Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of first-come, (...) first-served allocation; (iv) the relevance of post-episode survival; (v) the difference between age and other factors that affect life-expectancy; and (vi) the need to avoid quality-of-life judgments. In the second part, we lay out some positions on which reasonable people can and do differ. These include (i) conflicts between maximizing benefits and priority to the worst off; (ii) role-based priority; and (iii) whether patients’ existing lifesaving resources should be subject to redistribution. (shrink)

What is the best question to ask an omniscient being? The question is intriguing; is it also paradoxical? We discuss several versions of what Ned Markosian calls the paradox of the question and suggest solutions to each of those puzzles. We then offer some practical advice about what do if you ever have the opportunity to query an omniscient being.

Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health. Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon. In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians to identify ethically justified responses to vaccine refusal.

In ANARCY, STATE AND UTOPIA Robert Nozick says that the fundamental question of political philosophy, one that precedes questions about how the state should be organized, is whether there should be any state at all. In the first part of his book he attempts to justify the state. We argue that he is not successful.

Our purpose in this article is to identify and suggest resolution for two core problematics of grounded theory. First, while grounded theory provides transparency to one part of the conceptualization process, where codes emerge directly from the data, it provides no such systematic or transparent way for gaining insight into the conceptual relationships between discovered codes. Producing a grounded theory depends not only on the definition of conceptual pieces, but the delineation of a relationship between at least two of those (...) pieces. Second, the conceptualization process of grounded theory is done in hierarchical fashion, where individual codes emerge from the data but then are used to generate insight into more general concepts and thematic statements. But various works on grounded theory have failed to provide any systematic way of using data specific levels of scale (the codes) to gain insight into more macro levels of scale (concepts and themes). We offer fractal concept analysis as a means of resolving both of these issues. By using a logic structure generator, fractal concept analysis delineates self-similar conceptual frameworks at various levels of abstraction, yielding a method for linking concepts together within and between levels of scale encountered in the grounded theory coding and categorization process. We conclude that this fractal analytic technique can bolster the aims of grounded theory as a formalized and systematic process for generating theory from empirical data. (shrink)

One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the ’QALY trap’: we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all (...) are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination. (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.

Nelson et al.(2023) argue that the inclusion of personal experience in bioethical debates has significant benefits and liabilities, illustrating their claim with two examples: unproven medical treatments and disability bioethics. We believe that the benefits of including personal experience in disability bioethics far exceed its liabilities. The absence of participants with relevant experience impoverishes and biases bioethical debates, while the biases risked by their inclusion are hardly unique to personal experiences and are readily mitigated.

These are my materials (a short precis, and replies to John MacFarlane, Mitchell Green, Ryan Wasserman, and Anthony Bigg and Kristie Miller) for a symposium on my book, _The Open Future: Why Future Contingents are All False_ (OUP, 2021) in *Analytic Philosophy*. [The contribution from MacFarlane is available on his website, those from Wasserman and Green are on their Academia profiles, and the contribution from Bigg and Miller is on Miller's PhilPapers profile.].

Manley and Wasserman (2008) have provided a convincing case against analyses of dispositions in terms of one conditional, and a very interesting positive proposal that links any disposition to a ‘suitable proportion’ of a particular set of precise conditionals. I focus on their positive proposal and ask just how precise those conditionals are to be. I argue that, contrary to what Manley and Wasserman imply in their paper, they must be maximally specific, describing in their antecedents complete centred (...) worlds. This suggests a natural semantics for dispositional expressions, which I briefly explore to argue that it lacks uniformity. I end by suggesting a variation on Manley and Wasserman's view which would preserve uniformity, though at the cost of some new puzzling questions. (shrink)

Book review of Wasserman, R. (2017), Paradoxes of Time Travel, OUP.

This article examines one of the sources of David Benatar’s anti-natalism. This is the view that ‘all procreation is [morally] wrong.’ (Benatar and Wasserman, 2015:12) One of its sources is the claim that each of our lives is objectively bad, hence bad whether we think so or not. The question I will pose is whether the constraints of metaphysical naturalism allow for an objective devaluation of human life sufficiently negative to justify anti-natalism. My thesis is that metaphysical naturalism does (...) not have the resources to support such a negative evaluation. Metaphysical naturalism is the view that causal reality is exhausted by nature, the space-time system and its contents. The gist of my argument is that the ideal standards relative to which our lives are supposed to be axiologically substandard cannot be merely subjective expressions of our desires and aversions; they must be (i) objectively binding standards that are (ii) objectively possible in the sense of concretely realizable. The realizability condition, however, cannot be satisfied on metaphysical naturalism; ergo, failure to meet these ideal standards cannot show that our lives are objectively bad. (shrink)