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Douglas MacKay
University of North Carolina, Chapel Hill
  1. Four Faces of Fair Subject Selection.Katherine Witte Saylor & Douglas MacKay - 2020 - American Journal of Bioethics 20 (2):5-19.
    Although the principle of fair subject selection is a widely recognized requirement of ethical clinical research, it often yields conflicting imperatives, thus raising major ethical dilemmas regarding participant selection. In this paper, we diagnose the source of this problem, arguing that the principle of fair subject selection is best understood as a bundle of four distinct sub-principles, each with normative force and each yielding distinct imperatives: (1) fair inclusion; (2) fair burden sharing; (3) fair opportunity; and (4) fair distribution of (...)
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  2. Standard of Care, Institutional Obligations, and Distributive Justice.Douglas MacKay - 2015 - Bioethics 29 (4):352-359.
    The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional role. I examine (...)
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  3. Government Policy Experiments and the Ethics of Randomization.Douglas MacKay - 2020 - Philosophy and Public Affairs 48 (4):319-352.
    Governments are increasingly using randomized controlled trials (RCTs) to evaluate policy interventions. RCTs are often understood to provide the highest quality evidence regarding the causal efficacy of an intervention. While randomization plays an essential epistemic role in the context of policy RCTs however, it also plays an important distributive role. By randomly assigning participants to either the intervention or control arm of an RCT, people are subject to different policies and so, often, to different types and levels of benefits. In (...)
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  4.  93
    The ethics of public policy RCTs: The principle of policy equipoise.Douglas MacKay - 2017 - Bioethics 32 (1):59-67.
    In this article, I ask whether a principle analogous to the principle of clinical equipoise should govern the design and conduct of RCTs evaluating the effectiveness of policy interventions. I answer this question affirmatively, and introduce and defend the principle of policy equipoise. According to this principle, all arms of a policy RCT must be, at minimum, in a state of equipoise with the best proven policy that is also morally and practically attainable and sustainable. For all arms of a (...)
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  5. Immigrant Selection, Health Requirements, and Disability Discrimination.Douglas MacKay - 2018 - Journal of Ethics and Social Philosophy 14 (1).
    Australia, Canada, and New Zealand currently apply health requirements to prospective immigrants, denying residency to those with health conditions that are likely to impose an “excessive demand” on their publicly funded health and social service programs. In this paper, I investigate the charge that such policies are wrongfully discriminatory against persons with disabilities. I first provide a freedom-based account of the wrongness of discrimination according to which discrimination is wrong when and because it involves disadvantaging people in the exercise of (...)
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  6.  84
    The Duty to Rescue and Investigators' Obligations.Douglas MacKay & Tina Rulli - 2017 - Kennedy Institute of Ethics Journal 27 (1):71-105.
    The duty to rescue is a highly plausible and powerful ethical principle. It requires agents to assist others in extreme need in cases where doing so does not conflict with some weighty moral aim; requires little personal sacrifice; and is likely to significantly benefit the recipients.1 As a general obligation, it binds all persons simply qua persons, and it is owed to all persons simply qua persons. Clinical investigators working in low-income countries frequently encounter sick or destitute people to whom (...)
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  7. Are Skill-Selective Immigration Policies Just?Douglas MacKay - 2016 - Social Theory and Practice 42 (1):123-154.
    Many high-income countries have skill-selective immigration policies, favoring prospective immigrants who are highly skilled. I investigate whether it is permissible for high-income countries to adopt such policies. Adopting what Joseph Carens calls a " realistic approach " to the ethics of immigration, I argue first that it is in principle permissible for high-income countries to take skill as a consideration in favor of selecting one prospective immigrant rather than another. I argue second that high-income countries must ensure that their skill-selective (...)
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  8. Chapter 3 Efficiency and Wellbeing.Douglas MacKay - manuscript
    A principal rationale for public policy is to address market failures. Pareto efficiency is therefore a highly common and relatively non-controversial evaluative criterion for many policy analyses and is discussed at length in policy analysis texts. This makes sense, for Pareto improvements involve making at least one person better off without making anyone worse off. Who could object to that? But does efficiency deserve the prominence it enjoys in public policy? Is one policy option better than another, at least in (...)
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  9. Rawlsian Justice and the Social Determinants of Health.Jayna Fishman & Douglas MacKay - 2018 - Journal of Applied Philosophy 36 (4):608-625.
    In this article, we suggest that the evidence regarding the social determinants of health calls for a deep re‐thinking of our understanding of distributive justice. Focusing on John Rawls's theory of distributive justice in particular, we argue that a full reckoning with the social determinants of health requires a re‐working of Rawls's principles of justice. We argue first that the social bases of health – a Rawlsian conception of the social determinants of health – should be considered a social primary (...)
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  10.  70
    Calculating qalys: Liberalism and the value of health states.Douglas MacKay - 2017 - Economics and Philosophy 33 (2):259-285.
    The value of health states is often understood to depend on their impact on the goodness of people's lives. As such, prominent health states metrics are grounded in particular conceptions of wellbeing – e.g. hedonism or preference satisfaction. In this paper, I consider how liberals committed to the public justification requirement – the requirement that public officials choose laws and policies that are justifiable to their citizens – should evaluate health states. Since the public justification requirement prohibits public officials from (...)
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  11. Designing a Just Soda Tax.Douglas MacKay & Alexandria Huber-Disla - forthcoming - Economics and Philosophy:1-21.
    Soda taxes are controversial. While proponents point to their potential health benefits and the public projects that could be funded with their revenue, critics argue that they are paternalistic and regressive. In this paper, we explore the prospects for designing a just soda tax, one that appropriately balances the often-competing ethical considerations of promoting social welfare, respecting people’s autonomy, and ensuring distributive fairness. We argue that policymakers have several paths forward for designing a just soda tax, but that the considerations (...)
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  12. Chapter 2 Identifying Policy Problems.Douglas MacKay - manuscript
    Policy analyses begin with a systematic overview of the policy problem they address. This includes a comprehensive discussion of the nature and context of the problem, and the institutional and behavioral factors responsible for its emergence. Problem statements must also explain why the status quo is bad or undesirable, why it is something that governments, rather than private actors, should address, and establish that the relevant government institutions have the legitimacy to intervene. In this chapter, I provide an overview of (...)
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  13. Basic Income, Cash Transfers, and Welfare State Paternalism.Douglas MacKay - 2019 - Journal of Political Philosophy 27 (4):422-447.
    Journal of Political Philosophy, EarlyView.
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  14. Public Policy Experiments without Equipoise: When is Randomization Fair?Douglas MacKay & Emma Cohn - 2023 - Ethics and Human Research 45 (1):15-28.
    Government agencies and nonprofit organizations have increasingly turned to randomized controlled trials (RCTs) to evaluate public policy interventions. Random assignment is widely understood to be fair when there is equipoise; however, some scholars and practitioners argue that random assignment is also permissible when an intervention is reasonably expected to be superior to other trial arms. For example, some argue that random assignment to such an intervention is fair when the intervention is scarce, for it is sometimes fair to use a (...)
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  15. Parenting the Parents: The Ethics of Parent-Targeted Paternalism in the Context of Anti-poverty Policies.Douglas MacKay - 2019 - In Nicolás Brando & Gottfried Schweiger (eds.), Philosophy and Child Poverty: Reflections on the Ethics and Politics of Poor Children and Their Families. Springer. pp. 321-340.
    Governments often aim to improve children’s wellbeing by targeting the decision-making of their parents. In this paper, I explore this phenomenon, providing an ethical evaluation of the ways in which governments target parental decision-making in the context of anti-poverty policies. I first introduce and motivate the concept of parent-targeted paternalism to categorize such policies. I then investigate whether parent-targeted paternalism is ever pro tanto wrong, arguing that it is when directed at parents who meet a threshold of parental competency. I (...)
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  16. Chapter 1 The Ethical Dimensions of Policy Analysis.Douglas MacKay - manuscript
    The field of public policy is dominated by the social sciences. Schools and departments of public policy and public administration are largely populated by economists, political scientists, and sociologists, and the vast majority of work in prestigious public policy journals employs empirical methods. This is unsurprising, in one respect, for collecting data, predicting and identifying the causal impacts of policies, and understanding political institutions and processes are massive, important tasks that require the tools of the social sciences. It is surprising, (...)
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  17. Government Policy Experiments and Informed Consent.Douglas MacKay & Averi Chakrabarti - 2019 - Public Health Ethics 12 (2):188-201.
    Governments are increasingly making use of field experiments to evaluate policy interventions in the spheres of education, public health and welfare. However, the research ethics literature is largely focused on the clinical context, leaving investigators, institutional review boards and government agencies with few resources to draw on to address the ethical questions they face regarding such experiments. In this article, we aim to help address this problem, investigating the conditions under which informed consent is required for ethical policy research conducted (...)
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  18.  58
    Geographic Location and Moral Arbitrariness in the Allocation of Donated Livers.Douglas MacKay & Samuel Fitz - 2019 - Journal of Law, Medicine and Ethics 47 (2):308-319.
    The federal system for allocating donated livers in the United States is often criticized for allowing geographic disparities in access to livers. Critics argue that such disparities are unfair on the grounds that where one lives is morally arbitrary and so should not influence one's access to donated livers. They argue instead that livers should be allocated in accordance with the equal opportunity principle, according to which US residents who are equally sick should have the same opportunity to receive a (...)
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  19. The Ethics of Public Policy Experiments: Lessons from Clinical Research Ethics.Douglas MacKay - 2020 - In Ana S. Iltis & Douglas MacKay (eds.), The Oxford Handbook of Research Ethics. New York, NY, USA: Oxford University Press.
    Social scientists and research ethicists have begun, somewhat belatedly, to confront and address the ethical challenges raised by public policy experiments. In doing so however, they have not fully availed themselves of the large and sophisticated literature on the ethics of clinical research which has developed over the past 40 years. While clinical and public policy research are different, I argue that the clinical research ethics literature yields valuable insights for discussions of the ethics of policy experiments. Focusing on seven (...)
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  20. Nudging in Donation Policies: Registration and Decision-Making.Douglas MacKay & Katherine Saylor - 2021 - In Solveig Lena Hansen & Silke Schicktanz (eds.), Ethical Challenges of Organ Transplantation. Transcript Verlag. pp. 65-80.
    In this chapter, we provide an overview of the ethical considerations relevant to the use of nudges in organ donation policy. We do not defend a position on the permissibility of nudging in this context, but instead aim to clearly outline the strongest arguments on the different sides of this issue that have been presented in the English-language scholarly bioethics literature. We also highlight the questions that are in need of further investigation. In part 1, we briefly discuss nudging before (...)
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  21. Fair Subject Selection in Clinical and Social Scientific Research.Douglas MacKay - 2020 - In Ana S. Iltis & Douglas MacKay (eds.), The Oxford Handbook of Research Ethics. New York, NY, USA: Oxford University Press.
    This chapter provides a critical overview and interpretation of fair subject selection in clinical and social scientific research. It first provides an analytical framework for thinking about the problem of fair subject selection. It then argues that fair subject selection is best understood as a set of four subprinciples, each with normative force and each with distinct and often conflicting implications for the selection of participants: fair inclusion, fair burden sharing, fair opportunity, and fair distribution of third-party risks. It then (...)
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  22. Review of For the Common Good: Philosophical Foundations of Research Ethics. [REVIEW]Douglas MacKay - 2022 - Kennedy Institute of Ethics Journal 32 (3):13-28.
    The principal goal of Alex John London's For the Common Good is to "articulate a new vision for the philosophical foundations of research ethics" which "moves issues of justice from the periphery of the field to the very center." At the core of this new vision is an understanding of research as a "collaborative social activity between free and equal persons," which aims to develop the knowledge public institutions require to establish and maintain a social order in which people may (...)
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