An axiom of medical research ethics is that a protocol is moral only if it has a “favorable risk-benefit ratio”. This axiom is usually interpreted in the following way: a medical research protocol is moral only if it has a positive expected value -- that is, if it is likely to do more good (to both subjects and society) than harm. I argue that, thus interpreted, the axiom has two problems. First, it is unusable, because it requires us to know (...) more about the potential outcomes of research than we ever could. Second, it is false, because it conflicts with the so-called “soft paternalist” principles of liberal democracy. In place of this flawed rule I propose a new way of making risk-benefit assessments, one that does comport with the principles of liberalism. I argue that a protocol is moral only if it would be entered into by competent subjects who are informed about the protocol. The new rule this eschews all pseudo-utilitarian calculation about the protocol’s likely harms and benefits. (shrink)

According to the moral standards most of us accept and live by, morality generally permits us to refrain from promoting the good of others and instead engage in non-harmful projects of our own choice. This aspect of so-called ‘ordinary morality’ has turned out to be very difficult to justify. Recently, though, various authors, including Bernard Williams and Samuel Scheffler, have proposed “Integrity Theories” that would vindicate this aspect of ordinary morality, at least in part. They are generated by treating as (...) a default some moral theory, like consequentialism, that demands that we do a great deal of good. The theory is then modified so as to make room for individuals to pursue the projects they value most deeply, and perhaps their trivial interests as well—i.e., so as to respect individual integrity. This paper presupposes that Integrity Theories are correct and that, for the reasons given by others, they can explain why morality should grant us agent-centered prerogatives to pursue our own projects and interests. The goal is to extend this work in two respects. First, it will be shown that previous authors have not paid sufficient attention to ordinary morality’s conflicting pronouncements about agent-centered prerogatives. Second, it is argued that Integrity Theories can vindicate those conflicting intuitions by positing a special kind of obligations, relievable obligations. (shrink)

For a long time many philosophers felt the incoherence objection was a decisive objection to rule-consequentialism, but that position has recently become less secure, because Brad Hooker has offered a clever new way for rule-consequentialists to avoid the incoherence objection. Hooker’s response defeats traditional forms of the incoherence objection, but this paper argues that another version of the problem remains. Several possible solutions fail. One other does not, but it introduces other problems into the theory. I conclude that the new (...) incoherence objection still poses a major challenge to rule-consequentialism, though not for the reasons usually assumed. It does not constitute a fatal objection to rule-consequentialism but instead highlights a theoretical drawback in the theory which must be taken into account during a more holistic evaluation of rule-consequentialism and its rivals. (shrink)

This paper examines the conservative point of view about distributive justice. The first section explains the methodology used to develop this point of view. The second section describes one conservative point of view and briefly provides empirical evidence that it reflects the viewpoint of many ordinary conservatives. The third section explains how this conservative view can ground objections to social safety net programs, using as examples the recent health reform legislation and more extensive proposals for a true national health system. (...) The fourth section sketches ways that non-conservative philosophers might try to refute those objections. Examining a conservative point of view leads to several important conclusions. One is that the conservative point of view is not properly represented in contemporary philosophical discussions. Another is that the conservative point of view cannot be refuted by appealing to existing egalitarian writings. A third is that if progressive philosophers such as myself want to address the conservative point of view, we must expand the range of issues that we discuss in contemporary political philosophy. Doing so is a vital task, because otherwise we ignore the political views held by as much as half the American population. (shrink)

Consequentialism is enticing, and yet it also seems overly demanding. As a result, many non-consequentialists try to explain why we aren’t required to maximize the good. One explanation is the Integrity Explanation: we aren’t required to maximize the good because morality must make room for us to pursue the projects we value most deeply. Some people hope that the Integrity Explanation will not just explain why consequentialism is false, but simultaneously vindicate the common-sense permission to generally refrain from promoting the (...) good of other people and instead spend our time on non-harmful actions of our choice. I argue that this hope is unrealistic, because if any version of the Integrity Explanation is correct, morality won’t contain broad permissions to refrain from promoting the good of others and do as we choose. Instead the basic structure of morality must be fundamentally different from what we usually take it to be. Our common-sense moral theories say that we take on responsibilities to others only in certain specific situations, but may otherwise engage in non-harmful actions of our choice. But if the Integrity Explanation is correct, then we are entitled to pursue our own interests to at least some extent, but unless we do, we come under obligations to maximize the good of others. (shrink)

I argue that any theory of moral obligation must be able to explain two things: why we cannot be thrust into a moral dilemma through no fault of our own, and why we can get into a moral dilemma through our own negligence. The most intuitive theory of moral obligation cannot do so. However, I offer a theory of moral obligation that satisfies both of these criteria, one that is founded on the principle that if you are required to do (...) something, then you would be blameworthy for failing to do it. I conclude by relating these results to the current literature on moral dilemmas. (shrink)

Many public health dilemmas involve a tension between the promotion of health and the rights of individuals. This article suggests that we should resolve the tension using our familiar liberal principles of government. The article considers the common objections that liberalism is incompatible with standard public health interventions such as anti-smoking measures or intervention in food markets; there are special reasons for hard paternalism in public health; and liberalism is incompatible with proper protection of the community good. The article argues (...) that we should examine these critiques in a larger methodological framework by first acknowledging that the right theory of public health ethics is the one we arrive at in reflective equilibrium. Once we examine the arguments for and against liberalism in that light, we can see the weaknesses in the objections and the strength of the case for liberalism in public health. (shrink)

The standard form of act-consequentialism requires us to perform the action with the best consequences; it allows choice between moral options only on those rare occasions when several actions produce equally good results. This paper argues for moral options and thus against act-consequentialism. The argument turns on the insight that some valuable things cannot exist unless our moral system allows options. One such thing is the opportunity for individuals to enact plans for their life from among alternatives. Because planning one’s (...) life has value, and because it requires moral options, a world governed by a moral system that admits of options is better than one governed by act-consequentialism. The paper argues that these facts entail that morality admits of a significant number of moral options; act-consequentialism is false. (shrink)

In the last forty years there has been a resurgence of interest in moral dilemmas—situations in which through no fault of a person’s own, he or she is morally required to do one thing, required to do another, but cannot do both. Some prominent figures have argued that such things could be. Opponents have marshaled several anti-dilemma arguments in response. For the most part, this debate has centered on issues in metaethics. Those metaethical questions are interesting, and resolving them could (...) (in principle, at least) settle the debate about moral dilemmas. However, this paper will show that this exclusive focus on metaethics has been a mistake. Both dilemma advocates and dilemma opponents have failed to recognize that the debate could also be settled by answering an important question in normative ethics: is it possible for there to be an absolute prohibition on allowing something to happen? If the answer is yes, then dilemmas are possible, and if the answer is no, then they are not. Furthermore, it will be argued that it is our instincts about this normative issue that truly shape our views on the dilemmas debate. After sorting out these issues, the paper argues that as yet there is no good reason to rule out the theory of dilemma advocates, and thus that the widespread rejection of moral dilemmas is not as well-founded as is often assumed. (shrink)

The paper argues that same-sex marriage ought to be legalized. The argument is ecumenical and appeals only to basic principles of liberal government. Specifically, the paper argues that if the government is offering an opportunity to one group, then it may not withhold the opportunity from another on the ground that the people receiving it are immoral or that their receipt of the opportunity would spread immoral messages. The only acceptable ground is that the group’s receipt would cause wrongful harm (...) to third-parties that would outweigh the benefits. Same-sex marriage would not do so, and thus it must to be allowed. As part of this argument, the paper addresses the popular stamp-of-approval and defense-of-marriage arguments against same-sex marriage. (shrink)

At least half of American adults are overweight or obese, and the number may be as high as two-thirds. These facts have spurred anti-obesity campaigns, and those campaigns have provoked difficult questions in public health and population ethics. Should the government merely inform people about the risks of unhealthy food? May it try to change behavior by taxing unhealthy food? May it ban some foods outright? This paper proposes that we should answer these questions using familiar liberal principles. The principles (...) show that several common arguments for obesity interventions are flawed. The principles also highlight several that succeed, and those arguments point toward a new proposal for food labeling and some potential market interventions. (shrink)

In the near future, our society may develop a vast array of medical enhancements. There is a large debate about enhancements, and that debate has identified many possible harms. This paper describes a harm that has so far been overlooked. Because of some particular features of enhancements, we could come to place more value on them than we actually should. This over-valuation would lead us to devote time, energy, and resources to enhancements that could be better spent somewhere else. That (...) mistake might not be trivial. By spending too much time, energy, and resources on enhancements, we could set back our pursuit of our deepest goals such as living happily and leading ethical lives. (shrink)

This paper is about the implications of a common view on global justice. The view can be called the Minimalist View, and it says that we have no positive duties to help the poor in foreign countries, or that if we do, they are very minimal. It might seem as if, by definition, the Minimalist View cannot require that we do very much about global poverty. However, in his book World Poverty and Human Rights, Thomas Pogge pointed out that this (...) conclusion is at least up for debate. Although Minimalism countenances very few positive duties to the global poor, it certainly countenances negative duties not to harm. Perhaps one can argue that these negative duties are somehow being violated, and thus even a Minimalist must make substantial compensation to the global poor. However, in this paper I argue that Pogge’s argument about Minimalism does not succeed. The second half of the paper offers ways to revise and improve the argument in order to make the case for assistance to the global poor. (shrink)

Don Marquis offered the most famous philosophical argument against abortion. His argument contained a novel defence of the idea that foetuses have the same moral status as ordinary adults. The first half of this paper contends that even if Marquis has shown that foetuses have this status, he has not proven that abortion is therefore wrong. Instead his argument falls victim to problems similar to those raised by Judith Thomson, problems that have plagued most anti-abortion arguments since. Once Marquis's anti-abortion (...) argument is shown to fail, this raises the question of whether there is some way to circumvent the problems. The second half of the paper argues that this issue hinges on important questions about responsibility for risky behaviour and the duties of parenthood. Because we have yet to develop appropriate theoretical frameworks for judging such questions, we cannot yet know whether Marquis's anti-abortion argument — and indeed most other anti-abortion arguments — can be completed. (shrink)

New York City has extensive public health regulations. Some regulations aim to reduce smoking, and they include high cigarette taxes and bans on smoking in public places such as bars, restaurants, public beaches, and public parks. Other regulations aim to combat obesity. They include regulations requiring display of calorie information on some restaurant menus and the elimination of transfats in much public cooking. One important issue is whether New York City officials -- including both public health officials and other city (...) officials -- have adequately explained the justification to the public. Explanation has practical importance; the public might not back controversial and restrictive regulations unless offered a good rationale. But explanation is also an official duty, since public officials should make their reasoning transparent to their constituents. This article argues that New York City has not adequately communicated the rationales for its regulations to the public. It then offers several suggestions for improving public communication. After laying out those suggestions, this article points out that even if communication were improved, New York City’s regulations would still raise difficult philosophical issues. Those issues are briefly discussed in the final sections. NOTE: this is a reprint of a conference presentation. (shrink)

President Bush and his Council of Economic Advisors have claimed that the U.S. shouldn’t adopt a national health program because doing so would slow innovation in health care. Some have attacked this argument by challenging its moral claim that innovativeness is a good ground for choosing between health care systems. This reply is misguided. If we want to refute the argument from innovation, we have to undercut the premise that seems least controversial -- the premise that our current system produces (...) more innovation than a national health program would. I argue that this premise is false. The argument requires clarifying the concept ‘national health program’ and examining various theories of human well-being. (shrink)