a version of the precautionary principle that serves as a plausible decision rule, to be adopted in situations where its main alternative—cost–benefit analysis—does not deliver. (shrink)

Kornblith’s “Epistemic Normativity” is a classic in the now voluminous literature on the source of epistemic normativity. His account is as simple as it is bold: the source is desire, not a desire for true belief, or knowledge, but any set of desires. No matter what desires you have, so long as you are a being of a kind that employs beliefs in cost-benefit analysis, certain sorts of truth-centered epistemic norms will have normative force for you. We (...) can distinguish two questions about epistemic normativity, both under discussion in Kornblith’s paper, but which he does not clearly distinguish: (i) why should we care about having beliefs that satisfy epistemic norms? (ii) how do epistemic considerations have reason-giving force with respect to particular propositions? I will argue that Kornblith’s proposal goes some distance toward answering the first question but is less helpful in answering the second. (shrink)

Economists can value things for cost-benefit analysis using either a structured or an unstructured approach. The first imposes some theoretical structure on the valuation; the second does not. This paper explains the difference between the approaches and examines the relative merits of each. Cost-benefit analysis may be aimed at finding what would be the best action, or alternatively at finding which action should be done in a democracy. The paper explains the difference, and argues (...) that the appropriate aim is the first. Given that, it comes down in favour of the structured approach to valuation. As an example, it discusses different approaches to valuing life in economics. (shrink)

Usually a relational approach, such as one appealing to care or love, is contrasted with an account of justice. In this chapter, however, I argue that distributive justice is well conceived as itself a matter of honouring people in virtue of their capacity to love and to be loved. After spelling out a familiar conception of love, I explain how treating people with respect in light of this capacity provides a plausible basis for human rights, one that rivals influential individualist (...) foundations such as Kantian respect for autonomy and Catholic honor of human life. I also articulate an egalitarian conception of how to allocate wealth that I argue is also a function of treating people's ability to love as special and that can compete against views salient in Anglo-American political philosophy such as cost-benefit analysis and John Rawls’ difference principle. (shrink)

A book review of Elizabeth Anderson, Value in Ethics and Economics (Cambridge, Mass.: Harvard University Press, 1993). I will pass over her compelling critiques of cost-benefit analysis, rational desire theory, and "consequentialist" moral theories, among many topics she dispatches successfully, with fierce intelligence and wit. Instead I want to focus on the central justificatory strategy that underpins her defense of her pluralist, nonconsequentialist, rational attitude theory of value. Anderson states at the outset that she is not that (...) interested in such metaethical questions as whether value judgments express beliefs or emotions or other attitudes (p. xiii). But I think her own answers to these questions might have implications for normative and pragmatic issues of concern to her. So I want to try tinkering with the metaethical arguments in ways that might streamline her treatment of the normative and pragmatic ones somewhat. (shrink)

I compare two different arguments for the importance of bringing new voices into science: arguments for increasing the representation of women, and arguments for the inclusion of the public, or for “citizen science”. I suggest that in each case, diversifying science can improve the quality of scientific results in three distinct ways: epistemically, ethically, and politically. In the first two respects, the mechanisms are essentially the same. In the third respect, the mechanisms are importantly different. Though this might appear to (...) suggest a broad similarity between the cases, I show that the analysis reveals an important respect in which efforts to include the public are more complex. With citizen science programs, unlike with efforts to bring more women into science, the three types of improvement are often in conflict with one another: improvements along one dimension may come at a cost on another dimension, suggesting difficult trade-offs may need to be made. (shrink)

With an increased emphasis on upstream activity and Defence Engagement, it has become increasingly more important for the UK Ministry of Defence (MOD) and government to understand the relationship between conflict and regional instability. As part of this process, the Historical and Operational Data Analysis Team (HODA) in Defence Science and Technology Laboratory (Dstl) was tasked to look at factors that influenced the regional spread of internal conflicts to help aid the decision making of government. Conflict contagion is the (...) process by which a conflict in one state (State A) influences the outbreak of conflict in another state (State B). The aim of looking at these factors was to produce a tool to assist in the cost/benefit analysis of intervening in future conflicts. The task was carried out by quantitatively studying a selection of contagion and non-contagion case studies over a set of 14 numerical variables that covered structural, political, socioeconomic and cultural factors of both States A and B. All case studies took place after the end of the Cold War. The dataset used contained both binary and continuous data. A range of statistical techniques were used including correlation, regression and principal component analyses along with graphical analytical methods. Unfortunately creating a tool to predict contagion has proven difficult and so the scope of the study was changed-as no statistically relevant link was found. However, it was shown that some links do exists between the variables and the existence of contagion, and it also appears it is a combination of variables which has an effect on the likelihood of contagion. Conflict contagion is a rare event and was only recorded in less than 1% of cases present in the dataset. Of the variables analysed, the most significant factor was the number of refugees present in State B who originated in State A for the year before the case study. It is recommended that further work be conducted. It is possible that a more detailed investigation, using a broader range of techniques and/or a wider selection of variables might be successful in assessing the likelihood of conflict contagion. (shrink)

Ambitious value learning proposals to solve the AI alignment problem and avoid catastrophic outcomes from a possible future misaligned artificial superintelligence (such as Coherent Extrapolated Volition [CEV]) have focused on ensuring that an artificial superintelligence (ASI) would try to do what humans would want it to do. However, present and future sentient non-humans, such as non-human animals and possible future digital minds could also be affected by the ASI’s behaviour in morally relevant ways. This paper puts forward Sentientist Coherent Extrapolated (...) Volition, an alternative to CEV, that directly takes into account the interests of all sentient beings. This ambitious value learning proposal would significantly reduce the likelihood of risks of astronomical suffering from the ASI’s behaviour, and thus we have very strong pro-tanto moral reasons in favour of implementing it instead of CEV. This fact is crucial in conducting an adequate cost-benefit analysis between different ambitious value learning proposals. (shrink)

Even where willingness-to-pay as a measure of welfare impact is adjusted for diminishing marginal utility, welfare economics is shown to favour policies that add to the life expectancy or that enhance the quality of life of persons who are already better-off. I propose an alternative, Equal Respect methodology, under an axiomatic claim that at the point of decision the prospective life years of all individuals are of equal intrinsic social value. This justifies equal valuation of risk mitigation across all persons; (...) similarly, all appraised impacts should be scaled to accord equal respect to difficult but no-less-valuable lives. (shrink)

In carrying out cost-benefit or cost-effective analysis, a discount rate should be applied to some kinds of future benefits and costs. It is controversial, though, whether future health is in this class. I argue that one of the standard arguments for discounting (from diminishing marginal returns) is inapplicable to the case of health, while another (favouring a pure rate of time preference) is unsound in any case. However, there are two other reasons that might support a (...) positive discount rate for future health: one relating to uncertainty, and the other relating to the instrumental benefits of improved health. While the latter considerations could be modelled via a discount rate, they could alternatively be modelled more explicitly, in other ways; I briefly discuss which modelling method is preferable. Finally, I argue against the common claims that failing to discount future health would lead to paradox, and/or to inconsistency with the way future cash flows are treated. (shrink)

The rule of rescue holds that special weight should be given to protecting the lives of assignable individuals in need, implying that less weight is given to considerations of cost-effectiveness. This is sometimes invoked as an argument for funding or reimbursing life-saving treatment in public healthcare even if the costs of such treatment are extreme. At first sight one might assume that an individualist approach to ethics—such as Scanlon’s contractualism—would offer a promising route to justification of the rule of (...) rescue. In this chapter I argue that contractualism cannot endorse the rule of rescue, whereas a collectivist approach that appeals to group solidarity would offer support for rescue cases. The argument, however, has its limitations, and though solidarity is of central concern in shaping public healthcare, there are good reasons for not endorsing the rule of rescue as a moral basis for allocating scarce resources in clinical care. (shrink)

With Being Me Being You, Samuel Fleischacker provides a reconstruction and defense of Adam Smith’s account of empathy, and the role it plays in building moral consensus, motivating moral behavior, and correcting our biases, prejudices, and tendency to demonize one another. He sees this book as an intervention in recent debates about the role that empathy plays in our morality. For some, such as Paul Bloom, Joshua Greene, Jesse Prinz, and others, empathy, or our capacity for fellow-feeling, tends to misguide (...) us in the best of cases, and more often reinforces faction and tribalism in morals and politics. These utilitarians, as Fleischacker refers to them, propose that empathy take a back seat to cost-benefit analysis in moral decision-making. As an intervention, the book is largely successful. Fleischacker’s defense of empathy is nuanced and escapes the myopic enthusiasm to which many partisans of empathy are prone. Anyone looking to understand the relationship between empathy and morality would do well to grapple with Being Me Being You. Still, Fleischacker overlooks that Smith would most likely be less convinced of the idea that greater empathy can help us overcome the great challenges of our time. (shrink)

Proponents of the public goods argument ('PGA') seek to ground the authority of the state on its putative indispensability as a means of providing public goods. But many of the things we take to be public goods – including many of the goods commonly invoked in support of the PGA – are actually what we might term publicized goods. A publicized good is any whose ‘public’ character results only from a policy decision to make some good freely and universally available. (...) This fact poses complications for the PGA, insofar as the set of possible publicized goods is quite extensive indeed. (shrink)

This paper defends the claim that mere temporal proximity always and without exception strengthens certain moral duties, including the duty to save – call this view Robust Temporalism. Although almost all other moral philosophers dismiss Robust Temporalism out of hand, I argue that it is prima facie intuitively plausible, and that it is analogous to a view about special obligations that many philosophers already accept. I also defend Robust Temporalism against several common objections, and I highlight its relevance to a (...) number of practical policy debates, including longtermism. My conclusion is that Robust Temporalism is a moral live option, that deserves to be taken much more seriously in the future. (shrink)

Davis called for “extreme caution” in the use of non-invasive brain stimulation to treat neurological disorders in children, due to gaps in scientific knowledge. We are sympathetic to his position. However, we must also address the ethical implications of applying this technology to minors. Compensatory trade-offs associated with NIBS present a challenge to its use in children, insofar as these trade-offs have the effect of limiting the child’s future options. The distinction between treatment and enhancement has some normative force here. (...) As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests diminish, and the need to protect the child’s autonomy looms larger. NIBS for enhancement involving trade-offs should therefore be delayed, if possible, until the child reaches a state of maturity and can make an informed, personal decision. NIBS for treatment, by contrast, is permissible insofar as it can be shown to be at least as safe and effective as currently approved treatments, which are themselves justified on a best interests standard. (shrink)

Cheating is widely considered a condemnable behavior in society and a big problem in the educational system. In this study, we employ the information-processing-based Bayesian Mindsponge Framework to explore deeper the subjective cost-benefit evaluation involving the perceived value of cheating. Conducting Bayesian analysis on 493 university students from Germany, Vietnam, China, Taiwan, and Japan, we found that students who have more positive attitudes toward cheating are more likely to cheat. However, a higher capability of cognitive reflection acts (...) as a moderator that negates the above effect. Re-evaluation of prior thoughts allows for more accurate assessments of the associated risks and possible costs, which help reduce the probability of carrying out cheating behavior. As rapid technological advancement may introduce new and efficient cheating methods, a better understanding of the psychology of cheating in students can help schools prepare better countermeasures. (shrink)

Control measures, such as “lockdowns”, have been widely used to suppress the COVID-19 pandemic. Under some conditions, they prevent illness and save lives. But they also exact an economic toll. How should we balance the impact of such policies on individual lives and livelihoods (and other dimensions of concern) to determine which is best? A widely used method of policy evaluation, benefit–cost analysis (BCA), answers these questions by converting all the effects of a policy into monetary equivalents (...) and then summing them up. A different method, social welfare analysis, proceeds by determining the effects of a policy on individual wellbeing and then applying an aggregation formula to them to evaluate the overall effects of a policy. In this chapter, we survey these methods and argue that social welfare analysis has important advantages. One crucial advantage is that it enables ethical considerations relating to the impact of policies on individual wellbeing and its distribution to be incorporated into policy assessments in a transparent way. We illustrate this with a simple numerical model for evaluating pandemic policies that vary in terms of the stringency of the controls that they impose on individual behaviour, showing how the evaluation depends on the ethical significance accorded to their impact on the wellbeing of different age and income groups. (shrink)

I frame my argument by way of Hayek's tendency to treat Hume and Smith as central articulations of the rule of law. The rest of the paper explores their defense of clientelism. First, I introduce Hume’s ideas on the utility of patronage in his essay, “Of the Independency of Parliament.” I argue that in Hume clientelism just is a feature of parliamentary business. It seems ineliminable. I then contextualize Hume’s account by comparing it to Montesquieu’s account of this system of (...) patronage in Book XIX, chapter 27 of The Spirit of the Laws. Montesquieu primarily treats it as a species of bad corruption. However, he also sees some benefits to it. I then turn to Smith and I show that he echoes Hume’s analysis of corruption in an easily ignored passage in Wealth of Nations. I then show that for Smith one argument in favor of a kind of federal parliamentary union between Great Brittain and her American colonies lies in its ability to facilitate and make more efficient the system of patronage by the Crown. While Smith’s account of these matters is quite Humean, one can discern in Smith a distinct cost-benefit argument for the acceptance of the necessity of a system of patronage in the service of the peaceful expansion and entrenchment of the rule of law in his proposal for parliamentary union. (shrink)

Par risques majeurs, on entend ceux qui s’attachent à des événements dont les conséquences défavorables, pour l’humanité ou pour l’environnement, sont d’une gravité exceptionnelle. On n’ajoutera ni que ces événements sont d’une intensité physique extrême, ni qu’ils surviennent rarement, car ce n’est pas toujours le cas. Seuls des risques majeurs de nature civile seront considérés dans cet ouvrage, et il s'agira, plus limitativement, de risques naturels, comme ceux d’inondation et de submersion marine, illustrés par la tempête Xynthia en 2010, de (...) risques technologiques industriels, comme celui d’une explosion d'usine, illustré par la catastrophe AZF en 2001, et de risques nucléaires, pour autant qu’ils mettent en jeu les dangers de la radioactivité, et qu’illustrent, hors de France, les catastrophes de Three Miles Island (1979), Tchernobyl (1986) et Fukushima (2011), -/- Conçu comme un rapport destiné au Conseil d'analyse économique (CAE) du Premier Ministre français, l'ouvrage comporte une introduction traitant du risque majeur pris en général (section 1). Dans sa partie principale, il aborde les trois risques majeurs qu'il a sélectionnés à travers les prismes successifs de la géographie et de la technologie (section 2), de l’histoire institutionnelle et juridique (section 3), enfin d’un bilan normatif accompagné de recommandations pour l'action publique (section 4). -/- Neuf compléments spécialisés, dus à d'autres auteurs, complètent l'ouvrage. Ils portent sur des aspects technologiques (F. Ménage; A. Quantin et D. Moucoulon; P. Saint-Raymond), juridiques (V. Sanseverino-Godfrin), économiques généraux (C. Grislain-Letrémy et B. Villeneuve; R. Lahidji; J. Percebois; A. Schmitt et S. Spaeter) et financiers (M. Pappalardo) et ils concernent principalement le risque nucléaire. -/- Dans cet ensemble de vaste format, on espère avoir su proposer, non seulement des évaluations et des préconisations destinées aux pouvoirs publics, comme il convenait au projet initial de rapport, mais aussi une synthèse qui soit utilisable par tous ceux - décideurs, scientifiques ou simples observateurs - que préoccupent les questions de risques majeurs. (shrink)

This chapter examines whether high prices for gene therapies are justified and whether the problems associated with high prices can be solved by the "pay for performance" (P4P) reimbursement model. To this end, we first describe how prices for new drugs, including gene therapies, are set in Germany (section 2.). P4P is then presented as an example of a reimbursement model (section 3.). The subsequent ethical analysis (section 4.) first examines whether P4P models can sustainably guarantee the right to (...) health and healthcare for all people (section 4.1; cf. on the "sustainable right to health" already Alex, 2021). It is then shown that cost-benefit analyses for setting prices for new gene therapies must be viewed critically from an ethical perspective and pose a problem for equity of access and thus also for the sustainable guarantee of a right to health (section 4.2). The final question is whether P4P is compatible with the idea of human dignity (Article 1 I 1 of the German Basic Law) (section 4.3; cf. already König et al., 2020). -/- Alex, K. (2021): Ethical conceptualization of a sustainable right to health(care). In: Schildmann, J. et al. (eds.): Defining the value of medical interventions. Normative and empirical challenges. Kohlhammer, Stuttgart: 29-48. PMID: 36256802 König, J. et al. (2020): Am individuellen Therapieergebnis orientierte Erstattungsverfahren in der Onkologie: ethische Implikationen am Beispiel der CAR-T-Zelltherapie. In: Ethik Med 32: 85–92. doi: 10.1007/s00481-020-00565-3. (shrink)

David Tomasi presents new, groundbreaking research on the science and application of Mind-Body Medicine strategies to improve clinical outcomes in inpatient psychiatry settings. Much more than a list of therapeutic recommendations, this book is a thorough description of how Mind-Body Medicine can be successfully applied, from a therapeutic as well as from an organizational, cost-effective analysis viewpoint, to the full spectrum of psychiatric treatments. Furthermore, this study examines the role of multidisciplinary and interdisciplinary treatment teams, with a special (...) focus on the profession and the role of psychotherapists and group therapists, thereby providing solid scientific evidence of the benefits of patient-provider therapeutic alliances. In this sense, this book serves as a guide for professionals and institutions both in the private and the public sphere, to learn effective treatment and management strategies. About the Author Psychotherapist, Researcher, and Philosopher Dr. David Låg Tomasi is the author of Medical Philosophy (ibidem, 2016) and the co-author of Positive Patient Response to a Structured Exercise Program Delivered in Inpatient Psychiatry (Global Advances in Health and Medicine, 2019), the most-read research item from the University of Vermont (Researchgate, 2019). A member of several national and international Academies of Sciences, Dr. Tomasi works in the Inpatient Psychiatry Unit at the UVM Medical Center, and teaches at the University of Vermont and the Community College of Vermont. ---- Ibidem / Columbia University Press. (shrink)

The literature on pluralism in economics has focused on the benefits expected from the plurality of theories, methods, and frameworks. This overlooks half of the picture: the costs. Neither have the multifarious costs been systematically analyzed in philosophy of science. We begin rectifying this neglect. We discuss how the benefits of plurality and diversity in science presuppose distinct types of plurality and how various benefit and plurality types are associated with different types of costs. Finally, we ponder how the (...) general mechanisms that give rise to the costs of plurality and diversity are aggravated by various disciplinary characteristics of economics. (shrink)

The aim of this commentary is to discuss the axiology of the cost–benefit approach assumed by Travis Rieder (2017) to analyze medical decision making in the case of extremely preterm infants.

Driven by technological innovations, newborn screening (NBS) panels have been expanded and the development of genomic NBS pilot programs is rapidly progressing. Decisions on disease selection for NBS are still based on the Wilson and Jungner (WJ) criteria published in 1968. Despite this uniform reference, interpretation of the WJ criteria and actual disease selection for NBS programs are highly variable. A systematic literature search [PubMED search “Wilson” AND “Jungner”; last search 16.07.22] was performed to evaluate the applicability of the WJ (...) criteria for current and future NBS programs and the need for adaptation. By at least two reviewers, 105 publications (systematic literature search, N = 77; manual search, N = 28) were screened for relevant content and, finally, 38 publications were evaluated. Limited by the study design of qualitative text analysis, no statistical evaluation was performed, but a structured collection of reported aspects of criticism and proposed improvements was instead collated. This revealed a set of general limitations of the WJ criteria, such as imprecise terminology, lack of measurability and objectivity, missing pediatric focus, and absent guidance on program management. Furthermore, it unraveled specific aspects of criticism on clinical, diagnostic, therapeutic, and economical aspects. A major obstacle was found to be the incompletely understood natural history and phenotypic diversity of rare diseases prior to NBS implementation, resulting in uncertainty about case definition, risk stratification, and indications for treatment. This gap could be closed through the systematic collection and evaluation of real-world evidence on the quality, safety, and (cost-)effectiveness of NBS, as well as the long-term benefits experienced by screened individuals. An integrated NBS public health program that is designed to continuously learn would fulfil these requirements, and a multi-dimensional framework for future NBS programs integrating medical, ethical, legal, and societal perspectives is overdue. (shrink)

Delusions are defined as irrational beliefs that compromise good functioning. However, in the empirical literature, delusions have been found to have some psychological benefits. One proposal is that some delusions defuse negative emotions and protect one from low self-esteem by allowing motivational influences on belief formation. In this paper I focus on delusions that have been construed as playing a defensive function (motivated delusions) and argue that some of their psychological benefits can convert into epistemic ones. Notwithstanding their epistemic costs, (...) motivated delusions also have potential epistemic benefits for agents who have faced adversities, undergone physical or psychological trauma, or are subject to negative emotions and low self-esteem. To account for the epistemic status of motivated delusions, costly and beneficial at the same time, I introduce the notion of epistemic innocence. A delusion is epistemically innocent when adopting it delivers a significant epistemic benefit, and the benefit could not be attained if the delusion were not adopted. The analysis leads to a novel account of the status of delusions by inviting a reflection on the relationship between psychological and epistemic benefits. (shrink)