John Rawls thinks republicanism is compatible with his political liberalism. Philip Pettit insists that the two conflict in important ways. In this paper, I make sense of this dispute by employing David Chalmers’s method of elimination to reveal the meaning underlying key terms in Rawls’s political liberalism and Pettit’s republicanism. This procedure of disambiguating terms will show how the two theories defend the same institutional arrangement on the same grounds. The procedure thus vindicates Rawls’s view of the two theories being (...) compatible. The reason for this compatibility is that both theories are politicized—that is, they are constructed to attract the compliance of all reasonable members of a modern, pluralistic society. (shrink)

Suppose that you prefer A to B, B to C, and C to A. Your preferences violate Expected Utility Theory by being cyclic. Money-pump arguments offer a way to show that such violations are irrational. Suppose that you start with A. Then you should be willing to trade A for C and then C for B. But then, once you have B, you are offered a trade back to A for a small cost. Since you prefer A to B, you (...) pay the small sum to trade from B to A. But now you have been turned into a money pump. You are back to the alternative you started with but with less money. This Element shows how each of the axioms of Expected Utility Theory can be defended by money-pump arguments of this kind. The Element also defends money-pump arguments from the standard objections to this kind of approach. This title is also available as Open Access on Cambridge Core. (shrink)

Every day, thousands of polls, surveys, and rating scales are employed to elicit the attitudes of humankind. Given the ubiquitous use of these instruments, it seems we ought to have firm answers to what is measured by them, but unfortunately we do not. To help remedy this situation, we present a novel approach to investigate the nature of attitudes. We created a self-transforming paper survey of moral opinions, covering both foundational principles, and current dilemmas hotly debated in the media. This (...) survey used a magic trick to expose participants to a reversal of their previously stated attitudes, allowing us to record whether they were prepared to endorse and argue for the opposite view of what they had stated only moments ago. The result showed that the majority of the reversals remained undetected, and a full 69% of the participants failed to detect at least one of two changes. In addition, participants often constructed coherent and unequivocal arguments supporting the opposite of their original position. These results suggest a dramatic potential for flexibility in our moral attitudes, and indicates a clear role for self-attribution and post-hoc rationalization in attitude formation and change. (shrink)

Critical-Range Utilitarianism is a variant of Total Utilitarianism which can avoid both the Repugnant Conclusion and the Sadistic Conclusion in population ethics. Yet Standard Critical-Range Utilitarianism entails the Weak Sadistic Conclusion, that is, it entails that each population consisting of lives at a bad well-being level is not worse than some population consisting of lives at a good well-being level. In this paper, I defend a version of Critical-Range Utilitarianism which does not entail the Weak Sadistic Conclusion. This is made (...) possible by a fourth category of absolute value in addition to goodness, badness, and neutrality. (shrink)

This Viewpoint analyzes policies for covering GLP-1 receptor agonist drugs for obesity treatment across 13 high-income countries. It identifies four key lessons for developing coverage policies: 1) using up-to-date cost-effectiveness analyses that incorporate new evidence of benefits, 2) negotiating lower prices while preserving innovation incentives, 3) prioritizing coverage for specific populations rather than issuing blanket denials, and 4) treating obesity medications similarly to high-cost drugs for other conditions. It argues that blanket coverage denials are unethical and that countries should implement (...) targeted coverage policies that maximize benefits while managing costs. (shrink)

Political candidates often believe they must focus their campaign efforts on a small number of swing voters open for ideological change. Based on the wisdom of opinion polls, this might seem like a good idea. But do most voters really hold their political attitudes so firmly that they are unreceptive to persuasion? We tested this premise during the most recent general election in Sweden, in which a left- and a right-wing coalition were locked in a close race. We asked our (...) participants to state their voter intention, and presented them with a political survey of wedge issues between the two coalitions. Using a sleight-of-hand we then altered their replies to place them in the opposite political camp, and invited them to reason about their attitudes on the manipulated issues. Finally, we summarized their survey score, and asked for their voter intention again. The results showed that no more than 22% of the manipulated replies were detected, and that a full 92% of the participants accepted and endorsed our altered political survey score. Furthermore, the final voter intention question indicated that as many as 48% (69.2%) were willing to consider a left-right coalition shift. This can be contrasted with the established polls tracking the Swedish election, which registered maximally 10% voters open for a swing. Our results indicate that political attitudes and partisan divisions can be far more flexible than what is assumed by the polls, and that people can reason about the factual issues of the campaign with considerable openness to change. (shrink)

Ontology and theology cannot be combined if ontology excludes non physical causes. This paper examines some possibilities for ontology to be combined with theology in so far as non physical causes are permitted. The paper builds on metaphysical findings that shows that separate ontological domains can interact causally indirectly via interfaces. As interfaces are not universes a first universe is allowed to be caused by an interface without violating the principle of causal closure of any universe. Formal theology can therefore (...) be based on the assumption that the (first) universe is caused by God if God is defined as the first cause. Given this, formal theology and science can have the same ontological base. (shrink)

A straightforward way to handle moral uncertainty is simply to follow the moral theory in which you have most credence. This approach is known as My Favourite Theory. In this paper, I argue that, in some cases, My Favourite Theory prescribes choices that are, sequentially, worse in expected moral value than the opposite choices according to each moral theory you have any credence in. In addition this, problem generalizes to other approaches that avoid intertheoretic comparisons of value, such as My (...) Favourite Option, the Borda Rule, Variance Normalization, and the Principle of Maximizing Expected Normalized Moral Value. (shrink)

Aggregating individuals’ consistent attitudes might produce inconsistent collective attitudes. Some groups therefore need the capacity to form attitudes that are irreducible to those of their members. Such groups, group-agent realists argue, are agents in control of their own attitude formation. In this paper, however, I show how group-agent realism overlooks the important fact that groups consist of strategically interacting agents. Only by eliminating group agency from our social explanations can we see how individuals vote strategically to gain control of their (...) groups and produce collective attitudes we cannot make sense of if we treat groups as agents. (shrink)

This literature review describes the current state of research on the Greek sophists. It draws on recent work on the beginnings of rhetoric, overviews of sophistic thought and case studies on Protagoras, Gorgias, Antiphon and Prodicus. It is shown that the traditional notion of a sophistic antithesis to philosophy has lost further ground: While earlier »rehabilitations« of sophistic thought still use the dichotomous distinction of philosophy und sophistic, now any generic talk of »the sophist« should better be regarded as misleading.

The revival of republicanism was meant to challenge the hegemony of liberalism in contemporary political theory on the grounds that liberals show insufficient concern with institutional protection against political misrule. This article challenges this view by showing how neorepublicanism, particularly on Philip Pettit’s formulation, demands no greater institutional protection than does political liberalism. By identifying neutrality between conceptions of the good as the constraint on institutional requirements that forces neorepublicanism into the liberal framework, the article shows that neutrality is what (...) neorepublicans must jettison to offer a tenable critique of liberalism. Only then can neorepublicans ensure greater protection against misrule by demanding that citizens participate more actively in politics. They can then also criticize liberalism for failing to appreciate the importance of such protection. (shrink)

John Locke’s account of personal identity is usually thought to have been proved false by Thomas Reid’s simple ‘Gallant Officer’ argument. Locke is traditionally interpreted as holding that your having memories of a past person’s thoughts or actions is necessary and sufficient for your being identical to that person. This paper argues that the traditional memory interpretation of Locke’s account is mistaken and defends a memory continuity view according to which a sequence of overlapping memories is necessary and sufficient for (...) personal identity. On this view Locke is not vulnerable to the Gallant Officer argument. (shrink)

This paper argues that the main global critiques of scientism lose their punch because they rely on an uncharitable definition of their target. It focuses on epistemological scientism and divides it into four categories in terms of how strong (science is the only source of knowledge) or weak (science is the best source of knowledge) and how narrow (only natural sciences) or broad (all sciences or at least not only the natural sciences) they are. Two central arguments against scientism, the (...) (false) dilemma and self‐referential incoherence, are analysed. Of the four types of epistemological scientism, three can deal with these counterarguments by utilizing two methodological principles: epistemic evaluability of reliability and epistemic opportunism. One hopes that these considerations will steer the discussion on scientism to more fruitful pastures in the future. For example, there are interesting methodological considerations concerning what evaluability or reliability and epistemic opportunism entail. (shrink)

Is an outcome where many people are saved and one person dies better than an outcome where the one is saved and the many die? According to the standard utilitarian justification, the former is better because it has a greater sum total of well-being. This justification involves a controversial form of moral aggregation, because it is based on a comparison between aggregates of different people's well-being. Still, an alternative justification—the Argument for Best Outcomes—does not involve moral aggregation. I extend the (...) Argument for Best Outcomes to show that any utilitarian evaluation can be justified without moral aggregation. (shrink)

Moral obligation and permissibility are usually thought to be interdefinable. Following the pattern of the duality definitions of necessity and possibility, we have that something’s being permissible could be defined as its not being obligatory to not do it. And that something’s being obligatory could be defined as its not being permissible to not do it. In this paper, I argue that neither direction of this alleged interdefinability works. Roughly, the problem is that a claim that some act is obligatory (...) or permissible entails that there is a moral law, whereas a negative claim that some act is not obligatory or not permissible does not. Nevertheless, one direction of the interdefinability can potentially be salvaged. I argue that, if we do not require the conceptual possibility of moral dilemmas, then there is a way to plausibly define obligation in terms of permissibility. I conclude that permissibility is the only feasible deontic primitive. (shrink)

A standard liberal claim is that freedom of choice is not only instrumentally valuable but also intrinsically valuable, that is, valuable for its own sake. I argue that each one of five conditions is plausible if freedom of choice is intrinsically valuable. Yet there exists a counter-example to the conjunction of these conditions. Hence freedom of choice is not intrinsically valuable.

Derek Parfit argues that fission is prudentially better for you than ordinary death. But is having more fission products with good lives prudentially better for you than having just one? In this paper, we argue that it is. We argue that, if your brain is split and the halves are transplanted into two recipients (who both have good lives), then it is prudentially better for you if both transplants succeed than if only one of them does (other things being equal). (...) This upshot rules out, among other things, that the prudential value of standing in the relation that matters in survival to multiple people is equal to their average well-being. (shrink)

According to Act Consequentialism, an act is right if and only if its outcome is not worse than the outcome of any alternative to that act. This view, however, leads to deontic paradoxes if the alternatives to an act are all other acts that can be done in the situation. A typical response is to only apply this rightness criterion to maximally specific acts and to take the alternatives to a maximally specific act to be the other maximally specific acts (...) that can be done in the situation. (This view can then be supplanted by a separate account for the rightness of acts that are not maximally specific.) This paper defends a rival view, Binary Act Consequentialism, where, for any voluntary act, that act is right if and only if its outcome is not worse than the outcome of not doing that act. Binary Act Consequentialism, which dates back to Jeremy Bentham, has few supporters. A number of seemingly powerful objections have been considered fatal. In this paper, I rebut these objections and put forward a positive argument for the view. (shrink)

This paper argues that Rousseau’s lawgiver is best thought of as a fictional teacher of peoples. It is fictional as it reflects an idea that is entertained despite its contradictory nature, and it is contradictory in the sense that it describes ‘an undertaking beyond human strength and, to execute it, an authority that amounts to nothing’ (II.7; 192). Rousseau conceives of the social contract as a necessary device for enabling the transferal of individual power to the body politic, for subsuming (...) individual wills under the general will, and for aligning the good of the individual with the common good. For the social contract to be valid, however, it needs to be preceded by a desire to belong to a moral community that can induce people to join willingly, and that will grant legitimacy to the laws established. If the social contract is the machinery that makes the body politic function, the lawgiver is ‘the mechanic who invents the machine’ (II.7; 191). In this paper we will look closer at the pedagogical functions of Rousseau’s mythical lawgiver by first examining the relationship between the social contract, the general will and the lawgiver. Then, we aim to flesh out a pedagogical understanding of the figure of the lawgiver by way of the two educational dimensions of accommodation and transformation. Finally, we will argue for the importance of understanding Rousseau’s lawgiver as a fictional device allowing for the fundamental and enduring educational task of balancing between the preservation and renewal of society. (shrink)

W. V. Quine wished to restrict the interests that matter to those of actual people. Actual-Population Utilitarianism is a version of utilitarianism where, following Quine, only the interests of actual people matter. It is well known that ethical theories of this kind, which depend on what is actual, typically lead to normative variance. In this paper, I put forward a new objection to Actual-Population Utilitarianism. I present a case in which Actual-Population Utilitarianism prescribes choices that are worse for everyone whose (...) interests matter than the opposite choices. Moreover, I put forward a case in which total and average versions of Actual-Population Utilitarianism prescribe choices that are worse than the opposite choice for everyone (full stop). This objection also applies if the Actual-Population Restriction is combined with non-utilitarian views, given some minimal assumptions. (shrink)

Standard definitions of causal closure focus on where the causes in question are. In this paper, the focus is changed to where they are not. Causal closure is linked to the principle that no cause of another universe causes an event in a particular universe. This view permits the one universe to be affected by the other via an interface. An interface between universes can be seen as a domain that violates the suggested account of causal closure, suggesting a view (...) in which universes are causally closed whereas interfaces are not. On this basis, universes are not affected by other universes directly but rather indirectly. (shrink)

The purpose of this article is to add to the debate on the normative status and legitimacy of indoctrination in education by drawing on the political philosophy of Benedict Spinoza (1632–1677). More specifically, I will argue that Spinoza’s relational approach to knowledge formation and autonomy, in light of his understanding of the natural limitations of human cognition, provides us with valuable hints for staking out a more productive path ahead for the debate on indoctrination. This article combines an investigation into (...) the early modern history of political ideas with a philosophical inquiry into a persistent conceptual problem residing at the heart of education. As such, the aim of the article is ultimately to offer an account of indoctrination less fraught with the dangers of epistemological and political idealism that often haunt rival conceptions. (shrink)

The money-pump argument aims to show that cyclic preferences are irrational. The argument can be based on a number of different exploitation schemes that vary in what needs to be assumed about the agent. The Standard Money Pump works for myopic and naive agents, but not for sophisticated agents who use backward induction. The Upfront Money Pump works for sophisticated agents, but not for myopic or naive agents. In this paper, I present a new money pump, the Universal Money Pump, (...) that works for myopic, naive, and sophisticated agents. Moreover, the Universal Money Pump (just like the Upfront Money Pump) also works for minimally sophisticated agents who need not assume that they will choose rationally at nodes that can only be reached by irrational choices. This enables an argument that rational preferences are acyclic, which is based on weaker assumptions about dynamic rationality than existing money-pump arguments. (shrink)

We have all been told of the death of grand narratives. We have been told that the days of asking eternal metaphysical questions in philosophy are long since over. When Wittgenstein’s (1953/2009, p. 174) famous spade hit bedrock it reminded us that we had better stop wasting our time on lofty questions without answers. Foucault (1970) prompted us to recall Borges’story of a certain Chinese encyclopedia showing us that there are many ways of ordering the world and that each way (...) changes the rules of the game a little bit. We found that history was contingent and that hierarchies, however firmly built, would all crumble in the end. In its place were the slightly disorienting feeling following the postmodernist’s proclamation of ‘the elusiveness of meaning and knowledge’ (Kirby, 2017, p. 5). (shrink)

Given reductionism about people, personal persistence must fundamentally consist in some kind of impersonal continuity relation. Typically, these continuity relations can hold from one to many. And, if they can, the analysis of personal persistence must include a non-branching clause to avoid non-transitive identities or multiple occupancy. It is far from obvious, however, what form this clause should take. This paper argues that previous accounts are inadequate and develops a new proposal.

It is natural to assume that every value bearer must be good, bad, or neutral. This paper argues that this assumption is false if value incomparability is possible. More precisely, if value incommensurability is possible, then there is a fourth category of absolute value, in addition to the good, the bad, and the neutral.

This article turns to the neglected pedagogical concept of ingenium in order to address some shortcomings of the admiration–emulation model of Linda Zabzebski’s influential exemplarist moral theory. I will start by introducing the problem of the admiration-emulation model by way of a fictional example. I will then briefly outline the concept of ingenium such as it appears in a Renaissance context, looking particularly at the pedagogical writings of Juan Luis Vives. This will set the stage for the next part, looking (...) at how early modern philosopher Benedict Spinoza adopts a Vivesian notion of ingenium, adjusting it so as to fit into the setting of his political theory. Next, I will turn to Spinoza’s use of the concept of ingenium in relation to his portrayal of exemplary persons, offering a pedagogical model of moral exemplarism that can counter some of the perceived problems of the admiration–emulation model as it highlights the necessary fallibility of efficient exemplars as well as acknowledges the socio-political dimension of emotions. Finally, I will lay out some preliminary consequences for educational theory, hoping to offer a way of reconciling moral exemplarism with a more realistic pedagogical and psychological framework. (shrink)

According to Longtermism, our acts’ expected influence on the expected value of the world is mainly determined by their effects in the far future. There is, given total utilitarianism, a straightforward argument for Longtermism due to the enormous number of people that might exist in the future, but this argument does not work on person-affecting views. In this paper, we will argue that these views might also lead to Longtermism if Prudential Longtermism is true. Prudential Longtermism holds for a person (...) if and only if our acts’ overall influence on that person’s expected well-being is mainly determined by the acts’ effects in the far future. We argue that (due to a small chance of anti-ageing and uploading) there could be an enormous amount of prudential value for some contemporary person in the far future and that value may be so large that it dominates their overall expectation of lifetime well-being. (shrink)

The ecological crisis almost forces different disciplines to search together for a better world. We all share one earth: the closer we reach a certain point, the closer we come together. This places the paper amid the so-called science and religion dialogue in which theology increasingly cognises empirical research and scientific data. On the other hand, sciences are becoming increasingly aware of the need to transcend their evidential limitations to find a comprehensive paradigm. This paper will apply an exemplary methodology (...) by selecting the eco-theology of Jürgen Moltmann as a theologian who takes relevant results of scientific ecological research seriously. The Club of Rome, on the other hand, is an example of social (and natural) sciences urging to find a new inclusive paradigm for a world in peril. The juxtaposition of theology and science provides the need for a new value system emerging in social sciences. Randers makes clear that the culture of consumerism had to be replaced by cultural elements that provide substantial longer-term satisfaction and increase well-being. The latest report of the Club of Rome (2022) and Moltmann’s latest two titles on this topic (2019 and 2020) have been integrated into the argument and previous publications of the author. Contribution: This exemplary approach contributes to a scientifically grounded and biblically founded eco-theology. The two exponents of science and eco-theology provide the much-needed vocabulary for each other. The Earth Charter, one could add, provides a grammar for the engagement of eco-theology and environmental science. (shrink)

A dialogue, in three parts, on utilitarian vulnerability to exploitation.

Institutions promoting republican freedom as non-domination are commonly believed to differ significantly from institutions promoting negative freedom as non-interference. Philip Pettit, the most prominent contemporary defender of this view, also maintains that these republican institutions are neutral between the different conceptions of the good that characterise a modern society. This paper shows why these two views are incompatible. By analysing the institutional requirements Pettit takes as constitutive of republican freedom, I show how they also promote negative freedom by reducing overall (...) interference. To avoid this result, republican institutions must be more restrictive and require that citizens conform to a life of political engagement. But then republican freedom will not be a neutral ideal. Rejecting negative freedom therefore means sacrificing neutrality. (shrink)

The Levelling-Down Objection is a standard objection to monistic egalitarian theories where equality is the only thing that has intrinsic value. Most egalitarians, however, are value pluralists; they hold that, in addition to equality being intrinsically valuable, the egalitarian currency in which we are equal or unequal is also intrinsically valuable. In this paper, I shall argue that the Levelling-Down Objection still minimizes the weight that the intrinsic badness of inequality could have in the overall intrinsic evaluation of outcomes, given (...) a certain way of measuring the badness of inequality, namely, the Additive Individual-Complaints Measure. (shrink)

In this paper Johan Dahlbeck sets out to propose a pedagogy of “as if,” seeking to address the educational paradox of how students can be influenced to approximate a life guided by reason without assuming that they are already sufficiently rational to adhere to dictates of practical reason. He does so by outlining a fictionalist account, drawing primarily on Hans Vaihinger's systematic treatment of heuristic fictions and on Spinoza's ideas about how passive affects can be made to strengthen reason. (...) Dahlbeck suggests that such an account can help us overcome the problem of assuming that reason needs to be enlisted as an instrument in the educational endeavor to live according to the guidance of reason. The reason this is so is that fictions can use passive affects that are prosocial and that thereby strengthen the sense of community necessary for laying a cooperative foundation for successful joint striving. Dahlbeck suggests further that exemplary teachers are crucial to this endeavor insofar as they can offer educational fictions as imaginative and temporary placeholders for the truth, allowing students to act “as if” they were already guided by reason. (shrink)

Abstract Criteria of scientific value are of different kinds. This paper concerns ultimate criteria, i.e. the axiology of science. Most ultimate criteria are multi?dimensional. This gives rise to an aggregation problem, which cannot be adequately solved with reference to attitudes and behaviour within the scientific community. Therefore, in many cases, there is no fact of the matter as to whether one theory is better than another. This, in turn, creates problems for methodology.

In Reason, Truth and History and certain related writings, Hilary Putnam attacked the fact-value distinction. This paper criticizes his arguments and defends the distinction. Putnam claims that factual statements presuppose values, that “the empirical world depends upon our criteria of rational acceptability,” and that “we must have criteria of rational acceptability to even have an empirical world.” The present paper argues that these claims are mistaken.

Derek Parfit’s argument against the platitude that identity is what matters in survival does not work given his intended reading of the platitude, namely, that what matters in survival to some future time is being identical with someone who is alive at that time. I develop Parfit’s argument so that it works against the platitude on this intended reading.

Public reason liberals expect individuals to have justificatory reasons for their views of certain political issues. This paper considers how groups can, and whether they should, give collective public reasons for their political decisions. A problem is that aggregating individuals’ consistent judgments on reasons and a decision can produce inconsistent collective judgments. The group will then fail to give a reason for its decision. The paper considers various solutions to this problem and defends a deliberative procedure by showing how it (...) incentivizes information sharing and leads to outcomes most acceptable to the group members. (shrink)

Principles of justice, David Estlund argues, cannot be falsified by people’s unwillingness to satisfy them. In his Utopophobia, Estlund rejects the view that justice must bend to human motivation to deliver practical implications for how institutions ought to function. In this paper, I argue that a substantive argument against such bending of justice principles must challenge the reasons for making these principles sensitive to motivational limitations. Estlund, however, provides no such challenge. His dispute with benders of justice is therefore a (...) verbal one over the true meaning of justice, which need not worry those with the intuition that justice should perform a function that requires bending. By focusing on John Rawls’s reasons for bending his justice principles, I point towards a substantive critique of bent justice. (shrink)

Here A, B, C, D, I, X and “Philosophy” discuss some features of the relation between identity and love.

Moral wrongness comes in degrees. On a consequentialist view of ethics, the wrongness of an act should depend, I argue, in part on how much worse the act's consequences are compared with those of its alternatives and in part on how difficult it is to perform the alternatives with better consequences. I extend act consequentialism to take this into account, and I defend three conditions on consequentialist theories. The first is consequentialist dominance, which says that, if an act has better (...) consequences than some alternative act, then it is not more wrong than the alternative act. The second is consequentialist supervenience, which says that, if two acts have equally good consequences in a situation, then they have the same deontic status in the situation. And the third is consequentialist continuity, which says that, for every act and for any difference in wrongness δ greater than zero, there is an arbitrarily small improvement of the consequences of the act which would, other things being equal, not change the wrongness of that act or any alternative by more than δ. I defend a proposal that satisfies these conditions. (shrink)

In this dialogue Otto K. and The Professor talk about how experiences from war can affect subjects over generations.

Can groups really be agents or is group agency just a fiction? Christian List and Philip Pettit argue influentially for group-agent realism by showing how certain groups form and act on attitudes in ways they take to be unexplainable at the level of the individual agents constituting them. Group agency is therefore considered not a fiction or a metaphor but a reality we must account for in explanations of certain social phenomena. In this paper, I challenge this defence of group-agent (...) realism by showing how it is undermined by individual-level analysis of how individuals interact within groups. While group agency can be a useful fiction, real agents are at the individual level, not the collective level. (shrink)

In the debate on how we ought to define political freedom, some definitions are criticized for implying that no one can ever be free to perform any action. In this paper, I show how the possibility of freedom depends on a definition that finds an appropriate balance between absence of interference and protection against interference. To assess the possibility of different conceptions of freedom, I consider the trade-offs they make between these two dimensions. I find that pure negative freedom is (...) clearly possible. Republican freedom might also be possible, though its protection requirement is too vague for a definitive verdict. Finally, the recently proposed ‘freedom as independence’ is impossible since it is an attempt to avoid the unavoidable trade-off. (shrink)

The full compliance assumption has been the focus of much recent criticism of ideal theory. Making this assumption, critics argue, is to ignore the important issue of how to actually make individuals compliant. In this article, I show why this criticism is misguided by identifying the key role full compliance plays in modelling fairness. But I then redirect the criticism by showing how it becomes appropriate when Rawls and other ideal theorists expect their model of fairness to guide real-world political (...) practice. Attempts to establish institutions conforming to this ideal could have undesirable consequences and might even undermine fairness itself. (shrink)

This article evaluates seven strategies for managing the high costs of GLP-1 receptor agonists (GLP-1RAs) like semaglutide and tirzepatide for weight management: complete exclusion of coverage, annual cost increase caps, lifetime cost caps, tiered access, formulary reevaluation, subscription payment models, and patent reform. The authors assess each strategy against three ethical objectives: benefiting people and preventing harm, showing equal moral concern, and mitigating disadvantage. Complete coverage exclusions, arbitrary reimbursement caps, and lifetime limits are deemed unethical as they fail to meet (...) these objectives. Tiering access based on relative benefit is considered justifiable, though current implementation often unfairly favors diabetes over obesity treatment. The authors recommend formulary reevaluation as the most ethical approach for smaller health plans, allowing them to prioritize more cost-effective treatments. For larger payers with market power and for governments, subscription payment models and patent reforms are potentially ethical solutions if implemented sustainably. The authors conclude that health plans should avoid ad hoc restrictions on GLP-1RAs in favor of comprehensive policy reforms that ensure sustainable access to these and future breakthrough treatments. (shrink)