Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...) Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. (shrink)

In the introductory “Intellectual Autobiography” of the Georg Henrik von Wright volume of the Library of Living Philosophers series, von Wright mentions the discrepancy he always felt between his narrow logical-analytical professional work and a drive to make philosophy relevant to his life, calling it a rift in his philosophical personality. This article examines the nature of the rift and the various stages the problem went through during von Wright’s career. It is argued that the initial impression that his books (...) The Varieties of Goodness and Explanation and Understanding had contributed to healing the rift, was subdued by a gradual shift in existential focus from individualistic ethics towards a critical concern for destructive ways of thinking inherent in the Western culture, connected with von Wright’s “political awakening” at the end of the 1960s. The most urgent questions of our times called for novel, non-analytical, ways of doing philosophy, employed in von Wright’s later works on science and reason, and the myth of progress. Eventually von Wright’s earlier methodological concerns were also alleviated by his belief that logical-analytical philosophy was inherently unsuitable for exposing the cultural structures it was very much a part of. (shrink)

Rawls’ realistic utopia has been subject to much criticism. The Realist claims Rawls’ realistic utopia to be too utopian. The Cosmopolitan, on the other hand, claims Rawls’ realistic utopia to be insufficiently utopian. In this essay, I argue that the criticism can be circumvented by means of clarifying an ambiguity in the concept of utopia. I argue that the Realist is not criticizing Rawls for being utopian, but unrealistic, impractical and idealistic (quixotic). The Cosmopolitan might be right in criticizing Rawls (...) for not being utopian enough. The orthodox understanding of utopia, adopted by the Cosmopolitan is, however, in itself quixotic. Drawing on Le Guin’s The Dispossessed, I propose a novel understanding of how utopia ought to be understood. Once the Rawlsian adopts this conception of utopia, it alleviates the objections raised by the Realist and the Cosmopolitan. (shrink)

In this thesis, I argue for a realistic account of what conceptual engineering can hope to achieve when engineering concepts. I criticize conceptual engineers for not taking the implementation challenge, and problems with the feasibility of their proposals, into account when proposing to change concepts, threatening to trivialize conceptual engineering. In addition, conceptual engineers have had a tendency to expect too much from concepts, and suggest extensive changes to the meaning to all uses of a concept. As a solution, I (...) suggest Fabianism, which is to have apparent goals, and realistic tactics to achieve those goals. Specifically, I suggest three remedies, which is to (a) view concepts as embedded in frameworks, and (b) make less extensive changes to the meaning of (c) only some (or one) uses of concepts. Essentially, I argue that we should engineer conceptual frameworks, and not individual concepts. In the second part of the thesis, I explore an implication of Fabianism on the way that conceptual engineers assess concepts, concluding that we should assess concepts by the functions they perform in a conceptual framework, which has not been the predominant view of concept assessment in conceptual engineering. (shrink)