Shaming behavior on social media has been the cause of concern in recent public discourse. Supporters of online shaming argue that it is an important tool in helping to make social media and online communities safer and more welcoming to traditionally marginalized groups. Objections to shaming often sound like high-minded calls for civility, but I argue that shaming behavior poses serious risks. Here I identify moral and political risks of online shaming. In particular, shaming threatens to undermine our commitment to (...) the co-deliberative practices of morality. As a result, online shaming can undermine the very goals it is supposed to accomplish. (shrink)

Shame is most frequently defined as the emotion we feel when we fail to live up to standards, norms, or ideals. I argue that this definition is flawed because it cannot explain some of the most paradigmatic features of shame. Agents often respond to shame with violence, but if shame is the painful feeling of failing to live up to an ideal, this response is unintelligible. I offer a new account of shame that can explain the link between shame and (...) violence. On my view, shame arises out of a tension between our identity and our self-conception: those things about which we feel shame are part of our identities, but they are not part of our self-conception. I conclude by arguing that this account of shame is a valuable moral emotion. (shrink)

Although moral philosophers have argued that shame is a valuable moral emotion, feminist philosophers have been skeptical. From the feminist perspective, shame appears to be an emotion more mediated by social circumstances than moral philosophers acknowledge. It is, they will argue, not an accident that shame occurs more frequently in people with marginalized identities. If who I am is a social subordinate, this would explain why women feel more shame. This argument relies on the assumption that the reason women feel (...) more shame is because they internalize negative social judgments about themselves. Although this explanation is tempting, in this chapter I want to evince a skeptical position against it. I want to put pressure on the claim that women internalize their oppression and that this process explains their shame. Instead, I argue that their shame can be explained by the difficulties of navigating one’s identity under conditions of oppression. (shrink)

Kant’s non-voluntarist conception of political obligation has led some philosophers to argue that he would reject self-government rights for indigenous peoples. Some recent scholarship suggests, however, that Kant’s critique of colonialism provides an argument in favor of granting self-government rights. Here I argue for a stronger conclusion: Kantian political theory not only can but must include sovereignty for indigenous peoples. Normally these rights are considered redress for historic injustice. On a Kantian view, however, I argue that they are not remedial. (...) Sovereignty rights are a necessary part of establishing perpetual peace. By failing to acknowledge the sovereignty of native groups, states once guilty of imperialism leave open the in principle possibility for future violence, even though no current conflict exists. Only in recognizing self-government rights can states truly commit to the cosmopolitan ideal. (shrink)

It is common to think that we would be morally better people if we never felt envy. Recently, some philosophers have rejected this conclusion by arguing that envy can often be directed toward unfairness or inequality. As such, they conclude that we should not suppress our feelings of envy. I argue, however, that these defenses only show that envy is sometimes morally permissible. In order to show that we would not be better off without envy, we must show how envy (...) is not merely morally permissible, but morally valuable. Here I provide a defense of envy's moral value. I argue that feelings of envy are integral to the value that moral agents place on the goods and talents that they judge to be central to a worthwhile life. (shrink)

One way of understanding Kant’s views about moral emotions is the cultivation view. On this view, emotions play a role in Kantian morality provided they are properly cultivated. I evince a sceptical position about the cultivation view. First, I show that the textual evidence in support of cultivation is ambiguous. I then provide an account of emotions in Kant’s theory that explains both his positive and negative views about them. Emotions capture our attention such that they both disrupt the mind’s (...) composure and serve as a surrogate for reason. As such, Kant cannot recommend that we cultivate our emotions. (shrink)

Attitudes like shame and contempt seem to be at odds with basic tenets of Kantian moral theory. I argue on the contrary that both attitudes play a central role in Kantian morality. Shame and contempt are attitudes that protect our love of honour, or the esteem we have for ourselves as moral persons. The question arises: how are these attitudes compatible with Kant's claim that all persons deserve respect? I argue that the proper object of shame and contempt is not (...) the humanity within a person, but rather her self-conceit, or the false esteem that competes with love of honour. (shrink)

Kant’s commitment to universalism has been called into question since increasing attention has been paid to his work on race in the last 20 years. This worry can easily be applied to Kant’s work on education: when Kant describes education as allowing humanity to fulfill its Bestimmung (vocation), scholars might reasonably conclude that such a claim only applies certain racial groups. Yet Salomo Friedlaender claims that if Kant’s moral theory is taught to children, “Every person is valued according to her (...) morality and no longer, as in our crude days, according to ‘race’ or national and religious affiliation.” This interpretation of Kant might strike some contemporary Kant scholars as naïvely optimistic, but neo-Kantians were well aware of Kant’s racial claims. By examining how neo-Kantians read Kant’s work on race, I argue that Friedlaender’s interpretation provides a way of reading an unracialized Bestimmung in the pedagogy. (shrink)

In everyday moral experience, we judge ourselves for our emotional responses. Most of the philosophical literature on recalcitrant emotions focuses on (a) whether and how they are possible or (b) whether and how they are irrational. My interest here is in the ways we blame ourselves for recalcitrant emotions. I aim to show that it is harder than it looks to explain self-blame for recalcitrant emotions. I argue recalcitrance alone does not give us a reason to feel any particular way (...) about our emotions and it is not sufficient grounds for self-blame. (shrink)

One of the more notorious passages in Kant occurs in the Doctrine of Right where he claims that ‘bloodguilt’ will cling to members of a dissolving society if they fail to execute the last murderer (MM, 6: 333). Although this is the most famous, bloodguilt appears in three other passages in Kant’s writings. These have received little attention in Kant scholarship. In this article, I examine these other passages and argue that bloodguilt functions as a symbol for the demandingness of (...) justice. I then offer a sympathetic interpretation of the passage from the Doctrine of Right. (shrink)

Kant typically is not identified with the tradition of virtue epistemology. Although he may not be a virtue epistemologist in a strict sense, I suggest that intellectual virtues and vices play a key role in his epistemology. Specifically, Kant identifies a serious intellectual vice that threatens to undermine reason, namely enthusiasm (Schwärmerei). Enthusiasts become so enamored with their own thinking that they refuse to subject reason to self-critique. The particular danger of enthusiasm is that reason colludes in its own destruction: (...) enthusiasm occurs when self-conceit and reason’s desire to transcend its boundaries mutually reinforce each other. I conclude by sketching an account of Kantian intellectual virtue that is consistent with Kantian moral virtue. (shrink)

Moral philosophers have defended anger as an important part of our moral lives. In spite of these defenses, skeptics have nonetheless argued that it would be better all things considered to get over anger to the extent that we can. They will often point to moral exemplars like Martin Luther King, Jr. or Gandhi to show both (a) that we can successfully overcome our feelings of anger and (b) that we would be morally better off doing so. In this chapter, (...) I argue against this aspiration. Those who advocate for such an aspiration fail to recognize that getting over anger would require us to radically reshape our moral psychology. I argue that feelings of anger are more central to our moral emotional lives than skeptics realize and that they cannot be removed without altering other valuable moral commitments. (shrink)

Spite is typically considered a vicious emotion that causes us to engage in petty, vindictive, and sometimes self-destructive behavior. Even though it has this bad reputation, I will argue that spite is a reactive attitude. Spite is emotional defiance of another’s command: to spite you, I will do something exactly because you told me not to. Our liability to feelings of spite presupposes that we recognize others as having practical authority, which is why it qualifies as a reactive attitude. I (...) conclude by offering conditions under which spite can be justified and unjustified. (shrink)

Our emotions can be revealing. They can not only reflect our character traits and our judgments, but they can also tell us things about ourselves that we do not fully realize or may not want to admit. In this chapter, I am particularly interested in how we relate to what I will call alienated emotions: emotional experiences that are unusual, surprising, or even disturbing. What, if anything, do our alienated emotions tell us about who we are? I argue here that (...) alienated emotions lead to important questions about the ethics of self-interpretation. (shrink)

The notion of relevance plays a role in many accounts of knowledge and knowledge ascription. Although use of the notion is well-motivated, theorists struggle to codify relevance. A reasonable person standard of relevance addresses this codification problem, and provides an objective and flexible standard of relevance; however, treating relevance as reasonableness seems to allow practical factors to determine whether one has knowledge or not—so-called “pragmatic encroachment.” I argue that a fuller understanding of reasonableness and of the role of practical factors (...) in the acquisition of knowledge lets us avoid pragmatic encroachment. (shrink)

Austin’s Sense and Sensibilia (1962) generates wildly different reactions among philosophers. Interpreting Austin on perception starts with a reading of this text, and this in turn requires reading into the lectures key ideas from Austin’s work on natural language and the theory of knowledge. The lectures paint a methodological agenda, and a sketch of some first-order philosophy, done the way Austin thinks it should be done. Crucially, Austin calls for philosophers to bring a deeper understanding of natural language meaning to (...) bear as they do their tasks. In consequence Austin’s lectures provide a fascinating start—but only a start—on a number of key questions in the philosophy of perception. (shrink)

Knowing what one believes sometimes takes effort—it sometimes involves seeking to know one’s beliefs as causes. And when one gains self-knowledge of one’s belief this way—that is, through causal self-interpretation—one engages in a characteristically human kind of psychological liberation. By investigating the nature of causal self-interpretation, I discover some surprising features of this liberty. And in doing so, I counter a trend in recent philosophical theories, of discounting the value of self-knowledge in projects of human liberation.

Kant’s conception of mental illness is unlikely to satisfy contemporary readers. His classifications of mental illness are often fluid and ambiguous, and he seems to attribute to human beings at least some responsibility for preventing mental illness. In spite of these apparent disadvantages, I argue that Kant’s account of mental illness can be illuminating to his views about the normative dimensions of human cognition. In contrast to current understandings of mental illness, Kant’s account is what I refer to as “non-pathological.” (...) That is, most mental illnesses are for Kant continuous with normally functioning cognition. Someone with a healthy reason can easily fall into mental illness and someone with mental illness can (perhaps not as easily) re-establish healthy reason. By accepting a non-pathological definition of mental illness, it follows for Kant that humans have more agency and responsibility regarding their mental health than current views allow, which explains why several of his writings aim to prescribe a “diet of the mind” (2:271). Contrary to popular readings of Kant as a champion of reason’s power, Kant’s conception of mental illness shows that he recognizes how fragile human reason can be. (shrink)

The use of child soldiers in armed conflict is an increasing global concern. Although philosophers have examined whether child soldiers can be considered combatants in war, much less attention has been paid to their moral responsibility. While it is tempting to think of them as having diminished or limited responsibility, child soldiers often report feeling guilt for the wrongs they commit. Here I argue that their feelings of guilt are both intelligible and morally appropriate. The feelings of guilt that child (...) soldiers experience are not self-censure; rather their guilt arises from their attempts to come to terms with what they see as their own morally ambiguous motives. Their guilt is appropriate because it reaffirms their commitment to morality and facilitates their self-forgiveness. (shrink)

What role does ‘ordinary language philosophy’ play in the defense of common sense beliefs? J.L. Austin and Ludwig Wittgenstein each give central place to ordinary language in their responses to skeptical challenges to common sense beliefs. But Austin and Wittgenstein do not always respond to such challenges in the same way, and their working methods are different. In this paper, I compare Austin’s and Wittgenstein’s metaphilosophical positions, and show that they share many metaphilosophical commitments. I then examine Austin and Wittgenstein’s (...) respective takes on the problem of other minds and the problem of our knowledge of the external world. Interestingly, we find Wittgenstein employing methods more frequently associated Austin and vice versa. Moreover, we find that a variety of defenses of common sense beliefs are compatible with ‘ordinary language philosophy.’. (shrink)

Several philosophers who argue that forgiveness is an important virtue also wish to maintain the moral value of retributive emotions that forgiveness is meant to overcome. As such, these accounts explicate forgiveness as an Aristotelian mean between too much resentment and too little resentment. I argue that such an account ends up making forgiveness superfluous: it turns out that the forgiving person is not praised for a greater willingness to let go of her resentment, but rather for her fairness or (...) good judgment. I conclude by arguing that the virtue of fair-mindedness is more compatible with maintaining the value of the retributive emotions than the virtue of forgiveness. (shrink)

In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, we (...) consider how nations ought to distribute a scarce life-saving resource across healthcare regions in a public health emergency, particularly in view of regional differences in projected need and existing capacity. We call this the regional triage question. Using the case study of ventilators in the COVID-19 pandemic, we show how the moral frameworks that we might adopt in response to individual triage decisions do not translate straightforwardly to this regional-level triage question. Having outlined what we take to be a plausible egalitarian approach to the regional triage question, we go on to propose a novel way of operationalising the ‘save the most lives’ principle in this context. We claim that the latter principle ought to take some precedence in the regional triage question, but also note important limitations to the extent of the influence that it should have in regional allocation decisions. (shrink)

In this paper we argue that the eudaimonist virtue of hope holds pride of place in development of psychological traits that promote human flourishing. The argument is part theoretical and part empirical. On the theoretical side, hope, the virtue, is the disposition to envision future good possibilities for oneself and one’s community and to move towards those possibilities. This renders hope necessary for any agent’s self-conscious pursuit of the goods that constitute flourishing, and also for the development of other virtues. (...) On the empirical side, we draw on evidence from psychology to argue that early in development, humans need relationships of trust with caregivers to develop the future orientation and features of agency constitutive of the virtue of hope. Thus the virtue of hope generally needs to be fostered, in part, through trusting relationships for humans to flourish. (shrink)

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity—Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on (...) the following key issues: § 1. Providing information about research integrity§ 2. Providing education, training and mentoring§ 3. Strengthening a research integrity culture§ 4. Facilitating open dialogue§ 5. Wise incentive management§ 6. Implementing quality assurance procedures§ 7. Improving the work environment and work satisfaction§ 8. Increasing transparency of misconduct cases§ 9. Opening up research§ 10. Implementing safe and effective whistle-blowing channels§ 11. Protecting the alleged perpetrators§ 12. Establishing a research integrity committee and appointing an ombudsperson§ 13. Making explicit the applicable standards for research integrity. (shrink)

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity—Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on (...) the following key issues: § 1.Providing information about research integrity § 2.Providing education, training and mentoring § 3.Strengthening a research integrity culture § 4.Facilitating open dialogue § 5.Wise incentive management § 6.Implementing quality assurance procedures § 7.Improving the work environment and work satisfaction § 8.Increasing transparency of misconduct cases § 9.Opening up research § 10.Implementing safe and effective whistle-blowing channels § 11.Protecting the alleged perpetrators § 12.Establishing a research integrity committee and appointing an ombudsperson § 13.Making explicit the applicable standards for research integrity. (shrink)

Which is better: a guarantee of a modest amount of moral value, or a tiny probability of arbitrarily large value? To prefer the latter seems fanatical. But, as I argue, avoiding such fanaticism brings severe problems. To do so, we must decline intuitively attractive trade-offs; rank structurally identical pairs of lotteries inconsistently, or else admit absurd sensitivity to tiny probability differences; have rankings depend on remote, unaffected events ; and often neglect to rank lotteries as we already know we would (...) if we learned more. Compared to these implications, fanaticism is highly plausible. (shrink)

Current approaches used in educational research and practice to evaluate the quality of written arguments often rely on structural analysis. In such assessments, credit is awarded for the presence of structural elements of an argument, such as claims, evidence, and rebuttals. In this article, we discuss limitations of such approaches, including the absence of criteria for evaluating the quality of the argument elements. We then present an alternative framework, based on the Rational Force Model (RFM), which originated from the work (...) of a Nordic philosopher Næss. Using an example of an argumentative essay, we demonstrate the potential of the RFM to improve argument analysis by focusing on the acceptability and relevance of argument elements, two criteria widely considered to be fundamental markers of argument strength. We outline possibilities and challenges with using the RFM in educational contexts and conclude by proposing directions for future research. (shrink)

For aggregative theories of moral value, it is a challenge to rank worlds that each contain infinitely many valuable events. And, although there are several existing proposals for doing so, few provide a cardinal measure of each world's value. This raises the even greater challenge of ranking lotteries over such worlds—without a cardinal value for each world, we cannot apply expected value theory. How then can we compare such lotteries? To date, we have just one method for doing so (proposed (...) separately by Arntzenius, Bostrom, and Meacham), which is to compare the prospects for value at each individual location, and to then represent and compare lotteries by their expected values at each of those locations. But, as I show here, this approach violates several key principles of decision theory and generates some implausible verdicts. I propose an alternative—one which delivers plausible rankings of lotteries, which is implied by a plausible collection of axioms, and which can be applied alongside almost any ranking of infinite worlds. (shrink)

In their thoughtful article, Malm and Navin (2020) raise concerns about a potentially unjust generational welfare tradeoff between children and adults when it comes to chicken pox. We share their c...

Philosophy & Public Affairs, Volume 50, Issue 2, Page 202-238, Spring 2022.

Aggregative moral theories face a series of devastating problems when we apply them in a physically realistic setting. According to current physics, our universe is likely _infinitely large_, and will contain infinitely many morally valuable events. But standard aggregative theories are ill-equipped to compare outcomes containing infinite total value so, applied in a realistic setting, they cannot compare any outcomes a real-world agent must ever choose between. This problem has been discussed extensively, and non-standard aggregative theories proposed to overcome it. (...) This paper addresses a further problem of similar severity. Physics tells us that, in our universe, how remotely in time an event occurs is _relative_. But our most promising aggregative theories, designed to compare outcomes containing infinitely many valuable events, are sensitive to how remote in time those events are. As I show, the evaluations of those theories are then relative too. But this is absurd; evaluations of outcomes must be absolute. So we must reject such theories. Is this objection fatal for all aggregative theories, at least in a relativistic universe like ours? I demonstrate here that, by further modifying these theories to fit with the physics, we can overcome it. (shrink)

Can it be rational to be risk-averse? It seems plausible that the answer is yes—that normative decision theory should accommodate risk aversion. But there is a seemingly compelling class of arguments against our most promising methods of doing so. These long-run arguments point out that, in practice, each decision an agent makes is just one in a very long sequence of such decisions. Given this form of dynamic choice situation, and the (Strong) Law of Large Numbers, they conclude that those (...) theories which accommodate risk aversion end up delivering the same verdicts as risk-neutral theories in nearly all practical cases. If so, why not just accept a simpler, risk-neutral theory? The resulting practical verdicts seem to be much the same. In this paper, I show that these arguments do not in fact condemn those risk-aversion-accommodating theories. Risk aversion can indeed survive the long run. (shrink)

This paper challenges the assumption that youth and youth agencies are in a condition of equa- lity when entering a participatory action research (PAR). By asserting that it is not a state of equality that practitioners nor youth should assume nor be immediately striving for, but a consis- tently equitable process, this article draws from and reflects on the relationship between young people and researchers who have used a PAR methodology in action oriented projects. Using the UNESCO Growing up in (...) Cities Canada project as a case example, this review extrapolates from and reflects on challenges faced by the project as a whole. Using semi-structured interviews to explore the roles of adults and youth, a number of strategies are highlighted as the techniques used to overcome these challenges. The discussion concludes with further reflection on the com- plexities of equality and equity, recommending a number of actions that have the potential to create an equitable environment in PAR projects similar to the one examined. (shrink)

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

Many real-world agents recognise that they impose harms by choosing to emit carbon, e.g., by flying. Yet many do so anyway, and then attempt to make things right by offsetting those harms. Such offsetters typically believe that, by offsetting, they change the deontic status of their behaviour, making an otherwise impermissible action permissible. Do they succeed in practice? Some philosophers have argued that they do, since their offsets appear to reverse the adverse effects of their emissions. But we show that (...) they do not. In practice, standard carbon offsetting does not reverse the harms of the original action, nor does it even benefit the same group as was harmed. Standard moral theories hence deny that such offsetting succeeds. Indeed, we show that any moral theory that allows offsetting in this setting faces a dilemma between allowing any wrong to be offset, no matter how grievous, and recognising an implausibly sharp discontinuity between offsettable actions and non-offsettable actions. The most plausible response is to accept that carbon offsetting fails to right our climate wrongs. (shrink)

Comment on "The ethical 'elephant' in the death penalty 'room'". Arguments in defense of the death penalty typically fall into one of two groups. Consequentialist arguments point out beneficial aspects of capital punishment, normally focusing on deterrence, while non-consequentialist arguments seek to justify execution independently of its effects, for example, by appealing to the concept of retribution. Michael Keane's target article "The ethical 'elephant' in the death penalty 'room'" should, we believe, be read as an interesting new consequentialist defense of (...) physician involvement in capital punishment. (shrink)

Two key questions of normative decision theory are: 1) whether the probabilities relevant to decision theory are evidential or causal; and 2) whether agents should be risk-neutral, and so maximise the expected value of the outcome, or instead risk-averse (or otherwise sensitive to risk). These questions are typically thought to be independent---that our answer to one bears little on our answer to the other. But there is a surprising argument that they are not. In this paper, I show that evidential (...) decision theory implies risk neutrality, at least in moral decision-making and at least on plausible empirical assumptions. Take any risk-aversion-accommodating decision theory, apply it using the probabilities prescribed by evidential decision theory, and every verdict of moral betterness you reach will match those of expected value theory. (shrink)

What role should legislation or policy play in avoiding the complications of in-vitro fertilization? In this article, we focus on single versus double embryo transfer, and assess three arguments in favour of mandatory single embryo transfer: risks to the mother, risks to resultant children, and costs to society. We highlight significant ethical concerns about each of these. Reproductive autonomy and non-paternalism are strong enough to outweigh the health concerns for the woman. Complications due to non-identity cast doubt on the extent (...) to which children are harmed. Twinning may offer an overall benefit rather than burden to society. Finally, including the future health costs for children in reproductive policy is inconsistent with other decisions. We conclude that mandatory single embryo transfer is not justified and that a number of countries should reconsider their current embryo transfer policy. (shrink)

The experiences described in the VIP transcripts are incredibly varied and yet frequently explicitly labelled by participants as "voices." How can we make sense of this? If we reflect carefully on uses of the word "voice", we see that it can express at least two entirely different concepts, which pick out categorically different phenomena. One concept picks out a speech sound (e.g. "This synthesizer has a "voice" setting"). Another concept picks out a specific agent (e.g. "I hear two voices: one (...) is a ten year-old boy…"). This chapter explores how these two concepts are related to one another in the context of voice-hearing. (shrink)

The prospect of vaccinating children and young people (CYP) against COVID raises questions that apply more widely to vaccination in children. When can CYP consent, on their own, for vaccination? What should happen if children and their parents disagree about the desirability of a vaccine? When, if ever, should vaccination proceed despite a child’s dissent or apparent refusal? A range of ethical dilemmas may arise. (Box 1) In this article, we will address general ethical issues relating to consent for vaccination, (...) highlighting their relevance to COVID. We will not address the wider ethical questions of whether or when children should be vaccinated against COVID. (shrink)

The querelle des femmes was an intellectual debate over the status of women that occurred in the early modern period, between the 1400s and 1700s. A common argument for the superiority of men and inferiority of women that appeared during the debate is that women are less physically strong than men, and are therefore inferior. In response, two distinct argumentative strategies were developed by defenders of women. First, some argued that men and women did not in fact differ in physical (...) strength. A second strategy was to deny that physical strength is relevant to the question of superiority. In this case, one would argue that a difference in strength is not normatively relevant to evaluations of worth. I argue that this second strategy was the more effective response to the argument that women were inferior because of their alleged physical weakness compared to men. (shrink)

In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an important (...) higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre‐existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID‐19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives. (shrink)